Dietary Modification Program Research Articles

Movement Skills and Physical Activity in Obese Children

The purpose of this study was to evaluate the Hunter Illawarra Kids Challenge Using Parent Support physical activity program in overweight children. A multisite randomized controlled trial was conducted with three intervention arms: 1) child-centered physical activity skill development program (Activity), 2) parent-centered dietary modification program (DIET), or 3) both programs combined (PA+DIET). Movement skill proficiency, perceived athletic competence, accelerometer-assessed physical activity, and parent-reported time spent in screen behaviors were assessed at baseline, 6 months, and 12 months in 165 prepubertal children aged 5.5-9 yr (59% girls, 78% obese). Differences in changes in outcomes between groups were assessed using linear mixed models. Compared with the diet group, the activity group (mean (95% confidence interval): +7.7 units (3.8-11.6 units)) and the activity + diet group (+6.7 units (2.9-10.5 units)) displayed 11%-13% greater improvement in overall movement skill proficiency (gross motor quotient) at 6 months. Perceived athletic competence increased across groups at follow-up (across groups: 6 months = +0.21 units (0.11-0.31 units), 12 months = +0.21 units (0.07-0.35 units)). Groups did not differ statistically for change in physical activity outcomes. Total screen time (min·wk(-1)) decreased in all groups at 6 months (across groups: -385.4 (-501.0 to -269.8)) and in the activity group (-261.8 (-470.5 to -53.1)) and activity + diet group (-340.5 (-534.6 to -146.4)) at 12 months. The diet group reported greater reductions in TV or DVD viewing time at 6 months compared with the activity group (248.6 (24.0-473.3)). The activity and the activity + diet programs were efficacious in improving overweight children's movement skill proficiency. All programs were efficacious in reducing time spent in screen behaviors. Other correlates may need to be targeted in addition to movement skills to increase physical activity among overweight children.

An Encouraging Intervention for Obese Children

In a randomized clinical trial, researchers compared the effectiveness of a 6-month child-centered physical-activity program, a parent-centered dietary-modification program, or both interventions in 165 prepubertal overweight children (age range 5.5–9.9 years) in Australia. Both interventions included weekly 2-hour face-to-face sessions for …

Child-centred physical activity programme and parent-centred dietary programme alone or combined lead to sustainable reductions in BMI in 5-10-year-olds: diet alone or diet plus activity programmes seemed most effective

Commentary on: AD Okely, CE Collins, PJ Morgan, et al.. Multi-site randomized controlled trial of a child-centered physical activity program, a parent-centered dietary-modification program, or both in overweight children: the HIKCUPS study. J Pediatr2010;157:388–94, 394.e1.

High general self-efficacy is associated with less weight loss under a supervised dietary modification program

Self-efficacy is an important prospective predictor for behavior modification. As for weight loss intervention, many studies have shown significant associations between situation-specific self-efficacy and weight loss. In this study, we investigated the association between general self-efficacy and body weight change during a 14-week supervised dietary modification program. In total, 154 obese, middle-aged, Japanese women were selected as the subjects. The intervention program mainly comprised diet counseling. The diet counseling consisted of weekly lectures on weight loss practices and individual counseling by skilled dieticians. All subjects were instructed to choose and consume a well-balanced, 1200 kcal diet per day while also keeping a daily food diary in which they recorded in detail every food they ate during the intervention period. Body weight, waist circumference, and coronary heart disease risk factors were measured before and after the intervention. Energy intake and activity energy expenditure were assessed before and during the intervention. General self-efficacy was assessed with the General Self-Efficacy Scale (GSES) before the intervention. Body weight decreased significantly (-7.8 ± 2.7 kg; -11.4 ± 3.7%) following the intervention. The weight reduction was significantly greater for the low GSES group than for the other GSES groups. Self-efficacy regarding "degree of confidence in one's ability relative to others" especially influenced the association between the weight loss and the GSES score. Subjects' fat intake influenced the weight loss differences among GSES groups. In conclusion, inconsistent with previous studies, high general self-efficacy was associated with less weight loss under a supervised dietary modification program among middle-aged, Japanese women.:

