High Rates Of Obesity Research Articles

Developing an obesity research agenda with British Pakistani women living in deprived areas with involvement from multisectoral stakeholders: Research priority setting with a seldom heard group.

IntroductionBritish Pakistani women have exceptionally high rates of obesity and yet are seldom heard in a research priority setting concerning weight management. The objectives of this study were (i) to ascertain what multisectoral professionals perceive to be the most pressing unmet obesity needs or topic areas that need more research in relation to Pakistani women living in deprived areas of Bradford and (ii) to determine the top 10 obesity health priorities for this group to develop an obesity research agenda.MethodsA two‐step process was adopted using the following: (i) a survey of a wide range of multisectoral professional stakeholders (n = 159) and (ii) a ranking exercise involving Pakistani women living in deprived areas of Bradford (n = 32) to select and prioritize their top 10 obesity health concerns and unmet needs from a list of 31 statements identified in the survey and previous research. Survey data were analysed using inductive content analysis and themes were identified. Themes were translated into statements to be ranked by Pakistani women. The ranking exercise was conducted by telephone either via voice or video call. Data were analysed using a reverse scoring system.ResultsSurvey responses were grouped into statements reflecting the following three categories: education needs; healthy behaviour barriers and mental well‐being. The highest rankings were given by Pakistani women to statements on mental health and the need for education. The top 10 prioritized statements were developed with members of the public into an obesity research agenda that reflected the target population.ConclusionActively engaging British Pakistani women in setting research priorities provided a unique opportunity to understand the key areas they think are important for future research. The culminating research agenda can be used by researchers to advance the field of obesity research in Pakistani communities, thus producing research outputs that are relevant to and have impact in this population.Patient or Public ContributionParticipants in the ranking exercise collected data. Public contributors were involved in developing the prioritized statements into a research agenda.

Narrative review of nutritional status among iraqi adults with type 2 diabetes

Type 2 diabetes is a global public health problem especially in middle east countries and Iraq has not spared from this pandemic. The prevalence in Iraq. and rank in Middle East. Beside increasing in prevalence- also poor glucose control. Nutrition plays a critical role. This paper narratively review variables that affect reduce the incidence of T2DM in Iraq and affect nutritional status among Iraqi withT2DM. The factors contribute to T2DM were high rates of obesity and overweight, as well as levels of body fat indicate a high prevalence of poor glycemic control. Likewise, levels of physical activity are low among older Iraqis.

Overcoming Therapy Resistance in Colon Cancer by Drug Repurposing.

Simple SummaryDespite improvements in standardized screening methods and the development of promising therapies for colorectal cancer (CRC), survival rates are still low. Drug repurposing offers an affordable solution to achieve new indications for previously approved drugs that could play a protagonist or adjuvant role in the treatment of CRC. In this review, we summarize the current data supporting drug repurposing as a feasible option for patients with CRC.Colorectal cancer (CRC) is the third most common cancer in the world. Despite improvement in standardized screening methods and the development of promising therapies, the 5-year survival rates are as low as 10% in the metastatic setting. The increasing life expectancy of the general population, higher rates of obesity, poor diet, and comorbidities contribute to the increasing trends in incidence. Drug repurposing offers an affordable solution to achieve new indications for previously approved drugs that could play a protagonist or adjuvant role in the treatment of CRC with the advantage of treating underlying comorbidities and decreasing chemotherapy toxicity. This review elaborates on the current data that supports drug repurposing as a feasible option for patients with CRC with a focus on the evidence and mechanism of action promising repurposed candidates that are widely used, including but not limited to anti-malarial, anti-helminthic, anti-inflammatory, anti-hypertensive, anti-hyperlipidemic, and anti-diabetic agents.

Social determinants of obesity in American Indian and Alaska Native peoples aged ≥ 50 years.

