Discussion Map and Cooking Classes: Testing the Effectiveness of Teaching Food Safety to Immigrants and Refugees

ObjectiveTo evaluate the effectiveness of a food safety map as an educational method with English language learners.MethodsEnglish language learner community members (n = 73) were assigned randomly to participate in 1 of 3 experimental conditions: food safety map, cooking class, and control. Participants in the food safety map and cooking class conditions completed a pre-education demographic and cooking history questionnaire, a post-education knowledge and intention questionnaire, and a 2-week post–cooking and food safety habits assessment. Participants in the control group received no educational training but completed the pre- and 2-week post-education assessments.ResultsThe cooking class and the map class were both effective in increasing food safety knowledge. Specifically, by comparing with the control group, they significantly increased participants' knowledge of safely cooking large meat (χ² [df = 2, n = 66] = 40.87; P < .001; V1 = .79) and correctly refrigerating cooked food (χ² [df = 2, n = 73] = 24.87, P < .001; V1 = .58). The two class types generated similar positive educational effects on boosting food safety behavioral intention (measured right after the class). The data collected 2 weeks after the classes suggested that individuals who took the classes followed the suggested food behaviors more closely than those in the control group (P < .01).Conclusions and ImplicationsThe food safety map is simple to use and prepare, beneficial for oral and visual learners, and inexpensive. Compared with a food safety cooking class, the map produces similar learning and behavioral outcomes.     

The Theory of Planned Behavior and the USDA Summer Food Service Program

ObjectiveExamine the impact of the Summer Food Service Program (SFSP) on the intentions to positively change fruit and vegetable consumption in a rural, low-income adolescent population using the Theory of Planned Behavior.DesignQuantitative data collected via a pre-post intervention survey to determine predictors of positive nutrition behaviors and changes in self-reported fruit and vegetable consumption.SettingA mid-sized university.ParticipantsFifty-seven high school students. Participants were primarily female (n = 36) and white (n = 56).InterventionParticipants followed the standards of the SFSP for 5 weeks and were provided with mandatory and optional nutrition education sessions.Main Outcome MeasureIntentions to change nutrition behaviors.AnalysisMultiple regression.ResultsPaired-sample t test showed a significant increase in knowledge from pretest (mean [M] = 11.18, SD = 1.68) to posttest (M = 12.91, SD = 1.76); t[56] = −8.09, P < 0.001; (t[56] = −8.09, P < 0.001) and in self-reported fruit and vegetable intake from pretest (M = 13.96, SD = 4.23) to posttest (M = 16.80, SD = 5.42); (t[56] = −3.20, P = 0.002). Regression demonstrated that all constructs of the Theory of Planned Behavior were significant (F[4, 52] = 14.56, P < 0.001 with an R² of 0.53) for their effects on behavior intentions with perceived behavioral control being the most salient predictor.Conclusions and ImplicationsOpportunities for shaping adolescent nutrient intake and eating behaviors during enrollment in the SFSP exist. Reinforcing positive attitudes, subjective norms, and perceived behavioral control may help to increase nutrition behavioral intentions and nutrition behaviors.     

The development and evaluation of a portion plate for youth: a pilot study

ObjectiveTo develop and evaluate a portion plate for adolescents (Nutri-plate).MethodsSixteen African American adolescents (mean age = 12.94 years; 66% male) were randomized to participate in either plate design or nutrition education sessions. Adolescents’ input was used to create the Nutri-plate, and participants’ food selection and intake was evaluated.ResultsAdolescents indicated the plate should include simple yet colorful visual and textual information about healthful eating. Participants left less food on their plate when dining with the Nutri-plate as compared with a plain plate (P < .01). Examination of effect sizes suggested that when using the Nutri-plate, participants selected less food overall (d = 0.73), more fruit (d = -0.64), more broccoli au gratin (d = -0.85), and less steamed broccoli (d = 0.87). Participants with higher body mass index selected a greater amount of healthful food when using the Nutri-plate (P < .05).Conclusions and ImplicationsFurther evaluation is needed to determine the influence of a portion plate on adolescents’ nutritional behaviors.     

