Encouraging Healthy Eating Research Articles

Situational diagnosis carried out at ESF 303

The Family Health Strategy (ESF) is crucial to expanding health coverage. This study, carried out by the second term of the Medicine course at the Centro Universitário de Goiatuba, analyzed the Family Health Strategy - 303, in Goiatuba, through situational diagnosis, which assesses the health conditions of a population, allowing us to know the challenges experienced in that place and plan strategic actions for possible improvements. Goiatuba, in Goiás, has 13 Family Health Units serving 35,664 inhabitants. Data from the health unit was collected and analyzed, including interviews with the preceptor and nurses, as well as site visits. A prevalence of cases of hypertension, diabetes and schizophrenia was observed, as well as structural weaknesses such as the lack of a vaccination room, a preventive care room, problems in the dental office and the absence of a full team of collaborators. These factors hamper the efficiency of the service and the quality of care. Pamphlets were distributed and an awareness campaign on healthy lifestyles was carried out, encouraging healthy eating, physical exercise and structural improvements to the unit were suggested, such as implementing psychological counseling. The research highlighted the importance of situational diagnosis in order to understand the reality of local health and implement more effective actions aimed at serving the entire population.

A qualitative exploration of food choice motives of Pacific Islanders: Implications for the use of the Food Choice Questionnaire in understudied populations

Nutrition transitions are key contributors to the obesity epidemic plaguing South Pacific Island countries (SPIC). Prior to European contact and colonisation, traditional Pacifica diets consisted mainly of root crops, indigenous fruits and vegetables, freshwater proteins and seafood(1). This diet has been replaced by diets high in processed foods which are high in salt, sugar and unhealthy fats(2). Various political, economic, environmental and socio-cultural factors have been associated with the proliferation of unhealthy foods in Pacifica diets. However, very few studies have examined how these changes have impacted individual food choices. This study aims to address the gap in the knowledge of food choice motives of Pacific Islanders. An online qualitative survey was used(1) to explore how the nine food choice motives in the widely used Food Choice Questionnaire (FCQ)(3) impact food choice and (2) to identify additional food choice motives, not captured in the FCQ. The first section of the survey included open-ended questions which explored the top three food choice motives of the participants. This section was followed by a series of open-ended questions exploring participant’s views on the nine food choice motives from the FCQ. The last part of the survey asked participants to identify any other food choice motives which were not already identified in the survey. An exploratory qualitative approach, employing inductive and deductive thematic analyses, was used to analyse results(4). The sample (N = 105) was predominantly female (73%), living with family (72%) and the average age was 22.06 years (S.D = 5.0). It consisted of 28% indigenous Fijians, 26% Fijians of Indian descent, 15% Solomon Islanders, 13% I-Kiribati and smaller percentages of students from Niue (3%), Samoa (5%), Tonga (5%) and Vanuatu (5%). Of the nine FCQ motives, the most commonly identified top three food choice motives included price (n = 54), health (n = 45), and sensory appeal, especially taste (n = 40). Participants also identified three new food choice motives which many ranked in their top three motives: satiety concerns (n = 22), food quality and hygiene when eating out (n = 26) and religious or cultural food restrictions (n = 11). Additionally, issues with face validity of the health, convenience, price, weight control and familiarity food choice motives from the FCQ were identified. These findings highlight the importance of validity studies prior to using FCQ, and more broadly other similar instruments, with understudied populations like that of SPIC. The findings also provided important insights into the food choice motives of Pacific Islanders and can inform public health interventions for encouraging healthy eating. Further research using an adapted FCQ with larger and diverse samples will increase its effectiveness of measuring food choice motives in the region.

Food and nutrition information requirements of Australian primary school parents.

