In-school versus out-of-school sedentary behavior patterns in U.S. children.

BACKGROUND: This study contributes to the literature by using accelerometers to describe sedentary behavior (SB) patterns in US children. The purpose of this study was to examine SB patterns in fifth-graders by specifically focusing on in-school versus out-of-school SB patterns to identify when (during the school day or outside of the school day) interventions should take place in order to decrease SB in children. METHODS: Data were collected from 206 fifth-graders (9-11 years old) in the Cherry Creek School District in metro Denver, Colorado (USA) during the spring of the 2010-2011 school year and fall of the 2011-2012 school year. Children wore Actical accelerometers continuously over an eight-day period. Data were analyzed using Wilcoxon rank tests, paired samples t-tests, and independent samples t-tests. Awake time was 6 AM-11 PM. We compared the percent of time spent in SB before school, during school, at recess/lunch and after school, as well as differences between boys and girls, and between children from low and high socioeconomic status schools. Children were classified as 'non-sedentary' or 'sedentary' if they participated in <360 min or ≥360 min per day of SB, respectively and were classified as 'inactive' or 'active' if they participated in <60 min or ≥ 60 min per day of MVPA, respectively. Cross-tabs were used (and Fisher's exact test) to identify the proportion of children in the following categories: 1) non-sedentary/inactive; 2) sedentary/inactive; 3) non-sedentary/active; and 4) sedentary/active. Statistical significance was set at p < 0.05. RESULTS: All children (boys and girls and children from low and high socioeconomic status schools) participated in significantly more SB outside of school hours versus during school hours and on weekend days compared to weekdays (p < 0.001). Girls participated in significantly more SB than boys during weekdays (p = 0.015). The majority of children (65.3 %) were classified as sedentary/active. CONCLUSIONS: Given that children appear to be more sedentary during the weekend, where more opportunities to be physically active with the whole family can easily be implemented, future interventions should focus on time periods outside of school hours in order to decrease sedentary behavior and increase light physical activity in particular.

Low Calorie Sweetener (LCS) use and energy balance.

For thirty years there has been a debate about whether low calorie sweeteners (LCS) provide a benefit for body weight management. Early studies showed that when consumed alone in a beverage appetite and food intake were increased. Some, observational longitudinal cohort studies reported an association between LCS usage and increasing BMI, suggesting that LCS may actually promote weight gain. In the ensuing decades numerous additional observational and experimental trials have been conducted with the experimental trials nearly uniformly showing a benefit for LCS, either in weight loss or weight gain prevention. The observational trials have been more inconsistent with two recent meta-analyses indicating either a small positive association between LCS usage and BMI (weighted group mean correlation, p=0.03) or an inverse association with body weight change (-1.35 kg, p=.004). Numerous potential mechanisms have been explored, mostly in animal models, in an attempt to explain this association but none have yet been proven in humans. It is also possible that the association between LCS and BMI increase in the observational studies may be due to reverse causality or residual confounding. Randomized controlled trials are consistent in showing a benefit of LCS which suggests that simple behavioral engagement by individuals attempting to control their weight is a sufficiently strong signal to overcome any potential mechanism that might act to promote energy intake and weight gain. Based on existing evidence, LCS can be a useful tool for people actively engaged in managing their body weight for weight loss and maintenance.

The effects of water and non-nutritive sweetened beverages on weight loss and weight maintenance: A randomized clinical trial.

OBJECTIVE: To evaluate the effects of water versus beverages sweetened with non-nutritive sweeteners (NNS) on body weight in subjects enrolled in a year-long behavioral weight loss treatment program. METHODS: The study used a randomized equivalence design with NNS or water beverages as the main factor in a trial among 303 weight-stable people with overweight and obesity. All participants participated in a weight loss program plus assignment to consume 24 ounces (710 ml) of water or NNS beverages daily for 1 year. RESULTS: NNS and water treatments were non-equivalent, with NNS treatment showing greater weight loss at the end of 1 year. At 1 year subjects receiving water had maintained a 2.45 ± 5.59 kg weight loss while those receiving NNS beverages maintained a loss of 6.21 ± 7.65 kg (P < 0.001 for difference). CONCLUSIONS: Water and NNS beverages were not equivalent for weight loss and maintenance during a 1-year behavioral treatment program. NNS beverages were superior for weight loss and weight maintenance in a population consisting of regular users of NNS beverages who either maintained or discontinued consumption of these beverages and consumed water during a structured weight loss program. These results suggest that NNS beverages can be an effective tool for weight loss and maintenance within the context of a weight management program.

Using Healthy Defaults in Walt Disney World Restaurants to Improve Nutritional Choices.

A retrospective study of kids' meals purchased at Walt Disney World was conducted to determine acceptance rates for healthy sides and beverages. Purchase data from all 145 Walt Disney World restaurants were analyzed using a log-linear model and a Poisson regression. Across all restaurants, 47.9% and 66.3% of guests accepted healthy default sides and beverages, respectively. Acceptance rates of sides and beverages were higher at quick-service restaurants (49.4% and 67.8%, respectively) compared to table-service restaurants (40.3% and 45.6%, respectively). The healthy defaults reduced calories (21.4%), fat (43.9%), and sodium (43.4%) for kids' meal sides and beverages. This study contributes by examining the use of kids' meal healthy defaults in quick-service and table-service restaurant formats at the world's largest theme park, a previously unstudied setting, and by providing the largest ever healthy default data set. The results suggest that healthy defaults can shift food and beverage selection patterns toward healthier options.

