Weight change in pediatric TennCare recipients referred to a commercial weight loss program.

BACKGROUND: The epidemic of overweight and obesity in the United States is not limited to adults but also affects children and adolescents. Low-income children are disparately affected because they have an elevated risk for developing obesity. Effective interventions are urgently needed to prevent and treat obesity in children. In 2006, Tennessee Medicaid (TennCare) and Weight Watchers formed the TennCare Weight Watchers Partnership Program, which allowed pediatric recipients to attend Weight Watchers with no out-of-pocket cost. METHODS: This study is a nonconcurrent prospective analysis of administrative data from the TennCare Weight Watchers Partnership Program. It examined the weight change of TennCare beneficiaries between the ages of 10 and 17 who participated in the program from January 2006 to January 2009 and compared the weight change to the recommendations of the Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Childhood and Adolescent Overweight and Obesity. RESULTS: Fifty-three percent of participants either met or exceeded the recommendations of the panel on childhood obesity at the end of their involvement in the program. Participants who attended the program for more than 12 weeks and those who attended 10 or more meetings had a 5% decrease in their body mass index z score. CONCLUSIONS: The TennCare Weight Watchers Partnership Program was successful in helping a majority of children and adolescents who participated to meet or exceed the Expert Committee's recommendations. This type of partnership can give children in low-income families the opportunity to participate in a structured program with a good chance of success.

The association of self-reported sleep, weight status, and academic performance in fifth-grade students.

BACKGROUND: To improve support and justification for health promotion efforts in schools, it is helpful to understand how students' health behaviors affect academic performance. METHODS: Fifth-grade students completed an online school-administered health survey with questions regarding their eating behavior, physical activity, academic performance, and sleep patterns. Differences in health behaviors were examined by sex, self-reported weight status, and sufficient (≥9 hours) versus insufficient sleep. Logistic regression was used to determine the relationship between academic performance and the health behaviors. RESULTS: One third of the sample did not get the recommended amount of physical activity and more than half of the students watched television ≥ 2 hours/day. Self-reported overweight status was related to lower self-reported academic performance, fewer lunch and breakfast occasions, less physical activity, not meeting the recommendations for vegetable and soda consumption as well as hours of television watching. Sufficient sleep (≥9 hours/night) was associated with better grades, meeting the recommended hours of daily television watching and video game playing, being more physically active and increased breakfast and lunch frequency. Percentage of serving free/reduced lunch, soda consumption, breakfast frequency, amount of physical activity, and television watching were associated with academic performance. CONCLUSION: More positive health behaviors generally were associated with better academic performance. Promoting healthy behaviors in schools might improve not only students' health academic performance as well.

Cluster analysis of the national weight control registry to identify distinct subgroups maintaining successful weight loss.

The National Weight Control Registry (NWCR) is the largest ongoing study of individuals successful at maintaining weight loss; the registry enrolls individuals maintaining a weight loss of at least 13.6 kg (30 lb) for a minimum of 1 year. The current report uses multivariate latent class cluster analysis to identify unique clusters of individuals within the NWCR that have distinct experiences, strategies, and attitudes with respect to weight loss and weight loss maintenance. The cluster analysis considers weight and health history, weight control behaviors and strategies, effort and satisfaction with maintaining weight, and psychological and demographic characteristics. The analysis includes 2,228 participants enrolled between 1998 and 2002. Cluster 1 (50.5%) represents a weight-stable, healthy, exercise conscious group who are very satisfied with their current weight. Cluster 2 (26.9%) has continuously struggled with weight since childhood; they rely on the greatest number of resources and strategies to lose and maintain weight, and report higher levels of stress and depression. Cluster 3 (12.7%) represents a group successful at weight reduction on the first attempt; they were least likely to be overweight as children, are maintaining the longest duration of weight loss, and report the least difficulty maintaining weight. Cluster 4 (9.9%) represents a group less likely to use exercise to control weight; they tend to be older, eat fewer meals, and report more health problems. Further exploration of the unique characteristics of these clusters could be useful for tailoring future weight loss and weight maintenance programs to the specific characteristics of an individual.

Healthy action against poverty: a descriptive analysis of food redistribution charity clients in Berlin, Germany.

