Diet-related Behaviors Research Articles

Social Determinants of Health-Related Needs During COVID-19 Among Low-Income Households With Children.

IntroductionLittle is known about the social needs of low-income households with children during the coronavirus-2019 (COVID-19) pandemic. Our objective was to conduct a cross-sectional quantitative and qualitative descriptive analysis of a rapid-response survey among low-income households with children on social needs, COVID-19–related concerns, and diet-related behaviors.MethodsWe distributed an electronic survey in April 2020 to 16,435 families in 4 geographic areas, and 1,048 responded. The survey asked families enrolled in a coordinated school-based nutrition program about their social needs, COVID-19–related concerns, food insecurity, and diet-related behaviors during the pandemic. An open-ended question asked about their greatest concern. We calculated descriptive statistics stratified by location and race/ethnicity. We used thematic analysis and an inductive approach to examine the open-ended comments.ResultsMore than 80% of survey respondents were familiar with COVID-19 and were concerned about infection. Overall, 76.3% reported concerns about financial stability, 42.5% about employment, 69.4% about food availability, 31.0% about housing stability, and 35.9% about health care access. Overall, 93.5% of respondents reported being food insecure, a 22-percentage-point increase since fall 2019. Also, 41.4% reported a decrease in fruit and vegetable intake because of COVID-19. Frequency of grocery shopping decreased and food pantry usage increased. Qualitative assessment identified 4 main themes: 1) fear of contracting COVID-19, 2) disruption of employment status, 3) financial hardship, and 4) exacerbated food insecurity.ConclusionOur study highlights the compounding effect of the COVID-19 pandemic on households with children across the spectrum of social needs.

Characterization and Correction of Bias Due to Nonparticipation and the Degree of Loyalty in Large-Scale Finnish Loyalty Card Data on Grocery Purchases: Cohort Study

BackgroundTo date, the evaluation of diet has mostly been based on questionnaires and diaries that have their limitations in terms of being time and resource intensive, and a tendency toward social desirability. Loyalty card data obtained in retailing provides timely and objective information on diet-related behaviors. In Finland, the market is highly concentrated, which provides a unique opportunity to investigate diet through grocery purchases.ObjectiveThe aims of this study were as follows: (1) to investigate and quantify the selection bias in large-scale (n=47,066) loyalty card (LoCard) data and correct the bias by developing weighting schemes and (2) to investigate how the degree of loyalty relates to food purchases.MethodsMembers of a loyalty card program from a large retailer in Finland were contacted via email and invited to take part in the study, which involved consenting to the release of their grocery purchase data for research purposes. Participants’ sociodemographic background was obtained through a web-based questionnaire and was compared to that of the general Finnish adult population obtained via Statistics Finland. To match the distributions of sociodemographic variables, poststratification weights were constructed by using the raking method. The degree of loyalty was self-estimated on a 5-point rating scale.ResultsOn comparing our study sample with the general Finnish adult population, in our sample, there were more women (65.25%, 30,696/47,045 vs 51.12%, 2,273,139/4,446,869), individuals with higher education (56.91%, 20,684/36,348 vs 32.21%, 1,432,276/4,446,869), and employed individuals (60.53%, 22,086/36,487 vs 52.35%, 2,327,730/4,446,869). Additionally, in our sample, there was underrepresentation of individuals aged under 30 years (14.44%, 6,791/47,045 vs 18.04%, 802,295/4,446,869) and over 70 years (7.94%, 3,735/47,045 vs 18.20%, 809,317/4,446,869), as well as retired individuals (23.51%, 8,578/36,487 vs 31.82%, 1,414,785/4,446,869). Food purchases differed by the degree of loyalty, with higher shares of vegetable, red meat & processed meat, and fat spread purchases in the higher loyalty groups.ConclusionsIndividuals who consented to the use of their loyalty card data for research purposes tended to diverge from the general Finnish adult population. However, the high volume of data enabled the inclusion of sociodemographically diverse subgroups and successful correction of the differences found in the distributions of sociodemographic variables. In addition, it seems that food purchases differ according to the degree of loyalty, which should be taken into account when researching loyalty card data. Despite the limitations, loyalty card data provide a cost-effective approach to reach large groups of people, including hard-to-reach population subgroups.