American Indian and Alaska Native peoples (AI/ANs) have a disproportionately high rate of obesity, but little is known about the social determinants of obesity among older AI/ANs. Thus, our study assessed social determinants of obesity in AI/ANs aged ≥ 50 years. We conducted a cross-sectional analysis using multivariate generalized linear mixed models to identify social determinants associated with the risk of being classified as obese (BMI ≥ 30.0 kg/m2). Analyses were conducted for the total study population and stratified by median county poverty level. Indian Health Service (IHS) data for AI/ANs who used IHS services in FY2013. 27,696 AI/ANs aged ≥ 50 years without diabetes. Mean BMI was 29.8 ± 6.6 with 43% classified as obese. Women were more likely to be obese than men, and younger ages were associated with higher obesity risk. While having Medicaid coverage was associated with lower odds of obesity, private health insurance was associated with higher odds. Living in areas with lower rates of educational attainment and longer drive times to primary care services were associated with higher odds of obesity. Those who lived in a county where a larger percentage of people had low access to a grocery store were significantly less likely to be obese. Our findings contribute to the understanding of social determinants of obesity among older AI/ANs and highlight the need to investigate AI/AN obesity, including longitudinal studies with a life course perspective to further examine social determinants of obesity in older AI/ANs.

The Relationship Between Bone Mineral Density and Body Composition Among Qatari Women With High Rate of Obesity: Qatar Biobank Data.

Studies have reported inconsistent results for the relationship between body composition and bone mineral density (BMD) among women, especially those with a high rate of obesity. This study aims to examine the association between BMD and body composition among Qatari women. A cross-sectional study, using data from the Qatar Biobank (QBB), was conducted on 2,000 Qatari women aged 18 and over. Measurements were taken by dual-energy X-ray absorptiometry (DEXA) for body composition [visceral fat and android fat (AF)], gynoid fat (GF), trunk fat, total fat mass (TFM), total lean mass (LM) and bone mineral density (BMD), including the lumber spine, neck, femur and total body. The participants were divided into groups of normal and low BMD, based on their T-score. Non-linear regression analysis using the restricted cubic spline method was performed according to the T-score of the total BMD for the fat mass variables. Women with a low BMD (T-score <-1) had significantly lower body composition indicators. LM was positively correlated with BMD at the spine (r = 0.29, p < 0.001), neck (r = 0.32, p < 0.001), and femur (r = 0.28, p < 0.001), as well as total BMD (r = 0.29, p < 0.001) and T-score (r = 0.31, p < 0.001), while the correlatio between TFM and BMD was negative and weak (r = −0.05, <0.017). Results of the non-linear regression indicated that components of fat distribution (TFM, AF, GF and trunk fat) were positively associated with total body T-score. In the adjusted non-liner regression, only a slight increase in T-score was recorded with an increase in FM. The association between FM and BMD was non-linear, suggesting that FM may not be a strong protector of bones among women with high rate of obesity.

Multilevel Factors for Adiposity Change in a Population-Based Prospective Study of Black Breast Cancer Survivors.

PURPOSEUnfavorable weight change after breast cancer diagnosis increases the risk of mortality, but individual and neighborhood risk factors affecting postdiagnosis weight and body fat changes are unclear among Black women, who have higher rates of obesity and mortality than any other racial/ethnic group.METHODSAdiposity changes during the period approximately 10 months-24 months after diagnosis were evaluated among 785 women diagnosed between 2012 and 2018 and enrolled in the Women's Circle of Health Follow-Up Study, a population-based prospective cohort of Black breast cancer survivors in New Jersey. Multilevel factors for weight and fat mass change (with gain or loss defined as a relative difference of 3% or more, and considering whether changes were intentional or unintentional) were estimated using multivariable polytomous logistic regressions and multilevel models.RESULTSAdiposity gain was prevalent: 28% and 47% gained weight and body fat, respectively, despite a high baseline prevalence of overweight or obesity (86%). Risk factors for fat mass gain included receiving chemotherapy (relative risk ratio: 1.59, 95% CI, 1.08 to 2.33) and residing in neighborhoods with a greater density of fast-food restaurants (relative risk ratio comparing highest with lowest tertile: 2.18, 95% CI, 1.38 to 3.46); findings were similar for weight gain. Only 9% of women had intentional weight loss, and multilevel risk factors differed vastly from unintentional loss.CONCLUSIONBoth individual and neighborhood factors were associated with adiposity change among Black breast cancer survivors. Residential environment characteristics may offer clinically meaningful information to identify cancer survivors at higher risk for unfavorable weight change and to address barriers to postdiagnosis weight management.

