Obesity-related Behaviors Research Articles

Influence of feeding state on neurofunctional differences between individuals who are obese and normal weight: A meta-analysis of neuroimaging studies

Obesity is a complex disorder associated with serious health risks. Examining differences in brain activity between normal weight and obese populations in response to food cues may help researchers and clinicians understand the underlying causes of overeating and obesity and help prevent them. Multiple neuroimaging studies have investigated weight differences in functional activity to food cues but have found varying results. We performed six meta-analyses of functional neuroimaging studies of weight differences in response to food images and isolated differences in processing between normal weight and obese participants. Within this study, 7 papers and 3 sets of unpublished data on functional activation to food images were analyzed using an Activation Likelihood Estimation meta-analytic approach. These analyses also addressed how feeding state impacts functional activity between weight groups. Feeding state affected weight related differences in neurofunctional activity triggered by visual food cues. In the premeal state, greater activation in the amygdala/hippocampus was found in obese participants compared to normal weight participants and, in the postmeal state, obese individuals had greater activation in the caudate and medial prefrontal cortex (MPFC) as compared to normal weight individuals. Regions of the brain associated with caloric evaluation, arousal, and memory were more active in the obese before eating, while less activity was found in an area linked to interoceptive processing. In the postmeal state, greater activity was found in the obese in areas related to risk vs. reward evaluation and reward processing. These findings may help researchers and clinicians understand and treat obesity related behaviors by identifying the altered functional regions that lead to obesity, providing a guide for future research on which neural regions need to be the target of further investigation.

Leveraging Text Messaging and Mobile Technology to Support Pediatric Obesity-Related Behavior Change: A Qualitative Study Using Parent Focus Groups and Interviews

BackgroundText messaging (short message service, SMS) is a widely accessible and potentially cost-effective medium for encouraging behavior change. Few studies have examined text messaging interventions to influence child health behaviors or explored parental perceptions of mobile technologies to support behavior change among children.ObjectiveOur aim was to examine parental acceptability and preferences for text messaging to support pediatric obesity-related behavior change.MethodsWe conducted focus groups and follow-up interviews with parents of overweight and obese children, aged 6-12 years, seen for “well-child” care in eastern Massachusetts. A professional moderator used a semistructured discussion guide and sample text messages to catalyze group discussions. Seven participants then received 3 weeks of text messages before a follow-up one-on-one telephone interview. All focus groups and interviews were recorded and transcribed verbatim. Using a framework analysis approach, we systematically coded and analyzed group and interview data to identify salient and convergent themes.ResultsWe reached thematic saturation after five focus groups and seven follow-up interviews with a total of 31 parents of diverse race/ethnicity and education levels. Parents were generally enthusiastic about receiving text messages to support healthy behaviors for their children and preferred them to paper or email communication because they are brief and difficult to ignore. Participants anticipated high responsiveness to messaging endorsed by their child’s doctor and indicated they would appreciate messages 2-3 times/week or more as long as content remains relevant. Suggestions for maintaining message relevance included providing specific strategies for implementation and personalizing information. Most felt the negative features of text messaging (eg, limited message size) could be overcome by providing links within messages to other media including email or websites.ConclusionsText messaging is a promising medium for supporting pediatric obesity-related behavior change. Parent perspectives could assist in the design of text-based interventions.Trial RegistrationClinicaltrials.gov NCT01565161; http://clinicaltrials.gov/show/NCT01565161 (Archived by WebCite at http://www.webcitation.org/6LSaqFyPP).

