Courtney Perry

Eating Frequency is Associated With Energy Intake but Not Obesity in Midlife Women

Midlife women tend to gain weight with age, thus increasing risk of chronic disease. The purpose of this study was to examine associations between overweight/obesity and behavioral factors, including eating frequency, in a cross‐sectional national sample of midlife women (n = 1,099) (mean age = 49.7 years, and BMI = 27.7 kg/m2). Eating behaviors and food and nutrient intakes were based on a mailed 1‐day food record. BMI was calculated from self‐reported height and weight, and level of physical activity was assessed by self‐reported questionnaire. After exclusion of low‐energy reporters (32% of sample), eating frequency was not associated with overweight/obesity (P > 0.05) and was not different between BMI groups (normal, 5.21 ± 1.79; overweight, 5.16 ± 1.74; obese, 5.12 ± 1.68, P = 0.769). Adjusted logistic regression showed that eating frequency, snacking frequency, breakfast consumption, eating after 10 pm and consuming meals with children or other adults were not significantly associated with overweight/obesity. Total energy intake increased as eating frequency increased in all BMI groups, however, obese women had greater energy intake compared to normal weight women who consumed the same number of meals and snacks. Intake of fruit and vegetables, whole grains, dietary fiber, dairy, and added sugars also increased as eating frequency increased. While eating frequency was not associated with overweight/obesity, it was associated with energy intake. Thus, addressing total energy intake rather than eating frequency may be more appropriate to prevent weight gain among midlife women.

Time spent in home meal preparation affects energy and food group intakes among midlife women.

Time spent in meal preparation may be indicative of the healthfulness of meals and therefore with weight status. The purpose of this study was to examine the association between amount of time spent preparing meals and meal food group and nutrient content by meal occasion (breakfast, lunch, and dinner) among 1036 midlife women. Participants completed a 1-day food record and eating occasion questionnaires for each meal occasion. ANCOVA was used to identify possible associations. Approximately half of the participants reported spending <5 min preparing breakfast and lunch, and <20 min preparing dinner. Less time spent preparing breakfast was associated with lower energy and fat intakes (p<0.0001), while less time spent preparing lunch and dinner was associated with lower vegetable and sodium intakes (p<0.0001). There were no apparent differences in the association between time spent preparing meals and meal content by weight status. Nutrition education should encourage home meal preparation while stressing the selection of healthier options. The differing associations by meal occasion suggest that interventions should be tailored according to meal type.

Weight Gain Prevention among Midlife Women: A Randomized Controlled Trial to Address Needs Related to the Physical and Social Environment

Women tend to gain weight at midlife (40–60 years) increasing risk of obesity-related chronic diseases. Within specific eating occasions, needs related to the physical and social environment may result in less healthy eating behavior, which can lead to weight gain over time. The purpose of this study was to determine if a dietitian-delivered nutrition counseling intervention tailored to eating occasion needs could improve diet and prevent weight gain among midlife women over two years. A randomized controlled trial was conducted with healthy midlife women (n = 354) in one U.S. metropolitan area. The intervention group (n = 185) received ten hours of individual nutrition counseling from dietitians over six months, while women in a control group (n = 169) received no counseling. Measured height, weight and waist circumference, and dietary intakes were collected at baseline and every six months over two years. Mixed linear models were used to test for intervention effect on change in outcome variables over time. Dietary intakes of fruit, reduced/low-fat dairy foods and refined grains were significantly improved over time in the intervention compared to control group. However, the intervention had no effect on weight over time (p = 0.48). Nutrition counseling tailored to address eating occasion needs improved self-reported diet but did not significantly affect weight change.

Process Evaluation Measures Used to Assess a Multi-component Dietary Intervention: 5 a Day in Minnesota Elementary Schools

Abstract LEARNING OUTCOME: Identify Process Evaluation procedures that can be used to assess the effectiveness, quality and quantity of implementation of a multi-component intervention program. The purpose of the 5 a Day Power Plus study is to implement and assess the effectiveness of a school-based intervention for promoting increased consumption of fruits and vegetables among multicultural urban elementary school children to reduce future risk of cancer. Twenty schools from one urban school district were randomly assigned to Intervention and Control conditions. A cohort of students, originally in the fourth grade, participated in the program during two school years (1994-96). The Intervention components included school foodservice environmental changes, classroom curricula, family involvement, and food industry support. Process Evaluations were one of the methods used to assess the effectiveness, quality and quantity of implementation of these four inter-dependent areas. Trained observers recorded student choices of fruits and vegetables at lunch and also observed the implementation of the food service intervention. Teachers were observed in classrooms and completed questionnaires and weekly checklists. Students used self-reported scorecards and were asked for their opinions using a survey. Home involvement was assessed by parent return cards. Industry support was assessed by teacher, student and industry surveys. Results were similar in both 4th and 5th grades. Standardized lunch room observations conducted monthly in all schools proved an effective method to follow the progress of the program. Results showed, on average, students in Intervention Schools chose 0.5 more servings of fruit and vegetables at lunch than students in Control Schools. Teachers rated taste testing, snack preparations and home snack packs as the most effective parts of the curricula. The industry component was also highly rated. 45% of the students reported they liked taste testing and snack packs best, while only 5% rated the incentives as most important. However, only 33% of the parents sent return cards to verify they were involved. Process Evaluation is a valuable tool to verify that the program was completed according to protocol, to determine the level of participation and to explain impact on eating habits. Effective, easy-to-use Process Evaluations, such as described here, are feasible and critical for evaluation of all nutrition education programs.