BACKGROUND: The socio-economic gap and its associated health inequalities are increasing in Germany. Actions against poverty include the redistribution of foods through charities. One project supported by the main German food redistribution charity is offering fresh produce including mostly fruits, vegetables and bread to people receiving welfare in Berlin, Germany. METHODS: Through retrospective analysis of monthly visits (from January 2006 to June 2010) data from 45 surplus food redistribution points was examined. Clients' health status and health behaviour were examined using self-report questionnaires. RESULTS: On average, 10,485 people visited the 45 food redistribution points weekly. A monthly increase of ∼900 additional clients per week over all distribution points could be observed since 2006. The percentage of retirees (28.2%), single parents (20.6%) and families with children (29.5%) was high. The results of the self-report questionnaires (n=101) revealed a sample population with a high percentage of smokers (59.4%) and moderate to heavy alcohol consumers (58.8%). Buying additional fruits and vegetables to those received through distribution points and eating breakfast regularly was associated with significantly better self- rated health status. CONCLUSION: Especially, vulnerable groups appear to supplement their diet with fresh produce from food redistribution points. The health status of the sample population is somewhat different from the German population with more unhealthy behavioural patterns. Future research is necessary to further investigate this impoverished population with increased health risks.

Knowledge of risk factors, and warning signs of stroke: a systematic review from a gender perspective.

Stroke is one of the leading causes of death globally. Awareness of stroke risk factors and warning signs are important for stroke prevention and seeking care. The purpose of this systematic review was to review existing literature that assessed the knowledge of stroke risk factors and warning signs and allowed separate gender analysis. We conducted a systematic review of all published studies (to August 2008) examining knowledge of stroke risk factors and warning signs that included women and provided results separated by gender. Two reviewers selected studies for inclusion, assessed quality, and extracted data. The database search identified 2158 references for screening and 158 were selected for possible inclusion. Twenty-two studies were reviewed including 20 cross-sectional and two pretest-posttest design surveys. Overall, better stroke knowledge was observed in women compared with men in the majority of the studies although there is a general lack of knowledge in both genders. Four out of 18 studies reported better risk factor knowledge and eight out of 15 studies reported better knowledge in stroke warning signs in women compared with men. Women tended to know more evidence-based stroke risk factors than men. Stroke knowledge also appeared to be related to country of study origin, age, education, and medical history. Stroke knowledge among different populations and both in men and women is suboptimal. More research is necessary to further investigate gender differences in stroke knowledge with specific focus on how to use these differences to improve public health campaigns.

Identifying the energy gap in the German population using results from representative national health surveys (1985-2002).

OBJECTIVE: The prevalence of overweight and obesity is increasing in most countries, including Germany. The idea of estimating the population-wide energy gap that is likely responsible for the epidemic has recently been introduced and discussed. DESIGN: Using published estimates of body weight from population-based data of national health surveys (1985-2002), the energy gap was calculated by estimating the distribution of the rate of weight gain within the German population (25-69 years of age) and the amount of excess energy storage that is responsible for this population-wide pattern of weight gain. SETTING: Germany. SUBJECTS: A representative sample of 26 614 participants (12 984 men, 13 630 women). RESULTS: The average annual weight gain was 0.22 kg for men and 0.32 kg for women over the 17-year period. An estimated 90 % of the population gained < 0.54 kg/year. Assuming that each kilogram of weight gained represents 32238 kJ (7700 kcal), the estimated energy accumulation was 19 kJ (4.64 kcal)/d in men and 28 kJ (6.75 kcal)/d in women aged 25-69 years. The distribution of estimated energy accumulation for 90 % of the German population was < 50 kJ (12 kcal)/d. CONCLUSIONS: With an assumed energy efficiency of 50 %, the findings suggest that weight gain could be prevented in 90 % of the German population with < 100 kJ (24 kcal) reduction in energy intake or increase in energy expenditure per day. Theoretically, further weight gain might be prevented using a small-changes approach that emphasizes the importance of making small changes in physical activity and food intake.

A small-changes approach reduces energy intake in free-living humans.