The impact of a child obesity treatment intervention on parent child-feeding practices

Effective treatment of childhood obesity requires a multi-factorial approach and should target factors impacting on a child's environment. To explore the impact of three treatment programs on parental child-feeding practices at 6, 12 and 24 months post-program. SUBJECTS/INTERVENTION: Overweight children (n=159) aged 5-7 years, recruited to the Hunter Illawarra Kids Challenge Using Parent Support (HIKCUPS) randomized controlled trial with three treatment arms; a dietary modification program, a physical activity skill development program or a combination of both programs. Main outcome measures. The Child Feeding Questionnaire (CFQ), a validated 31-item questionnaire measuring child-feeding practices, completed by parents. Statistical analysis. Linear mixed models were used to assess change over time and to determine differences by intervention group. A significant decrease (p<0.01) in CFQ domain scores were reported and sustained at 24 months for all groups, in the domain of pressure to eat (mean+/-SEM, 1.8+/-0.06, 1.6+/-0.06) with increases in degree of monitoring (4.0+/-0.07, 4.2+/-0.06). The domain of restriction showed significant decreases in dietary intervention groups only (baseline 3.9+/-0.05, 24 months 3.7+/-0.06), the domain scores for concern were found to be strongly associated with child BMI z-score (r=0.73, p < 0.001) at baseline only. This study provides evidence that specific child-feeding domains are modifiable in the context of a targeted obesity intervention and further that changes can be sustained over time. HIKCUPS study: National Centre for Clinical Trials (NCT): 00107692 clinicaltrials.gov Identifier: NCT00107692 http://clinicaltrials.gov/ct2/home.

A Review of Interventions Based on Dietary Diversification or Modification Strategies with the Potential to Enhance Intakes of Total and Absorbable Zinc

Dietary diversification or modification has the potential to prevent deficiencies of zinc and other coexisting limiting micronutrients simultaneously, without risk of antagonistic interactions. In this review, we have addressed the following. The first section focuses on strategies with the potential to enhance intake and/or bioavailability of zinc, and includes interventions (with and without nutrition education) based on agriculture, production or promotion of animal-source foods through animal husbandry or aquaculture, and commercial and household processing strategies to enhance zinc absorption. Outcome indicators include intakes of foods or nutrients (although rarely zinc) and, in some cases, zinc status, or zinc-related functional responses. The next two sections address whether dietary diversification or modification can achieve increases in absorbable zinc that are sufficient to enhance zinc status or zinc-related functional responses in breastfed infants and toddlers and in older children and women of reproductive age. Evidence for the impact of dietary diversification or modification on behavior change and on nutritional status in the short and long term, and the possible role of modifying factors (e.g., baseline nutritional status, socioeconomic status, infection, sex, age, and life-stage group) is the emphasis of the next section. The following section highlights the evidence for three potential adverse effects of dietary diversification or modification: aflatoxin contamination from germinated cereals, loss of water-soluble nutrients, and displacement of breastmilk. Finally, an example of a dietary diversification or modification program (Homestead Food Production) developed and implemented by Helen Keller International is given, together with the critical steps needed to scale up dietary diversification or modification for programs and future research needs.

Process Evaluation of the Hunter Illawarra Kids Challenge Using Parent Support Study: A Multisite Randomized Controlled Trial for the Management of Child Obesity

The purposes of this article are to (a) outline findings from secondary or process outcome data of the Hunter Illawarra Kids Challenge Using Parent Support (HIKCUPS) study and (b) inform the design and development of future research interventions and practice in the management of child obesity. Data were collected by means of facilitator evaluations, independent session observation, attendance records, and parent questionnaires. Internal validity and reliability of the program delivery were high. All parents reported positive changes in their children as a result of the physical activity program, the dietary modification program, or both. Most participants completed the home activities, but more than half reported that finding time to do them was problematic. Facilitator review indicated that future programs should specifically cater to children of similar age or same sex, allow adequate time for explanation of complex nutritional concepts, and use intrinsic motivators for participants. Recommendations for future interventions, specifically the implementation of subsequent HIKCUPS or other multisite effectiveness studies, are detailed.