Dairy Intake and Related Self-Regulation Improved in College Students Using Online Nutrition Education

BackgroundDairy intake by college students is markedly lower than recommendations. Interventions to improve dairy intake based on Social Cognitive Theory (SCT) have potential to successfully change behavior by improving mediators that influence dietary choices.ObjectiveWe aimed to use SCT to improve social support, self-efficacy, outcome expectations, self-regulation, and behavior related to dairy intake in college students.DesignWe conducted a randomized nutrition education intervention.Participants/settingParticipants included 211 college students (mean age 20.2±0.1 years; 63% women and 37% men) recruited from a university campus. Participants in the intervention group (n=107) and comparison group (n=104) received an 8-week dairy intake or stress management intervention, respectively, via electronic mail. Data collection included dairy intake from 7-day food records and SCT variables from questionnaires administered during January 2008 and April 2008.Main outcome measuresChanges in dairy intake and SCT variables (ie, social support, self-efficacy, outcome expectations, and self-regulation).Statistical analyses performedMultivariate analysis of covariance, with age and sex as covariates (P<0.05).ResultsNinety-one percent of participants (n=97 intervention, n=94 comparison) provided data; complete data were analyzed for 85% of participants (n=90 intervention, n=89 comparison). Participants in the intervention group reported higher intake of total dairy foods (P=0.012) and improved use of self-regulation strategies for consuming three servings per day of total dairy (P=0.000) and low-fat dairy foods (P=0.002) following the intervention.ConclusionsNutrition education via electronic mail based on an SCT model improved total dairy intake and self-regulation. Participants reported increased dairy intake and better use of self-regulation strategies. Future interventions should focus on benefits of consuming low-fat vs higher-fat dairy foods.     

The Shaping Healthy Choices Program: Design and Implementation Methodologies for a Multicomponent,School-Based Nutrition Education Intervention

ObjectiveTo provide a framework for implementation of multicomponent, school-based nutrition interventions. This article describes the research methods for the Shaping Healthy Choices Program, a model to improve nutrition and health-related knowledge and behaviors among school-aged children.DesignLongitudinal, pretest/posttest, randomized, controlled intervention.SettingFour elementary schools in California.ParticipantsFourth-grade students at intervention (n = 252) and control (n = 238) schools and their parents and teachers. Power analyses demonstrate that a minimum of 159 students per group will be needed to achieve sufficient power. The sample size was determined using the variables of nutrition knowledge, vegetable preference score, and body mass index percentile.InterventionA multicomponent school-based nutrition education intervention over 1 academic year, followed by activities to support sustainability of the program.Main Outcome MeasuresDietary and nutrition knowledge and behavior, critical thinking skills, healthy food preferences and consumption, and physical activity will be measured using a nutrition knowledge questionnaire, a food frequency questionnaire, a vegetable preferences assessment tool, the Test of Basic Science Process Skills, digital photography of plate waste, PolarActive accelerometers, anthropometrics, a parent questionnaire, and the School and Community Actions for Nutrition survey.AnalysisEvaluation will include quantitative and qualitative measures. Quantitative data will use paired t, chi-square, and Mann-Whitney U tests and regression modeling using P = .05 to determine statistical significance.     