Pass the popcorn: “Obesogenic” behaviors and stigma in children's movies

ObjectiveTo determine the prevalence of obesity-related behaviors and attitudes in children’s movies.Design and MethodsWe performed a mixed-methods study of the top-grossing G- and PG-rated movies, 2006–2010 (4 per year). For each 10-minute movie segment the following were assessed: 1) prevalence of key nutrition and physical activity behaviors corresponding to the American Academy of Pediatrics obesity prevention recommendations for families; 2) prevalence of weight stigma; 3) assessment as healthy, unhealthy, or neutral; 3) free-text interpretations of stigma.ResultsAgreement between coders was greater than 85% (Cohen’s kappa=0.7), good for binary responses. Segments with food depicted: exaggerated portion size (26%); unhealthy snacks (51%); sugar-sweetened beverages (19%). Screen time was also prevalent (40% of movies showed television; 35% computer; 20% video games). Unhealthy segments outnumbered healthy segments 2:1. Most (70%) of the movies included weight-related stigmatizing content (e.g. “That fat butt! Flabby arms! And this ridiculous belly!”).ConclusionsThese popular children’s movies had significant “obesogenic” content, and most contained weight-based stigma. They present a mixed message to children: promoting unhealthy behaviors while stigmatizing the behaviors’ possible effects. Further research is needed to determine the effects of such messages on children.

Inhibitory control and perception of the future health in obese adolescents and normal weight adolescents

BackgroundChildhood obesity tracks into adulthood, meaning obesogenic behaviours learned in early years are likely to be sustained throughout life. Studies of the neurocognitive mechanisms underlying obesity-related behaviours have implicated the role of impulsivity in weight gain. Food-related and physical-activity-related impulsive actions such as discounting of the future health benefits of present rewards or the inability to inhibit tempting unhealthy choices can lead to gradual weight gain. Impulsivity was compared in a group of obese and non-obese adolescents to test this hypothesis. Methods47 obese adolescents (mean body-mass index [BMI] 33·22 [SD 8·0]) who attended a residential lifestyle summer camp with a mean age of 14·28 years (SD 1·7) were recruited with parental consent over two summers. A normal weight control group (BMI 20·6 [SD 2·3]) with a mean age of 13·83 years (SD 1·7) from a UK secondary school were used for comparison. Behavioural measures of impulsivity were tested using the stop signal reaction time (SSRT) as a marker of inhibitory control and the temporal discounting constant for monetary rewards. Self-reported scores of impulsivity using Cloninger's junior temperament and character inventory were correlated with behavioural measures by use of a Spearman's correlation. FindingsThe non-obese group had better inhibitory control as measured by the SSRT with a mean value of 156·93 ms (SD 43·12) compared with the obese group with a mean value of 218·42 ms (80·48; p=0·0001). Additionally, SSRT direction errors were significantly higher in the obese adolescents (5·48 [SD 4·88]) than in normal weight individuals (2·88 [0·41]; p=0·0001), and the proportion of successful stops were significantly higher in the normal weight adolescents (0·49 [SD 0·1]) than in the obese group (0·53 [0·09]; p=0·02). Those who were obese (k=0·56 [SD 0·36]) were found to discount the future value of money significantly more than normal weight individuals (0·40 [0·29]; p=0·018) and scored higher on the novelty seeking subscale of the junior temperament and character inventory (r=0·23; p=0·03). InterpretationImpulsivity is a unitary construct, which is an independent predictor of BMI in adults and may act as a causal factor in adolescents. Obese adolescents exhibit poor inhibitory control and discount the future for monetary rewards more than their non-obese counterparts. In addition, there were greater response errors and a failure to stop during the no-go paradigm, suggesting the presence of either inattention or hyperactive traits in addition to impulsive behaviours in the obese group. The difference in socioeconomic status between both groups may be a confounding factor and was not available for analysis. Bias was reduced by ensuring all participants were in full-time education, matched for age, and masked to testing. Understanding of the neurocognitive mechanisms underlining obesogenic behaviours such as impulsivity is needed to improve existing interventions, through the development of novel methods to train self-control and self-efficacy as part of a personalised approach to weight reduction. FundingNone.

