H. Raymond Allen

A novel method to remotely measure food intake of free-living individuals in real time: the remote food photography method

The aim of the present study was to report the first reliability and validity tests of the remote food photography method (RFPM), which consists of camera-enabled cell phones with data transfer capability. Participants take and transmit photographs of food selection and plate waste to researchers/clinicians for analysis. Following two pilot studies, adult participants (n 52; BMI 20-35 kg/m2 inclusive) were randomly assigned to the dine-in or take-out group. Energy intake (EI) was measured for 3 d. The dine-in group ate lunch and dinner in the laboratory. The take-out group ate lunch in the laboratory and dinner in free-living conditions (participants received a cooler with pre-weighed food that they returned the following morning). EI was measured with the RFPM and by directly weighing foods. The RFPM was tested in laboratory and free-living conditions. Reliability was tested over 3 d and validity was tested by comparing directly weighed EI to EI estimated with the RFPM using Bland-Altman analysis. The RFPM produced reliable EI estimates over 3 d in laboratory (r 0.62; P < 0.0001) and free-living (r 0.68; P < 0.0001) conditions. Weighed EI correlated highly with EI estimated with the RFPM in laboratory and free-living conditions (r>0.93; P < 0.0001). In two laboratory-based validity tests, the RFPM underestimated EI by - 4.7 % (P = 0.046) and - 5.5 % (P = 0.076). In free-living conditions, the RFPM underestimated EI by - 6.6 % (P = 0.017). Bias did not differ by body weight or age. The RFPM is a promising new method for accurately measuring the EI of free-living individuals. Error associated with the method is small compared with self-report methods.

Validity of the Remote Food Photography Method (RFPM) for estimating energy and nutrient intake in near real-time.

Two studies are reported; a pilot study to demonstrate feasibility followed by a larger validity study. Study 1s objective was to test the effect of two ecological momentary assessment (EMA) approaches that varied in intensity on the validity/accuracy of estimating energy intake (EI) with the Remote Food Photography Method (RFPM) over 6 days in free‐living conditions. When using the RFPM, Smartphones are used to capture images of food selection and plate waste and to send the images to a server for food intake estimation. Consistent with EMA, prompts are sent to the Smartphones reminding participants to capture food images. During Study 1, EI estimated with the RFPM and the gold standard, doubly labeled water (DLW), were compared. Participants were assigned to receive Standard EMA Prompts (n = 24) or Customized Prompts (n = 16) (the latter received more reminders delivered at personalized meal times). The RFPM differed significantly from DLW at estimating EI when Standard (mean ± s.d. = −895 ± 770 kcal/day, P < 0.0001), but not Customized Prompts (−270 ± 748 kcal/day, P = 0.22) were used. Error (EI from the RFPM minus that from DLW) was significantly smaller with Customized vs. Standard Prompts. The objectives of Study 2 included testing the RFPMs ability to accurately estimate EI in free‐living adults (N = 50) over 6 days, and energy and nutrient intake in laboratory‐based meals. The RFPM did not differ significantly from DLW at estimating free‐living EI (−152 ± 694 kcal/day, P = 0.16). During laboratory‐based meals, estimating energy and macronutrient intake with the RFPM did not differ significantly compared to directly weighed intake.

Use of a Computerized Tracking System to Monitor and Provide Feedback on Dietary Goals for Calorie-Restricted Diets: The POUNDS LOST Study

The use of self-monitoring as a tool to facilitate behavioral modification is common in many lifestyle-based weight loss interventions. Electronic tracking programs, including computer-based systems and smart phone applications, have been developed to allow individuals to self-monitor their behavior digitally. These programs offer an advantage over traditional self-report modalities in that they can provide users with direct feedback about dietary and/or physical activity adherence levels and thereby assist them in real-time decision making. This article describes the use of an Internet-based computerized tracking system (CTS) that was developed specifically for the POUNDS LOST study, a 2-year randomized controlled trial designed to test the efficacy of four macronutrient diets for weight and fat reduction in healthy, overweight men and women (body mass index range = 25.0–39.9 kg/m2). The CTS served many functions in this study, including data collection, dietary and exercise assessment and feedback, messaging system, and report generation. Across all groups, participants with high usage of the CTS during the initial 8 weeks lost greater amounts of weight than participants with low usage (8.7% versus 5.5% of initial body weight, respectively; p < .001) at week 32. Rates of CTS utilization were highest during the first year of this 2-year intervention, and utilization of the CTS declined steadily over time. The unique features of the CTS combined with technological developments, such as smart phone applications, offer significant potential to improve the users self-monitoring experience and adherence to health promotion programs designed specifically for individuals with obesity and type 2 diabetes.

The development of the Body Morph Assessment version 2.0 (BMA 2.0): tests of reliability and validity.

This study tested the psychometric characteristics of the Body Morph Assessment version 2.0 (BMA 2.0). A sample of 563 adults composed of four groups classified by gender and ethnicity (Caucasian men and women and African-American men and women) were studied. Support for the internal consistency and test-retest reliability of the BMA 2.0 was found for both men and women. A study of convergent validity was conducted. The BMA 2.0 was found to have adequate reliability and validity. Norms were established for the BMA 2.0 estimates of current body size (CBS), ideal body size (IBS), and acceptable body size (ABS) for Caucasian and African-American men and women. In summary, the BMA 2.0 is a reliable and valid computerized measure of CBS, IBS, ABS, the CBS-IBS discrepancy (body dissatisfaction), and provides an estimate of over/underestimation of body size as compared to individuals of the same sex and body mass index.