To explore what Australian primary school parents want to learn about food and nutrition to improve their children's eating behaviours, as well as the associations between parents' personal and demographic characteristics and their views regarding their food and nutrition knowledge needs. An online nationwide cross-sectional survey was conducted in 2021 using a mixed-methods approach. Logistic regression analysis was utilised to examine the relationship between parents' demographics, personal values and their views. Content analysis was performed using Leximancer. Australia. Seven hundred and eighty-seven parents. Fifty-one per cent wanted to learn more about food and nutrition to improve their children's healthy eating habits, and 77% of those preferred schools to provide that information. Online/printed newsletters and YouTube were the most preferred methods for receiving food and nutrition related information. Higher universalism-concern value (concern for the welfare of those in the larger society and world) scores were positively associated parents' preference for schools to provide food and nutrition-related information. Parents with non-English-speaking backgrounds and younger parents were more likely to want to learn about food and nutrition. Parents wanted to learn more about encouraging healthy eating, ideas for the lunchbox, food labels and age-specific portion sizes and recommendations. Findings can inform public health educators and assist them in designing future food and nutrition education programmes and resources targeting primary school parents.

Exploring the feasibility of using evidence-based feeding practices to promote children's healthy eating in holiday clubs.

Encouraging healthy eating is a public health priority in the United Kingdom (UK), given the high prevalence of poor diet and overweight/obesity among school-aged children. Holiday clubs are organisations providing childcare and activities during the school holidays and frequently provide food to children at risk of food insecurity, primarily through government-funded programmes like the Holiday Activities and Food programme. However, the research suggests that holiday clubs could do more to maximise opportunities to promote children's healthy eating by using evidence-based feeding practices. During August-September 2020, video-based interviews were conducted exploring staff perceptions of the feasibility of using four evidence-based feeding practices to promote children's healthy eating: modelling; involvement in food choice; involvement in food preparation and cooking and involvement in meal planning. Feasibility was assessed using four dimensions of a feasibility framework (acceptability, demand, practicality and implementation). UK holiday clubs. Twenty-five staff actively involved in delivering UK holiday clubs (project leaders, coordinators, cooks and coaches/youth workers). Staff generally reported good acceptability (dimension 1) and demand (dimension 2) for the feeding practices. However, the practicality (dimension 3) of using the practices was dependent on various factors (logistics, resources, staff readiness, children, peers and parents). Promisingly, in the fourth feasibility dimension (implementation), staff provided numerous practical solutions to overcome these barriers. Evidence-based feeding practices can be implemented in numerous ways and are therefore generally feasible in holiday clubs. Holiday clubs should be empowered to use evidence-based feeding practices through training resources, sharing networks and provision of sustainable funding.

Adherence to the 10 steps for a healthy diet in pregnant women in Southeast Brazil

Introduction: Nutritional guidelines in prenatal care can influence the pregnant woman's eating behavior, reducing the risks for the mother-baby binomial. Objective: To analyze adherence to the 10 steps for healthy eating during pregnancy and its association with maternal and socioeconomic factors in pregnant women in Espírito Santo, Brazil. Methods: Data were obtained through an electronic questionnaire widely publicized on social networks. Socioeconomic, prenatal and eating behavior data were collected from 368 participants. The 10 Steps to Healthy Eating during pregnancy, adapted from the Brazilian Ministry of Health, using the Praise-Guide-Recommend System (EOR) were used as evaluation criteria. Pearson's chi-square test and Fisher's exact test were used to analyze differences between proportions. The binary logistic regression model was used to investigate the association between independent variables and steps towards healthy eating. A significance level of 5% and a confidence interval of 95% were adopted. Results: Most pregnant women reported adherence of 3 to 5 steps (78.5%), fitting into the O-Orientation category. It was observed that receiving nutritional guidance during prenatal care increased adherence in step 4 (OR: 1.99; 95%CI: 1.26-3.15), in step 5 (OR: 2.02; 95%CI: 1 .26-3.24) and step 9 (OR: 1.66; 95%CI: 1.66-2.58). Conclusion: The results suggest the need to strengthen prenatal actions, mainly related to guidelines on encouraging healthy and adequate eating habits.

