Perceptions About Health, Nutrition Knowledge, and MyPlate Food Categorization Among US Adolescents: A Qualitative Study.

OBJECTIVE: To understand how adolescents define related nutrition terms and use food groups to classify commonly consumed foods into the MyPlate food groups. DESIGN: Qualitative study with telephone interviews. SETTING: Houston metropolitan area in Texas. PARTICIPANTS: A convenience sample of 21 adolescents from a volunteer database of the research center. MAIN OUTCOMES MEASURES: Sociodemographic questions were asked before semiquantitative structured interviews. The interview focused on understanding how adolescents defined health, other nutrition terms, and food groups, and how to use the MyPlate icon in categorizing commonly consumed foods into groups. ANALYSIS: Hybrid thematic approach with inductive and deductive analyses. RESULTS: Adolescents defined being healthy in terms of wellness-type behaviors (eg, diet, physical activity, and sleep). They perceived clear differences between terms such as healthy vs unhealthy food but struggled to define others (eg, energy-dense foods and processed foods). Mixed dishes, hard candies, chocolate chip cookies, and potato chips were the most difficult foods for the adolescents to classify into the MyPlate food groups, whereas apple, lettuce, and milk were easily classified. CONCLUSIONS AND IMPLICATIONS: Food guidance systems, public health policies, and behavioral nutrition programs targeting adolescents might use health and nutrition terms and prescriptive food categories more clearly understood by adolescents.

Impact of Strategies for Preventing Obesity and Risk Factors for Eating Disorders among Adolescents: A Systematic Review.

An effective behavior change program is the first line of prevention for youth obesity. However, effectiveness in prevention of adolescent obesity requires several approaches, with special attention paid to disordered eating behaviors and psychological support, among other environmental factors. The aim of this systematic review is to compare the impact of two types of obesity prevention programs, inclusive of behavior change components, on weight outcomes. "Energy-balance" studies are aimed at reducing calories from high-energy sources and increasing physical activity (PA) levels, while "shared risk factors for obesity and eating disorders" focus on reducing disordered eating behaviors to promote a positive food and eating relationship. A systematic search of ProQuest, PubMed, PsycInfo, SciELO, and Web of Science identified 8825 articles. Thirty-five studies were included in the review, of which 20 regarded "energy-balance" and 15 "shared risk factors for obesity and eating disorders". "Energy-balance" studies were unable to support maintenance weight status, diet, and PA. "Shared risk factors for obesity and eating disorders" programs also did not result in significant differences in weight status over time. However, the majority of "shared risk factors for obesity and eating disorders" studies demonstrated reduced body dissatisfaction, dieting, and weight-control behaviors. Research is needed to examine how a shared risk factor approach can address both obesity and eating disorders.

Unhealthy weight control behaviors, disordered eating, and body image dissatisfaction in adolescents from São Paulo, Brazil

Objective: To identify the frequency of disordered eating (DE) and unhealthy weight control behaviors (UWCB) among adolescents and associations with age, sex, actual weight status, perceived weight status, and body image dissatisfaction. Methods: Cross-sectional study of 1,156 adolescents. DE was assessed using a specific self-report questionnaire, UWCB by specific behaviors that were not typically recommended for weight management, and body dissatisfaction by Stunkard's silhouettes. Results: The frequency of DE was 17.3%, and that of UWCB, 31.9%; 80.1% of participants were dissatisfied with body image. Perception of oneself as overweight was associated with 1.795-fold odds of DE. Those with UWCB had 7.389-fold odds of DE, while DE increased the odds of UWCB 7.280-fold. Girls, participants who perceived themselves as overweight, and those who reported body dissatisfaction were 2.266, 2.381, and 1.752 times more likely to have UWCB, respectively. Conclusion: A high prevalence of UWCB and a moderate prevalence of DE behaviors was found in adolescents from the city of São Paulo, Brazil. Those who perceived themselves as overweight had more DE and UWCB, and both behaviors were related. UWCB was more common in girls and among those dissatisfied with their bodies.

Unhealthy weight control behaviors, disordered eating, and body image dissatisfaction in adolescents from São Paulo, Brazil.

