Factors that predict weight loss success differ by diet intervention type.

Background: Many types of diet intervention can achieve negative energy balance and successful weight loss in persons with obesity. However, within any dietary strategy, there is large inter-individual variation in the weight loss response. The aim of this study is to determine factors that predict weight loss success for diet interventions that vary by macronutrient and caloric composition. Methods: Participants with BMI 30.0 to 49.9 kg/m2 self-selected one of three diet intervention trials for weight loss: low carbohydrate (LOW CHO), low fat (LOW FAT), or low calorie (LOW KCAL). Multivariable regression models were developed to determine the significance of predictor demographic, body composition, metabolic, clinical, and dietary variables for each diet type. Results: Weight loss over 12-16 weeks averaging -5.1 ± 4.0 kg from baseline weight, p < 0.001, was not significantly different among diet types. Several different factors were identified that account for the inter-individual variance in weight loss success. Regardless of diet type, the most robust predictor of weight loss success was completion of the intervention, accounting for 20-30% of the variance. Factors predicting diet intervention completion were age, physical activity level, blood leptin level, blood pressure, and the amount of weight loss occurring. Differences by diet type in cardiometabolic risk factor reduction were identified with LOW CHO decreasing glycemia/insulinemia factors, LOW FAT decreasing lipidemia factors, and LOW KCAL decreasing inflammatory factors. Conclusion: These data provide evidence to inform more precise and personalized approaches to diet intervention for weight loss and cardiometabolic health.

Improving Health Behaviors Through Community Engagement: Challenge for a Healthier Louisiana.

There is increasing recognition that community-based approaches may have merit in improving physical activity and healthy eating behaviors. The "Challenge for a Healthier Louisiana" program supported twelve projects that addressed the root causes of obesity through integrated community-level changes. Partnerships provided community-based obesity prevention by promoting healthier eating and/or physical activity through enhanced infrastructure, policy changes, and programming. To evaluate whether the program resulted in changes in healthy eating and/or physical activity among adults, surveys were conducted pre- and postintervention among participants. Participants who were exposed to physical activity programs were more likely to adopt the consumption of fruits (odds ratio = 2.0; 95% confidence interval [1.1, 3.6]), were more likely to eat vegetables once per day (p = .028), and were more likely to participate in physical activity (p = .053). Participants who were exposed to healthy eating programs were more likely to eat fruit once per day (p = .035), were more likely to eat vegetables at least once per day (p = .008), and were more likely to participate in physical activity (p = .018). In conclusion, there is some indication that the Challenge for a Healthier Louisiana program produced changes in health behaviors among program participants; however, the sustainability of these changes will require further evaluation.

Engaging communities to develop and sustain comprehensive wellness policies: Louisiana's schools putting prevention to work.

BACKGROUND: Tobacco use, obesity, and physical inactivity among Louisiana's youth pose a serious public health problem. Given the potential of school environments to affect student well-being, the Louisiana Tobacco Control Program developed and tested a pilot program, Schools Putting Prevention to Work. The objective was to assist school districts in developing a comprehensive school wellness policy and engaging their school community to generate environments that support healthful choices and behaviors. COMMUNITY CONTEXT: The pilot was implemented in 27 school districts, reaching an estimated 325,000 people across the state. Demographics of participating students were similar to all Louisiana's public school students. METHODS: A school wellness project state team advised project development. A subgroup that included contractors and partners implemented and modified the pilot. Sites were selected though an application process. Site representatives received trainings, technical assistance, and funding to organize school-based support-building activities and coordinate a school health advisory council to develop policy and sustain healthy school environments. Project sites reported progress monthly; evaluation included data from sites and project administrators. OUTCOME: Twenty-five comprehensive school wellness policies (covering 100% tobacco-free schools and daily physical activity and healthier cafeteria items) were approved by school boards. Environmental changes such as physical activity breaks, healthier vending options, and tobacco-free campuses were adopted. INTERPRETATION: This pilot demonstrated a successful approach to achieving policy and environmental change. The state team engaged and guided school districts to motivate students, parents, faculty/staff/administration, and businesses to establish and maintain opportunities to improve lifestyle health.

Improvements in nutritional intake and quality of life among frail homebound older adults receiving home-delivered breakfast and lunch.

OBJECTIVE: This study evaluated the influence that expanding a home-delivered meals service to include breakfast and lunch would have on the nutritional status and quality of life of at-risk older adults. DESIGN: This cross-sectional field study compared two groups. The breakfast group (n=167) received a home-delivered breakfast and lunch, 5 days per week. The comparison group (n=214) received a home-delivered lunch 5 days per week. Participants' 24-hour food recall, demographics, malnutrition risk, functional status, and surveys of quality of life as health, loneliness, food enjoyment, food security, and depression were obtained. PARTICIPANTS: Study participants were recruited from five Elderly Nutrition Programs involved in the Morning Meals on Wheels breakfast service demonstration project. They formed a geographically and racially/ethnically diverse sample. Participants ranged in age from 60 to 100 years, were functionally limited, and at high nutritional risk. Most were low income, lived alone, and had difficulty shopping or preparing food. STATISTICAL ANALYSIS: Descriptive statistics were used to assess group comparability. Independent sample t tests were used to examine group differences, with Bonferroni's method used to control for familywise Type I error. RESULTS: Breakfast group participants had greater energy/nutrient intakes (P<.05), greater levels of food security (P<.05), and fewer depressive symptoms (P<.05) than comparison group participants. CONCLUSIONS: The addition of a breakfast service to traditional home-delivered meals services can improve the lives of frail, homebound older adults. Agencies should be encouraged to expand meals programs to include a breakfast service to a targeted population.