Breaking Academic Silos: Pedagogical Recommendations for Equitable Obesity Prevention Training and Research During an Age of Nutrition Polarization.

Introduction: Obesity is a preventable chronic condition and a risk factor for poor health and early mortality. Weight stigma and weight-neutral medicine are popular topics in social media that are often at odds with current medical guidelines on obesity treatment and prevention. This conflict may erode the public's trust in science, impede research progress on preventing obesity in marginalized groups, and uphold the ongoing and historical lack of diversity among nutrition trainees. Methods: The authors conducted a series of student-led dialogue sessions with nutrition graduate students in Boston, Massachusetts, from March to May 2023 to understand perceptions of obesity research, health equity, and racism and discrimination. This article summarizes the lessons learned and provides pedagogical recommendations for jointly addressing obesity at the population level and the recruitment, training, and retention of diverse scholars, clinicians, and public health practitioners. Results: Dialogue sessions revealed that students perceive a disproportionate focus on the harms of obesity as a chronic disease, highlighting that inadequate attention is given to weight stigma and discrimination. Some participants believed that weight-based discrimination is equally detrimental to individual health and wellbeing as having obesity. Discussions also emphasized the need to pinpoint the multidimensional and cultural manifestations of weight stigma, which necessitates collaboration across social sectors and academic disciplines. Students recognized the urgent need to apply an equity lens to obesity research and teaching but felt limited in their access to experts within nutrition science who specialize in racism, discrimination, eating disorders, and weight stigma. Conclusions: This study identified concrete opportunities for urgently needed new training and research in population-level obesity prevention, emphasizing antiracism, harm reduction, and elimination of stigma and bias across multiple levels of science and society. Overall, the decision to use the BMI within pedagogy and training must be explicitly stated-research, population surveillance, decision-making, or treatment pedagogy and training-while acknowledging its strengths and limitations across diverse settings. Finally, the social determinants of obesity should incorporate not only weight stigma but also racism and multiple forms of discrimination.

The cost of doubt: assessing the association between attributional ambiguity and mental health.

OBJECTIVE: To quantify the association between attributional ambiguity-the uncertainty of whether an experience is discrimination-and mental health. METHODS: Using a nationally representative sample of U.S. adults recruited through an online survey by Ipsos (April 23 and May 3, 2021), attributional ambiguity was quantified by asking participants if they experienced anything in the past 6 months that they were unsure was discrimination. The survey also assessed the degree to which these experiences caused participants to feel bothered and to ruminate on them. Multiple linear regression models were used to analyze associations between attributional ambiguity and depressive symptoms and mental health status. RESULTS: Black and Hispanic participants reported higher rates of attributional ambiguity than White participants. Experiencing attributional ambiguity was associated with higher levels of depressive symptoms and poorer self-reported mental health status. Among those who reported attributional ambiguity, increases in bother and rumination scores were positively associated with depressive symptoms. CONCLUSION: Attributional ambiguity is an important yet overlooked social determinant of mental health. More research is needed to fully understand the impact of this stressor on population health, particularly among minoritized populations.

The Influence of Contested Racial Identity and Perceived Everyday Discrimination Exposure on Body Mass Index in US Adults.

Contested racial identity-the discrepancy between one's self-identified race and socially assigned race-is a social determinant of health and may contribute to overweight and obesity. Obesity is associated with a host of short- and long-term health conditions, including cardiovascular disease, a leading cause of death. Individuals racialized as Black, Hispanic, and Latino are at the greatest risk of obesity. Previous research indicates that experiencing interpersonal discrimination is associated with higher body mass index (BMI) in adults, and individuals with a contested racial identity are disproportionately exposed to interpersonal discrimination. However, the association between BMI and contested racial identity is unknown. This cross-sectional study measured the relationship between contested racial identity and perceived everyday discrimination on BMI in a nationally representative sample of US adults. Contested racial identity was measured with a binary variable indicating agreement between participants' self-identified race and socially assigned race. Weighted unadjusted and adjusted multiple linear regression models quantified the associations between BMI and contested racial identity with and without the mean discrimination score. Covariates included nativity status, income, education, racial identity salience, gender, and age. Among 1689 participants, 18.3% had a contested racial identity. Contested identity was associated with significantly higher BMI (ß = 1.01, 95% CI = 0.06, 1.92), but the relationship was attenuated when adjusting for interpersonal discrimination, suggesting that individuals with contested identity may face a greater risk of obesity due to their disproportionately high exposure to interpersonal racial discrimination. Further research is needed to elucidate the impact of racism on BMI and obesity risk.