OBJECTIVE: To identify the frequency of disordered eating (DE) and unhealthy weight control behaviors (UWCB) among adolescents and associations with age, sex, actual weight status, perceived weight status, and body image dissatisfaction. METHODS: Cross-sectional study of 1,156 adolescents. DE was assessed using a specific self-report questionnaire, UWCB by specific behaviors that were not typically recommended for weight management, and body dissatisfaction by Stunkard's silhouettes. RESULTS: The frequency of DE was 17.3%, and that of UWCB, 31.9%; 80.1% of participants were dissatisfied with body image. Perception of oneself as overweight was associated with 1.795-fold odds of DE. Those with UWCB had 7.389-fold odds of DE, while DE increased the odds of UWCB 7.280-fold. Girls, participants who perceived themselves as overweight, and those who reported body dissatisfaction were 2.266, 2.381, and 1.752 times more likely to have UWCB, respectively. CONCLUSION: A high prevalence of UWCB and a moderate prevalence of DE behaviors was found in adolescents from the city of São Paulo, Brazil. Those who perceived themselves as overweight had more DE and UWCB, and both behaviors were related. UWCB was more common in girls and among those dissatisfied with their bodies.

Food Sources of Shortfall Nutrients Among US Adolescents: National Health and Nutrition Examination Survey (NHANES) 2011-2014.

To identify food sources of shortfall nutrients consumed by adolescents (n = 3156), data from the National Health and Nutrition Examination Survey (NHANES) (2011-2014) were used. Some of the food groups commonly consumed by adolescents made a significant contribution to shortfall nutrient intakes in the diet. Many food sources that provided significant amounts of shortfall nutrients were from foods that also provided nutrients to limit. Awareness of nutrient intakes and food sources is essential to establish dietary guidance in a practical context. Efforts to continue monitoring the food sources of nutrients consumed by adolescents will be important to improve the current knowledge on this topic of research.

Nutritional Status, Lifestyle and Lipid Profile in Vegetarians

Abstract Background: Vegetarian diets have been linked to reduced risk of chronic noncommunicable diseases, since they positively modulate biochemical parameters, particularly those related with glycemic control and lipemia, and considered as potential strategy for weight control. Objective: To compare the nutritional status, lifestyle and lipid profile of adult vegetarians with omnivores in a sample of individuals in the city of São Paulo. Methods: This was a cross-sectional study. Anthropometric, biochemical and lifestyle variables were compared between vegetarians and omnivores. A significance level of 5% was considered for all analyses. Results: Vegetarians were more likely to practice physical activity (64.3% vs 42.5%, p = 0.056) and consuming dietary supplements (48.1% vs 20.5%, p = 0.012). There was no statistically significant difference for the variables: age, sex, triglycerides, total cholesterol and low-density lipoprotein between the two groups. Vegetarians had significantly lower weight [60.8 kg (56.7 - 69.4) vs 71.1 kg (58.0 - 75.4), p = 0.038], BMI [22.4 kg/m2 (20.9 - 23.8) vs 24.6 kg/m2 (21.7 - 26.1), p = 0.001], and waist circumference [(81.8 ± 8.2 vs 87.8 ± 10.9 cm, p = 0.003)], and higher high-density lipoprotein (54.88 ± 14.44 vs 47.30 ± 12.27 mg /dL p = 0.008) than omnivores. Conclusion: Compared with omnivores, vegetarians had a better nutritional status, with lower BMI and waist circumference, significantly higher levels of plasma lipoprotein high-density, and healthier lifestyle.

Brazilian Children's Dietary Intake in Relation to Brazil's New Nutrition Guidelines: a Systematic Review.

PURPOSE OF REVIEW: This systematic review reports the latest scientific evidence, from cross-sectional and cohort studies, describing the dietary intake of children and adolescents from Brazil. The goal of the review was to describe intakes according to Brazil's new food classification system (NOVA) which classifies foods according to the degree of processing, i.e., unprocessed/minimally processed, processed culinary ingredients, processed food, and ultra-processed food. Due to a paucity of data using the NOVA classification system, studies with other intake descriptors were included. RECENT FINDINGS: Results using the NOVA system showed a somewhat high intake of (ultra-)processed items, than of minimally processed items. Studies using other methods of dietary assessment showed not only high intake of sources rich in fat, sugar, and sodium, most of them processed items (e.g., savory snacks and sweets) but also intake of fruit, vegetables, and whole grains. Overall, the literature was marred by inconsistencies and variation in study definitions and methods making it hard to make firm conclusions regarding the dietary intake of Brazilian children. The development of tools to evaluate the complexities of dietary intake is much needed. Such a tool needs to be accepted and adopted by numerous study groups, to describe dietary status among Brazilian children and devise the most effective, and to evaluate the success of nutrition education programs.

