Get healthy together: a program to improve counseling for childhood obesity in community-based WIC clinics.

Counseling parents of overweight children is a sensitive issue that has been reported to be difficult for many health professionals. The Get Healthy Together (GHT) project involved an 18-month intervention that provided skills training and new tools to Women, Infants, and Children (WIC) program staff and a staff wellness program to improve the physical self-concept and functioning of WIC employees. All WIC staff from the 48 WIC clinics in New Mexico participated in this study. The design used random assignment to intervention or control condition. Staff participating in the Get Healthy Together project reported improved confidence in their ability to counsel parents of overweight children and improved counseling skills related to health behaviors. Use of the innovative tools provided visual aids that helped parents understand the health implications of their child's weight without the parents becoming defensive. These tools are publicly available in English and Spanish on the WIC Works Sharing Gallery (website: http://www.nal.usda.gov/wicworks/Sharing_Center/gallery/healthytogether.html).

Innovative tools help counselors discuss childhood obesity with parents.

BACKGROUND: Childhood overweight and obesity pose potential health risks for many children under the age of 5 years. Women, Infants, and Children (WIC) nutritionists are in a unique position to help reduce this problem because of their frequent counseling contacts with clients during certification visits. Therefore, four new tools to facilitate nutritional counseling of parents of overweight children during certifications were developed and systematically evaluated. METHODS: The Nutrition and Activity Self-History (NASH) form, Report Card/Action Plan (ReCAP), Talking Tips, and Healthy Weight Poster were evaluated by WIC nutritionists via an online survey. Anchors on the Likert scale were 0 for Strongly Disagree to 6 for Strongly Agree. Four regional focus groups were also conducted. Data were analyzed descriptively. RESULTS: The response rate on the survey was 83% (n=63). Focus groups were comprised of staff that volunteered to participate (n=34). The NASH form, which replaces a food frequency questionnaire for identifying nutrition risk, had a mean rating of 5.20 as "Helpful when counseling about weight." The ReCAP, Talking Tips, and Healthy Weight Poster achieved mean ratings of 5.70, 4.75, and 5.30, respectively, in this category. Focus group responses were very positive about the usefulness of the ReCAP and Healthy Weight Poster to visually convey the concept of BMI percentile for age using a green, yellow, and red color-coded "traffic light" approach to showing healthy versus unhealthy BMI values. CONCLUSIONS: WIC programs and other pediatric health care settings may want to consider adopting these innovative tools to better serve their clients and address pediatric overweight in the populations they serve.

Motivational interviewing skills are positively associated with nutritionist self-efficacy.

OBJECTIVE: To examine the relationships between physical and social self-concepts, motivational interviewing (MI), and nutrition assessment skills with dimensions of counseling self-efficacy. DESIGN: Cross-sectional survey. SETTING: Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinics. PARTICIPANTS: Sixty-five WIC nutritionists. MAIN OUTCOME MEASURES: Counseling self-efficacy on topics related to physical activity and nutritional behaviors and in the presence of language and cultural differences. ANALYSIS: Multiple linear regression. RESULTS: Nutritionists' perception of their own MI skills was positively associated with their self-efficacy for counseling clients of a culture different than their own, when counseling about physical activity, and when counseling about nutrition behavior. Hispanic ethnicity and social self-concept were positively associated with counseling self-efficacy when culture differences were present. Physical self-concept was positively associated with self-efficacy related to physical activity topics. Nutrition assessment skill was negatively associated with self-efficacy for working with non-English-speaking clients. CONCLUSIONS AND IMPLICATIONS: Development of MI skills and strategies to improve social and physical self-concept may increase WIC nutritionists' counseling self-efficacy, particularly when counseling clients from diverse backgrounds.

Evaluation of the BOD POD for estimating percent body fat in collegiate track and field female athletes: a comparison of four methods.

This investigation examined the accuracy of the BOD POD on a group of Division I collegiate track and field female athletes (N = 30). Hydrostatic weighing (HW) was used as the gold standard method. Body density (Db) values obtained from the BOD POD (Db BP) were compared with those determined by HW (Db HW). Both Db values were converted to percent body fat (%BF) using the Siri equation for comparison. Percent body fat values obtained from the BOD POD (BF BP) were also compared with those obtained from dual-energy X-ray absorptiometry (DXA, BF DXA) and skinfold (SF, BF SF). The validity of the BOD POD was assessed using repeated-measures analysis of variance (ANOVA), and the relationship between the methods was examined through Pearson correlation. Average Db BP was 0.00890 g x cm(-3) lower (p < 0.05) than Db HW, resulting in a significant overestimation of %BF (p < 0.05) by the BOD POD. Values for BFDXA and BFBP also differed significantly (p < 0.05). On the other hand, BFSF and BF BP were not significantly different. The correlation between percent body fat values obtained from HW (BFHW) and BF BP was good (r = 0.88, SEE = 2.30) as well as between BF SF and BF BP (r = 0.85, SEE = 2.05). Conversely, the correlation between BFDXA and BF BP was poor (r = 0.25, SEE = 5.73). The strong correlation between BF BP and BF HW presented here suggests that the BOD POD has the potential to be used as a body composition analysis tool for female athletes. The advantages of the BOD POD over HW encourage further investigation of this instrument. However, the fact that the BOD POD and SF results did not differ significantly might suggest that the SF could be used in its place until a better rate of accuracy for this instrument is established.

Dietary intake and parents' perception of mealtime behaviors in preschool-age children with autism spectrum disorder and in typically developing children.

Parents of children with autism spectrum disorder (ASD) frequently report that their children have selective eating behaviors and refuse many foods, which could result in inadequate nutrient intake. This preliminary cross-sectional descriptive study investigated dietary intake and parents' reported perception of food behaviors of 20 3- to 5-year-old children with ASD. Twenty typically developing children matched for sex, age, and ethnicity were also studied as a case-control comparison. Nutrient intake determined from 3-day food records was adjusted for day-to-day variation to determine the estimate of usual intake distribution for the two groups. This distribution was compared with the Estimated Average Requirement or Adequate Intake recommendations. The reported food behaviors and use of vitamin or mineral supplements were compared for matched pairs using the exact McNemar test. Nutrient intake was similar for both groups of children, with the majority of children consuming more than the recommended amounts for most nutrients. Nutrients least likely to be consumed in recommended amounts were vitamin A, vitamin E, fiber, and calcium. Children with ASD were more likely to consume vitamin/mineral supplements than typically developing children. Compared with parents of typically developing children, parents of children with ASD were more likely to report that their children were picky eaters and resisted trying new foods, and they were less likely to describe their children as healthy eaters or that they eat a variety of foods. Despite the similar and generally adequate nutrient intake for the 40 children in this study, parents of children with ASD had more negative perceptions of their children's dietary behaviors.