Resources,Barriers, and Tradeoffs: A Mixed Methods Analysis of School Pre-Consumer Food Waste

BackgroundFood waste is a global problem. School food waste before the point of purchase, pre-consumer waste, has been little studied.ObjectiveOur aim was to elicit a comprehensive assessment and understanding of pre-consumer food waste amounts, behaviors, policies, and attitudes.DesignThis study used mixed methods, featuring a convergent parallel design using key respondent interviews (n=20) and 80 hours of structured kitchen observations, including food waste measurement.Participants/settingSchool and district kitchens (n=14) using stratified random sampling to ensure school level and kitchen type reflected the population of three Colorado school districts in 2016-2017. Kitchen managers, district-level nutrition services directors, and sustainability staff were interviewed.Statistical analyses performedMean food waste volumes and percentages were calculated. Linear regressions were used to determine the relationship between school kitchen characteristics and food waste volumes. Interviews were coded to identify common themes.ResultsTrim waste and overproduction contributed the most to overall pre-consumer food waste; substandard foods and overproduction were the most common reasons for edible waste. Several competing priorities conflicted with schools’ and districts’ waste reduction efforts: food safety, promoting diet quality, food choice, and customer satisfaction. Batch cooking, production record use, shallow salad bar pans, and other inventory management techniques facilitated waste reduction. Staffing, space, and time constraints made it more difficult to implement these strategies. Increased food choice options were positively associated with pre-consumer waste volume (β=49.5, P=0.04), and this relationship remained significant once regression models adjusted for district, salad bar use, and new menu items (β=70.3, P=0.05).ConclusionsSchool nutrition programs are complex, and a systems approach is warranted to reduce overall waste in the context of existing food safety and nutrition policies. More research is needed to elucidate the impact of food choice on overall food waste of the school meal system.     

Impact of advanced and basic carbohydrate counting methods on metabolic control in patients with type 1 diabetes

ObjectiveDiets based on carbohydrate counting remain a key strategy for improving glycemic control in patients with type 1 diabetes. However, these diets may promote weight gain because of the flexibility in food choices. The aim of this study was to compare carbohydrate counting methods regarding anthropometric, biochemical, and dietary variables in individuals with type 1 diabetes, as well as to evaluate their knowledge about nutrition.MethodsParticipants were allocated in basic or advanced groups. After 3 mo of the nutritional counseling, dietary intake, anthropometric variables, lipemia, and glycemic control were compared between groups. A questionnaire regarding carbohydrate counting, sucrose intake, nutritional knowledge, and diabetes and nutrition taboos also was administered.ResultsTen (30%) participants had already used advanced carbohydrate counting before the nutritional counseling and these individuals had a higher body mass index (BMI) (P < 0.01) and waist circumference (WC) (P = 0.01) than others (n = 23; 69.7%). After 3 mo of follow-up, although participants in the advanced group (n = 17; 51.52%) presented higher BMI (P < 0.01) and WC (P = 0.03), those in the basic group (n = 16; 48.48%) showed a higher fat intake (P < 0.01). The majority of participants reported no difficulty in following carbohydrate counting (62.5% and 88% for basic and advanced groups, respectively) and a greater flexibility in terms of food choices (>90% with both methods).ConclusionsAdvanced carbohydrate counting did not affect lipemic and glycemic control in individuals with type 1 diabetes, however, it may increase food intake, and consequently the BMI and WC, when compared to basic carbohydrate counting. Furthermore, carbohydrate counting promoted greater food flexibility.     

Food insecurity and food choices in rural older adults with diabetes receiving nutrition education via telemedicine

ObjectiveTo evaluate differences between rural older adults with diabetes reporting the presence or absence of food insecurity with respect to meal planning, preparation, shopping, obesity, and glycemic control after receiving nutrition counseling through telemedicine.MethodsFood insecurity data were obtained by telephone survey (n = 74). Group differences for continuous variables were measured by t tests; categorical variables by Pearson chi-square tests.ResultsParticipants reporting mild food insecurity (23%) had higher body mass index (35.5 ± 7.1 kg/m² vs 30.5 ± 6.0 kg/m², P = .01) and lower household incomes (P = .03) and were more likely to consider cost of ingredients in food preparation compared to food-secure participants (P = .03). Most purchased fresh produce (97%) and considered the dietitian's advice when purchasing food. Both groups report similar adherence to dietitians' advice and had similar glycemic control.Conclusions and ImplicationsStrategies to address higher levels of obesity associated with food insecurity are needed.     