"Healthy Habits, Healthy Girls-Brazil": an obesity prevention program with added focus on eating disorders.

PURPOSE: To evaluate the immediate post-intervention and 6-month post-intervention effects of a Brazilian school-based randomized controlled trial for girls targeting shared risk factors for obesity and disordered eating. METHODS: Total of 253 girls, mean of 15.6 (0.05) years from 1st to 3rd grades of high school participated in this 6-month school-based cluster randomized controlled trial. "Healthy Habits, Healthy Girls-Brazil (H3G-Brazil)", originally developed in Australia, emphasized 10 key nutrition and physical activity (PA) messages delivered over 6 months. Disordered eating prevention procedures, i.e., prevention of weight-teasing, body satisfaction, and unhealthy weight control behavior, were added to the intervention. Body dissatisfaction, unhealthy weight control behaviors and social cognitive-related diet, and physical activity variables were assessed at baseline, immediate post-intervention, and 6-month post-intervention. Intervention effects were determined by one-way analysis of covariance or logistic regression, after checking for the clustering effects of school. The control group did not receive intervention prior to follow-up assessment. A conservative significance level was set at p < 0.01. RESULTS: Beneficial effects were detected for PA social support (F = 6.005, p = 0.01), and healthy eating strategies (F = 6.08, p = 0.01) immediate post-intervention; and healthy eating social support (F = 14.731, p = 0.00) and healthy eating strategies (F = 5.812, p = 0.01) at 6-month post-intervention. Intervention group was more likely to report unhealthy weight control behaviors (OR = 1.92, 95% CI 1.15-3.21, p = 0.01) at 6-month post-intervention. No other significant immediate or 6-month post effects were detected. CONCLUSION: H3G-Brazil demonstrated positive 6-month effects on some social cognitive variables but an adverse effect on unhealthy weight control behaviors. Thus, this study was not able to achieve synergy by combining obesity and disordered eating prevention procedures in an intervention among low-income girls in Brazil. TRIAL REGISTRATION: Level I: cluster randomized controlled trial.

Top food sources of percentage of energy, nutrients to limit and total gram amount consumed among US adolescents: National Health and Nutrition Examination Survey 2011-2014.

OBJECTIVE: To identify most commonly consumed foods by adolescents contributing to percentage of total energy, added sugars, SFA, Na and total gram intake per day. DESIGN: Data from the National Health and Nutrition Examination Survey (NHANES) 2011-2014. SETTING: NHANES is a cross-sectional study nationally representative of the US population.ParticipantsOne 24 h dietary recall was used to assess dietary intake of 3156 adolescents aged 10-19 years. What We Eat in America food category classification system was used for all foods consumed. Food sources of energy, added sugars, SFA, Na and total gram amount consumed were sample-weighted and ranked based on percentage contribution to intake of total amount. RESULTS: Three-highest ranked food subgroup sources of total energy consumed were: sugar-sweetened beverages (SSB; 7·8 %); sweet bakery products (6·9 %); mixed dishes - pizza (6·6 %). Highest ranked food sources of total gram amount consumed were: plain water (33·1 %); SSB (15·8 %); milk (7·2 %). Three highest ranked food sources of total Na were: mixed dishes - pizza (8·7 %); mixed dishes - Mexican (6·7 %); cured meats/poultry (6·6 %). Three highest ranked food sources of SFA were: mixed dishes - pizza (9·1 %); sweet bakery products (8·3 %); mixed dishes - Mexican (7·9 %). Three highest ranked food sources of added sugars were: SSB (42·1 %); sweet bakery products (12·1 %); coffee and tea (7·6 %). CONCLUSIONS: Identifying current food sources of percentage energy, nutrients to limit and total gram amount consumed among US adolescents is critical for designing strategies to help them meet nutrient recommendations within energy needs.