A systematic review of the influences of food store product placement on dietary-related outcomes.

ContextProduct placement strategies have been used to influence customers’ food purchases in food stores for some time; however, assessment of the evidence that these techniques can limit unhealthy, and promote healthy, food choices has not been completed.ObjectiveThis systematic review aimed to determine how product placement strategies, availability, and positioning, in physical retail food stores located in high-income countries, influence dietary-related behaviors.Data SourcesFrom a search of 9 databases, 38 articles, 17 observational studies, and 22 intervention studies met the study inclusion criteria.Data ExtractionTwo reviewers independently extracted data relating to study design, study population, exposures, outcomes, and key results. Each study was also assessed for risk of bias in relation to the research question.Data AnalysisMeta-analysis was not possible owing to heterogeneous study designs and outcomes. As recommended by Cochrane, results were synthesized in effect direction plots using a vote-counting technique which recorded the direction of effect and significance level according to the expected relationship for health improvement.ConclusionsThe majority of studies showed that greater availability and more prominent positioning of healthy foods, or reduced availability and less prominent positioning of unhealthy foods, related to better dietary-related behaviors. A large number of results, however, were nonsignificant, which likely reflects the methodological difficulties inherent in this research field. Adequately powered intervention studies that test both the independent and additive effects of availability and positioning strategies are needed.Systematic Review RegistrationPROSPERO registration no. 42016048826

The FLASHE Study: A Publicly Available Data Resource

Abstract Objectives The Family Life, Activity, Sun, Health and Eating (FLASHE) survey was conducted in 2014 to collect information on eating, physical activity, sedentary behaviors, and behavioral correlates from a national sample of parent-adolescent dyads in the United States. It is a publicly available data resource which can be used to research questions about psychosocial, generational, household and neighborhood correlates of health behaviors. Methods Data were collected from dyads of caregivers and their adolescent children (ages 12–17) (n = 1072 completed dyads) between April – October 2014. Two surveys for each respondent: one on diet-related behaviors and one on physical activity-related behaviors were collected. An additional 407 dyads wore an accelerometer for seven days and completed an activity log. A ‘geoFLASHE’ dataset used parent-provided address information for home and school to geocode these locations and compute a set of variables applied to several different neighborhood definitions, including both circular and street-network buggers with distances ranging from 400 – 1200 meters. Accelerometer variables were computed for a subset of adolescents who wore an Actigraph Gt3x+ for seven days and includes estimates from raw and activity counts data. Training webinars on dyadic analytical methods, models and applications were provided. Results The geoFLASHE dataset includes variables for neighborhood, socioeconomic status factor, factor scores for built environment characteristics (high density, older neighborhood, and short commutes), and other variables for each buffer configuration. The adolescent accelerometer dataset offers summary variables of accelerometer data and minute-level estimates of light, moderate, and vigorous activity using Crouter, Chandler, and GGIR processing methods. Additionally, training webinar, questionnaires, survey data files and codebooks are available. Conclusions The FLASHE study data resources can be used to understand cancer-related health behaviors in family dyads. Funding Sources FLASHE study was funded by the National Cancer Institute under contract number HHSN2612012000391 issued to Westat, Inc.

An Analysis of Diet-related Behaviors according to the Gender and BMI of University Students in Cheongju

An Analysis of Diet-related Behaviors according to the Gender and BMI of University Students in Cheongju

Evidence-based customized nutritional intervention improves body composition and nutritional factors for highly-adherent children and adolescents with moderate to severe obesity.