Comprehensive Behavioral-Motivational Nutrition Education Improves Depressive Symptoms Following Bariatric Surgery: A Randomized,Controlled Trial of Obese Hispanic Americans

ObjectiveTo evaluate the effect of 2 post-bariatric support interventions on depressive symptoms of Hispanic Americans treated with gastric bypass for morbid or severe obesity.Design/SettingProspective randomized, controlled trial conducted in a laparoscopic institution.Participants/InterventionsDuring the Phase 1 clinical trial (from preoperative evaluation to 6 months after surgery), all participants received standard care. During Phase 2 (6–12 months after surgery), participants were randomly assigned to receive either standard care (n = 72) or comprehensive support (n = 72). Comprehensive group participants received 6 educational sessions focused on behavior change strategies and motivation with nutrition counseling.Main Outcome MeasuresDepression scores and weight change over time.AnalysisIndependent samples t tests and regression analysis assessed relationships among depression scores and excess weight loss.ResultsParticipants receiving behavioral-motivational intervention scored significantly lower on Beck's Depression Inventory questionnaire scores than those receiving standard care. For those with depressive symptoms at randomization, 24% of participants who received the comprehensive intervention reported no depressive symptoms at 12 months after surgery, compared with 6% of those who received standard care (P < .001). Patients' depressive mood improvement was significantly and positively associated with excess weight loss and attendance at educational sessions (P < .001).Conclusions and ImplicationsFindings support the importance of post-bariatric comprehensive behavioral-motivational nutrition education for decreasing risk for depression and improving weight loss.     

Nutrition Knowledge and Associated Behavior Changes in a Holistic,Short-term Nutrition Education Intervention with Low-income Women

ObjectiveTo assess the impact of a short-term nutrition intervention using education on a comprehensive array of nutrition and health topics in low-income women.DesignPre- and postintervention surveys; 1 study condition (intervention group); experiential learning; pilot testing of education sessions.SettingCommunity centers, homeless shelters, or University of Minnesota, in Minneapolis–St Paul metropolitan area.ParticipantsEthnically diverse, low-income women (n = 118), 23–45 years of age.InterventionThree educational sessions providing a comprehensive curriculum of nutrition and health education via experiential and interactive lectures, activities, and demonstrations. One week to implement knowledge and behavioral changes, and pre- and postsurvey sessions to collect anthropometric data and evaluate changes in knowledge and behavior.Main Outcome MeasuresHealth benefits of all food groups; identification of healthful foods; shopping, cooking, and gardening; and energy balance.AnalysisPaired t tests, Pearson correlations.ResultsPostintervention increases in nutrition knowledge and favorable nutrition behavioral changes (P < .05).Conclusions and ImplicationsA short-term nutrition intervention using comprehensive nutrition and health education through experiential and interactive lessons, activities, and demonstrations has the capacity to increase nutrition knowledge and favorably change nutrition behaviors in a sample of low-income women.     

Advance Quantity Meal Preparation Pilot Program Improves Home-Cooked Meal Consumption,Cooking Attitudes,and Self-Efficacy

ObjectiveTo evaluate the effects of a group-based Advance Quantity Meal Preparation (AQMP) program on the consumption of home-cooked meals, cooking attitudes, and self-efficacy in healthy adults.MethodsParticipants (n = 10) in a group setting prepared healthy meals weekly consisting of 10 entrees and 5 snacks for 6 weeks. A survey assessing cooking attitudes, cooking self-efficacy, and cooking behavior and consumption at 3 time points: preprogram, postprogram (T2), and 3 months postprogram (T3).ResultsThe AQMP program increased the proportion of overall home-cooked meal consumption (T2, P = 0.03), home-cooked dinner consumption (T2, P = 0.04), cooking attitudes (T3, P = 0.01), and cooking self-efficacy (T2, P = 0.002).Conclusions and ImplicationsThis pilot study indicates that AQMP may increase home-cooked meal consumption, cooking attitudes, and cooking self-efficacy.     

