Diet Quality is Low among Female Food Pantry Clients in Eastern Alabama

ObjectiveExamine diet quality, food security, and obesity among female food pantry clients.DesignCross-sectional study.SettingA food pantry in Lee County, Alabama.ParticipantsFifty-five female food pantry clients between 19 and 50 years of age.Main Outcome Measure(s)Diet quality using United States (US) Department of Agriculture Healthy Eating Index (HEI-2005), adult obesity (Body Mass Index [BMI] ≥ 30 kg/m²), household food security (US Department of Agriculture Module).AnalysisAnalysis of variance and multivariate models.ResultsDiet quality of the women was generally poor, with a mean HEI of a 43 on a 100 point scale. Having low education level (less than a high school degree) and being a smoker were related to lower overall diet quality. Sixty-seven percent of the clients were obese while 65% percent were food insecure.Conclusions and ImplicationsFood pantry clients are characterized by high levels of food insecurity, obesity and poor diet quality. Smoking was associated with food insecurity and low diet quality. Increased outreach efforts to improve nutrition education and to help food pantry clients stop smoking could be beneficial.     

Evaluating a Food Pantry–Based Intervention to Improve Food Security,Dietary Intake,and Quality in Midwestern Food Pantries

BackgroundVoices for Food was a longitudinal community, food pantry–based intervention informed by the social ecological model, and designed to improve food security, dietary intake, and quality among clients, which was carried out in 24 rural food pantries across 6 Midwestern states.ObjectiveOur objective was to evaluate changes in adult food security, dietary intake, and quality from baseline (2014) to follow-up (2016), and to assess the role of adult food security on dietary outcomes.DesignA multistate, longitudinal, quasi-experimental intervention with matched treatment and comparison design was used to evaluate treatment vs comparison group changes over time and changes in both groups over time.Participants/settingAdult food pantry clients (n = 617) completed a demographic food security survey, and up to three 24-hour dietary recalls at baseline (n = 590) and follow-up (n = 160).InterventionCommunity coaching served as the experimental component, which only “treatment” communities received, and a food council guide and food pantry toolkit were provided to both “treatment” and matched “comparison” communities.Main outcome measuresChange in adult food security status, mean usual intakes of nutrients and food groups, and Healthy Eating Index-2010 scores were the main outcome measures.Statistical analyses performedLinear mixed models estimated changes in outcomes by intervention group and by adult food security status over time.ResultsImprovements in adult food security score (–0.7 ± 0.3; P = .01), Healthy Eating Index-2010 total score (4.2 ± 1.1; P < .0001), and empty calories component score (3.4 ± 0.5; P <.0001) from baseline to follow-up were observed in treatment and comparison groups, but no statistically significant changes were found for adult food security status, dietary quality, and usual intakes of nutrients and food groups between the 2 groups over time. The intervention effect on dietary quality and usual intake changes over time by adult food security status were also not observed.ConclusionsFood pantry clients in treatment and comparison groups had higher food security and dietary quality at the follow-up evaluation of the Voices for Food intervention trial compared with baseline, despite the lack of difference among the groups as a result of the experimental coaching component.     

CHILE: Outcomes of a group randomized controlled trial of an intervention to prevent obesity in preschool Hispanic and American Indian children

ObjectiveWe examined the outcomes of the Child Health Initiative for Lifelong Eating and Exercise (CHILE) study, a group randomized controlled trial to design, implement, and test the efficacy of a trans-community intervention to prevent obesity in children enrolled in Head Start centers in rural American Indian and Hispanic communities in New Mexico.MethodsCHILE was a 5-year evidence-based intervention that used a socioecological approach to improving dietary intake and increasing physical activity of 1898 children. The intervention included a classroom curriculum, teacher and food service training, family engagement, grocery store participation, and healthcare provider support. Height and weight measurements were obtained four times (fall of 2008, spring and fall of 2009, and spring of 2010), and body mass index (BMI) z-scores in the intervention and comparison groups were compared.ResultsAt baseline, demographic characteristics in the comparison and intervention groups were similar, and 33% of all the children assessed were obese or overweight. At the end of the intervention, there was no significant difference between the two groups in BMI z-scores.ConclusionsObesity prevention research among Hispanic and AI preschool children in rural communities is challenging and complex. Although the CHILE intervention was implemented successfully, changes in overweight and obesity may take longer than 2 years to achieve.     