Process Evaluation and Impact Results of the Worksite Component of a Multilevel, Multicomponent Obesity Prevention Trial in Six Native American Communities

ABSTRACT Native Americans (NA) have higher obesity rates compared to other populations. Employed adults spend a significant amount of time at work. OPREVENT2, an obesity prevention trial in 6 NA communities, included a worksite component that incorporated nutrition and physical activity educational media, competitions, tastes tests, and coffee station makeovers. Process evaluation results indicate a well-implemented worksite component based on team standards. Statistically significant improvements of coffee stations healthy offerings (p = .006), but none in health policies and resources, were observed. Partnering with businesses to create healthier working environments was successful and future trials should investigate the effects on an individual level.

The Effects of Price, Income, and Household Characteristics on Ultra-Processed Food Consumption In Jakarta, Indonesia

During the 2010s, ultra-processed food consumption in Indonesia increases and leads to high rates of obesity and chronic non-communicable diseases. DKI Jakarta has the highest ultra-processed food consumption and obesity prevalence in Indonesia. Therefore, raw data from “Core” and “Consumption and Expenditure” modules of March 2019 Susenas (Indonesia National Socioeconomic Survey) are analysed to examine ultra-processed food consumption and how economic factors and household characteristics affect it in Jakarta. The analysis is conducted using M-estimation robust regression due to a large number of influential outliers in the data. The research sample is divided into three classes based on daily per capita expenditure. The results show that ultra-processed food consumption increases with income class. Higher ultra-processed food consumption occurs in households that pay higher price for ultra-processed food, have higher per capita income, have more children or adolescents, and have working female household head or wife. For Class 3 households, formal sector households consume more ultra-processed food than informal sector households. While for Class 1 households, households with female household head or wife with senior high school degree or above consume more ultra-processed food than households with female household head or wife with junior high school degree or below.

Barriers to Healthy Eating and Physical Activity in the Mississippi Delta

Rural regions in the United States are home to approximately 15-20% of the country’s population. These regions are often characterized by low access to medical care and high rates of disease and death. The literature has detailed the heterogeneous nature of rural health disparities, calling for research detailing regional factors that influence individual-level risk factors such as diet and physical activity. The Mississippi Delta population is largely characterized by high obesity rates, poor diet, and low levels of physical activity. This study presents the most detailed observations of the community-level barriers and facilitators to healthy eating and physical activity within Mississippi Delta communities, contextualizing the findings of a survey of 352 individuals across 25 communities to provide implications and direction for future activities aimed at reducing obesity in the Mississippi Delta. This study observed a high prevalence of overweight (22.9%) and obese (62.1%) body mass index classifications. Chi-square analyses revealed significant relationships between body mass index, age, and health conditions. Community food and physical activity environments and rural characteristics were largely implicated as barriers to fruit and vegetable consumption and physical activity. This article will detail the individual and community-level barriers as they were observed among this sample of Mississippi Delta residents. Next steps involve using qualitative research techniques to guide the development of programmatic strategies for reducing obesity through diet and physical activity in these communities and other rural regions in the United States.