Development and Reliability Testing of a Nutrition Knowledge Questionnaire for Australian Children (the CNK-AU)

ObjectiveTo adapt and test an existing questionnaire to assess Australian children's level of nutrition knowledge.DesignThe child nutrition knowledge questionnaire for Australian children consists of 8 nutrition-related categories: healthy choices, portion and serving sizes, balanced meals, nutrition labels, nutrient functions, and food sources, safety, and categories. Participants completed the questionnaire at 2 time points, with 1 week in between.SettingThe questionnaire was completed online in a primary school classroom using an Android tablet.ParticipantsFifth- and sixth-year students (n = 94; aged 10.9 years; SD, 0.76) at a primary school in New South Wales, Australia.Variables MeasuredItem difficulty, item discrimination, and reliability.AnalysisItem analysis, interrater reliability, and test-retests.ResultsThe intrarater reliability per item between the first visit and 1 week later was moderate to substantial for the majority of items (mean κ = 0.50; SD, 0.21). Test-retest found a significant correlation for total score (r = 0.756), with all categories except portion and serving sizes showing significant correlations above r = 0.502.Conclusions and ImplicationsThe child nutrition knowledge questionnaire for Australian children has the potential to be a reliable and practical questionnaire for measuring Australian children's nutrition knowledge. The questionnaire may be useful for future work evaluating the effectiveness of nutrition education interventions and would potentially be adapted to other cultures.     

Good Grubbin': Impact of a TV Cooking Show for College Students Living Off Campus

ObjectiveTo determine if a series of 4 15-minute, theory-driven (Social Cognitive Theory) cooking programs aimed at college students living off campus improved cooking self-efficacy, knowledge, attitudes, and behaviors regarding fruit and vegetable intake.DesignA randomized controlled trial with pre-, post- and follow-up tests.SettingUniversity campus.ParticipantsStudents (n = 101) from upper-level nonhealth courses (n = 37 male and n = 94 living off campus).InterventionThe intervention group (n = 50) watched 4 weekly episodes of the cooking show, Good Grubbin’. The control group (n = 51) watched 4 weekly episodes on sleep disorders.Main Outcome MeasuresDemographic information; knowledge, self-efficacy, motivations, barriers of eating fruits and vegetables; self-efficacy, motivations, barriers and behaviors of cooking; fruit and vegetable intake food frequency questionnaire.AnalysisRepeated-measure analysis of variance and chi-square analyses were used to compare outcome variables.ResultsThere were significant improvements in knowledge of fruit and vegetable recommendations in the intervention group compared to the control group postintervention and at 4-month follow-up (P < .05). There were no significant changes in fruit and vegetable motivators, barriers, self-efficacy or intake.Conclusions and ImplicationsA television show on nutrition and cooking may be influential in changing students’ knowledge, but it seems to have little impact on dietary behaviors. With a recent increase in popularity of cooking shows, future research should investigate the impact an extended cooking and nutrition show series might have on young adult viewers.     

Nutrition Literacy Tailored Interventions May Improve Diet Behaviors in Outpatient Nutrition Clinics

ObjectivesNutrition literacy examines the intersection of nutrition knowledge and skills; however, no evidence shows interventions tailored to nutrition literacy deficits affect diet behaviors. This study examined the effects of nutrition interventions tailored to individual nutrition literacy deficits on improving diet-related behaviors.MethodsFive outpatient clinics were randomized to 2 arms. The nutrition literacy and diet behaviors of patients were assessed before intervention with a dietitian and again 1 month later. Intervention-arm dietitians received patient nutrition literacy levels and tailored interventions toward nutrition literacy weaknesses. Differences in diet behaviors between arms were analyzed using Mann-Whitney U-tests and within-arms using Wilcoxon signed-rank tests.ResultsIntervention-arm patients improved 10 of 25 measured diet behaviors; control-arm patients improved 6 behaviors. Similarly, intervention-arm patients reported increased green vegetable consumption from baseline to follow-up (z = 2.00; P = 0.04).Conclusions and ImplicationsNutrition interventions tailored toward nutrition literacy deficits may play an important role in improving patient diet behaviors.     