Weight-teasing: does body dissatisfaction mediate weight-control behaviors of Brazilian adolescent girls from low-income communities?

The objective was to examine the mediation hypothesis of body dissatisfaction and analyze their association with weight-teasing and body satisfaction. A total of 253 girls who attended 10 schools from São Paulo, Brazil, participated in this study. Data collection was carried out through a validated and self-reported questionnaire. Study variables were weight-teasing (independent), body satisfaction (mediation), and weight control behavior (outcome). Effect mediation analyses showed a significance level of 5% (p < 0.05). Prevalence of family and peers weight-teasing were 38.5% and 40.6%, respectively. Body dissatisfaction was associated with unhealthy weight control behaviors when controlled by family and peer weight-teasing. Data indicate that family and peers teasing are important aspects that interfere in body satisfaction and weight control behaviors.

Sustained impact of the "Healthy Habits, Healthy Girls - Brazil" school-based randomized controlled trial for adolescents living in low-income communities.

Pediatric obesity is a major public health concern in low- and middle-income countries, such as Brazil. There is an urgent need for preventive programs for adolescents and, the assessment of their sustained impact. This paper reports the longer-term (6-month post intervention) effects of the "H3G-Brazil" obesity prevention program on weight status and weight-related behaviors. A cluster randomized controlled trial starting with 10 public schools in the city of São Paulo, Brazil involved 253 adolescent girls [mean (se) age = 15.6 (0.87) years]. Body mass index (BMI), waist circumference (WC), dietary intake, physical activity (PA) and sedentary behaviors (SB) were assessed at baseline, immediate post-intervention and 6-month post-intervention (follow-up). ANCOVA was performed using intention to treat principles. There was no effect on BMI, the primary outcome. Although, meaningful increases occurred in waist circumference for both groups, the intervention group presented a lower increase (F = 3.31, p = 0.04). This effect size, however, was lower than the criterion for small (d = 0.102). Unfortunately, significant results favored the control group for time spent on TV/weekdays (F = 5.13, p = 0.01), TV/weekends (F = 5.46, p = 0.01) and sedentary behaviors/weekdays (F = 5.32, p = 0.04). No other significant results were found. This obesity prevention intervention among Brazilian adolescent girls did not have the desire effect on BMI. The significantly lower increase in waist circumference in the intervention groups is inconsistent with the adverse changes detected in sedentary time.

Obesity and eating disorders in integrative prevention programmes for adolescents: protocol for a systematic review and meta-analysis.

INTRODUCTION: Obesity and eating disorders are public health problems that have lifelong financial and personal costs and common risk factors, for example, body dissatisfaction, weight teasing and disordered eating. Obesity prevention interventions might lead to the development of an eating disorder since focusing on weight may contribute to excessive concern with diet and weight. Therefore, the proposed research will assess whether integrating obesity and eating disorder prevention procedures ('integrated approach') do better than single approach interventions in preventing obesity among adolescents, and if integrated approaches influence weight-related outcomes. METHODS AND ANALYSIS: Integrated obesity and eating disorder prevention interventions will be identified. Randomised controlled trials and quasi-experimental trials reporting data on adolescents ranging from 10 to 19 years of age from both sexes will be included. Outcomes of interest include body composition, unhealthy weight control behaviours and body satisfaction measurements. MEDLINE/PubMed, PsycINFO, Web of Science and SciELO will be searched. Data will be extracted independently by two reviewers using a standardised data extraction form. Trial quality will be assessed using the Cochrane Collaboration criteria. The effects of integrated versus single approach intervention studies will be compared using systematic review procedures. If an adequate number of studies report data on integrated interventions among similar populations (k>5), a meta-analysis with random effects will be conducted. Sensitivity analyses and meta-regression will be performed only if between-study heterogeneity is high (I2 ≥75%). ETHICS AND DISSEMINATION: Ethics approval will not be required as this is a systematic review of published studies. The findings will be disseminated through conference presentations and peer-reviewed journals.

Weight-teasing: does body dissatisfaction mediate weight-control behaviors of Brazilian adolescent girls from low-income communities? / Provocações em relação ao peso corporal: a insatisfação com o próprio corpo afeta o comportamento de controle de peso de adolescentes brasileiras de comunidades de baixa renda? / Burlas y acoso por el peso: ¿la insatisfacción corporal afecta al comportamiento para el control del peso en adolescentes brasileñas dentro de comunidades con baja renta?