Impact of a child obesity intervention on dietary intake and behaviors

The aims of this study were to describe the dietary intakes and food behavior changes of overweight and obese children participating in the Hunter Illawarra Kids Challenge Using Parent Support (HIKCUPS) study and to describe the impact of a best practice dietary modification program. A multicenter randomized controlled trial with allocation to one of three intervention arms: (1) parent-centered nutrition lifestyle program; (2) child-centered physical activity skill development program; or (3) both the programs. One hundred and sixty-five overweight, pre-pubertal children 5-9 years of age (58% female). Dietary intake was assessed at baseline, 6 and 12 months post-commencement of the program using a semiquantitative food frequency questionnaire. After 6 and 12 months, all groups improved their dietary intake, with no differences detected between groups (P>0.05). Total quantity of food (g) and kJ kg(-1) decreased significantly at both time points (P<0.05). Percent energy derived from core food groups, except fruit, increased significantly at 12 months compared to baseline (P<0.05), and non-core foods decreased, with the largest decreases being for sweetened drinks (5.0+/-0.4 vs 2.9+/-0.3% of energy baseline to 12 months, P<0.001) and packaged lunch box snacks (5.4+/-0.3 vs 4.1+/-0.3% of energy baseline to 12 months, P<0.001). All treatment groups in the HIKCUPS study appear to be equally efficacious in improving dietary intake in overweight and obese children.

THE ROLE OF MINDFULNESS IN HEALTH BEHAVIOR CHANGE

LEARNING OBJECTIVE • To increase awareness of mindfulness-based treatments and how these approaches can be beneficial for individuals engaged in weight loss, dietary modification, and physical activity programs.

The HIKCUPS trial: a multi-site randomized controlled trial of a combined physical activity skill-development and dietary modification program in overweight and obese children

BackgroundChildhood obesity is one of the most pressing health issues of our time. Key health organizations have recommended research be conducted on the effectiveness of well-designed interventions to combat childhood obesity that can be translated into a variety of settings. This paper describes the design and methods used in the Hunter Illawarra Kids Challenge Using Parent Support (HIKCUPS) trial, an ongoing multi-site randomized controlled trial, in overweight/obese children comparing the efficacy of three interventions: 1) a parent-centered dietary modification program; 2) a child-centered physical activity skill-development program; and 3) a program combining both 1 and 2 above.Methods/DesignEach intervention consists of three components: i) 10-weekly face-to-face group sessions; ii) a weekly homework component, completed between each face-to-face session and iii) three telephone calls at monthly intervals following completion of the 10-week program. Details of the programs' methodological aspects of recruitment, randomization and statistical analyses are described here a priori.DiscussionImportantly this paper describes how HIKCUPS addresses some of the short falls in the current literature pertaining to the efficacy of child obesity interventions.The HIKCUPS trial is funded by the National Medical Research Council, Australia.

Dietary fats, eating guides, and public policy: history, critique, and recommendations

Controversies over the nutrition science of dietary fat, and equally over the advice furnished to consumers about dietary fat, have confounded US nutrition policies and eating guidance for the last 90 years. This is so despite the remarkable congruence between the first US food guides (1916) and the most recent (2000 Dietary Guidelines for Americans), both of which state that dietary fats should be consumed “moderately.” The 2002 Report of the US Food and Nutrition Board (issued jointly by the United States and Canada) quantifies this by stating that healthy dietary fat should constitute “25–35 percent of calories.” However, the US consumer guide, the Food Guide Pyramid (released in 1992 but based on data from the early 1980s) states that dietary fats should be consumed “sparingly,” which is explained to be “a diet low in fat.” This direct conflict in official dietary policies causes consumer confusion and erodes efforts of public and private health promotion efforts to stem the increasing incidence of overweight and obesity in Americans. The most successful population-wide dietary behavior modification program in US history was the food rationing program in World War II. Its successes were based equally on consensus nutrition profiles for good health and messages that communicated the rationing program effectively. The current US incidence of overweight and obesity, and the chronic diseases to which they are precursors, will be mitigated and prevented only with major changes in national dietary policies and programs based on successful experiences and models. The first step in this much-needed process is acknowledgment that current dietary guidance and education policies have been and are unsatisfactory.