Contribution of lifestyle factors to educational differences in abdominal obesity among the adult population

This is the first study to systematically examine the behavioral factors that may explain the inverse association between education and abdominal obesity in adults. Cross-sectional study conducted among 3541 men and 3564 women representative of the population aged 25-64 years in Spain. Abdominal obesity was defined as waist circumference >102 cm in men and >88 cm in women. Analyzes were performed with logistic regression, with progressive adjustment for obesity-related behaviors. The age-, sex- and town size-adjusted odds ratios for abdominal obesity were 1.69 in men and 1.85 in women among individuals with lowest versus highest education. After adjustment for all the studied behaviors, the odds ratio was reduced to 1.49 in men and to 1.45 in women. The factors with the largest contribution to the higher prevalence of abdominal obesity in individuals with lowest versus highest education were more time spent watching TV and less time spent in exercising, as well as a higher energy intake in women. Tobacco and alcohol consumption, physical activity at home, leisure walking, sedentary behaviors other than TV watching, and sleep duration did not explain the educational gradient in abdominal obesity. Watching TV, physical exercise and energy intake explain a substantial part of the inverse association between education and abdominal obesity.

Obesity-Related Eating Behaviors Are Associated with Higher Food Energy Density and Higher Consumption of Sugary and Alcoholic Beverages: A Cross-Sectional Study

ObjectivesObesity-related eating behaviors (OREB) are associated with higher energy intake. Total energy intake can be decomposed into the following constituents: food portion size, food energy density, the number of eating occasions, and the energy intake from energy-rich beverages. To our knowledge this is the first study to examine the association between the OREB and these energy components.MethodsData were taken from a cross-sectional study conducted in 2008–2010 among 11,546 individuals representative of the Spanish population aged ≥18 years. Information was obtained on the following 8 self-reported OREB: not planning how much to eat before sitting down, eating precooked/canned food or snacks bought at vending machines or at fast-food restaurants, not choosing low-energy foods, not removing visible fat from meat or skin from chicken, and eating while watching TV. Usual diet was assessed with a validated diet history. Analyses were performed with linear regression with adjustment for main confounders.ResultsCompared to individuals with ≤1 OREB, those with ≥5 OREB had a higher food energy density (β 0.10; 95% CI 0.08, 0.12 kcal/g/day; p-trend<0.001) and a higher consumption of sugary drinks (β 7; 95% CI −7, 20 ml/day; p-trend<0.05) and of alcoholic beverages (β 24; 95% CI 10, 38 ml/day; p-trend<0.001). Specifically, a higher number of OREB was associated with higher intake of dairy products and red meat, and with lower consumption of fresh fruit, oily fish and white meat. No association was found between the number of OREB and food portion size or the number of eating occasions.ConclusionsOREB were associated with higher food energy density and higher consumption of sugary and alcoholic beverages. Avoiding OREB may prove difficult because they are firmly socially rooted, but these results may nevertheless serve to palliate the undesirable effects of OREB by reducing the associated energy intake.

Children’s Healthy Living (CHL) Program for remote underserved minority populations in the Pacific region: rationale and design of a community randomized trial to prevent early childhood obesity

BackgroundAlthough surveillance data are limited in the US Affiliated Pacific, Alaska, and Hawaii, existing data suggest that the prevalence of childhood obesity is similar to or in excess of other minority groups in the contiguous US. Strategies for addressing the childhood obesity epidemic in the region support the use of community-based, environmentally targeted interventions. The Children’s Healthy Living Program is a partnership formed across institutions in the US Affiliated Pacific, Alaska, and Hawaii to design a community randomized environmental intervention trial and a prevalence survey to address childhood obesity in the region through affecting the food and physical activity environment.Methods/DesignThe Children’s Healthy Living Program community randomized trial is an environmental intervention trial in four matched-pair communities in American Samoa, the Commonwealth of the Northern Mariana Islands, Guam, and Hawaii and two matched-pair communities in Alaska. A cross-sectional sample of children (goal n = 180) in each of the intervention trial communities is being assessed for outcomes at baseline and at 24 months (18 months post-intervention). In addition to the collection of the participant-based measures of anthropometry, diet, physical activity, sleep and acanthosis nigricans, community assessments are also being conducted in intervention trial communities. The Freely Associated States of Micronesia (Federated States of Micronesia, and Republics of Marshall Islands and Palau) is only conducting elements of the Children’s Healthy Living Program sampling framework and similar measurements to provide prevalence data. In addition, anthropometry information will be collected for two additional communities in each of the 5 intervention jurisdictions to be included in the prevalence survey. The effectiveness of the environmental intervention trial is being assessed based on the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework.DiscussionThe Children’s Healthy Living Program environmental trial is designed to focus on capacity building and to maximize the likelihood of sustainable impact on childhood obesity-related behaviors and outcomes. The multiple measures at the individual, community, and environment levels are designed to maximize the likelihood of detecting change. This approach enhances the likelihood for identifying and promoting the best methods to promote health and well-being of the children in the underserved US Affiliated Pacific Region.Trial registrationNIH clinical trial # NCT01881373