Effectiveness of Expanded Food and Nutrition Education Program in Changing Nutrition-Related Outcomes Among Adults With Low Income: A Systematic Review

ObjectiveTo review the effect of the Expanded Food and Nutrition Education Program (EFNEP) in changing nutrition-related outcomes.MethodsRelevant research conducted before December 2020 was identified using PubMed, Web of Science, Google Scholar, and the EFNEP Research Database. The methodological quality of each eligible study was assessed.ResultsOf the 406 studies found, 30 were eligible; 26 studies were on EFNEP, and 4 included both EFNEP and Supplemental Nutrition Assistance Program Nutrition Education (SNAP-Ed). The sample sizes ranged from 35 to 122,961. Outcome measures included consumption of food groups, nutrients, other nutrition-related behaviors, and food security. At least 1 immediate behavior change (P < 0.05) was reported in each study, but long-term maintenance of behavior change was not evident.DiscussionThis review found a consistent, immediate improvement in nutrition behaviors after program participation but poor retention over time. Overall, variation in programming and outcome measures, incomplete reporting, and generally low study quality by modern standards precluded strong conclusions.Implications for Research and PracticeThis review identified the need for control groups, improved reporting of program protocols, theory-based curriculum, and measurement of long-term outcomes.     

Food Insecurity,Poor Diet Quality,and Obesity among Food Pantry Participants in Hartford,CT

ObjectiveExamine relationships between food security, diet quality, and body mass index (BMI) among food pantry users.MethodsConvenience sample of 212 food pantry clients in Hartford, CT from June, 2010 to May, 2011. Main outcomes included food security (United States Department of Agriculture module), fruit and vegetable consumption (Block Screener), and BMI (stadiometer and digital medical scale). Chi-square tests, Spearman correlations, and logistic regression models were analyzed.ResultsOver half of the sample (50.5%) had very low food security. Mean BMI was 29.5 kg/m². Age was positively associated with food security (P < .01). Food-secure participants were twice as likely to eat fruit, vegetables, and fiber as food-insecure participants (P = .04). Women were 4 times as likely to be obese as men (P < .01), yet food insecurity was not associated with obesity in this sample.Conclusions and ImplicationsEnsuring the nutritional adequacy of donated food is an important consideration for food donors and pantry staff.     

Adolescents demonstrate improvement in obesity risk behaviors after completion of choice, control & change, a curriculum addressing personal agency and autonomous motivation

BackgroundThe rapid increase of obesity and diabetes risk beginning in youth, particularly those from disadvantaged communities, calls for prevention efforts.ObjectiveTo examine the impact of a curriculum intervention, Choice, Control &; Change, on the adoption of the energy balance–related behaviors of decreasing sweetened drinks, packaged snacks, fast food, and leisure screen time, and increasing water, fruits and vegetables, and physical activity, and on potential psychosocial mediators of the behaviors.DesignTen middle schools were randomly assigned within matched pairs to either intervention or comparison/delayed control conditions during the 2006-2007 school year.Subjects/settingStudents were from low-income New York City neighborhoods; 562 were in the intervention condition, and 574 in the comparison condition.InterventionStudents received the 24 Choice, Control &; Change lessons that used science inquiry investigations to enhance motivation for action, and social cognitive and self-determination theories to increase personal agency and autonomous motivation to take action.Main outcome measuresSelf-report instruments to measure energy balance?related behaviors targeted by the curriculum and potential psychosocial mediators of the behaviors.Statistical analysesAnalysis of covariance with group (intervention/control) as a fixed factor and pretest as covariate.ResultsStudents in intervention schools compared to the delayed intervention controls reported consumption of considerably fewer sweetened drinks and packaged snacks, smaller sizes of fast food, increased intentional walking for exercise, and decreased leisure screen time, but showed no increases in their intakes of water, fruits, and vegetables. They showed substantial increases in positive outcome expectations about the behaviors, self-efficacy, goal intentions, competence, and autonomy.ConclusionsThe Choice, Control &; Change curriculum was effective in improving many of the specifically targeted behaviors related to reducing obesity risk, indicating that combining inquiry-based science education and behavioral theory is a promising approach.     