BACKGROUND/OBJECTIVESEvidence-based customized nutritional interventions are required for effective treatment of moderate to severe obese children and adolescents.SUBJECTS/METHODSSixty six (64.1% of 103) of the eligible participants who joined the usual care or physical activity group in the clinic were involved in 16-week intervention. Customized nutritional intervention was implemented for each participant based on a nutrition care process (NCP) model. Sociodemographic assessment, anthropometrics data, health- and dietary-related behaviors, and dietary intake of the study subjects were assessed at baseline and follow-up. All participants engaged in 30-minute nutritional sessions on a monthly basis.RESULTSAfter 16 weeks, there were significant improvements in body composition [BMI (−0.8 ± 0.9, P < 0.05), BMI z-score (−0.3 ± 0.2, P < 0.001), body fat (kg) (−1.3 ± 2.1, P < 0.05), and body fat (%)(−1.5 ± 1.9, P < 0.05)] as well as macronutrient intake [total energy intake (kcal) (−563.7 ± 656.8, P < 0.05), energy (%) (−26.5 ± 30.0, P < 0.05) and fat (g) (−28.3 ± 40.6, P < 0.05)] in the adherent group than the non-adherent group. The SOC was higher in both groups after the intervention (P < 0.001).CONCLUSIONSOur results highlight the positive effects of an evidence-based approach as a multidisciplinary intervention for people-centered nutritional care and weight management.

ASSOCIAÇÃO ENTRE O LETRAMENTO FUNCIONAL EM SAÚDE E O AUTOCUIDADO COM O DIABETES MELLITUS

Objetivo: associar o nível de letramento funcional em saúde e autocuidado com Diabetes. Método:estudo transversal, quantitativo, realizado com 97 pacientes de um centro de referência paraatenção ao diabético, de fevereiro a junho de 2018. Com dados pelo Brief Test of Functional HealthLiteracy in Adults e o Questionário de atividades de autocuidado com o diabetes. Foi feita análisedescritiva e o teste Qui-quadrado.Resultados: o letramento funcional inadequado foi identificado em 47% dos pacientes. Observouseassociação entre o letramento inadequado e baixos níveis de adesão a: seguimento de dietasaudável e orientação alimentar (p&lt;0,001), ingesta de doces (p&lt;0,001) e avaliação da glicemia nonúmero de vezes recomendado (p&lt;0,001).Conclusão: o nível inadequado de letramento está associado com baixas médias de adesão acomportamentos relacionados à dieta e ao monitoramento da glicemia. Estes achados sugeremincluir na prática clínica a avaliação do letramento e de autocuidado com o diabetes.

Food environment and its relation to diet behavior and obesity in China

Objective: In this study, a systematic review was made on scientific evidence regarding the impact of food environment on diet-related behavior and obesity in China. Methods: Search on related keywords and references were conducted from four electronic databases including the Cochrane Library, PubMed, Web of Science, and CNKI. Results: Data showed that good availability, accessibility of neighborhood food outlets had increased the diversity of food, including the intakes of total calories, protein, fat, and carbohydrate; however, the consumption of healthy foods such as fruit and vegetables was reducing among the Chinese residents. The effects of neighborhood food environment on obesity remained inconclusive. A large number of fast food restaurants around schools might be responsible for the increase of risk on obesity among students. Regulations set on the school vicinity food stalls might reduce the intake of sugary beverages, snacks and fast food among students. Conclusion: Building a healthy food environment is warranted to nudge the Chinese people towards a healthier diet pattern. However, more evidence is needed to support the evidence in building a healthy food environment.

Cognitive and environmental interventions to encourage healthy eating: evidence-based recommendations for public health policy.

Policymakers are focused on reducing the public health burden of obesity. The UK average percentage of adults classified as obese is 26%, which is double that of the global average. Over a third of UK adults report using at least one weight management aid. Yet, many people still struggle to change their diet-related behaviour, despite having the awareness, intention and capability to do so. This ‘intention–behaviour gap’ may be because most existing dietary-choice interventions focus on individual decision-making, ignoring the effects of environmental cues on human behaviour. Behaviour change interventions that ‘nudge’ people into making healthier choices by modifying the food environment have been shown to be effective. However, this type of intervention is typically challenging for policymakers to implement for economic, ethical and public accessibility reasons. To overcome these concerns, policymakers should consider ‘boosting’ interventions. Boosting involves enhancing competences that help people make decisions consistent with their goals. Here, we outline cognitive training as a boosting intervention to tackle obesity. We synthesize the evidence for one type of cognitive training (go/no-go training) that may be effective at modifying food-related decisions and reducing body weight. We offer evidence-based recommendations for an obesity-focused Public Health Wales behaviour change programme.