521-P: Care Partner in Virtual Diabetes Self-Management Education and Support

Background: Support from care partners (CPs) , family or friends who are involved in diabetes management, is associated with improved self-management and clinical outcomes for adults with type 2 diabetes (T2D) . Therefore, guidelines recommend active CP involvement in diabetes self-management education and support (DSMES) . Telemedicine is increasingly being used to deliver DSMES and may facilitate CP involvement. Objective: To examine the frequency and type of CP involvement in virtual DSMES sessions delivered to patients in their homes over 12 months as part of the Telemedicine for Reach, Education, Access, Treatment, and Ongoing Support study, designed to evaluate the impact of longitudinal DSMES conducted via videoconferencing. Methods: 43 patients with T2D and an HbA1c>9% were enrolled from rural federally qualified health centers. A diabetes care and education specialist (DCES) performed an initial in-person needs assessment, followed by individualized virtual DSMES sessions via videoconferencing over 12 months. Participants were surveyed on the presence and roles of CPs at baseline, and DCES recorded CP involvement at each DSMES session. Twenty participants identified a diabetes CP at baseline; 75% lived with their CP and 60% of CPs were the patient’s significant other. Patients reported that CPs regularly helped with self-management by encouraging healthy eating (80%) , medication adherence (70%) , and discussing home blood glucose results (70%) . Nine participants had a CP involved in at least one virtual DSMES session; CPs performed diverse functions, including assisting with technology, setting up continuous glucose monitors, reviewing nutrition recommendations, and facilitating information sharing between participants and DCES. Conclusions and Future Direction: For adults with T2D, virtual visits offer opportunities for CPs to support and enhance DSMES. Efforts to more actively engage existing CPs could better leverage this resource to support ongoing diabetes self-management. Disclosure M.Zupa: None. P.A.Johnson: None. J.S.Krall: Research Support; Becton, Dickinson and Company, Sanofi. J.Ng: Research Support; Sanofi. S.L.Reynolds: None. A.Rosland: None. L.M.Siminerio: Advisory Panel; Abbott, Bayer AG, Research Support; Becton, Dickinson and Company, Sanofi. Funding NIDDK (R34DK123370) NCATS (TR001856)

DEVELOPMENT OF TEXT-MESSAGING TO SUPPORT THE SOUTH AFRICAN DIABETES PREVENTION PROGRAM

Objective: Emerging evidence suggests that the addition of text-messaging to standard healthy lifestyle interventions may improve the outcomes of diabetes prevention programs (DPP). This paper describes the process of developing text-messages for people at risk of developing diabetes in low-resourced communities as part of the South African DPP (SA-DPP). Design and method: The development comprised multiple steps which included nutrition and physical activity experts, who were guided by recommended steps for developing and pre-testing text messaging for health behavior change. The steps included: 1) Message development: 44 nutrition messages and 23 exercise messages were formulated based on the existing SA-DPP curriculum and its formative research; 2) these text messages were evaluated for readability/understandability in terms of content, language, and quality of information through interviews [structured questionnaire conducted telephonically or in-person] with 75 participants from two low-resourced areas; 3) messages not well understood according to the interviews were refined by the expert panel; 4) participants from step 2 who showed the least understanding of the messages participated in three workshops to evaluate the refined text-messages; and 5) the text bank was finalized. Results: Based on the results of the readability survey, 37 of the 69 formulated text messages [24 of the 44 encouraging healthy eating, and 13 of the 23 promoting physical activity] were refined by the expert panel. Focused discussions revealed that participants still had some difficulties with terms such as “variety’’ and “diet’’, and the concept of avoiding certain foods e.g. sugar, sweets, chocolates and salty snacks and eating a “fresh’’ salad with a meal. Thus, a further seven messages were refined considering alternate terminology proposed by the participants. The final text bank includes a total of 67 messages; topics covered are on fruit, vegetables and variety in the diet (n = 15), limiting fat intake (n = 10), avoiding sugar (n = 11), avoiding salt (n = 5), promoting fibre-rich foods (n = 1), messages promoting physical activity (n = 21) and general check-in messages (n = 4). Conclusions: This paper outlines the evidenced-based and participatory process of developing understandable healthy lifestyle text messages to promote and maintain behavior change objectives of participants at risk for developing diabetes.