OBJECTIVE: America On the Move (AOM) is a national weight gain prevention initiative that promotes small lifestyle changes by increasing walking by 2000 steps/day and reducing energy intake by about 100 kcal/day. The study's intent was to determine the impact of these small changes recommendations on steps/day and energy intake. METHODS: In this cross-sectional study, food and fluid intake and physical activity in 116 healthy overweight adults (BMI: 25-36 kg/m(2); age: 18-60y) was compared between a non-intervention and an intervention week using diet diaries and pedometers. The major outcomes were steps/day, daily caloric intake, macronutrient intake and meal size. Within subject ANOVAs were conducted to compare results between intervention and non-intervention weeks. RESULTS: Total energy intake was lower during intervention week than non-intervention week (P < .01), including macronutrient contents (all P's < .01), meal size (P < .01), consumption of sugar (P < .01), sugared sodas (P < .01) and sodium (P < .01). Steps/day were higher during intervention week than non-intervention week (P < .01). CONCLUSIONS: The results support previous research showing that the message to increase steps/day results in an increase in physical activity. The results demonstrate for the first time that the message to reduce intake by 100 kcal/day does actually result in a lower intake in the short term. People seem to be able to make positive changes in diet and physical activity in response to these messages. If these small changes can be sustained, this approach could be effective in preventing further weight gain in the population.

Do calorie-controlled portion sizes of snacks reduce energy intake?

In a cross-over study, participants (n=59) were randomly assigned to receive either 100 kcal packs or standard size packages of snacks for 1 week. After a minimum of a 1-week washout period, participants received the other form of the snack for 1 week. Snack consumption was recorded by participants in a diary. Participants consumed an average of 186.9 fewer grams of snacks per week when receiving 100 kcal snack packs compared to standard size packages of snacks. Post hoc comparisons revealed the effect of package size depended on both randomization order and study week. Total grams of snacks consumed in week 1 differed significantly between the two randomized groups. In week 2, however, grams of snacks did not differ significantly between the two groups. This interaction was primarily due to a significantly lower consumption of snacks from standard size packages in the week following the portion-controlled packages. The results suggest that portion-controlled packaging reduce total intake from the provided snacks. Further, initial exposure to portion-controlled packages might have increased awareness of portion size such that less was consumed when larger packages were available.

Small changes in dietary sugar and physical activity as an approach to preventing excessive weight gain: the America on the Move family study.

OBJECTIVES: The intent of this study was to evaluate whether small changes in diet and physical activity, as promoted by the America on the Move initiative, could prevent excessive weight gain in overweight children. METHODS: In this family-intervention study, the America on the Move small-changes approach for weight-gain prevention was evaluated in families with at least 1 child (7-14 years old) who was overweight or at risk for overweight. These children were the primary target of the intervention, and parents were the secondary target. Families were randomly assigned to either the America on the Move group (n = 100) or the self-monitor-only group (n = 92). Families who were assigned to the America on the Move group were asked to make 2 small lifestyle changes: (1) to walk an additional 2000 steps per day above baseline as measured by pedometers and (2) to eliminate 420 kJ/day (100 kcal/day) from their typical diet by replacing dietary sugar with a noncaloric sweetener. Families who were assigned to the self-monitor group were asked to use pedometers to record physical activity but were not asked to change their diet or physical activity level. RESULTS: During a 6-month period, both groups of children showed significant decreases in BMI for age. However, the America on the Move group compared with the self-monitor group had a significantly higher percentage of target children who maintained or reduced their BMI for age and, consistently, a significantly lower percentage who increased their BMI for age. There was no significant weight gain during the 6-month intervention in parents of either group. CONCLUSIONS: The small-changes approach advocated by America on the Move could be useful for addressing childhood obesity by preventing excess weight gain in families.

Step-counter determined walking in youth in Colorado.

BACKGROUND: Results from a statewide telephone survey of walking showed that the average adult in Colorado takes 6804 steps/d, and that steps/d were negatively associated with body mass index. No similar data exist for children. METHODS: As part of the Colorado survey, demographic information was obtained from parents for 116 children. A subsample of 59 children and adolescents (age 10 to 17 y) agreed to wear a step counter for four consecutive days. RESULTS: The youth reported taking an average of 7902 steps/d. There was a trend for children's steps/d to be positively associated with parents' steps/d and negatively associated with TV watching. CONCLUSION: This sample of children is not large enough to be considered a representative sample of Colorado youth, but this cross-sectional study provides some much needed information about steps/d in children and generates some interesting hypotheses about steps/d and other measures of health and overweight.

Influence of physiological and subjective arousal on food intake in humans.