Design and participant characteristics of TX sprouts: A school-based cluster randomized gardening, nutrition, and cooking intervention

AimsTo outline the study design, outcome measures, protocol and baseline characteristics of enrolled participants of Texas (TX) Sprouts, a one-year school-based gardening, nutrition, and cooking cluster randomized trial. MethodsEight schools were randomly assigned to the TX Sprouts intervention and eight schools to the delayed intervention over three years (2016–2019). The intervention arm received: formation/training of Garden Leadership Committees; a 0.25-acre outdoor teaching garden; 18 student lessons including gardening, nutrition, and cooking activities, taught weekly during school hours by hired educators throughout one school year; and nine parent lessons taught monthly to families. The delayed intervention was implemented the following academic year and received the same protocol as the intervention arm. Primary outcomes included: dietary intake, dietary-related behaviors, obesity, and metabolic parameters. Child measures included: height, weight, waist circumference, body composition, blood pressure, and dietary psychosocial variables. A subsample of children were measured for glucose, hemoglobin-A1C, and 24-hour dietary recalls. Parent measures included: height and weight, dietary intake, and related dietary psychosocial variables. ResultsOf the 4239 eligible students, 3137 students consented and provided baseline clinical measures; 3132 students completed child surveys, with 92% of their parents completing parent surveys. The subsamples of blood draws and dietary recalls were 34% and 24%, respectively. Intervention arm baseline descriptives, clinical and dietary data for children and parents are reported. ConclusionThe TX Sprouts intervention targeted primarily low-income Hispanic children and their parents; utilized an interactive gardening, nutrition, and cooking program; and measured a battery of dietary behaviors, obesity and metabolic outcomes.

Process evaluation of a community-based diabetes prevention program in China: the Pathway to Health (PATH).

High prevalence of diabetes and prediabetes has emerged as a concern in China. The Pathway to Health Program was designed to prevent type 2 diabetes onset in prediabetic women in a north China urban community. This process evaluation of a randomized controlled trial analysed participant surveys at the 6- and 12-month assessment times, participant weekly logs, class attendance records and post-study participant focus group results. The reported levels of participant engagement in physical activity (PA)-related behaviors were higher than diet-related behaviors at the 6-month assessment. The engagement in both PA- and diet-related behaviors declined during the 6-month follow-up period. Step counts from the participants' pedometers indicated an increase in PA in the first 6 months of the intervention. Study participants expressed high levels of satisfaction with the intervention and increased their scores on diabetes-related knowledge. Conflicts with work and family responsibilities were the main barriers for missing health lessons, likely contributing to minimal weight loss. There was good fidelity in program implementation. Intensive lifestyle modification programs are difficult to sustain once the program is complete. A more structured 6-month follow-up phase may have provided needed support to enable participants to maintain their lifestyle changes.

Diet-related Behaviors Are Associated with Energy Intake and Body Weight Loss During a Sustained Military Training Exercise (P16-012-19)