College students’ attitudes about ways family, friends, significant others and media affect their eating and exercise behaviors and weight perceptions

Objective: This study examined college students’ perceptions of how parents, family, friends, significant others, and the media influenced eating and exercise behaviors and weight perceptions. Participants: Forty-one college students, mostly female, participated in interviews. Methods: A Grounded Theory approach, using open coding and memoing, was used to uncover key themes. Results: Healthy cooking and exercise role models at home were viewed as positive, encouraging healthy eating and exercise. Criticism was perceived as negative for healthy habits and weight perceptions. Friends and significant others who practiced positive health habits and were body accepting were uplifting. Cultural transmission of the thin ideal could occur through the media. Some noted that media messages were becoming more positive. Conclusions: Using peers, especially friends, as collaborators in interventions, and discussing parental influences on eating, exercise, and weight perceptions may positively impact obesity prevention programs and interventions for college students.

The Roles of Family and School Members in Influencing Children's Eating Behaviours in China: A Narrative Review.

This review explores the influences of family and school members on children in China, in order to promote healthy eating behaviours among children and prevent childhood malnutrition in the Global South. Family members and school members are defined as parents, guardians (such as grandparents and other relatives), siblings, peers, and teachers. A search of four databases returned 94 articles, 18 of which met the eligibility criteria. Most of the included studies were from mainland China; a few were from Hong Kong and Taiwan. More quantitative than qualitative studies were found, among which, cross-sectional studies were dominant. The 18 papers included in the study explored the influences of family members and school members on the eating behaviours of children, based on seven themes: (1) social–demographic characteristics, (2) food intake of parents, (3) nutritional knowledge and health awareness of family or school members, (4) parents’ perceptions of their children’s body weight, (5) feeding strategies of family members, (6) family relationships, and (7) intergenerational differences of caregivers. In the current analysis, parental education levels, mother’s occupation, health awareness of parents and teachers, and positive feeding styles, such as encouraging healthy eating and controlling overeating, were positively correlated with the healthy eating behaviours of children. Meanwhile, healthy eating behaviours of children were negatively associated with caregivers’ lack of nutritional knowledge, misperception of weight, instrumental and/or emotional feeding, and working on nonstandard shifts. More related research using cross-disciplinary approaches is needed and there should be more discussions about how teachers, siblings, and peers affect the dietary behaviours of children.

Efficacy of a smartphone application-based intervention for encouraging children's healthy eating in Denmark.

The growing rates of childhood obesity constitute a public health challenge worldwide. Therefore it is important to identify effective and widely applicable interventions to prevent it. This study aims to explore children's experience of using a newly developed smartphone application (app) designed to promote healthy eating and evaluate its efficacy on encouraging healthy eating. First, two focus groups were conducted to explore children's experience of using the app. Then, a quasi-experimental design was used to evaluate the app's efficacy. The children were asked to use the app for three months. Afterwards, the effect of the intervention was evaluated. 118 children aged 9 to 13 years (M=10.9, Sd=1.1) participated in the study. The children's experience of using the app was relatively positive, and they found the app easy to use. A significant increase in fruit (η2=.10) and vegetable preferences (η2=.37) and fruit intake (η2=.06) was found in the experimental group. No effects were found for vegetable intake, selfefficacy for healthy eating, or peer norms for healthy and unhealthy eating (p>0.05). The smartphone app-based intervention could potentially serve as an attractive and low-cost intervention to reach a wide population of children for the promotion of healthy eating and prevention of childhood obesity.

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Nutritional education through recreational activities as an entertainment tool in Hotel businesses

Food, with its different flavors, is introduced into a child’s life by the family and through nutritional education. Recreational activities also give children the ability to understand what to eat, and how to eat it. Due to the high demand for tourist accommodation that focuses on the family segment, the tourist trade, particularly hotel business, is hiring more employees in the recreation and leisure sector, in order to assist children and parents who want to enjoy a few hours of carefree leisure and rest. This article aims to show that recreational activities that provide nutritional education can be developed by hotel businesses as a form of children’s entertainment, stimulating creativity, teamwork, imagination, interpersonal relationships, the comfort of parents, along with an improvement in dietary habits. This study involves applied, exploratory, descriptive and bibliographic research, with a quantitative analysis to evaluate the level of children's satisfaction, using a visual 3-point Likert Scale. As an action strategy, we organized lectures with fun activities. We conclude that activities associated with nutritional learning are accepted by children as a means of socialization and entertainment, making them tools for use in accommodation establishments, as a recreational activity aimed at encouraging healthy eating.