Dietary Quality and Usual Intake of Underconsumed Nutrients and Related Food Groups Differ by Food Security Status for Rural,Midwestern Food Pantry Clients

BackgroundFood pantry users represent a predominantly food insecure population, yet dietary intake may differ among food secure (FS), low FS, and very low FS clients. Usual intake of food groups and nutrients by food security status has not previously been compared among food pantry clients.ObjectiveThis study aimed to estimate the usual intakes of underconsumed nutrients (ie, potassium; dietary fiber; choline; magnesium; calcium; vitamins A, D, E, and C; and iron) and related food groups (ie, vegetables, fruits, whole grains, and dairy) and dietary quality, and to evaluate their relationship with food security status.DesignThis cross-sectional, secondary analysis used baseline data from a prior intervention study (Clinical Trial Registry: NCT03566095). A demographic questionnaire, the US Household Food Security Survey Module, and up to three 24-hour dietary recalls on nonconsecutive days, including weekdays and weekends, were collected.Participants/settingThis community-based study included a convenience sample of adult, midwestern food pantry clients (N=579) recruited from August to November 2014.Main outcome measuresMain outcomes evaluated were Healthy Eating Index-2010 scores and usual intakes of underconsumed nutrients and related food groups.Statistical analyses performedLinear regression models and the National Cancer Institute method, adjusting for confounders, were used to estimate associations of food security with diet quality and usual intake, respectively.ResultsBeing FS was associated with a higher whole grains HEI-2010 score and higher mean usual intake of whole grains compared with being low FS. Being FS was associated with higher usual intakes of iron and dairy compared with being very low FS. Being FS was associated with a higher mean usual intake of dark green vegetables compared with being low FS and very low FS. Usual intakes were below federal guidance for all subgroups of food security.ConclusionsAlthough food security status may differentiate dietary intake among food pantry clients, improvements are needed among all clients.     

The Effect of Food Stamp Nutrition Education on the Food Insecurity of Low-income Women Participants

ObjectiveTo determine the effect of Food Stamp Nutrition Education (FSNE) in Indiana on participants' food insecurity and food insufficiency.DesignA single-blind randomized design. A randomized experimental group completed 5 FSNE lessons as an intervention between a pre- and posttest, whereas a control group completed a pre- and posttest without FSNE intervention.SettingClient homes and community locations in 24 Indiana counties.ParticipantsFemale head-of-household participants ≥ 18 years old; n = 219.InterventionFSNE lessons targeting food insecurity and nutrition.Main Outcome MeasuresDependent variables food insecurity and food insufficiency were quantified with the 6-item United States Household Food Security Scale and United States Department of Agriculture Food Insufficiency Question, respectively. The independent variable was the randomly assigned treatment group.AnalysisParticipants' characteristics were compared with chi-square analysis. Analyses of covariance models were constructed to find the effect of treatment group on food insecurity and food insufficiency. Significance indicated at P ≤ .05.ResultsFood insecurity and food insufficiency in the experimental group compared with the control group were significantly improved (P = .03, P = .04, respectively).Conclusions and ImplicationsFSNE was successful in improving participants' food insecurity and food insufficiency, indicating nutrition education is an appropriate intervention for food insecurity.     