Food policies and obesity in low- and middle-income countries

• We examine the implication of food policies on body weight outcomes. • An increase in tariff rate on “unhealthy” foods is associated with reduction in obesity rates. • An increase in subsidy rate is associated with higher obesity rates. • These implications of these food policies are more pronounced among poorer individuals. • We highlight heterogenous implications of trade and fiscal policies. Understanding the public health implications of food policies is crucial to combat recently increasing overweight and obesity rates in many low-and-middle income countries (LMICs). This study examines the implication of food policies, mainly tariff rates on “unhealthy” foods (sugar and confectionery products as well as fats and oils) and governments’ subsidies, on individuals’ body weight outcomes. We compile several macro- and micro-level datasets that provide macro-level information on food policies and micro-level anthropometric data for several LMICs. We exploit temporal dynamics in tariff rates on “unhealthy” foods and governments’ spending on subsidies to estimate fixed effects models characterizing the evolution of body weight outcomes. We find that temporal dynamics in tariff rates on unhealthy and energy-dense foods are significantly and negatively associated with body weight. Conditional on several observable and time-invariant unobservable factors, a decrease in tariff rates on sugar and confectionary foods or fats and oils is associated with an increase in overweight and obesity rates. On the other hand, an increase in subsidy rate, as a share of government expenditure, is significantly associated with higher overweight and obesity rates. Interestingly, we find that the implications of these food policies are more pronounced among poorer individuals. This may be explained by the fact that poorer households usually spend a larger share of their income on food consumption or unhealthy foods; and that poorer individuals are often beneficiaries of government subsidies in many LMICs. These findings have important implications for informing public health policies in LMICs, which are experiencing an unprecedented rise in overweight and obesity rates.

Abstract P233: Child Opportunity Index And Prevalence Of Obesity And Hypertension In Adolescents With Congenital Heart Disease

Introduction: The Child Opportunity Index (COI) is a measure of neighborhood conditions encompassing educational, health, environmental, social, and economic components that affect child development. Worse COI has been associated with increased cardiometabolic risk in children. Hypertension (HTN) and obesity leads to left ventricular hypertrophy (LVH) and are risk factors for cardiac events in adulthood. However, the impact of COI on patients with congenital heart disease (CHD) has not been well described. Hypothesis: We hypothesized that CHD youths with lower COI would have higher rates of obesity and hypertension compared to higher COI patients. Methods: We retrospectively reviewed adolescent CHD patients with an echocardiogram between 2012-2019. Patients aged 13-17 years with blood pressure (BP), height, weight, and echo measurement for LVMi-HT 2.7 were included. Home location was geocoded and linked to public COI data. Patients were classified by COI into Very Low (VL), Low (L), Moderate (M), High (H), and Very High (VH) opportunity levels. Obesity was defined as body mass index (BMI) ≥ 95 th percentile. Blood pressure was defined as normotensive (NT, SBP &lt; 120 mm Hg), elevated BP (E-BP, 120 ≤ SBP &lt; 130 mm Hg), Stage 1 HTN (HTN-1, 130 ≤ SBP &lt; 140 mm Hg), and Stage 2 HTN (HTN-2, SBP ≥ 140 mm Hg). Left ventricular hypertrophy (LVH) was defined as LVMi-HT 2.7 ≥ 38.6 g/ht 2.7 . Results: A total of 801 patients (mean age 15.5 ± 1.5 years, 57.43% male [460/801]) were included in this analysis. COI groups were VL 157/801 (19.6%), L 165/801 (20.6%), M 226/801 (28.2%), H 142/801 (17.7%), and VH 111/801 (13.9%). Overall, 117/801 (14.6%) patients were obese, 141/801 (17.6%) patients were hypertensive, and 209/801 (26.1%) patients had LVH. Obesity within COI groups was VL 34/157 (21.7%), L 26/165 (15.8%), M 30/226 (13.3%), H 20/142 (14.1%), and VH 7/111 (6.3%). HTN-1 or HTN-2 was seen in VL 25/157 (15.9%), L 36/165 (21.8%), M 41/226 (18.1%), H 23/142 (16.2%), VH 16/111 (14.4%). LVH was present in VL 50/157 (31.9%), L 47/165 (28.5%), M 63/226 (27.9%), H 26/142 (18.3%), and VH 23/111 (20.7%). Conclusions: Youths with CHD living in lower opportunity areas have a high proportion of obesity and hypertension. Furthermore, end-organ changes are seen with a high prevalence of LVH in lower opportunity CHD youths. In conclusion, these findings support the importance of considering social determinants of health like neighborhood opportunity in assessing cardiovascular risk in CHD youths.

Travel burden in a rural primary care behavioral weight loss randomized trial: Impact on visit attendance and weight loss.