Predictors of meeting physical activity and fruit and vegetable recommendations in 9-11-year-old children.

OBJECTIVE: Childhood obesity represents a significant public health problem. This study examined physical activity and nutrition behaviours and attitudes of 9-11-year-olds, and factors influencing these behaviours. DESIGN: Study participants recorded pedometer steps for 7 days and completed physical activity enjoyment, food attitudes and food frequency questionnaires. Fruit and vegetable sales data were collected from schools. The setting for the study was elementary schools in metropolitan Denver, Colorado (USA). METHOD: Logistic regression was used to determine significant predictors of meeting physical activity/fruit and vegetable intake recommendations. RESULTS: Overall, 42.0% of boys and 44.1% of girls met step count recommendations. Further, 30.9% of boys and 32.8% of girls met step count requirements associated with low risk for overweight/obesity. Enjoyment of physical activity significantly predicted achieving recommendations. Overall, 66.4%, 51.3% and 65.8% of 9-11-year-olds achieved adequate fruit, vegetable, or fruit and vegetable intake, respectively. Enjoyment of fruit/vegetable consumption, perceived parental intake and encouragement and cups of vegetables purchased predicted achieving adequate intake. CONCLUSION: The majority of young people aged 9-11 years failed to meet step count recommendations to prevent the risk for overweight/obesity. A significant proportion also failed to achieve adequate fruit and/or vegetable intake. Future programmes and interventions should affect multiple environments in order to improve child enjoyment of physical activity and fruit/vegetable intake in order to improve the physical, mental and emotional health of children.

Implications of Facilitators and Barriers to Implementing Fuel Up to Play 60.

OBJECTIVES: The primary purpose of this study was to identify barriers and facilitators of Fuel Up to Play 60 (FUTP60) program implementation. METHODS: This was an observational study occurring over 20 months in 4 schools in metropolitan Denver, Colorado. Key informant interviews and FUTP60 surveys examined the barriers and facilitators of program implementation and utilization of other health-promotion programs. RESULTS: Program advisors stated that the adaptability of FUTP60 eased program implementation in schools, helped schools to meet wellness policy goals, and that the program message resonated with students. CONCLUSIONS: FUTP60's adaptability to a school's needs, its simple messaging and student-centric model were major facilitators of program implementation and should be considered when implementing other school-based programs.

The influence of herbs, spices, and regular sausage and chicken consumption on liking of reduced fat breakfast and lunch items.

UNLABELLED: Adults often consume more fat than is recommended. We examined factors that may improve liking of reduced fat and reduced saturated fat foods, including the addition of herbs and spices and habitual consumption of different high-fat and low-fat food items. We randomized adults to taste 3 different conditions: full fat (FF), reduced fat with no added spice (RF), and reduced fat plus spice (RFS). Subjects rated their liking of French toast, sausage and the overall meal, or chicken, vegetables, pasta, and the overall meal on a 9-point hedonic Likert scale. Overall liking of the RF breakfast and lunch meals were lower than the FF and RFS versions (breakfast: 6.50 RF compared with 6.84 FF, P = 0.0061; 6.50 RF compared with 6.82 RFS, P = 0.0030; lunch: 6.35 RF compared with 6.94 FF, P < 0.0001; 6.35 RF compared with 6.71 RFS, P = 0.0061). RFS and FF breakfast and lunch meals, French toast, chicken, and vegetable likings were similar. FF and RFS conditions were liked more than RF for the breakfast and lunch meals, French toast, chicken entrée, and vegetables. Liking of all 3 sausage conditions was similar. FF pasta was liked more than RFS and RF (7.47 FF compared with 6.42 RFS, P < 0.0001; 7.47 FF compared with 6.47 RF, P < 0.0001). Habitual consumption of roasted chicken was associated with reduced liking of FF chicken (r = -0.23, P = 0.004) and FF pasta (r = -0.23, P = 0.005). Herbs and spices may be useful for improving the liking of lower fat foods and helping Americans maintain a diet consistent with the U.S. Dietary Guidelines. PRACTICAL APPLICATION: Americans consume more fat than is recommended in the Dietary Guidelines for Americans. This study shows that you can take foods like French toast, chicken, or a vegetable side and cut the fat and calories by up to 50% while restoring flavor with herbs and spices. People typically use butter, cheese, or fatty meat to enhance the flavor of their food. We found that even when we reduced the fat in our meals by using lower fat dairy and meat products but then added herbs and spices, we were able to deliver the flavor people desire for a fraction of the calories.

Accuracy of self-reported height and weight in children aged 6 to 11 years.

The purpose of this study was to determine the ability of first-, third-, and fifth-graders to accurately self-report height and weight. Self-reported and measured values for height and weight were recorded for 487 students. The ability to self-report a reasonable value for height and weight improved with grade level, but children in all 3 grade levels significantly underreported their height and weight. Only fifth-graders accurately self-reported their weight; therefore, using self-reported height and weight to determine the prevalence of overweight and obesity for elementary school-aged children is not recommended.