EFNEP's Impact on the Quality of Life of Its Participants and Educators

ObjectiveDetermine whether the Expanded Food and Nutrition Education Program (EFNEP) affects the quality of life (QOL) of its participants and educators.DesignLongitudinal, where QOL was measured 3 times for participants (pre, post, 3-month delayed post) and educators (before and 6 and 12 months after training).SettingParticipants' and educators' QOL was measured in Colorado, Kansas, Missouri, and Nebraska. Georgia and Texas measured educators; Minnesota and Virginia measured participants.ParticipantsEnglish speaking EFNEP participants and educators.Main Outcome MeasuresThe investigators used the QOL Profile to measure QOL in 3 domains: Being (who one is), Belonging (connection with social and physical environment), and Becoming (achieving personal goals).AnalysisChi-square and t tests compared group demographics; repeated-measures ANOVA detected changes over time; ANCOVA examined the influence of demographic variables.ResultsBoth groups had QOL Profile scores above 1.5, which is considered acceptable. Participants improved from pre to post in the Being domains including Overall Being (least square means [standard error of the mean], 3.1 [0.2] to 4.1 [0.3]), and in Social Belonging (3.5 [0.3] to 3.8 [0.3]); most improvements were sustained at 3 months. Educators improved in the Belonging domains, and a number of scores continued to improve at 1 year after training, for example, Social Belonging (4.2 [0.5], 5.0 [0.5], and 5.8 [0.6]); and Community Belonging (3.5 [0.5], 3.8 [0.5], and 4.7 [0.5]) at the 3 time points, respectively.Conclusions and ImplicationsEFNEP improved the QOL of participants, primarily in the Being domain, and of educators, primarily in the Belonging domain. The QOL profile has the potential to broaden the assessment of EFNEP impacts.     

Impact of a Capacity-Building Intervention on Food Marketing Features in Recreation Facilities

ObjectiveTo explore the impact of a capacity-building intervention (CBI) to support implementing provincial nutrition guidelines on food marketing in recreation facilities (RFs).DesignRandomized controlled trial within a natural experiment: food marketing in RFs from 3 guideline provinces randomly assigned to intervention (GL+CBI) or comparison (GL-ONLY) was compared with facilities in 1 province without guidelines (NO-GL). Food marketing was assessed by the Food and Beverage Marketing Assessment Tool for Settings.SettingCanadian provinces with/without voluntary nutrition guidelines for RFs.Participants51 RFs.Intervention18-month CBI.Main Outcome MeasuresChange in Food and Beverage Marketing Assessment Tool for Settings scores and marketing features between baseline and follow-up across groups.AnalysisKruskal–Wallis with post hoc Mann–Whitney U tests.ResultsNo significant differences in food marketing features between baseline and follow-up across groups except for a change in food marketing frequency (P = 0.045). The increase in frequency in NO-GL (median, 6.0; interquartile range, −2.0 to 8.5) was significantly greater than changes in the GL+CBI (P = 0.033) and GL-ONLY sites (P = 0.049).Conclusions and ImplicationsCapacity-building was not associated with improved food marketing features potentially because of nonmandated nutrition guidelines, low priority for change, and vague or narrow facility goals and guidelines. Nutrition guidelines with specific unhealthy food marketing restrictions should be mandated and supported.     

Biopsychosocial characteristics of overweight and obese primary care patients: do psychosocial and behavior factors mediate sociodemographic effects?

BACKGROUND: The increasing prevalence of obesity and obesity-related conditions in primary care settings challenges the health care system. Thus, we used available baseline data from an on-going clinical trial to examine the biopsychosocial characteristics of overweight and obese primary care patients. The primary research objective was to ascertain whether theoretically important psychosocial and behavioral variables mediate the empirical relationships between sociodemographic factors and body mass index (BMI). METHODS: Overweight or obese primary care patients (n=665) enrolled in an on-going trial of a cognitive-behavioral obesity intervention provided baseline sociodemographic, psychosocial, nutritional, physical activity, and anthropometric data that were analyzed via multiple regression. RESULTS: Lower educational attainment was associated with a higher BMI after controlling for decisional balance, social support, self-efficacy, energy intake, and energy expenditure (P<0.05). In contrast, ethnicity was not associated with BMI after controlling for the psychosocial and behavioral variables. Decisional balance and social support variables were associated with BMI and energy intake, but the directions of some of the associations were not consistent with a priori expectations. CONCLUSIONS: Overall, we found some evidence of mediation by the psychosocial and behavioral variables of the relationship between ethnicity and BMI, but not for the relationship between education and BMI. In addition, some of the relationships between the psychosocial variables and BMI were opposite of our expectations.     