Rural residents have higher obesity rates and need access to treatment. Travel burden may limit use and effectiveness of clinic-based behavioral weight loss treatment, which includes frequent visits. This paper examines the impact of travel distance and time on visit attendance and weight loss during a 2-year cluster randomized trial. Thirty-six primary care practices were randomized to 1 of 3 methods of providing behavioral weight loss counseling: individual clinic visits, group clinic visits, or group phone visits. Participants in the clinic visit conditions were included in this secondary analysis (n = 875). Travel distance and time was measured using ArcGIS and categorized as <15 miles (and minutes) or ≥15 miles (and minutes). Percent visit attendance and percent weight loss were measured 6 and 24 months. Participants traveling ≥15 miles (n = 211) had lower attendance than those traveling <15 miles (n = 664) for individual clinic visits, both in the first 6 months (81.4% vs 89.1%, respectively; P = .005) and between 7 and 24 months (52.8% vs 61.6%, respectively; P = .02). Travel time revealed similar findings. Neither travel distance nor time had an effect on attendance to group clinic visits. Travel distance and time were not significantly associated with weight loss for either individual or group visits. Travel burden to clinics was associated with visit attendance for individual visits but not for group visits and was not significantly associated with weight loss. Assessment of travel burden as a potential barrier to clinic-based weight loss interventions should be based on local empirical data.

Impact of Weight Status Reporting on Childhood Body Mass Index.

Background: Many states have adopted school-based BMI screening or surveillance programs in an effort to address high rates of childhood obesity, some of which involve provision of confidential BMI reports to parents. While there is evidence that parents are attuned to information in the reports, there is less evidence showing that the reports are effective in preventing excess childhood weight gain. Methods: Data from Arkansas, the state with the nation's first and longest running and BMI screening program, were used to measure the impact of BMI reports. This was done through a regression discontinuity design that compared future BMI z-scores among children falling within a narrow band around the obese and overweight thresholds. We derived the effects of BMI reports by comparing students who received different types of reports around the relevant threshold. Results: While we are unable to detect any differences in BMI z-scores between the children who received the overweight report and the children who received the healthy weight report, we detected some differences between children who received the obese report and children who received the overweight report. These findings hold across subsamples by age, minority status, and school meal status. Conclusions: Based on these data, overweight or obese reports to do not meaningfully impact future BMI z-scores. This may be due, in part, to the format of parental reports, which may dampen the surprise element of an overweight or obese report.

Impact of Maternal Age on Singleton Pregnancy Outcomes in Primiparous Women in South Korea.

We aimed to determine the association between maternal age and pregnancy outcomes in singleton primigravidae in South Korea. We reviewed the medical data of singleton primigravidae women who gave birth between 2013 and 2018 and underwent the National Health Screening Examination using the administrative database from the National Health Insurance claims data. As advanced maternal age is associated with various comorbidities that could affect pregnancy outcomes, we divided the patients according to their age and comparatively analyzed the prevalence of high-risk pregnancy complications including rates of cesarean delivery, after adjusting for maternal demographics. Perinatal and postpartum complications according to maternal age were also investigated. Overall, 548,080 women were included in this study: 441,902 were aged <35 years; 85,663, 35–39 years; 20,515, ≥40 years. Patients’ demographics differed according to their age. Increasing maternal age was significantly associated with higher income levels and higher rates of obesity, pre-existing diabetes, and hypertension. With the increasing maternal age, the rate of obstetric complications, including gestational diabetes, preeclampsia, placenta previa, placental abruption, and cesarean delivery, increased. Maternal age was also positively correlated with perinatal morbidity including preterm birth and low birth weight. Additionally, advanced maternal age was a risk factor for hospitalization before delivery, more frequent outpatient visits, and readmission after delivery. These observations were maintained in the multivariate analysis results. Advanced maternal age appears to be associated with various adverse obstetric outcomes for primigravidae women, and the frequency of hospitalizations was higher in this group. Considering the current social environment of late pregnancies and childbirth in South Korea, effective policy consideration is required to support safe childbirth in women with advanced maternal age.

