A qualitative study of diverse experts' views about barriers and strategies to improve the diets and health of Supplemental Nutrition Assistance Program (SNAP) beneficiaries.

The Supplemental Nutrition Assistance Program (SNAP), the largest federal food assistance program, currently serves 44.7 million Americans with a budget of $75 billion in 2011. This study engaged leading experts for in-depth, semi-structured interviews to explore their opinions concerning the existing challenges and barriers to eating nutritiously in SNAP. Experts also proposed strategies for improving nutritional status among SNAP recipients. Twenty-seven individuals were interviewed from advocacy, government, industry, and research organizations. Interviews were recorded, transcribed, coded, and analyzed for thematic content. The high cost of nutrient-rich foods, inadequate SNAP benefits, limited access to purchasing healthy foods, and environmental factors associated with poverty were identified as barriers that influence nutrition among low-income households in the United States. Six themes emerged among respondents from diverse sectors about how to address these challenges, including providing SNAP participants with incentives to purchase nutrient-rich food consistent with the 2010 Dietary Guidelines for Americans, restricting the purchase of nutrient-poor foods and beverages with program benefits, modifying the frequency of SNAP benefit distribution, enhancing nutrition education, improving the SNAP retailer environment, and increasing state and federal level coordination and consistency of program implementation. Given the recent dramatic increase in SNAP enrollment, policymakers must address existing barriers as well as consider new strategies to improve nutrition policies in SNAP so that the program can continue to address food insecurity needs as well as provide a healthful diet for SNAP beneficiaries.

'The worst of the Bangladeshi and the worst of the British': exploring eating patterns and practices among British Bangladeshi adolescents in east London.

OBJECTIVES: This article examines how aspects of a specific locality, history and set of practices interact to produce an obesogenic environment. The analysis grid for environments linked to obesity (ANGELO) framework and a biocultural approach are used to examine one obesogenic environment--that experienced by British Bangladeshi adolescents (ages 11-14 years old) in Tower Hamlets, east London. Interdisciplinary literature and methods explore how physical, economic, cultural, and political pressures in school, street, and home micro-environments influence eating patterns and practices. DESIGN: This ethnographic research included living on a council estate and working as an assistant physical education teacher in two secondary schools in Tower Hamlets. Anthropometric and socioeconomic characteristics were collected from the young people whose physical education classes I assisted (n=447). Then interviews and questionnaires were completed with a subsample of participants (n=165) drawn from the first phase of research to understand the factors that influence eating patterns. RESULTS: Among this group of adolescents, interwoven cultural and structural pressures encourage frequent consumption of energy-dense foods in their schools, streets, and homes. They were exposed to factors that have led to the widespread increase in the prevalence of overweight and obesity such as the increased availability and affordability of energy-dense foods. In addition, they faced cultural and structural pressures associated with being the adolescent children of immigrants from Bangladesh and living in an economically depressed neighborhood. CONCLUSION: To develop a comprehensive understanding of the factors that may lead to weight gain in different ethnic, geographic and socioeconomic contexts it is important to examine the pressures specific to that context that might influence the variety and frequency of food consumption. This type of research may lead to the identification of points of intervention that are specific to the pressures and sensitivities of particular environments.

Potential of an analog scaling device for measuring fullness in children: development and preliminary testing.

Improving children's abilities to recognize when they are full is one strategy to prevent overweight, but currently, there are few validated instruments to assist this process. In the present study, we developed and tested the potential of an analog scaling device for quantifying sensations such as fullness in 4-5 year old children. The device was a picture of a doll with a rectangular stomach over which a sliding bar could be moved to communicate rated fullness levels. Eleven 4-5 year old children were shown pictures of French fries and fruit salad in five varying portion sizes that increased in diameter exponentially by a power of 1.5, ranging from 5.2 to 18.5 cm. Success in using the device was predefined as an increase in ratings as a function of increasing portion size, in at least one of two trials. Eight children were successful with the fries, and ten were successful with the fruit salad. Mean ratings across children were significantly different from each other for both foods. These data show that children can be trained to use an analog scale to quantify differences in portion sizes of foods. Future experiments will validate this scaling procedure for measuring fullness in real eating situations. If successful, this methodology might have applications to the measurement of other bodily sensations in young children.