Multimethod Analyses of Discretionary Time Use and Health Behaviors Among Urban Low-Income African-American Adolescents

The objective of this pilot study was to examine the relations between discretionary time (DT) social context, health behaviors (dietary intake and physical activity), and body mass index (BMI) in a sample of urban low-income African-American early adolescents. Multiple methods were used, including accelerometers, 24-hour dietary recalls, anthropometric measurements, and Experience Sampling Method (ESM). Participants included 9 boys (mean = 12.9 years) and 16 girls (mean = 12.9 years). Sixteen participants were at a healthy weight (10 girls and 6 boys), and 9 were overweight or obese (5 girls and 3 boys). Eighth graders had higher BMI z scores, engaged in less healthful eating during DT, and spent less time in vigorous exercise in DT than sixth graders. Participants spent the majority of DT with siblings, which was associated with increased light physical activity as measured by accelerometers. The ESM data suggested that adolescents engaged in increased physical activity and decreased sedentary activity when with peers but increased sedentary activity when with parents. Increased percentage of DT spent with parents was associated with increased daily fat intake. Data also indicate high consumption of unhealthy foods across all DT social contexts and activities. Peers may provide a protective social context with regard to obesity-related health behaviors. Targeting changes in health behaviors during the middle school years may be an effective means of decreasing obesity risk among urban African-American adolescents. Interventions for urban African-American early adolescents may benefit from facilitating physical activity with peers and targeting change in family health behaviors.

Trends in physical activity, sedentary behavior, diet, and BMI among US adolescents, 2001-2009.

The high prevalence of adolescent obesity in the United States has been attributed to population changes in physical activity (PA), sedentary behaviors, and dietary behaviors. This study examines 8-year trends in these behaviors in US adolescents ages 11 to 16. Nationally representative samples of US students in grades 6 to 10 were recruited during the 2001-2002 (N = 14607), 2005-2006 (N = 9150), and 2009-2010 (N = 10848) school years by using multistage stratified designs, with census regions and grades as strata, and school districts as the primary sampling units. African-American and Hispanic students were oversampled to obtain better estimates for those groups. Using the Health Behavior in School-aged Children quadrennial surveys, identical questions assessed BMI, PA, and sedentary and dietary behaviors at each school year. Logistic and linear regression analyses were conducted taking into account the sampling design and controlling for age, gender, race/ethnicity, and family affluence. Across the quadrennial surveys, significant increases were identified in number of days with at least 60 minutes of PA, daily consumption of fruits and vegetables, eating breakfast on weekdays and weekends, and BMI. Television viewing and consumption of sweets and sweetened beverages decreased across this same period. These same patterns were seen in all racial/ethnic groups. These patterns suggest that public health efforts to improve the obesity-related behaviors of US adolescents may be having some success. However, alternative explanations for the increase in BMI over the same period need to be considered.

Obesity-related abnormal eating behaviors in Type 2 diabetic patients

To determine the obesity-related abnormal eating behaviors in Type 2 diabetic patients. It was a cross-sectional study involving 120 Type 2 diabetic patients. Body weight and height of the individuals were measured and body mass index (BMI) was calculated. Bulimic Investigatory Test-Edinburg (BITE) was used to measure binge eating attitudes. Night eating symptoms were defined as consuming >25% of daily energy after suppertime. To determine the glycaemic control, HbA1c levels were analyzed. Data analyzed by SPSS 13.0 for Windows. The mean age of the patients was 55.3±9.29 years. The mean diabetes duration was 11.1±2.04 years. The 50% of the patients had a BMI higher than 25kg/m(2). The obese diabetic patients were more likely to have diabetic complications than non-obese subjects (x (2) = 8.588, p=0.040). The percentages of the diabetic patients who met the criteria for binge eating and night eating were 17.2% and 42% respectively. Half of the patients were skipping a main meal per day. The frequencies of obesity-related abnormal eating behaviors were not statistically different in obese patients versus non-obese participants (p>0.05). The mean HbA1c levels were higher in diabetic patients than biochemical references and there was a significant difference between obese and non-obese patients (p<0.05). Obesity-related abnormal eating behaviors were prevalent in Type 2 diabetic patients and related with diabetic complications and glycaemic control.