Demographic, military, and health comorbidity variables by mild TBI and PTSD status in the LIMBIC-CENC cohort

ABSTRACT Objective To describe associations of demographic, military, and health comorbidity variables between mild traumatic brain injury (mTBI) history and posttraumatic stress disorder (PTSD) status in a sample of Former and current military personnel. Setting Participants recruited and tested at seven VA sites and one military training facility in the LIMBIC-CENC prospective longitudinal study (PLS), which examines the long-term mental health, neurologic, and cognitive outcomes among previously combat-deployed U.S. Service Members and Veterans (SM/Vs). Participants A total of 1,540 SM/Vs with a history of combat exposure. Data were collected between 1/1/2015 through 3/31/2019. Design Cross-sectional analysis using data collected at enrollment into the longitudinal study cohort examining demographic, military, and health comorbidity variables across PTSD and mTBI subgroups. Main Measures PTSD Checklist for DSM-5 (PCL-5), mTBI diagnostic status, Patient Health Questionnaire 9-item (PHQ-9), Pittsburgh Sleep Quality Index (PSQI), AUDIT-C, and other self-reported demographic, military, and health comorbidity variables. Results Ten years following an index date of mTBI exposure or mid-point of military deployment, combat-exposed SM/Vs with both mTBI history and PTSD had the highest rates of depression symptoms, pain, and sleep apnea risk relative to SM/Vs without both of these conditions. SM/Vs with PTSD, irrespective of mTBI history, had high rates of obesity, sleep problems, and pain. Conclusion The long-term symptom reporting and health comorbidities among SM/Vs with mTBI history and PTSD suggest that ongoing monitoring and intervention is critical for addressing symptoms and improving quality of life.

Fast assessment of left ventricular systolic function in obstructive sleep apnea patients with automated function imaging: Comparison with mitral annular plane systolic excursion.

Early detection of left ventricular (LV) subclinical dysfunction is clinically relevant before developing irreversible impairment in obstructive sleep apnea (OSA) patients. Mitral annulus plane systolic excursion (MAPSE) is a fast tool for OSA due to high prevalent obesity; another quick but more comprehensive tool is LV global longitudinal stain (GLS) based on automated function imaging (AFI). We therefore aimed to compare the feasibility and reproducibility of AFI to MAPSE in OSA patients, as a good model in whom obesity is common. A comprehensive echocardiographic examination was done in 186 consecutive patients having polysomnography for suspected OSA. MAPSE was measured by using M-mode to calculate excursion of mitral annulus. GLS was derived by offline analysis of three long-axis views that semi-automatically detects LV endocardial boundary, which is adjusted manually as necessary with AFI measurement. Variability of AFI and MAPSE were compared among the different subgroups. Despite a relatively high obesity rate (42.9%), the feasibility of AFI was 94% (175/186) and that of 100% in MAPSE. AFI showed excellent correlation (r=.882) superior to MAPSE (r=.819) between the Expert and Beginner. Intra- and inter- observer variability of AFI and MAPSE in Bland-Altman analysis were 5.5% and 6.5%; 6.2% and 8.8%, respectively. In repeated measurements, AFI showed higher intra-class correlation (ICC=.95) than MAPSE (ICC=.87) (p<0.05). Furthermore, analysis showed that AFI was feasible even in more obese patients (BMI≥28kg/m2 ). Even in obese patients with OSA, AFI-GLS is feasible and more reliable for less expert operators than MAPSE in detecting LV longitudinal dysfunction.

The association between dietary factors and body weight and composition in boys with Duchenne muscular dystrophy.