Association of Racial Discrimination With Adiposity in Children and Adolescents.

Importance: Childhood obesity is a major public health issue and is disproportionately prevalent among children from minority racial and ethnic groups. Personally mediated racism (commonly referred to as racial discrimination) is a known stressor that has been linked to higher body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) in adults, but little is known about the association of racial discrimination and childhood and adolescent adiposity. Objective: To assess the prospective association between self-reported experiences of racial discrimination and adiposity (BMI and waist circumference) in a large sample of children and adolescents in the Adolescent Brain Cognitive Development (ABCD) study. Design, Setting, and Participants: This cohort study used complete data from the ABCD study (2017 to 2019), involving a total of 6463 participants. The ABCD study recruited a diverse sample of youths from across the US, with rural, urban, and mountain regions. Data were analyzed from January 12 to May 17, 2023. Exposure: The child-reported Perceived Discrimination Scale was used to quantify racial discrimination, reflecting participants' perceptions of being treated unfairly by others or unaccepted by society based on their race or ethnicity. Main Outcomes and Measures: Weight, height, and waist circumference were measured by trained research assistants. BMI z scores were computed by applying the US Centers for Disease Control and Prevention's age and sex-specific reference standards for children and adolescents. Waist circumference (inches) was quantified as the mean of 3 consecutive measures. Measurements were taken from time 1 (ie, 2017 to 2019) and time 2 (ie, 2018 to 2020). Results: Of the 6463 respondents with complete data, 3090 (47.8%) were female, and the mean (SD) age was 9.95 (0.62) years. Greater racial discrimination exposure at time 1 was associated with higher BMI z score in both unadjusted (ß, 0.05; 95% CI, 0.02-0.08) and adjusted regression models (ß, 0.04; 95% CI, 0.01-0.08). Discrimination at time 1 was associated with higher waist circumference in unadjusted (ß, 0.35; 95% CI, 0.15-0.54) and adjusted (ß, 0.24; 95% CI, 0.04-0.44) models. Conclusions and Relevance: In this cohort study of children and adolescents, racial discrimination was positively associated with adiposity, quantified by BMI z score and waist circumference. Interventions to reduce exposure to racial discrimination in early life may help reduce the risk of excess weight gain across throughout life.

Use of Bland-Altman Analysis to Examine the Racial and Ethnic Representativeness of Study Populations in Community-Based Pediatric Health Research.

Importance: Children from marginalized racial and ethnic groups are underrepresented in health research. To improve external validity and routinize race and ethnicity reporting, a specific and standardized methodology for quantifying representativeness of participant populations is needed. Objective: To develop a standardized method for quantifying the racial and ethnic representativeness of study samples. Design, Setting, and Participants: In this cross-sectional study, data from 7 US community-based health studies (conducted between 2003 and 2017) were retrospectively pooled to assess the school-level representativeness of enrolled samples by race and ethnicity. The sampling frame for the study was constructed using the National Center of Education Statistics Common Core of Data, which provides year-specific racial and ethnic counts by grade. Representativeness was quantified by aggregating children's data at the school level, reported individually for Asian, Black, Hispanic or Latino, Native Hawaiian or other Pacific Islander, White, or multiple races. In this analysis, the Asian and Native Hawaiian or other Pacific Islander subgroups were combined. Data were analyzed from April 1 to June 15, 2022. Exposure: Community-based nutritional health studies conducted with children in grades 1 to 8. Main Outcomes and Measures: Visual comparisons of percentage expected and percentage observed of the pooled sample by race and ethnicity were performed using scatterplots and Bland-Altman plots. Spearman rank-order correlation was used to assess associations. Results: This study included 104 study schools (N = 5807 children) located in California, Kentucky, Massachusetts, Mississippi, and South Carolina. Bland-Altman analysis revealed notable patterns and variability in the representativeness of racial and ethnic groups. Differences in the overall representativeness of Asian or Native Hawaiian or other Pacific Islander children (0.45 percentage points [95% CI, -7.76 to 8.66]), Black children (0.12 percentage points [95% CI, -15.73 to 15.96]), and White children (-0.72 percentage points [95% CI, -23.60 to 22.16]) were negligible, but measures of spread suggested that target population demographics affected representativeness differently across groups. Conclusions and Relevance: The results of this cross-sectional study suggest that replicating, testing, and scaling the proposed method for quantifying racial and ethnic representativeness, which uses measures of spread, could improve the transparency of race and ethnicity reporting during publication and lead to a more externally valid health evidence base. During implementation, investigators should adopt community-based research methods and allocate appropriate resources during recruitment, including a priori assessment of population demographics, as these conditions may affect racial and ethnic study enrollment differently. Prioritizing these methodological decisions could alleviate rising inequities.