The objective was to examine the mediation hypothesis of body dissatisfaction and analyze their association with weight-teasing and body satisfaction. A total of 253 girls who attended 10 schools from São Paulo, Brazil, participated in this study. Data collection was carried out through a validated and self-reported questionnaire. Study variables were weight-teasing (independent), body satisfaction (mediation), and weight control behavior (outcome). Effect mediation analyses showed a significance level of 5% (p < 0.05). Prevalence of family and peers weight-teasing were 38.5% and 40.6%, respectively. Body dissatisfaction was associated with unhealthy weight control behaviors when controlled by family and peer weight-teasing. Data indicate that family and peers teasing are important aspects that interfere in body satisfaction and weight control behaviors.

O estudo teve como objetivo examinar a hipótese da mediação pela insatisfação com o próprio corpo e analisar as associações com a provocação por terceiros e com a satisfação com o corpo. A amostra incluiu um total de 253 adolescentes do sexo feminino matriculadas em dez escolas na cidade de São Paulo, Brasil. Os dados foram coletados com um questionário validado e auto-preenchido. As variáveis de estudo foram as provocações feitas por outros em relação ao peso da adolescente (independente), a satisfação com o corpo (de mediação) e o comportamento de controle do peso (desfecho). As análises de mediação mostraram um efeito estatisticamente significativo (p < 0,05). As taxas de prevalência de provocações relacionadas ao peso, feitas por familiares e colegas, foram 38,5% e 40,6%, respectivamente. Depois de ajustar para a provocação por familiares e colegas, a insatisfação com o próprio corpo esteve associada a comportamentos prejudiciais de controle de peso. Os dados indicam que as provocações por familiares e colegas são aspectos importantes que interferem na satisfação com o corpo e com os comportamentos de controle de peso.

El objetivo fue examinar la mediación en la hipótesis de la insatisfacción corporal y analiza su asociación con las burlas y acoso por el peso y la satisfacción corporal. Un total de 253 niñas que iban a diez escuelas de São Paulo, Brasil, participaron en este estudio. La obtención de datos se llevó a cabo mediante un cuestionario validado y autoinformado. Las variables de estudio fueron acoso por peso (independiente), satisfacción corporal (mediación), y control de peso comportamiento (resultado). El efecto de los análisis de mediación mostró un nivel de significancia del 5% (p < 0.05). La prevalencia de la familia y las burlas/acoso por el peso entre compañeras fueron de un 38,5% y un 40,6%, respectivamente. La insatisfacción corporal se asoció con comportamientos poco saludables de control de peso, cuando estuvo controlada por la familia y las burlas y acoso por el peso entre colegas. Los datos indican que la familia y las burlas/acoso entre compañeras son aspectos importantes que interfieren en la satisfacción corporal y comportamientos sobre el control de peso.

Home food availability, parents'/caregivers' support, and family meals influence on dietary servings of low-income urban adolescent girls from Brazil

BACKGROUND: There is a striking lack of evidence about parents'/caregivers' influence on their children's dietary intake across Brazil and other middle- and low-income countries. Therefore, the purpose of this study was to identify the associations between adolescents' dietary intake and home environment, family meals and parental support. METHODS: Cross-sectional study with 14­18 years old adolescent girls was conducted in 10 public schools in the city of São Paulo. Girls' dietary intake, home food environment, parental support, and family meals' frequency were self-reported by 253 adolescents. Brazilian Food Pyramid recommendation was used as reference for the dietary intake. Linear regressions were used to verify the associations between home environmental, parental support, and family meal frequency with dietary intake. RESULTS: Girls parents' support for healthy eating was positively associated with the fruits group (mean (95%CI) 0.75 (0.66 to 0.84) ß = 0.26,p= 0.003), and the vegetables group (3.40 (3.08 to 3.72, ß = 0.25,p= 0.006)and negatively associated with the meat and eggs group (2.09 (1.93 to 2.25), ß =−0.14,p= 0.041). Home environment was associated with fruits group (0.73 (0.63 to 0.82), ß = 0.35,p= 0.001). The associations between sharing family meals and food groups were not statistically significant. However, girls demonstrated a positive association with dietary intake and sharing family meals. CONCLUSION: Parental support and home food environment were associated with dietary intake of the adolescent girls. Future studies - mainly from low- and middle-income countries - are needed to provide additional evidence on these associations and the effects of youth home environment

Attitudes toward health and taste of food among women with bulimia nervosa and women of a non-clinical sample.