Associations Between Intuitive Eating Behaviors and Fruit and Vegetable Intake Among College Students

ObjectiveTo assess associations between intuitive eating behaviors and fruit and vegetable intake among college students.MethodsIntuitive eating behaviors were measured with the Intuitive Eating Scale-2 (IES-2), which reports a total and 4 subscale scores. Fruit and vegetable intake was measured with the National Institutes of Health Eating at America's Table Fruit and Vegetable screener. Questionnaires were completed online.ResultsMedian age of participants was 20 years (n = 293; n = 72 male). Total IES-2 score was not correlated with fruit and vegetable intake. Body–Food Choice Congruence and Eating for Physical Rather Than Emotional Reasons subscales were positively associated with fruit and vegetable intake (r = .462, P < .001 and r = .177, P = .002, respectively). The Unconditional Permission to Eat subscale was negatively associated with fruit and vegetable intake (r = –.308, P < .001).Conclusions and ImplicationsCorrelations between fruit and vegetable intake and intuitive eating behaviors differed by IES-2 subscale scores. If IES-2 is used in nutrition research, education, or counseling with the aim of increasing fruit and vegetable intake, addressing subscale behaviors individually might be considered.     

Impacts of A Taste of African Heritage: A Culinary Heritage Cooking Course

ObjectiveTo examine changes in cooking and dietary behaviors and health outcomes following participation in A Taste of African Heritage, a culinary heritage cooking course.DesignOne group, pre-post program design, surveys, and physical assessments.SettingCommunity centers, churches, health care settings, homes, and housing complexes.ParticipantsParticipants (n = 586, 84% women) were recruited by partner organizations from 2013–2018 across 21 states and the District of Columbia.Intervention(s)A 6-week cooking curriculum that teaches history, nutrition, and cooking techniques to reconnect participants with the vibrant, healthy traditions of the African Diaspora.Main Outcome Measure(s)Weekly frequency of cooking, food group intake, and exercise assessed by surveys, measured weight, waist circumference, and blood pressure.AnalysisLinear and logistic mixed-effects models with random intercepts for participant and teacher, sex and site type as covariates comparing pre-post physical measurements and binary behavioral outcomes, P < 0.0033 for statistical significance after Bonferroni correction.ResultsIntake frequencies of fruit, vegetable, and greens and exercise frequency were improved from preprogram to postprogram (all P < 0.0021). Weight, waist circumference, and systolic blood pressure were also improved from preprogram to postprogram (all P <0.0001).Conclusions and ImplicationsParticipation in A Taste of African Heritage was associated with positive behavior changes and health outcomes. Integrating cultural heritage and behaviors are positive components to connect participants to healthy old ways or traditions.     

Psychometric Analyses of the Eating and Food Literacy Behaviors Questionnaire with University Students