Assessing and counseling the obese patient: Improving resident obesity counseling competence

ObjectiveTo evaluate obesity counseling competence among residents in a primary care training programMethodsWe delivered a 3 h obesity curriculum to 28 Primary Care residents and administered a pre-curriculum and post curriculum survey looking specifically at self-assessed obesity counseling competence.ResultsNineteen residents completed both the pre curriculum survey and the post curriculum survey. The curriculum had a positive impact on residents’ ability to ascertain patient’s stage of change, use different methods to obtain diet history (including 24 h recall, food record or food frequency questionnaire), respond to patient’s questions regarding treatment options, assist patients in setting realistic goals for weight loss based on making permanent lifestyle changes, and use of motivational interviewing to change behavior. When looking at the 5As domains, there was a significant improvement in the domains of Assess, Advise, and Assist. The proportion of residents with a lower level of self-assessed obesity counseling competence reduced from 75% before the curriculum to 37.5% (p = 0.04) after the curriculum.ConclusionOur curriculum addressing weight loss counseling using the 5As model increased obesity counseling competence among residents in a primary care internal medicine residency program.     

The Influence of Worries on Emotional Eating,Weight Concerns,and Body Mass Index in Latina Female Youth

PurposeTo investigate the effect of worries on weight concerns, emotional eating, and body mass index (BMI) percentile in an ethnically diverse sample of female youth.MethodsThis study used baseline and follow-up data from a brief school-based physical activity intervention trial involving minority female youth. Partial correlations adjusted for intervention status, age, and ethnicity were used to assess the relationships between emotional eating, weight concerns, and BMI percentile at follow-up. Multilevel modeling was used to analyze the relationships between baseline worries and follow-up emotional eating, weight concerns, and BMI percentile. Additional analysis assessed whether emotional eating mediated and/or moderated the relationship between baseline worries and follow-up BMI. Data were analyzed using SAS version 9.1.ResultsThe sample consisted of 404 minority females (67.1% Latina; mean age = 12.5 ± .6; 60.6% were of normal weight). Weight concerns were positively correlated with emotional eating and BMI percentile (p < .001 for both). At follow-up, baseline worries significantly predicted emotional eating (p = .027) and weight concerns (p < .001) but not BMI percentile (p = .183). Emotional eating did not mediate the relationship between baseline worries and follow-up BMI percentile; however, it did moderate the relationship between baseline worries and follow-up BMI percentile (p = .003).ConclusionsIn this sample, worries were associated with psychosocial variables but not with BMI percentile. Reducing worries in those with high emotional eating scores may influence future weight gain among Latina females.     

Development and Testing of a Nutrition,Food Safety,and Physical Activity Checklist for EFNEP and FSNE Adult Programs

ObjectiveTo develop and assess reliability and validity of the Nutrition, Food Safety, and Physical Activity Checklist to measure nutrition, food safety, and physical activity practices among adult Expanded Food and Nutrition Education Program (EFNEP) and Food Stamp Nutrition Education program (FSNE) participants.MethodsTest-retest reliability (Cronbach α), internal consistency (Pearson Correlation), criterion-related validity (Spearman Correlation Coefficients), and sensitivity-to-change, were calculated for dietary quality, food safety, and physical activity, based on data collected from 73 EFNEP and FSNE participants.ResultsNutrition and physical activity domains achieved reliability coefficients of 0.70. The instrument scored Spearman correlation coefficients of 0.20 for nutrition, 0.34 for food safety, and 0.28 for physical activity.Conclusions and ImplicationsThe instrument consistently measured dietary and physical activity practices, but not food safety. All domains obtained low correlation coefficients, although consistent with other studies' validity results.     