Taste preferences and health concerns play important roles in determining eating attitudes, thus influencing food choices. Disordered eating attitudes are common among women, and can lead to the development and maintenance of eating disorders (ED). Attitudes toward health and taste of food among ED patients and its comparison with non-clinical women are not well known, and this knowledge could improve eating interventions. In this study, we compared taste preferences and health concerns in 27 women with diagnosis of bulimia nervosa (BN) and 216 women of a non-clinical sample. All participants completed the Health and Taste Attitude Scale (HTAS). Using analysis of covariance we compared the HTAS scores of the BN patients with those of the college students. Risk behaviors for ED (assessed by the Eating Attitudes Test) were identified in 54 (25%) of the non-clinical sample, all of whom were therefore excluded in comparison of BN patients. Non-clinical sample, compared to patients, scored higher on the HTAS Taste domain (p < 0.001) and its pleasure subscale (p < 0.001), whereas patients scored higher on the HTAS Health domain (p < 0.05) and its light product interest subscale (p < 0.05). Based on our data, eating attitudes of women of non-clinical sample are related to taste and pleasure, whereas women with BN are concerned with adopting a diet regarded as healthy, thus increasing their interest in "light" products. Therefore, the taste and health concerns must be considered in nutrition interventions for women in general, and prevention and treatment of ED as determinants of food choice.

Health behavioral theories used to explain dietary behaviors in adolescents: a systematic review

Background: Health behavior theories are useful to interpret adolescents'dietary behaviors. Evidences show that theories are influenced by social and psychological determinants. So, the purpose of this study is to systematically review studies that tested social cognitive theories (non-integrated) that predict adolescents 'dietary behaviors. METHODS: A structured electronic search of all publication years (through April 2016) was conducted to identify studies in MEDLINE, SciELO, PsycINFO, Scopus, and LILACS with full text. Included publications were cross-sectional and longitudinal (non-intervention) studies involving adolescents (10 to 18 years) that examined the associations between constructs of social-cognitive theories and dietary behaviors. Related strings in titles, abstracts, and indexing fields were searched. RESULTS: Theories used to explain dietary intake were the planned behavior and the social cognitive. It wasobserved evidences of positive associations between the social cognitive constructs and the fruits, the vegetables, the milk groups, and the whole-wheat foods (e.g., bread rich in fiber) and negative associations with sugar- sweetened beverages, soft drinks, snacks high in fat, sugar, and/or sodium, and sweet treats. Theories explained greater proportion of variance for intention to dietary intake. The variance for intention ranged from 3% for pizzas, candy bars, candies, and sugar-sweetened beverages to 68% for whole-wheat food (i.e., bread rich in fiber). CONCLUSION:Longitudinal designs are necessary to comprehend the theories and evaluate the behavioral changes. Finally, the use of food groups should be employed in the studies to help the comparisons and present higher reproducibility. Studies always based on objective, systematic, and rigorous evidences

Validation of the Disordered Eating Attitude Scale for adolescents / Validação da Escala de Atitudes Alimentares Transtornadas para adolescentes

ABSTRACT Objective To perform the psychometric evaluation of the Disordered Eating Attitude Scale (DEAS) for adolescents. Methods Sample consisted of 1,119 Brazilian adolescents (12-18 years old; 59.6% female) studying at technical schools in São Paulo state-Brazil, who answered an online survey with the DEAS, the Eating Attitude Test (EAT-26), and the Restraint Scale (RS). The internal consistency of the DEAS was assessed using Cronbach’s alpha. The convergent validity of DEAS was evaluated by means of Pearson’s coefficient correlation with EAT-26 and RS. The test-retest reliability was evaluated using a sub-sample of 61 adolescents. Known-groups validity was determined by comparing female student mean scores with scores of 33 female adolescents with eating disorders. Results The reliability of the DEAS was 0.79. EAT-26 and RS scores were positively correlated with DEAS scores (EAT: 0.78 for females and 0.59 for males, p < 0.001; RS: 0.63 for females and 0.48 for males, p < 0.001). The DEAS total and subscale scores differentiated students and patients with eating disorders (p < 0.001). The intra-class correlation coefficient for test-retest reliability was 0.87. Conclusion Results indicate that the DEAS adolescent version showed good internal consistency, convergent validity, known-groups validity, and test-retest reliability, suggesting its potential in identifying disordered eating attitudes among adolescents. It could also be helpful in identifying adolescents at risk from eating disorders, assisting in prevention programs.