ObjectivesSustained negative energy balance during military operations contributes to degradations in physical and cognitive performance. Characterizing the diet-related behaviors and nutrition knowledge of Soldiers who self-select higher energy intakes during military operations may identify strategies for promoting energy balance. This study aimed to identify diet-related behaviors of Soldiers who self-selected higher energy intakes during a simulated military operation. MethodsDietary intake and body weight were measured daily in 54 Soldiers (91% male, BMI 25 ± 4 kg/m2, 25 ± 4 yr) participating in a 3-d military exercise. During the exercise, Soldiers were provided with military rations (2787–3003 kcal/d), and in some cases consumed items from home or mobile catering. Food frequency and nutrition knowledge questionnaires were completed before the exercise to assess diet quality by HEI-2010 total score and nutrition knowledge, respectively, and questionnaires assessing eating behaviors during the exercise were completed daily and after the exercise. Associations between diet quality, nutrition knowledge, and diet-related behaviors with 1) daily energy intake (EI) and 2) weight loss (∆BW) were determined by backwards elimination multiple linear regression. ResultsEI (mean ± SD: 1947 ± 627 kcal/d) and ∆BW (−1.4 ± 1.2%) during the exercise were not correlated. After adjusting for baseline BMI, EI was associated with diet quality (β ± SE: 17 ±9 kcal/d, P = 0.07) and eating frequency (170 ± 86 kcal/d, P = 0.06) and more often intentionally eating foods to improve performance (−389 ± 207 kcal/d, P = 0.07) during the exercise (R2 = 0.27, P = 0.03). In contrast, greater ∆BW was associated only with more often “not allowing myself to eat” certain foods during the exercise (R2 = 0.11; −0.8 ± 0.4%, P = 0.04). Nutrition knowledge was not a significant predictor in either model. ConclusionsFindings suggest that self-selected energy intake and body weight loss during military operations may be associated with habitual adherence to healthier dietary patterns and conscious decisions regarding what and how often to eat and/or drink during operations, but not with general nutrition knowledge. Funding SourcesU.S. Army Medical Research & Materiel Command; US Army Natick Research, Development, & Engineering Center. Disclaimer: Authors’ views do not reflect official DoD policy.

Household Food Insecurity Is Associated with Higher Adiposity Among U.S. Schoolchildren Ages 10–15 Years (OR02-05-19)

ObjectivesThis study assesses the relationship between household food insecurity and adiposity, measured as BMI-for-age z-score (BMI-z), overweight/obesity, and waist circumference, as well as dietary intake and diet-related behaviors in US children. MethodsA total of 5138 US schoolchildren ages 4–15 years from 130 communities in the cross-sectional Healthy Communities Study were included in this analysis. Household food insecurity was self-reported using a validated 2-item screener. Dietary intake was assessed using National Cancer Institute’s (NCI) Dietary Screener Questionnaire (DSQ), a 26-item food frequency questionnaire, and dietary behaviors were assessed during a household survey. Data were analyzed using multilevel statistical models, including interaction tests for age, sex, and race/ethnicity. ResultsFood insecure children had a BMI z-score of 0.14 higher (95% CI: 0.06, 0.21) and a waist circumference of 0.91 cm higher (95% CI: 0.18, 1.63) than food secure children. Food insecure children have 1.17 times the odds of being overweight/obesity compared with food secure children (95% CI: 1.02, 1.34). There was no significant interaction by sex or race/ethnicity. Food insecure children consumed more sugar from sugar sweetened beverages (0.36 tsp/day; 95% CI: 0.09, 0.63), and ate breakfast (−0.28 days/week; 95% CI: −0.39, −0.17) and together with family (−0.22 days/week; 95% CI: −0.37, −0.06) less frequently compared to food secure children. ConclusionsThe present study found a significant, positive association between household food insecurity and child adiposity for children ages 10–15 years, as well as for several dietary intake and diet-related behaviors. This research helps disentangle the complex picture of food insecurity as a contributor to childhood obesity and poorer dietary outcomes in diverse populations. Funding SourcesResearch was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under award number K01HL131630. The authors would also like to acknowledge the Global Food Initiative at the University of California Office of the President for their support of this project.