Collective Efficacy and Obesity-Related Health Behaviors in a Community Sample of African Americans

The social environment is important to body mass index and obesity. However, it is unknown if perceptions of the social environment are associated with obesity-related behaviors in populations at greatest risk for being overweight or obese. We evaluated the relationship between collective efficacy and diet and physical activity in a community-based sample of African American adults who were residents in an urban area. Data were collected as part of an academic-community partnership from November 2009 to 2011. We evaluated whether participants met the recommended guidelines for diet and physical activity based on collective efficacy and their sociodemographic background, health care variables, and self-efficacy in a community-based sample of African American adults (n=338) who were residents in the Philadelphia, PA metropolitan area. Overall, many participants did not meet the recommended guidelines for fruit and vegetable intake or physical activity. The likelihood of meeting the recommended guidelines for fruit intake increased with greater levels of collective efficacy (OR 1.56, 95% CI 1.18, 2.07, p=0.002) and self-efficacy for diet (OR 1.56, 95% CI 1.19, 2.04, p=0.001). Collective efficacy was not associated with physical activity and the positive association between collective efficacy and vegetable intake was not statistically significant (OR 1.25, 95% CI 0.94, 1.65, p=0.12). It is important to determine the most effective methods and settings for improving diet and physical activity behaviors in urban African Americans. Enhancing collective efficacy may be important to improving adherence to recommended guidelines for obesity-related health behaviors.

Obesity and Climate Change

Obesity and climate change are 2 modern world dilemmas. However, despite an understanding of many of the causal factors relating to each, large-scale interventions have had minimal impact on either problem to date. Some behaviors associated with obesity (eg, processed food consumption, nonrenewable fuel use, etc) also affect greenhouse gas (GHG) emissions associated with climate change. This suggests that interventions aimed at curbing GHGs might also have public health benefits. Personal carbon trading is an emission reduction intervention that has been proposed to influence obesity-related behaviors. This article builds on the links between obesity and climate change and discusses some of the early findings of the Norfolk Island Carbon and Health Evaluation study designed to assess the impact of personal carbon trading on obesity and GHG emissions. Early results suggest that health and environmental scientists should be working more closely to develop cross-disciplinary initiatives and messages around health and environmental issues.

OP64 More than Obesity Prevention? Defining Outcomes in the Healthy Towns Programme in England

BackgroundIn 2008, £30 million was invested by UK Government in the Healthy Towns (HT) Programme in England. Nine urban areas were selected to develop and implement interventions to tackle the...

Sustainability of promotora initiatives: program planners' perspectives.

The use of promotoras de salud is an increasingly widespread delivery approach for community-based health education and promotion programs targeting obesity-related lifestyle behaviors for Hispanic populations. Addressing a gap in the literature, this research examined the sustainability of promotora-led initiatives from the perspectives of those who plan, implement, and evaluate these programs. We conducted 24 in-depth interviews with program planners representing 22 promotora programs focused on Hispanic women's health in 10 states. Findings illustrated program planners' opinions regarding the components, logistics, and barriers to promotora program sustainability. Several participants challenged the notion of promotora program sustainability by reframing the issue as promoting individual promotoras' well-being and social mobility rather than maintaining their role in the program over time. Implications for community health planning, management, and policy include developing sustainability strategies during program planning stages and implementation of policies to more effectively integrate promotoras into existing health care systems at local, state, and national levels.