RESUMO Objetivo Realizar a avaliação psicométrica da Escala de Atitudes Alimentares Transtornadas (EAAT) para adolescentes. Métodos A amostra foi composta por 1.119 adolescentes (12-18 anos; 59,6% do sexo feminino) estudantes de escolas técnicas do estado de São Paulo, que responderam online à EAAT, ao Teste de Atitudes Alimentares (EAT-26) e à Escala de Restrição (RS). A consistência interna da EAAT foi avaliada usando o alpha de Cronbach e a validade convergente por meio do coeficiente de correlação de Pearson com o EAT-26 e a RS. A confiabilidade teste-reteste foi avaliada usando uma subamostra de 61 adolescentes. A validade known-groups foi determinada pela comparação dos escores médios de estudantes do sexo feminino com os escores de 33 adolescentes do sexo feminino com transtornos alimentares. Resultados A consistência interna foi de 0,79, e as pontuações no EAT-26 e na RS estiveram positivamente correlacionadas com a pontuação da EAAT (EAT: 0,78 para o sexo feminino e 0,59 para o masculino, p < 0,001; RS: 0,63 para o sexo feminino e 0,48 para o masculino, p < 0,001). O escore da EAAT diferenciou estudantes e pacientes com transtornos alimentares (p < 0,001). O coeficiente de correlação intraclasse na confiabilidade teste-reteste foi de 0,87. Conclusão A versão da EAAT para adolescentes mostrou boa consistência interna, validade convergente, known-groups e confiabilidade teste-reteste, sugerindo o seu potencial na identificação de atitudes alimentares transtornadas entre adolescentes. Ela pode, portanto, ser útil na identificação de adolescentes com risco de transtornos alimentares, auxiliando em programas de prevenção.

Preventing obesity among Brazilian adolescent girls: Six-month outcomes of the Healthy Habits, Healthy Girls-Brazil school-based randomized controlled trial.

BACKGROUND: School-based trials to prevent and reduce prevalence of pediatric obesity in low-income countries are necessary. In Brazil, addressing adolescent obesity is a public health priority. OBJECTIVE: To evaluate the impact of a group randomized controlled trial involving a 6-month multicomponent school-based obesity prevention program targeting adolescent girls. METHODS: The Healthy Habits, Healthy Girls-Brazil program recruited participants (n=253; 16.05±0.05 years) from ten eligible public technical schools in São Paulo, Brazil. The program was adapted from an Australian intervention study, which is based on the Social Cognitive Theory. The primary outcome measure was body mass index (BMI), and secondary outcomes included BMI z score, waist circumference, and various sedentary and dietary health-related behaviours. RESULTS: Although changes in BMI were not statistically significant, differences favored the intervention group (adjusted mean difference, -0.26kg/m(2),se SE=0.018, p=0.076). Statistically significant intervention effects were found for waist circumference (-2.28cm; p=, p=0.01), computer screen time on the weekends (0.63h/day, p; p=0.02), total sedentary activities on the weekends (-0.92h/day, p<0.01), and vegetable intake (1.16servings/day, p=0.01). CONCLUSION: These findings provide some evidence for the benefit of a school-based intervention to prevent unhealthy weight gain in adolescent girls living in low-income communities.

The "Healthy Habits, Healthy Girls" randomized controlled trial for girls: study design, protocol, and baseline results.