Customized Nutritional Intervention to Improve Body Composition, Macronutrient Intake, and Nutritional Behavior in Moderate to Severe Obese Children and Adolescents (P21-063-19)

ObjectivesEvidence-based customized nutritional interventions are required for effective treatment of moderately-severely obese children and adolescents. MethodsEligible participants who agreed to participate in the intervention program provided informed consent. Customized nutritional intervention was implemented for each participant based on a nutrition care process (NCP) model. Sociodemographic assessment, anthropometrics, biochemical data, health- and dietary-related behaviors, and dietary intake of the study subjects were assessed at baseline and follow-up. All participants engaged in 30-minute nutritional sessions on a monthly basis. ResultsOne hundred three [mean age: 12.4 years, severely obese: n = 69(67%)] children and adolescents were assessed at baseline. After 16 weeks, there were significant improvements in body composition [BMI (−0.8 ± 0.9, P < 0.05), BMI z-score (−0.3 ± 0.2, P < 0.001), body fat (kg) (−1.3 ± 2.1, P < 0.05), and body fat (%)(−1.5 ± 1.9, P < 0.05)] as well as macronutrient intake [total energy intake (kcal)(−563.7 ± 656.8, P < 0.05), energy (%)(−26.5 ± 30.0, P < 0.05) and fat (g)(−28.3 ± 40.6, P < 0.05)] in the adherent group than the non-adherent group. The stage of change according to the transtheoretical model (TTM) was higher in both groups after the intervention (P < 0.001). ConclusionsOur customized nutritional intervention resulted in improvements in body composition, macronutrient intake, and nutritional behavior in adherent moderately-severely obese children and adolescents. These results highlight the positive effects of an evidence-based approach as a multidisciplinary intervention for people-centered nutritional care and weight management. Funding SourcesThis study was funded by Korea Centers for Disease Control and Prevention Grant 2015-ER6401-00.

Assessing the Economic Feasibility of Assuring Nutritionally Adequate Diets for Vulnerable Populations in Uttar Pradesh, India: Key Findings from ‘Cost of the Diet’ Analysis (OR21-05-19)

ObjectivesUttar Pradesh (UP) is the most populous state with the highest burden of undernutrition in India. Alive & Thrive is working to strengthen behavior change communication (BCC) on diet diversity and quantity, using health systems platforms to deliver maternal nutrition intervention. However, evidence on the accessibility and affordability associated with recommended diets is limited. This study aims to: 1) examine the costs of nutritious foods in local markets, 2) identify inexpensive sources of essential micronutrients which could be promoted through BCC interventions. MethodsData collection included 24 market surveys and 125 household interviews to obtain food prices and consumption patterns. Cost of Diet (CotD), a linear programing software, was used to estimate the lowest cost for meeting nutrient requirements of 4 types of diet: 1) energy only diet (EO), 2) energy and macronutrient diets (MAC); 3) nutritious diet (NUT-meets recommended intakes for energy and nutrients), and 4) a food habits diet (FHAB-meet energy and nutrient requirements based upon local dietary habits). The diets were compared to identify relative costs and nutrient requirements met. ResultsThe FHAB diet (USD 90/month for a household of 6 people) was over twice as expensive compared to the energy only diet. EO and MAC diets were affordable for all households, but they indicated inadequate nutrient intakes for vitamins A, C, B-12, folic acid, calcium, and iron. NUT and FHAB diets met all nutrient requirements but were not affordable for the lowest quartile of households. Recommended intakes of Vitamins A, C, B12, and calcium were most difficult to meet. Key foods identified which provided majority of essential macro and micronutrients included wheat flour, buffalo milk, soybean, and spinach. Multiple sources of iron and calcium were identified as affordable and accessible in local markets. ConclusionsFoods available in local market are sufficient for households to obtain recommended intakes of macro- and micronutrients. Economic constraints and dietary habits are key barriers to achieve a nutritious diet. Practical, habitual diet-related behavior change communication to middle and high-income households and additional social protection for poorer households could improve optimal nutrient intakes. Funding SourcesBill & Melinda Gates Foundation through POSHAN, led by International Food Policy Research Institute.

A Pragmatic Review to Assist Planning and Practice in Delivering Nutrition Education to Indigenous Youth.