Comparable effects of diet and exercise on body composition and lipoproteins in older men

Changes in body composition, fat distribution and lipoprotein lipids in response to weight loss elicited by a 10-month program of hypocaloric diet (HD) therapy alone or combined with aerobic exercise training (AEX+HD) were examined in sedentary obese older males. Body composition was assessed by hydrodensitometry and fat distribution was evaluated with skinfold thickness and circumference measures. The HD group underwent a dietary/behavioral modification program to reduce caloric intake. The AEX+HD group underwent a similar dietary modification program combined with aerobic exercise training. Following completion of the study, 15 subjects from each group were individually pair matched based on age (57.1 +/- 1.7 vs 61.3 +/- 2.4 yrs) and their reduction in body mass (-7.6 +/- 1.3 vs -8.0 +/- 1.1 kg). Reductions in fat and fat-free mass and skinfold thickness and circumferences were similar in both groups. In both the AEX+/HD and HD groups there were significant reductions in the ratio of low-density lipoproteins to high-density lipoproteins (HDL-C) and triglycerides and a significant increase in HDL2-C. There were no differences in final values or absolute and relative changes in the various lipoprotein values between the two groups. These results suggest weight loss induced by diet alone or combined with aerobic exercise cause similar changes in body composition and lipoprotein lipids.

Projected numbers of cancers diagnosed in the US elderly population, 1990 through 2030.

As based on Bureau of the Census population projections and age-specific cancer incidence rates for 1985 to 1989 from the National Cancer Institute's Surveillance, Epidemiology and End Results program, the number of incident cancers diagnosed annually in the United States among persons aged 65 and over is projected to reach 1.5 million by the year 2030, or 2.4 times the number estimated for 1990. These projections, which may be conservative because birth cohort patterns (based on Connecticut rates) suggest possible future increases in incidence rates for all cancer sites combined, have implications for planning expanded primary prevention efforts, such as smoking cessation (especially for women) and dietary modification programs, and for projecting health care needs and costs.

Effect of Age, Family Status, and Physical Activity on Selected Dietary Components of TAC Pilots

This study gathered dietary data on Tactical Air Command (TAC) pilots for descriptive and analytic purposes. One hundred eighteen TAC pilots from five bases were interviewed concerning their diet, age, family configuration, and exercise level. Dietary information was recorded using the PruCal 3-day dietary report form, while the remaining information was recorded on a personal interview form. Pilots were grouped according to age (three levels), family configuration (three levels), and exercise (three levels). The groups in each category were tested (analysis of variance) for differences in their intake of protein, carbohydrates, fat, alcohol, and caffeine, and for demographic differences. Differences between exercise groups were found for weight and carbohydrates consumed. Age group differences were seen in alcohol intake and fat consumption. Further findings suggest pilots do not have diets which meet dietary guidelines. There appears to be a need for nutrition education, dietary modification programs, and further study of the diets of TAC pilots.