What Motivates Engagement in a Community-Based Behavior Change Strategy for Overweight Children?

Introduction. The success of family-based community programs for childhood obesity may be increased by promoting social-cognitive factors that influence motivation and participant engagement. Incentivizing behavior can potentially enhance engagement and encourage behavior change. This research investigated motivators to engagement with a multicomponent incentive-based strategy to improve attendance and health-related behavior change in a family community-based weight management program for overweight and obese children. Method. Qualitative analysis combining; demographic data (n = 512), survey of parents (n = 273), and stakeholder (n = 10) and family interviews (n = 24). Participants were selected from program providers and families participating in an Australian community weight management program during a randomized controlled trial (n = 512 children). Maximum variation sampling (demographics and group characteristics) and inductive thematic analysis were used. Results/Conclusion. Four factors influencing engagement were (1) personal value, (2) achievement, (3) support, and (4) overwhelm. These themes corroborated with social-cognitive factors, fostered by a combination of behavior change components in the program that increased participant accountability and intrinsic motivation. Focusing on autonomous goal planning with parental involvement, tracking of goals, and reviewing of goals may complement existing strategies in child-focused treatment programs. Low-value noncash incentives linked to goal setting for encouraging healthy eating and physical activity were well accepted and may enhance family engagement and attendance.

740-P: Effect of Family Support Intervention on Support Roles and Impact of Support on HbA1c among Adults with Type 2 DM

Many adults with DM have a family supporter (FS) involved in their care. Informal support has been linked with better DM management and outcomes. We evaluated the effect of a patient and FS engagement intervention on FS roles in DM care, and the impact of those roles on HbA1c. Two-hundred and thirty-nine adult Veterans with type 2 DM and a FS were randomized to intervention vs. usual care for 12 months. Intervention dyads received one coaching session, biweekly automated calls to prompt action planning on new DM concerns, coaching calls to prepare for clinic visits, and summaries of primary care visits and DM complication risk. All models were controlled for baseline HbA1c, age, sex, insulin use, and FS cohabitation with patient. Over 12 months, participants in the intervention group were more likely to have increased involvement in several FS roles, including: deciding when to contact healthcare providers about concerns (AOR 2.080, 95% CI 1.137,3.804), remembering to go to appointments (AOR 2.852, 95% CI 1.503, 5.412), take (1.853, 95% CI 1.001, 3.428) and refill (AOR 2.193, 1.196, 4.019) medications, and perform (AOR 2.615, 95% CI 1.405, 4.867) and review (AOR 2.822, 95% CI 1.506, 5.290) home testing. Changes in help navigating the healthcare system, and encouraging healthy eating and exercise were not different by intervention arm. Help remembering to take medications at baseline was associated with 0.457% increase in HbA1c over 12 months (95% CI 0.107, 0.807, p=0.011), and no support roles were significantly associated with HbA1c decrease. In conclusion, this intervention increased FS involvement in diabetes-specific self-management, with less impact on general lifestyle support. Patients with support for taking medication prior to the intervention had significant subsequent increases in HbA1c. This may indicate family are recognizing which patients have challenges with medication taking, but need more training to effectively help improve subsequent patient outcomes. Disclosure M. Zupa: None. M. Heisler: None. J. Piette: None. R.B. Trivedi: None. S.C. Stoll: None. D. Obrosky: None. E.Z. Lovelace: None. M.K. Mor: None. A. Rosland: None. Funding VA Health Services Research and Development (IIR 14–074-1); Michigan Center for Diabetes Translational Research (5P60-DK09292); Michigan Claude D. Pepper Older Americans Independence Center (AG-024824); VA Ann Arbor Center for Clinical Management Research; University of Pittsburgh (5T32DK007052-45)

Implementation of an Early Childhood Healthy Eating and Physical Activity Program in New South Wales, Australia: Munch & Move.