Many health promotion campaigns have incorporated multi-component nutrition interventions to promote healthy diet-related behaviours among Indigenous communities, particularly children and adolescents. However, these campaigns show mixed results and while research often describes outcomes of approaches and interventions, it does not extensively describe implementation processes and best practices for nutrition education for Indigenous youth. To enhance knowledge and understanding of best processes in nutritional education approaches with Indigenous youth, we conducted a search using multiple databases including PubMed, Google Scholar, the Australian Indigenous HealthInfoNet and Australian government research databases to identify relevant peer-reviewed and grey literature as well as educational resources, such as websites and handbooks for teachers, parents, and students. We list and describe common features of successful nutritional interventions in Indigenous settings, steps for nutrition education targeting youth, school-based nutrition education for different ages, and general guidelines for teaching Indigenous students. Current best practice and knowledge gaps for the delivery of nutrition education to Indigenous youth are described.

Nutrition and Environmental Pollution Extension Curriculum Improved Diet-Related Behaviors and Environmental Health Literacy.

Kentucky experiences some of the nation’s worst health outcomes related to obesity, diabetes, high blood pressure, and other age-related chronic diseases linked with oxidative stress and inflammation, which in turn are associated with poor diet, lack of physical activity, and exposure to certain environmental pollutants. In the Commonwealth, deteriorating infrastructure, inappropriate waste disposal, and potential occupational injury related to mining, agriculture, and other regionally important industries exacerbate the need for residents to have basic knowledge of potential environmental health threats. Unfortunately, community-level understanding of the complex connections between environmental exposures and health is limited, with many Kentuckians unaware that the Commonwealth is home to 13 hazardous waste sites included in the United States Environmental Protection Agency Superfund National Priorities List (NPL). The NPL highlights priority sites for long-term remedial action to reduce environmental contaminants. To enhance the understanding of environmental health and protective actions, the University of Kentucky Superfund Research Center Community Engagement Core developed a 9-lesson extension curriculum “Body Balance: Protect Your Body from Pollution with a Healthy Lifestyle” (Body Balance) and partnered with Kentucky’s Family and Consumer Sciences (FCS) Cooperative Extension Service to pilot the curriculum in Kentucky communities. FCS agents in 4 Kentucky counties delivered the Body Balance pilot study (18-31 participants per lesson). Pre- and post-lesson questionnaires revealed increased knowledge and awareness of the effects of environmental pollution on health and the protective role of dietary strategies. Focus group participants (n = 18) self-reported positive behavior changes because of increases in knowledge and leadership from their FCS agent. The Body Balance curriculum appeared to be a promising mechanism for raising environmental health and diet knowledge, as well as for promoting positive behavior changes among white, middle/older-aged women in rural Kentucky communities.

Decreasing the use of edible oils in China using WeChat and theories of behavior change: study protocol for a randomized controlled trial