ObjectivesThis study developed and validated a questionnaire to measure young adults’ perceived food literacy and behaviors toward food and created an explanatory model.DesignCross-sectional.SettingLarge southeastern US university.ParticipantsA total of 1,896 students, aged 18–30 years, were recruited. Data from 1,813 were analyzed.Variables MeasuredHealth and nutrition, taste, food preparation, planning and decision-making, and convenience.AnalysisExploratory factor analysis, test-retest reliability, confirmatory factor analysis, and structural equation modeling were performed.ResultsExploratory factor analysis returned 5 factors with acceptable internal structure. Test-retest reliability coefficients ranged from 0.63 to 0.92. Confirmatory factor analysis suggested that a 5-factor model was an appropriate fit for the data (χ² = 588.05; degrees of freedom = 142; root mean square error of approximation = 0.06; comparative fit index = 0.98; Tucker-Lewis Index = 0.97; standardized root mean square residual = 0.05). Structural equation modeling revealed relationships from health and nutrition to food preparation (0.25, P < 0.001), planning and/or decision-making (0.57, P < 0.001), taste (−0.14, P < 0.001), and convenience (−0.31, P < 0.001). The structural equation model demonstrated adequate fit (adjusted goodness of fit = 0.91; comparative fit index = 0.93; non-normed fit index = 0.91; root mean square error of approximation = 0.06; and standardized root mean square residual = 0.07) and a significant chi-square test (χ² = 628.92; degrees of freedom = 171, P < 0.001).Conclusions and ImplicationsYoung adults consider food literacy-related factors and behavioral concerns when making food choices.     

Pilot Study Results for a Novel Behavior Plus Nutrition Intervention for Caregivers of Young Children With Type 1 Diabetes

ObjectiveTo present results for a parent-based educational intervention targeting mealtime behaviors plus nutrition among families of young children (mean age, 5.0 ± 1.2 years) with type 1 diabetes mellitus (T1DM).MethodsThe researchers recruited 9 caregivers who participated in the 6-session intervention and completed baseline and posttreatment assessments, which included dietary intake, acceptability of diet changes, mealtime behavior, and mean blood glucose values.ResultsChildren's mean daily blood glucose levels decreased from 185 ± 46 mg/dL to 159 ± 40 mg/dL (P < .001). There were also decreases in problematic parent and child mealtime behaviors. There was no change in children's dietary intake indicators that could be detected.Conclusions and ImplicationsIt appears promising that this targeted behavior plus nutrition intervention can improve glycemic control and behavior for young children with type 1 diabetes mellitus. Larger, randomized controlled trials will clarify significant results, limitations, and sustainability. Techniques within the program may have application to current practice.     

Self-Reported Changes and Perceived Barriers to Healthy Eating and Physical Activity among Global Breast Cancer Survivors: Results from an Exploratory Online Novel Survey

BackgroundDespite being motivated to improve nutrition and physical activity behaviors, cancer survivors are still burdened by suboptimal dietary intake and low levels of physical activity.ObjectiveThe aim of this study was to assess changes in nutrition and physical activity behaviors after cancer diagnosis or treatment, barriers to eating a healthy diet and staying physically active, and sources for seeking nutrition advice reported by breast cancer survivors.DesignThis was a cross-sectional study.Participants/settingThe study included 315 survivors of breast cancer who were recruited through social media and provided completed responses to an online exploratory survey.Main outcome measuresSelf-reported changes in nutrition and physical activity behaviors after cancer diagnosis or treatment, perceived barriers to healthy eating and physical activity, and sources of nutrition advice were measured.Statistical analysisFrequency distribution of nutrition and physical activity behaviors and changes, barriers to healthy eating and physical activity, and sources of nutrition advice were estimated.ResultsAbout 84.4% of the breast cancer survivors reported at least 1 positive behavior for improving nutrition and physical activity after cancer diagnosis or treatment. Fatigue was the top barrier to both making healthy food choices (72.1%) and staying physically active (65.7%), followed by stress (69.5%) and treatment-related changes in eating habits (eg, change in tastes, loss of appetite, and craving unhealthy food) (31.4% to 48.6%) as barriers to healthy eating, and pain or discomfort (53.7%) as barriers to being physically active. Internet search (74.9%) was the primary source for seeking nutrition advice. Fewer than half reported seeking nutrition advice from health care providers.ConclusionsDespite making positive changes in nutrition and physical activity behaviors after cancer diagnosis or treatment, breast cancer survivors experience treatment-related barriers to eating a healthy diet and staying physically active. Our results reinforce the need for developing tailored intervention programs and integrating nutrition into oncology care.