Vitamin D intakes and health outcomes in infants and preschool children: Summary of an evidence report.

BACKGROUND: A systematic review was commissioned to support an international expert group charged to update the Food and Agriculture Organisation of the United Nations (FAO)/World Health Organisation (WHO)'s vitamin D intake recommendations for children aged 0-4 years. MATERIALS AND METHODS: Multiple electronic databases were searched to capture studies published from database inception to the 2nd week of June 2020 according to key questions formulated by the FAO/WHO. Relevant studies were summarised and synthesised by key questions and by health outcomes using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. RESULTS: The 146 included studies examined the effects of different vitamin D intake levels on a variety of health outcomes (e.g. infectious disease, growth, neurodevelopment, rickets, and bone mineral density), and on outcomes for setting vitamin D upper limits (e.g. hypercalcemia, hypercalciuria, and nephrocalcinosis). For most outcomes, the strength of evidence was low or very low. Evidence was rated moderate for the effect of daily vitamin D supplementation on raising serum 25(OH)D concentrations, and a random-effects meta-regression analysis of 28 randomised controlled trials (mostly in infants 0-12 months) showed that each 100 IU/d increase in vitamin D supplementation was associated with an average of 1.92 (95% CI 0.28, 3.56) nmol/L increase in achieved 25-hydroxy-vitaminn D (25[OH]D) concentration (n = 53 intervention arms; p = .022) with large residual heterogeneity (I2 = 99.39%). Evidence was very low on two of the upper limit outcomes - hypercalcemia and hypercalciuria. CONCLUSIONS: The evidence report provided the expert group with a foundation and core set of data to begin their work to set vitamin D nutrient reference values. To move the field forward, future studies should use standardised 25(OH)D assay measurements and should examine the relationship between long-term vitamin D status and health outcomes.Key MessagesResults of a large complex systematic review suggest the current totality of evidence from trials and prospective observational studies do not reach sufficient certainty level to support a causal relationship between vitamin D intake and asthma, wheeze, eczema, infectious diseases, or rickets (most trials reported no rickets) in generally healthy infants and young children.In this systematic review, the only body of evidence that reached a moderate level of certainty was regarding the effect of daily vitamin D supplementation (vitamin D3 or D2 supplements to infants/children) on increasing serum 25(OH)D concentrations. However, currently there is no consensus on the definitions of vitamin D status, e.g. deficiency, insufficiency, sufficiency and toxicity, based on serum 25(OH)D concentrations.This systematic review provided an international expert group a foundation and core set of data through intake-response modelling to help set vitamin D nutrient reference values for infants and children up to 4 years of age.

Association Between Restaurant Menu Item Descriptions and Their Nutrient Content.

INTRODUCTION: Item descriptions on restaurant menus often include claims about health and other attributes, and these are much less regulated than the language on packaged food labels. This study tests whether menu items with claims have different nutritional content from items without claims. METHODS: Investigators compiled a data set of menu items, their claims, and their nutrition content using MenuStat. Data included 84,788 item-year observations at up to 96 of the top-selling restaurant chains from 2012 to 2018. Items were identified with general health, health-related ingredients, nutrient content, product sourcing, and vegan or vegetarian claims through a matching algorithm. Mixed-effects models were used to examine the effect of claims on calories, nutrients to limit (e.g., saturated fat and sodium), and other nutrients by dish types (sides, main dishes, desserts). RESULTS: Most dishes with claims were lower in calories; however, items with claims were not consistently lower in other nutrients to limit (sodium, saturated fat, sugar, or trans fat). Vegan or vegetarian desserts had 128 mg (95% CI=20.9, 235.1) more sodium than desserts without this claim. Main and side dishes with claims had equivalent or higher sugar content than items without claims. Many items with claims were lower in saturated fat, especially main dishes with a nutrient content claim (-2.8 percentage points, 95% CI= -3.4, -2.2). CONCLUSIONS: Items with claims were high in nutrients to limit. Additional efforts to increase transparency around excessive ingredients, such as the sodium warning labels, could be implemented by the restaurant industry.