BackgroundThe consumption of edible oils in China has increased rapidly in recent years, and the total amount of edible-oil intake in the country has ranked first in the world. The choice and intake of edible oils, as a source of fats, are important factors that affect people’s health. Many chronic diseases are closely associated with high-calorie and saturated-fat intake. The influence of traditional concepts that promote the use of edible oils among women, particularly housewives, plays a key role in a household’s diet and nutrition because the diet-related knowledge, attitude and behaviour of housewives are dominant factors in planning and preparing their family’s meals. WeChat, which was developed by Tencent, is a multipurpose messaging, social media and mobile payment application (app) in China. Described by Forbes as one of the world’s most powerful apps, WeChat provides considerable convenience in disseminating knowledge. Accordingly, this study aims to design a pilot intervention to decrease the use of edible oils in Chinese households. The intervention, which is based on theories of behaviour change, will be implemented through WeChat.Design and methodsThe study design is a randomised controlled trial that adopts knowledge, attitude and practice, social cognitive and stages of change theories as theoretical models. A total of 800 housewives between the ages of 25 and 45 years will be recruited on WeChat and from the communities in four areas (including rural and urban) in Chongqing, China. A self-administered questionnaire will be used to collect information regarding age, educational level, occupation, family members, edible-oil intake habits, knowledge of edible oils and WeChat usage habits. A total of 200 participants will be selected and randomly assigned to two equal-sized groups: group A (the intervention group) and group B (the control group). Group A will receive health education regarding edible oils for four consecutive weeks, whereas group B will be treated as the blank control. Each participant will complete a battery of knowledge, attitude and behaviour tests immediately, 3 months and 6 months after the intervention. In addition, weight, moisture rate, fat rate, visceral fat level and body mass index will be calculated using a multifunctional weighing scale, namely, Tanita BC-601 (Japan). The study is currently in the design stage.DiscussionThis study aims to increase knowledge and awareness of the appropriate use of edible oils, thereby encouraging participants to change behaviour by decreasing the intake of unhealthy levels of edible oils. It will be the first intervention to investigate the use of edible oils in China through WeChat. We predict that receiving health education regarding edible oils through WeChat will substantially improve the knowledge and attitude of the respondents. The members of the intervention group will have increased awareness and will be willing to decrease their use of edible oils to remain healthy. Results of this study may provide scientific evidence for the effect of health education through WeChat on edible oil-intake behaviour, thereby offering a comprehensive intervention to decrease the use of edible oils and promote a healthy lifestyle.Trial registrationChinese Clinical Trial Registry (primary registry in the World Health Organisation registry network): ChiCTR-IOR-17013472. Registered on 21 November 2017.

Calorie information and dieting status modulate reward and control activation during the evaluation of food images.

Several public health departments throughout North America have responded to the obesity epidemic by mandating that restaurants publish calories at the point of purchase—with the intention of encouraging healthier food decisions. To help determine whether accompanying calorie information successfully changes a food’s appetitive value, this study investigated the influence of calorie information on brain responses to food images. During functional magnetic resonance imaging (fMRI) scanning, dieting (N = 22) and non-dieting (N = 20) participants viewed pictures of food with and without calorie information and rated their desire to eat the food. When food images were paired with calorie information, not only did self-reported desire to eat the food decrease, but reward system activation (Neurosynth-defined from the term “food”) decreased and control system activation (the fronto-parietal [FP] control system) increased. Additionally, a parametric modulation of reward activation by food preferences was attenuated in the context of calorie information. Finally, whole brain multivariate pattern analysis (MVPA) revealed patterns of activation in a region of the reward system—the orbitofrontal cortex (OFC)—that were more similar for food images presented with and without calorie information in dieting than non-dieting participants, suggesting that dieters may spontaneously consider calorie information when viewing food. Taken together, these results suggest that calorie information may alter brain responses to food cues by simultaneously reducing reward system activation and increasing control system activation. Moreover, individuals with greater experience or stronger motivations to consider calorie information (i.e., dieters) may more naturally do so, as evidenced by a greater degree of representational similarity between food images with and without calorie information. Combining an awareness of calories with the motivation to control them may more effectively elicit diet-related behavior change.

How we eat determines what we become: opportunities and challenges brought by food delivery industry in a changing world in China.

Rapid economic growth and urbanization have brought notable changes in China. This trend had dramatic impacts to food industry and diet-related behaviors, which leads to increasing prevalence of overweight and obesity as well as diet-related non-communicable diseases (NCDs). With a rapid development of internet and e-commerce market, another emerging trend that should not be overlooked is the change in food shopping habits induced by the popularity of online-to-offline (O2O) food delivery service in China. The O2O food market is a booming industry in China, the market scale of O2O food industry is increasing with remarkable speed. More than 1/5 of total population in China has already became the users of O2O food delivery market. Development of this new trend in food environment is inevitable. This game-changing trend brings great opportunities to improve food accessibility and availability but meanwhile poses inevitable challenges to the whole public health system and social environment in China. This paper offers a unique perspective of the opportunities and challenges that the new industry brings to food environment, health outcomes caused by related behavior change, and its broader influence on social environment.