Variability in Response to a Low-Fat, Low-Cholesterol Diet in Children with Elevated Low-Density Lipoprotein Cholesterol Levels

The reduction of dietary cholesterol and fat lowers low-density lipoprotein cholesterol (LDL-C) and reduces risk of coronary heart disease in adults. The purpose of this study was to determine the individual variability of response of serum lipid and lipoprotein levels to a low-fat, low-cholesterol diet in children with elevated LDL-C levels. Thirty-two children (2 to 16 years of age) enrolled in a diet modification program, who had LDL-C levels of at least 110 mg/dL but normal triglyceride levels for their ages, were studied. Lipid levels and dietary nutrients were analyzed at the time of admission, and final assessments were made at least 3 months after entry. There was a significant correlation, for the group as a whole, between change in LDL-C concentration and change in grams of dietary saturated fat; however, there was marked individual variability in LDL-C response. There were no significant correlations between changes in LDL-C levels and changes in either total fat, polyunsaturated fat, or cholesterol intake. It is concluded that modest decreases in dietary saturated fat coincide with a lowering of LDL-C concentration, over a short term, in many children, but the degree of lowering varies considerably from one child to another. This variability is consistent with the concept that response of serum lipid levels to dietary changes is modified by genetic, metabolic, and other, as of yet, undefined variables.

A review of dietary interventions aimed at controlling hypertension.

Before planning programs to change dietary behavior in groups of individuals, evidence about the effectiveness of different interventions is needed. Articles published in the journals indexed by Index Medicus between the years 1975-84 were reviewed for evidence concerning the effectiveness of dietary modification programs in achieving dietary change. All program evaluations published in English and aimed at control of blood pressure levels in adults were eligible for review. Twenty-nine articles relevant to the synthesis contained sufficient information evaluating the contribution of dietary intervention. These 20 studies addressed changes in fat consumption, reduction in salt intake and reduction in calories consumed. The methods of intervention ranged from residential programs, through individual counseling and group discussion involving spouses, to audiovisual tapes. The studies had varying periods of follow-up; among those with one or more years of follow-up, a number of studies were able to demonstrate effectiveness using different outcome measures. For some dietary components, notably changes in fat intake and reduction in salt consumption, it has been possible to identify a minimal effective intervention, such as self-help materials or individual instruction, while changes in calorie intake or weight seem to require group counseling with family member involvement. The findings from this information synthesis should prove useful to those planning dietary interventions.

Long-term follow-up of obesity in adolescents

Fifty adolescents, 12-17 years of age, were treated for obesity from 1967 to 1972. They were contacted in 1977 to obtain follow-up data. Each subject had been treated in a program of dietary counseling and behavior modification. Mean weight on follow-up was 18.1 lb (8.2 kg) lower than mean initial weight (P less than 0.05). The mean decrease over desired weight was 29.5%. Twenty-two patients reported a weight loss of greater than 20 lb (P greater than 0.001). (9.1 kg) and 15 patients reported a weight loss of 0-20 lb (9.1 kg). Thirty-eight percent of the patient were no longer obese (greater than 20% over ideal body weight) and an additional 22% were no longer overweight (10-20% over ideal body weight). These results suggest that a dietary and behavior modification program offered to adolescents may show beneficial results in young adulthood.

Developing and evaluating audiovisual media for dietary education

A 5-year diet modification program was initiated in 1975 at the National Heart and Blood Vessel Research and Demonstration Center (Baylor College of Medicine) Houston Texas in the effort to demonstrate the relative effectiveness of various instructional techniques in changing the dietary habits of healthy adults recruited from the general public. The ongoing and community-wide study was designed to change the dietary patterns of 1000 voluntary participants in accordance with the principles of a low-saturated fat low-cholesterol diet -- the Help Your Heart Eating Plan. The participants are healthy adults 18 years of age or older with plasma lipid levels representative of the American adult population. The individuals are recruited each year and randomly assigned to 1 of 3 groups to determine the effects of various educational approaches in inducing dietary change. Prior to program initiation 8 pilot audiovisual presentations were developed and produced for use sequentially in the first 8 weekly dietary instruction sessions. Averaging 5-8 minutes in length the pilot presentations consisted of a series of 35 millimeter slides synchronized with an audiocassette taped narration. A 2-part evaluation of the 8 pilot presentations was designed and implemented. Cognitive evaluation results showed that the pilot programs were generally effective education tools if education is defined as knowledge gain yet certain cognitive objectives were not effectively accomplished and indicated the portions of the presentations which required revision.