The purpose of this article is to describe the study design, protocol, and baseline results of the "Healthy Habits, Healthy Girls" program. The intervention is being evaluated through a randomized controlled trial in 10 public schools in the city of São Paulo, Brazil. Data on the following variables were collected and assessed at baseline and will be reevaluated at 7 and 12 months: body mass index, waist circumference, dietary intake, nutrition, physical activity, social cognitive mediators, physical activity level, sedentary behaviors, self-rated physical status, and overall self-esteem. According to the baseline results, 32.4% and 23.4% of girls were overweight in the intervention and control groups, respectively, and in both groups a higher percentage failed to meet daily recommendations for moderate and vigorous physical activity and maximum screen time (TV, computer, mobile devices). There were no significant differences between the groups for most of the variables, except age (p = 0.000) and waist circumference (p = 0.014). The study showed a gap in the Brazilian literature on protocols for randomized controlled trials to prevent obesity among youth. The current study may thus be an important initial contribution to the field.

The “Healthy Habits, Healthy Girls” randomized controlled trial for girls: study design, protocol, and baseline results / Ensaio randomizado controlado para meninas “Hábitos Saudáveis, Meninas Saudáveis”: delineamento, protocolo de estudo e resultados do baseline / Ensayo randomizado controlado para niñas “Hábitos Saludables, Niñas Saludables”: delineación, protocolo de estudio y resultados iniciales

The purpose of this article is to describe the study design, protocol, and baseline results of the “Healthy Habits, Healthy Girls” program. The intervention is being evaluated through a randomized controlled trial in 10 public schools in the city of São Paulo, Brazil. Data on the following variables were collected and assessed at baseline and will be reevaluated at 7 and 12 months: body mass index, waist circumference, dietary intake, nutrition, physical activity, social cognitive mediators, physical activity level, sedentary behaviors, self-rated physical status, and overall self-esteem. According to the baseline results, 32.4% and 23.4% of girls were overweight in the intervention and control groups, respectively, and in both groups a higher percentage failed to meet daily recommendations for moderate and vigorous physical activity and maximum screen time (TV, computer, mobile devices). There were no significant differences between the groups for most of the variables, except age (p = 0.000) and waist circumference (p = 0.014). The study showed a gap in the Brazilian literature on protocols for randomized controlled trials to prevent obesity among youth. The current study may thus be an important initial contribution to the field.

O objetivo deste artigo é descrever o delineamento, protocolo de estudo e resultados do baseline do programa “Hábitos Saudáveis, Meninas Saudáveis”. A intervenção será avaliada por meio de um ensaio randomizado controlado em 10 escolas públicas de São Paulo, Brasil. As variáveis foram mensuradas no baseline e serão avaliadas após 7 e 12 meses do baseline: índice de massa corporal, circunferência da cintura, dieta, mediadores sociais cognitivos da nutrição e atividade física, nível de atividade física, comportamentos sedentários, autopercepção física e autoestima global. Resultados do baseline demonstraram que 32,4% do grupo intervenção e 23,4% do controle estavam acima do peso, e para ambos uma grande porcentagem não atingiu as recomendações diárias de atividade física moderada/vigorosa, e tempo de tela. Para a maioria das variáveis, com exceção de idade (p = 0,000) e circunferência da cintura (p = 0,014), não houve diferença significante entre os grupos. Há uma lacuna na literatura brasileira sobre ensaios randomizados controlados para prevenir obesidade em adolescentes. Este trabalho pode apresentar uma importante contribuição para a área.

El propósito de este trabajo es describir el diseño del estudio, protocolo y resultados iniciales del programa “Hábitos Saludables, Niñas Saludables”. La intervención se evaluó a través de un ensayo controlado aleatorio en 10 escuelas de São Paulo, Brasil. Las variables se recogieron y evaluaron al inicio del estudio y serán evaluadas tras 7 y 12 meses en base a: índice de masa corporal; circunferencia de cintura; dieta; factores mediadores cognitivos-sociales de nutrición y actividad física; actividad física; sedentarismo; auto-percepción y autoestima. Los resultados iniciales demostraron que el 32,4% y el 23,4% del grupo intervención y control tenían sobrepeso, y para ambos grupos un mayor porcentaje no cumplían con las recomendaciones diarias de actividad física y tiempo dedicado a actividades de ocio. La mayoría de las variables, con excepción edad (p = 0,000) y circunferencia de cintura (p = 0,014), no presentaron diferencias entre grupos. Existe un cierto vacío en la literatura brasileña sobre protocolos de ensayos controlados aleatorios para prevenir la obesidad en jóvenes. Este tipo de trabajos podrían ser una contribución para este campo.