OBJECTIVES: This study explored the influence of physiologic and subjective arousal on ambient factors of the food environment, such as the eating location, the presence of other people, sound, and time of day and on food intake. It was hypothesized that the influence of environmental stimuli on food intake would be mediated by arousal. METHODS: College students were asked to wear heart rate monitors and to record their food intake in a 7-d diet diary. Subjective arousal (elation and excitement) and aspects of the eating environment were recorded for each meal occasion. RESULTS: Results showed that subjective arousal seems to be related to food intake (P < 0.01) and appears to be affected by environmental stimuli such as the eating location (P < 0.01) and the number of people present (P < 0.01), but only small effects of some environmental stimuli on heart rate were found with higher average heart rates in restaurants (P < 0.05). No effects of heart rate on food intake were detected. Regression analyses failed to show arousal as a significant mediator between environmental stimuli and food intake. CONCLUSION: It can be concluded that, for normal individuals in their everyday environment, ambient influences on food intake are not mediated by changes in arousal. However, the environment and the emotional state of the individual appear to play a role in the individual's eating behavior.

Listening to music while eating is related to increases in people's food intake and meal duration.

The relationship of listening to music while eating with food consumption in the natural environment was assessed in 78 college students. They recorded their food intake along with environmental factors such as meal duration, music, including speed and volume, location, number of people present and the time of day in a detailed diet diary for 7 consecutive days. The data show that the presence of music is associated with higher food intake. Within subject comparisons revealed higher food and fluid intake and longer meal duration while listening to music but no significant differences in music speed or volume. The likelihood of listening to music appeared to be associated with the environmental variables of the number of people present and the time of day. The presence of music appears to be one of a set of environmental factors that influences food and fluid intake in the natural world.

Effect of ambience on food intake and food choice.

Eating takes place in a context of environmental stimuli known as ambience. Various external factors such as social and physical surroundings, including the presence of other people and sound, temperature, smell, color, time, and distraction affect food intake and food choice. Food variables such as the temperature, smell, and color of the food also influence food intake and choice differently. However, the influence of ambience on nutritional health is not fully understood. This review summarizes the research on ambient influences on food intake and food choice. The literature suggests that there are major influences of ambience on eating behavior and that the magnitude of the effect of ambience may be underestimated. Changes in intake can be detected with different levels of the number of people present, food accessibility, eating locations, food color, ambient temperatures and lighting, and temperature of foods, smell of food, time of consumption, and ambient sounds. It is suggested that the manipulation of these ambient factors as a whole or individually may be used therapeutically to alter food intake and that more attention needs to be paid to ambience in nutrition-related research.

Television viewing is associated with an increase in meal frequency in humans.

In sample of 76 undergraduate students (mostly female) in the USA, television viewing was associated with increased meal frequency and as a result with increased daily intake of energy.

Food intake in the real world: implications for nutrition and aging.

Nutrient intakes are affected by two classes of factors, physiological and environmental. In the real world, environmental variables such as social factors, palatability, and the time of eating appear to have large influences on amounts ingested in the short-term. Physiological control mechanisms also operate to regulate intake, and they induce compensatory responses to deviations from the norm. These physiological influences only appear to have weak influences on short-term intake unless there are large deviations from the normal state, but over the long-term they act patiently and persistently to rectify the excesses produced by environmental fluctuations and thereby tend to maintain a relative balance between energy intake and expenditure. As individuals age there is a progressive decline in physiological function including the mechanisms that act to control intake in the young. This should not produce a problem in a healthy individual in a stable environment: however, if that situation should change due to illness or an environmental change such as the death of a spouse, which produces decline in intake, elderly individuals would not have the physiological mechanisms present to compensate. Thus, the deficit in energy intake would not be replaced, and the lower level of intake would be maintained as long as the new health condition or environment remains stable. Hence, the decline in the effectiveness of the physiological systems with age makes the elderly particularly vulnerable and unable to rebound from deficits. Although the elderly have difficulty compensating for deficits automatically by physiologically-induced adjustments, the studies of real world intake reviewed in this article suggest that compensation can be produced by adjustments to the environment. The elderly appear to be as responsive to environmental factors as younger individuals. In particular, they appear to increase intake in response to social facilitation, diurnal rhythms, the eating environment, and palatability to the same extent as their juniors. These data suggest that alterations in the social, temporal, environmental, or hedonic conditions of eating could induce desired alterations in the nutrient intakes of the elderly. The study of real world eating behavior has produced evidence that suggests that this strategy can work. It remains for future applied investigations to ascertain whether or not this strategy is effective in treating undernutrition in the elderly.