The effectiveness of psychosocial interventions to support psychological well-being in post-operative bariatric patients: A systematic review of evidence

BackgroundBariatric surgery is considered an effective obesity management intervention for individuals with a BMI greater than 40, or 35 with co-morbidities. However, research documents that psychological difficulties prevalent amongst individuals seeking surgery may persist post-operatively. This systematic review aims to assess the evidence to show which psychosocial interventions support psychological well-being post-operatively.MethodsThe review is registered with Prospero (CRD42018100280), complying with PRISMA guidelines. The research protocol included grey literature and database searches of psychosocial interventions for post-operative bariatric patients, between November 2017 and September 2019. The primary outcome was psychological well-being; secondary outcomes included weight loss maintenance and quality of life (QoL). The primary reviewer screened titles and extracted data. Study quality was assessed independently by two reviewers, using the Effective Public Health Practice Project criteria. Due to heterogeneity across studies, narrative synthesis was considered suitable for data analysis.ResultsTen studies met inclusion criteria. Psychosocial intervention content was delivered in a variety of ways (e.g., clinic, internet-based). Overall, participants (N = 382, Mage = 46.4) receiving psychosocial interventions post bariatric surgery, demonstrated improvements in psychological well-being and weight loss maintenance, compared to baseline measures and/or controls. The strength of evidence is currently limited by the small number of studies found and study quality, limiting the power to detect clinically meaningful changes; findings should therefore be considered preliminary.ConclusionPreliminary findings suggest that interdisciplinary interventions including acceptance-based approaches, psychoeducation, nutrition and lifestyle modification, delivered 1-year post-operative, are promising. Further scientific enquiry is warranted with well-designed studies and long-term follow-ups.     

Healthy Choices for Every Body Adult Curriculum Improves Participants' Food Resource Management Skills and Food Safety Practices

Objective

To evaluate the impact of the University of Kentucky's Healthy Choices for Every Body (HCEB) adult nutrition education curriculum on participants' food resource management (FRM) skills and food safety practices.

Association Between Educational Attainment and EFNEP Participants’ Food Practice Outcomes

ObjectiveExamine the association between educational attainment and improvement in food practice outcomes of the California Expanded Food and Nutrition Education Program (EFNEP) participants.DesignSecondary data analysis.ParticipantsA total of 19,089 participants, 92.3% female, 77.2% Hispanic, 19.7% with ≤ sixth-grade education, and 68.9% with incomes ≤ 100% of the federal poverty level.Main Outcome MeasuresImprovement in food resource management practices (FRMP), nutrition practices, and food safety practices (FSP).AnalysisWilcoxon signed rank tests examined pre-post outcomes. Mann-Whitney U tests compared whether participants in the lowest and highest educational attainment quartiles had similar levels of improvement.ResultsCalifornia EFNEP is associated with improved FRMP (z = ?95.33), nutrition practices (z = ?94.91), and FSP (z = ?92.37); (P < 0.001). Lowest educational quartile was associated with more improvement in FRMP and FSP (P < 0.001).Conclusions and ImplicationsCalifornia EFNEP contributed to improved food practice outcomes for low and high educational attainment participants. Program content and instruction are effective across the education continuum.     

iStart Smart: A Primary-Care Based and Community Partnered Childhood Obesity Management Program for Chinese-American Children: Feasibility Study

Children who are ethnic minorities, low income and live in urban neighborhoods are at higher risk for obesity. This study examined the feasibility and efficacy of a primary care-based and community partnered obesity intervention in Chinese American children. An experimental design with a historical comparison group was used to explore the feasibility of an obesity intervention for overweight Chinese American children, ages 7–12. Data were collected on weight, height, blood pressure, waist circumference, physical activity, food intake, knowledge, and self-efficacy about diet and physical activity at baseline, 2 months, and 6 months post-baseline. Significant improvements in BMI, blood pressure, and nutrition knowledge and self-efficacy were found in the intervention group. Intervention group reduced their BMI compared to the comparison group (F = 8.65, p = .004). An obesity intervention in primary care setting is feasible and demonstrates a short-term effect on weight loss in Chinese American children.