Chapter I: Background, Objectives, and Design

Extensive evidence implicates diet as one of the key factors in the etiology of atherosclerosis, and suggests that the disease can be prevented by changes in diet, particularly to lower serum cholesterol level. In 1960, an Executive Committee on Diet and Heart Disease was established to explore the matter of mass field trials on the prevention of atherosclerotic coronary heart disease. After two years of deliberations, the Executive Committee concluded that a well controlled mass field trial was needed to test the hypothesis that alteration of the amount and type of fat and the amount of cholesterol in the diet would decrease incidence of first attacks of clinical coronary heart disease in middle-aged American men. It estimated that a study population of up to 100,000 men, with a follow-up period of four or five years, would be required to obtain a statistically reliable test of the hypothesis if the incidence were reduced by 20 per cent. The Committee further concluded that, on the basis of information then available to it, a definitive decision could not be made concerning the feasibility of such a large-scale study. It therefore recommended that the next major endeavor be a smaller feasibility study. Based on this recommendation, a common protocol was developed for a collaborative feasibility study. Feasibility of two types of mass field trial was to be evaluated: 1. among free-living men from the general population, and 2. among long-term residents of mental institutions, with both studies to be conducted on a double-blind basis, through use of special fat-modified foods. The original protocol enumerated eleven topics to be clarified by this National Diet-Heart Study in a one to two year research endeavor: 1. Effectiveness of recruitment of volunteers from several sources; 2. rate of volunteering; 3. effectiveness of three concomitant dietary modifications-moderate reduction of per cent calories derived from total fat and/or saturated fat, increase in per cent calories from polyunsaturated fat and in the polyunsaturated to saturated fat ratio (P/S), and moderate reduction in dietary cholesterol; 4. availability, palatability, distribution, and cost of specially prepared foods; 5. indices of adherence to diet; 6. extent of reduction of serum cholesterol levels; 7. dropout, non-adherence, and non-response rates; 8. feasibility of a double-blind technique; 9. personnel, equipment, and physical facilities necessary; 10. geographic and laboratory variations within a common protocol; 11. experience in the pooling data from a cooperative study. Findings of the first months of the Study revealed several problems requiring further investigation. Therefore, the decision was made to continue beyond the first year, with appropriate modification of the protocol for the second year. These further efforts-designated the Extended Study and the Second Study respectively-aimed to evaluate the following major problems, in addition to those explored during the initial year (First Study): 1. What proportion of the participants in the First Study would volunteer for the Extended Study? What would the non-adherence and dropout rates be in the Extended Study and the Second Study (with use of newly recruited men in the latter)? 2. Could new individuals be recruited for such studies with the explicit understanding that some of them would be randomly assigned to a control group? 3. Could costs be reduced by having participants select lean cuts of meat on the open market? 4. Could participants be satisfactorily instructed to select and trim meats? Would their intake of fat and cholesterol be well controlled? Would they demonstrate adequate blood lipid responses? 5. Could new experimental diets, acceptable to the participants, be devised and evaluated? How would they compare to the diets utilized in the First Study? Could the differences between control and experimental groups be enhanced? 6. Could diet modification programs be made less demanding for participants, nutritionists, and investigators? Would such altered programs be effective? 7. Could any evidence of a seasonal variation in serum cholesterol level be detected, as a possible confounding factor influencing the trend of serum cholesterol level? Facilities for the study of free-living or "open" populations were established in five cities (Baltimore, Boston, Chicago, Minneapolis-St. Paul, Oakland), and of an institional or "closed" population at the Faribault State School and Hospital, Minnesota. A Central Staff was established, and-in co-operation with the Principal Investigators-it procured and distributed the special fat-modified foods; developed forms and a manual of uniform procedures; distributed these materials; administered the double-blind design; maintained quality control; and assumed responsibility for the central collection, tabulation, analysis, and distribution of data. A Central Laboratory analyzed all sera for total cholesterol.