Neurocognitive correlates of obesity and obesity-related behaviors in children and adolescents

Childhood obesity rates have risen dramatically over the past few decades. Although obesity has been linked to poorer neurocognitive functioning in adults, much less is known about this relationship in children and adolescents. Therefore, we conducted a systematic review to examine the relationship between obesity and obesity-related behaviors with neurocognitive functioning in youth. We reviewed articles from 1976 to 2013 using PsycInfo, PubMed, Medline and Google Scholar. Search terms included cognitive function, neurocognitive function/performance, executive function, impulsivity, self-regulation, effortful control, cognitive control, inhibition, delayed gratification, memory, attention, language, motor, visuo-spatial, academic achievement, obesity, overweight, body mass index, waist-hip ratio, adiposity and body fat. Articles were excluded if participants had health problems known to affect cognitive functioning, the study used imaging as the only outcome measure, they were non-peer-reviewed dissertations, theses, review papers, commentaries, or they were non-English articles. Sixty-seven studies met inclusion criteria for this review. Overall, we found data that support a negative relationship between obesity and various aspects of neurocognitive functioning, such as executive functioning, attention, visuo-spatial performance, and motor skill. The existing literature is mixed on the effects among obesity, general cognitive functioning, language, learning, memory, and academic achievement. Executive dysfunction is associated with obesity-related behaviors, such as increased intake, disinhibited eating, and less physical activity. Physical activity is positively linked with motor skill. More longitudinal research is needed to determine the directionality of such relationships, to point towards crucial intervention time periods in the development of children, and to inform effective treatment programs.

Parenting styles and practices in children's obesogenic behaviors: scientific gaps and future research directions.

Given the emerging global childhood obesity epidemic and the specter of a generation of children who will have a shorter life expectancy than that of their parents, recent research has focused on factors that influence children's weight status and obesogenic behaviors (i.e., eating, physical activity, and screen media use). Parents act as primary socializing agents for children, and thus growing evidence supports the role of parenting styles and practices in children's obesity-related behaviors and weight. Studying these processes in children and adolescents is important for several reasons. First, diet and physical activity behaviors and weight status track from childhood and adolescence into adulthood. Furthermore, diet and physical activity behaviors and weight status confer significant risk for cancer, diabetes, cardiovascular disease, and other chronic diseases. The purpose of this article is to describe the scientific gaps that need to be addressed to develop a more informed literature on parenting styles and practices in the domains of weight status and obesogenic behaviors, as identified by an expert panel assembled by the National Cancer Institute.

The future is now: Comparing the effect of episodic future thinking on impulsivity in lean and obese individuals

The choice of small immediate rewards as opposed to larger delayed rewards, or delay discounting, is an important dimension of impulsive decision making. The inability to delay gratification is related to obesity, as well as other maladaptive behaviors such as substance abuse, problem drinking, smoking, pathological gambling, and risky HIV behaviors. One way to reduce delay discounting (DD) may be to use prospective imagery in the form of episodic future thinking (EFT) during inter-temporal decision making. We have recently shown that EFT reduces DD and ad libitum energy intake in obese individuals. However, no studies have examined whether the magnitude of the EFT effect differs between lean and overweight/obese individuals. We conducted a within-subject design experiment to compare the efficacy of EFT versus a control task in reducing DD between lean (N=24) and overweight/obese (N=24) women. Participants attended two sessions in which they engaged in either EFT or control episodic thinking during a DD task. We also examined whether individual differences such as trait time perspective, behavioral inhibition or behavioral activation moderated the EFT effect on DD. Results showed EFT reduced DD similarly for lean and overweight/obese individuals. The EFT effect was moderated by behavioral activation. This suggests EFT is just as effective in reducing impulsive decision making in obese individuals as it is in lean individuals and may be useful in reducing other impulsive obesity related behaviors.