Background: Childhood obesity is an important public health issue. Approximately 20% of 2–4 year olds are overweight or obese, meaning 1 in 5 Australian children start school above a healthy weight. In the state of New South Wales (NSW) the combined prevalence of childhood overweight and obesity is significantly higher among children from low socioeconomic status backgrounds and children from regional, rural and remote areas. This paper describes implementation of a healthy eating and active play program (Munch & Move) for center-based early childhood education and care (ECEC) services aimed at influencing healthy behaviors in young children in NSW, Australia. It shows changes over time including a focus on disadvantaged, Aboriginal and remote communities. It also discusses the challenges and future opportunities for the program.Methods: Routine data in relation to service delivery (reach) and implementation indicators are collected by Local Health District staff. Fifteen implementation indicators (known as practices) were introduced to monitor the implementation of Munch & Move (six related to promoting and encouraging healthy eating, four related to improving physical activity, two related to small screen recreation; and three related to quality of service delivery).Results: As of 30 June 2017, 88.4% of ECEC services have staff trained in Munch & Move. Of the 15 practices related to promoting and encouraging healthy eating, increasing physical activity and improving the quality of service delivery 13 practices saw significant improvements between 2012 and 2017. This was consistent for services with a high proportion of Aboriginal children and for services in disadvantaged and remote communities. There has been a statistically significant increase in the proportion (37.6–81.0%, p < 0.0001) and type of ECEC services (preschools 36.1–81.3%, p < 0.0001, long day care 38.6–81.0%, p < 0.0001, and occasional care 34.0–74.6%, p < 0.0001) that have implemented the program since 2012 as well as in services with a high proportion of Aboriginal children (33.6–85.2% p < 0.0001), services in disadvantaged communities (37.4–83.3% p < 0.001), and services in remote communities (27.8–59.4% p < 0.0139).Discussion: This paper demonstrates that Munch & Move has seen large improvements in the delivery of training, practice achievements and program adoption in ECEC services across NSW including services in disadvantaged and remote communities and that have a higher proportion of Aboriginal children.

Two observational studies examining the effect of a social norm and a health message on the purchase of vegetables in student canteen settings

There is some evidence from laboratory-based studies that descriptive social-norm messages are associated with increased consumption of vegetables, but evidence of their effectiveness in real-world settings is limited. In two observational field studies taking an ecological approach, a vegetable-related social norm (e.g. “Did you know that most students here choose to eat vegetables with their meal?”), and a health message (e.g. “Did you know that students who choose to eat vegetables have a lower risk of heart disease?”) were displayed in two different student canteens. Purchases were observed during three stages: baseline, intervention (when the posters were displayed) and immediate post-intervention (when the posters had been removed). Study 1 (n = 7598) observed the purchase of meals containing a portion of vegetables and Study 2 (n = 4052) observed the purchase of side portions of vegetables. In Study 1, relative to baseline, the social-norms intervention was associated with an increase in purchases of vegetables (from 63% to 68% of meals; OR = 1.24, CI = 1.03–1.49), which was sustained post-intervention (67% of meals; OR = 0.96, CI = 0.80–1.15). There was no effect of the health message (75% of meals at baseline, and 74% during the intervention; OR = 0.98, CI = 0.83–1.15). In Study 2, relative to baseline, there was an effect of both the social norm (22.9% of meals at baseline, rising to 32.5% during the intervention; OR = 1.62, CI = 1.27–2.05) and health message (rising from 43.8% at baseline to 52.8%; OR = 0.59, CI = 0.46-0.75). The increase was not sustained post-intervention for the social norm intervention (22.1%; OR = 0.59, CI = 0.46-0.75), but was sustained for the health intervention (48.1%; OR = 0.83, CI = 0.67–1.02). These results support further testing of the effectiveness of such messages in encouraging healthier eating and indicate the need for larger-scale testing at multiple sites using a randomised-controlled design.

Media, Technology Use, and Attitudes: Associations With Physical and Mental Well-Being in Youth With Implications for Evidence-Based Practice.