Duchenne muscular dystrophy (DMD) is a X-linked neuromuscular disorder. Boys with DMD have high rates of obesity, although little is known about dietary factors that may contribute to weight gain in this population. The present study aimed to explore the relationship between dietary factors, body mass index (BMI) z-score, body composition and motor function and to describe dietary intake in boys with DMD. A cross-sectional analysis of 3-day food diaries from ambulant and steroid treated boys with DMD aged 5-13 years was conducted. Correlation analysis explored the relationship between dietary factors, BMI z-score, fat mass percentage (FM%) and lean mass percentage (LM%). The median age was 8.5 years (interquartile range [IQR] = 7.2-10.5years). Median energykg-1 day-1 in those within a healthy weight range (n = 11) was 316 kJkg-1 day-1 (IQR=276-355kJkg-1 day-1 ) and greater than estimated requirements and, for those above a healthy weight (n = 26), energy intake was 185 kJkg-1 day-1 (IQR=143-214kJkg-1 day-1 ) and lower than estimated requirements. Energykg-1 day-1 was negatively associated with BMI z-score (r = -0. 650) and FM% (r = -0.817) but positively associated with LM% (r = 0.805; all analyses p = <0.01). Younger age was associated (r = -0.609 p = <0.01) with a higher energykg-1 day-1 . For all participants, vegetable, grains, meat/alternatives and dairy intakes were sub-optimal. Younger boys with DMD within a healthy weight range are overconsuming energy dense nutrient poor foods. A focus on improving diet quality during early childhood may prove to be a useful strategy for reducing excess weight gain and supporting healthier eating habits in this vulnerable clinical population.

Health Care Challenges faced by Native American Nations: Obesity and Diabetes

The article aims to discuss and analyze one of the serious challenges faced by Native American Nations across the United States.On the example of the largest Native American ethnic group – Navajo Nation. The article states the problem of high rates of overweightand obesity, Type 2 diabetes that create serious public health concerns for the Navajo Nation. It has more than 300,000 enrolledmembers in 110 chapters spread across 27,000 square miles in northeastern Arizona, New Mexico and Utah. The Indian HealthService estimates that 25,000 members of the Navajo have Type 2 diabetes and 75,000 are pre-diabetic.Keywords: Diabetes, Navajo Nation, obesity, historical trauma, health

Examining Foods and Beverages Served and Child Food Insecurity across Early Care and Education (ECE) Programs in Communities with High Rates of Obesity and Food Insecurity

ABSTRACT The purpose of this study was to examine implementation of serving food and beverage evidence-based practices (nutrition EBPs) across CACFP participating licensed childcare centers (CCCs, n = 51) and family childcare homes (FCCHs, n = 49) in central California. Results indicated that FCCHs reported significantly higher (p < .05) implementation of nutrition EBPs and barriers than CCCs. Both CCCs and FCCHs refer families to WIC/SNAP when they observe child food insecurity and control how much food is served to children. It is important to consider organizational structure (CCCs, FCCHs) and child food insecurity when developing policies/interventions for improving implementation of nutrition EBPs in ECEs.

The effect of educational intervention based on the theory of planned behavior on improving physical and nutrition status of obese and overweight women

BackgroundRegarding the high rate of obesity and overweight among women, develop a comprehensive and effective program it seems necessary to improve their nutritional behaviors and physical activity. This study aims to survey the effect of educational intervention based on the theory of planned behavior (TPB) on improving physical and nutritional activities of obese and overweight women.MethodsThis experimental study was performed on 400 obese and overweight women over the age of 20. The sampling method was A simple random sampling. The data collection was valid and reliable self-reports measure, questionnaires. This tools was including demographic information, questionnaire based on the constructs of the theory of planned behavior, physical activity performance questionnaire and nutritional performance questionnaire that individuals completed before and 6 months after the educational intervention. The training intervention for the experimental group consisted of 12 sessions of 50–55 min. Data analyzed by SPSS22 and by using chi-square test, independent t-test and paired t-test.ResultsFindings showed that before the educational intervention, was no significant difference between the experimental and control groups in terms of education, household monthly income, occupation, mean age, marital status, awareness, attitude, perceived behavioral control, subjective norms, physical activity and nutritional behavioral intentions, and physical activity and nutritional performance, weight and BMI. However, six months after the training intervention, there was a significant increase in each of the TPB contracts, weight and BMI in the experimental group, while no significant difference was observed in the control group. The meaningful level was considered 0.05.ConclusionOur findings partially support of applying theory of planned behavior in reducing the weight, BMI and improved nutritional performance and physical activity of the study subjects. TPB could be an important strategy for effective future educational interventions.