A Call for Culinary Skills Education in Childhood Obesity-Prevention Interventions: Current Status and Peer Influences

D URING THE PAST DECADE, THERE HAS BEEN AN interest in resurrecting formal culinary skills education for youths (ie, school-aged children). These pursuits have been provoked by what policy makers, scientists, and food and nutrition practitioners suggest is a societal decline in culinary skills. Some stakeholders believe that this “de-skilling” represents a transition caused by sociodemographic shifts, such as nontraditional family structures, women in the workforce, and time constraints. Current consumers have new value equations for making food decisions. Although health, taste, cost, and convenience predict food choices, cost and convenience are weighted with more value than ever before. Cooking from scratch is no longer the norm in consumers’ kitchens. Dramatic changes in domestic cooking practices have led to decreased transference of essential cooking skills from parents to youths. Family cooking has become a means to an end, rather than a process for social connectedness, cultural expression, and life enhancement. As youths gain autonomy in their transition to young adulthood, they often lack the skills necessary to complete basic food-related tasks. Some believe that an emerging inability to prepare meals at home is predictive of poor dietary habits, contributing to childhood obesity. This commentary serves as an update on the call to incorporate culinary skills education in childhood obesityprevention interventions. Food, nutrition, and dietetics practitioners should evaluate investments in culinary skills education approaches. This commentary addresses the question of why culinary skills education is important within the childhood obesity epidemic context, how effective culinary skills education interventions have been at modifying obesity-related risk behaviors, and how to design more effective culinary skills education programs in the future by drawing upon peer influences.

Residency and racial/ethnic differences in weight status and lifestyle behaviors among US youth.

Elevated risk for obesity is found in rural environments and in some minority populations. It is unclear whether living in rural or nonmetropolitan areas and being a minority compound the risk of obesity beyond that of either factor acting alone. Our purpose was to examine adolescent obesity in light of the potential concomitant influences of race/ethnicity, residency, and obesity-related lifestyle behaviors. We assessed obesity prevalence, physical activity, consumption of fatty snack foods, and screen time in 8,363 US adolescents based on variation in race/ethnicity and residency. Descriptive, bivariate, and multivariate statistics were used to: (1) calculate race- and residency-based rates of obesity and obesity-related lifestyle behaviors and (2) generate race- and residency-based obesity odds ratios as a function of those same behaviors. The results indicated that nonmetropolitan black youth had the highest risk of obesity (26%), rate of consuming fatty snack foods on more than 2 days/week (86%), and rate of spending more than 2 hours/day in screen time (91%) compared to white metropolitan youth. Compared to their metropolitan counterparts, black nonmetropolitan youth had greater odds of being obese if they exercised less than daily (1.71 times), ate fatty snack foods on more than 2 days/week (1.65 times), or spent more than 2 hours/day in screen time (1.64 times). Race/ethnicity and residency may have a compounding effect on the risk of obesity. Prevention and intervention must be viewed in a socioecological framework that recognizes the importance of culture and community on obesity-related behaviors.

Randomized Controlled Trial Targeting Obesity-Related Behaviors: Better Together Healthy Caswell County

IntroductionCollaborative and multilevel interventions to effectively address obesity-related behaviors among rural communities with health disparities can be challenging, and traditional research approaches may be unsuitable. The primary objective of our 15-week randomized controlled pilot study, which was guided by community-based participatory research (CBPR) principles, was to determine the effectiveness of providing twice-weekly access to group fitness classes, with and without weekly nutrition and physical activity education sessions, in Caswell County, North Carolina, a rural region devoid of medical and physical activity resources.MethodsParticipants were randomly divided into 2 groups: group 1 was offered fitness sessions and education in healthful eating and physical activity; group 2 was offered fitness sessions only. Outcome measures were assessed at baseline and immediately after the intervention. Standardized assessment procedures, validated measures, and tests for analysis of variance were used.ResultsOf 91 enrolled participants, most were African American (62%) or female (91%). Groups were not significantly different at baseline. Group 1 experienced significantly greater improvements in body mass index (F = 15.0, P < .001) and waist circumference (F = 7.0, P = .01), compared with group 2. Both groups significantly increased weekly minutes of moderate physical activity (F = 9.4, P < .003). Participants in group 1 also had significantly greater weight loss with higher attendance at the education (F = 14.7, P < .001) and fitness sessions (F = 18.5, P < .001).ConclusionThis study offers effective programmatic strategies that can reduce weight and increase physical activity and demonstrates feasibility for a larger scale CBPR obesity trial targeting underserved residents affected by health disparities. This study also signifies successful collaboration among community and academic partners engaged in a CBPR coalition.