Previous research has shown that the use of technology and media, in their different available forms, may have detrimental effects on the physical and mental well-being of adolescents and young adults. The present study aimed to investigate the use of different types of technology and media, attitudes toward them, and how they relate to physical and mental well-being in Lebanese university students. A descriptive, correlational, cross-sectional design was used. A sample of 244 undergraduates completed a self-report measuring media and technology use and attitudes, eating-related variables (e.g., healthy eating, body image dissatisfaction [BID], and eating disorders [EDs] risk), trait emotional intelligence (TEI), and psychopathology indicators (stress, anxiety, and depression). The use of mobile phone multimedia (music, pictures, and videos) correlated with unhealthy eating and stress. Social media use was associated with BID, EDs risk, and the self-control construct of TEI. Anxiety of separation from technological devices and dependence on them was associated with increased BID, EDs risk, depression, and anxiety. Practical implications are discussed in terms of setting limits and boundaries on technology use during childhood and adolescence, and encouraging healthy eating and physical activity at home and on college campuses. Moreover, social media could be used as a platform for intervention and prevention programs to decrease BID, EDs, depression, and anxiety.

Association between Body Image Dissatisfaction and Self-Rated Health, as Mediated by Physical Activity and Eating Habits: Structural Equation Modelling in ELSA-Brasil.

This study investigated whether the association between body image dissatisfaction and poor self-rated health is mediated by insufficient physical activity and unhealthy eating habits. The participants were 6727 men and 8037 women from the baseline (2008–2010) of the Longitudinal Study of Adult Health (Estudo Longitudinal de Saúde do Adulto, ELSA-Brasil). Structural equation modelling was used. Associations were found between body image dissatisfaction and poor self-rated health in both sexes. Insufficient physical activity was a mediator. However, unhealthy eating habits were found to exert a mediator effect only via insufficient physical activity. Body image dissatisfaction was found to associate, both directly and possibly indirectly, with poor self-rated health, mediated by insufficient physical activity and unhealthy eating habits. Accordingly, encouraging physical activity and healthy eating can contribute to reducing body image dissatisfaction and favour better self-rated health.

A Civic Engagement Approach to Encourage Healthy Eating and Active Living in Rural Towns: The HEART Club Pilot Project.

To assess the feasibility and effectiveness of a civic engagement curriculum (encouraging Healthy Eating and Activity in Rural Towns [HEART] Club) designed to engage rural residents in improving their local food or physical activity environment. Pre-post surveys and focus groups. Three rural Northeastern towns in the United States. Twenty-six rural residents (7-12 per town) recruited by local extension educators. Online surveys were used to assess outcomes related to feasibility (satisfaction) and effectiveness (knowledge, awareness, motivation, self-efficacy, and group efficacy for community change). Feasibility was also assessed through attendance logs, benchmark achievement records, and post-implementation focus groups. Participant characteristics and feasibility measures were summarized using descriptive statistics. Pre-post changes in effectiveness outcomes were assessed using Wilcoxon signed rank tests. Focus group data were thematically examined to identify barriers to and facilitators of HEART Club progress. Meeting attendance and program satisfaction were high (88% and 91%). Participants reported improvements in awareness; however, no other significant changes were observed. All HEART Clubs accomplished 3 or more project benchmarks after 6 months of implementation. Despite competing priorities and limited finances, groups effectively leveraged existing resources to achieve their goals. Important facilitators of success included stakeholder support, effective leadership, and positive group dynamics. These findings suggest that resident-driven initiatives that build upon local resources and establish feasible goals can successfully foster environmental change in rural communities.

Process of developing text messages on healthy eating and physical activity for Chilean mothers with overweight or obese preschool children to be delivered via WhatsApp

AbstractBackground: Chile has a very high prevalence of childhood obesity; 25% among 4–5 y olds. Numerous school-based strategies have been implemented with no lasting improvement. Given that parents are key in obesity prevention and that their participation in programs is low, mobile technology is increasingly being used to test its effectiveness in changing children’s behavior. Objective: to report the process of developing text messages for Chilean mothers of low socioeconomic status with overweight or obese preschool children. Methodology: The process involved 3 stages: (a) initial elaboration of 60 messages on healthy eating and physical activity (b) 3 focus groups which included similar participants as the target population and (c) consensus on the final messages obtained from 56 experts, using the Delphi technique. Results: a list of 40 text messages encouraging healthy eating and promotion of physical activity which underwent a rigorous process are ready to be delivered via WhatsApp to low-income ...