Parent-Targeted Mobile Phone Intervention to Increase Physical Activity in Sedentary Children: Randomized Pilot Trial

Background Low levels of moderate-to-vigorous physical activity are associated with adverse health consequences. Objective The intent of the study was to determine the feasibility and efficacy of a 12-week physical activity promotion program targeting children, which was delivered to parents through mobile phones. Methods Potential participants were recruited through advertisements placed in the newspaper, local hospitals and schools, and an email listserv. Sedentary children aged 6-10 years were randomly assigned to a minimal (MIG) or intensive (IIG) intervention group. Parents in the MIG were given a goal to increase (within 1 month) and maintain their child’s activity at 6000 pedometer steps/day above their baseline levels and to monitor their child’s steps daily. Parents in the IIG were given the same steps/day and monitoring goals, in addition to text messages and articles containing additional behavioral strategies (based on the Social Cognitive Theory) designed to promote their child’s physical activity. The intervention components were delivered via mobile phone. Anthropometrics, body composition, and questionnaires were administered in a clinic. Children wore a New Lifestyles pedometer (NL-1000) each day throughout the intervention and parents were to monitor their child’s step counts daily. Results Out of 59 children who screened for the study, a total of 27 children (mean age 8.7, SD 1.4 years; 56%, 15/27 female; 59%, 16/27 African American) were enrolled and completed the study. Overall, 97.90% (2220/2268; 98.20%, 1072/1092 for MIG; 97.60%, 1148/1176 for IIG) of expected step data were successfully entered by the parent or study coordinator. Parents in the MIG and IIG were sent approximately 7 and 13 text messages per week, respectively, averaged over the course of the study. IIG parents accessed an average of 6.1 (SD 4.4) articles over the course of the intervention and accessed a fewer number of articles in the last month compared to the first 2 months of the study (P=.002). Children in both the MIG and IIG significantly increased their physical activity, averaged over 12 weeks, by 1427.6 (SD 583.0; P=.02) and 2832.8 (SD 604.9; P<.001) steps/day above baseline, respectively. The between group difference was not statistically significant (P=.10; effect size=.40), nor was the group by time interaction (P=.57). Regardless of group assignment, children who significantly increased their physical activity reported greater increases in physical activity enjoyment (P=.003). The number of behavioral articles accessed by IIG parents was significantly correlated with change in children’s steps/day (r=.575, P=.04). Changes in children’s steps/day were unrelated to changes in their body composition, mood, and food intake. Conclusions Parent-targeted mobile phone interventions are feasible, yet more intense interventions may be needed to support parents’ efforts to increase their children’s physical activity to levels that approximate national recommendations. Trial Registration Clinicaltrials.gov NCT01551108; http://clinicaltrials.gov/show/NCT01551108 (Archived by WebCite at http://www.webcitation.org/6TNEOzXNX).

Development of an Internet/Population-Based Weight Management Program for the U.S. Army

A significant number of Army soldiers are sufficiently overweight to exceed the maximum weight allowances defined by the Army weight control program (AR600–9). Also, the body weights of a substantial number of soldiers approach the maximum weight allowances. These soldiers should not gain additional weight if they are to meet Army weight allowances. The conventional approach to this overweight problem is assigning soldiers to remedial physical training and mandatory referral for nutrition counseling by a health care provider. An alternative to this conventional approach is to target the entire population of soldiers (population-based intervention) to promote weight loss in overweight soldiers and weight gain prevention in soldiers who are approaching overweight status. To accomplish this objective, the Healthy Eating, Activity, and Lifestyle Training Headquarters (H.E.A.L.T.H.) program was developed. This article describes the rationale for developing the program, the components of the program, and the utilization promotion strategies of the program. The H.E.A.L.T.H. program includes two primary components: (1) a Web site tailored to the standards established in Field Manual 21–20, Physical Fitness Training, Army physical fitness test, and AR600-9, the army weight control program, and (2) a health promotion program designed to promote awareness of the H.E.A.L.T.H. Web site and to facilitate use of the Web site by soldiers and their family members. The Web site is equipped with personalized planning tools and progress tracking over time related to fitness, caloric intake, and lifestyle behavior change goals. The health promotion program includes media advertisements and “ground roots” efforts to facilitate use by soldiers.

Baton Rouge Healthy Eating and Lifestyle Program (BR-HELP): A Pilot Health Promotion Program

Preventing weight gain rather than treating recognized obesity is an important economic and public health response to the growing levels of obesity nationwide. Community centers offer potential sites for community health promotion programs targeting African Americans. In this article, results from a pilot health promotion program at a community center are reported. The purpose of this 12-month pilot program was to improve diet and increase physical activity to prevent weight gain in African-American adults by delivering a lifestyle intervention. Fifty-one African-American adults were randomized into two groups: lifestyle intervention or financial counseling, and 73% completed the program. At the end of 12 months, weight for all participants was maintained from baseline to completion with no significant differences between the groups. Both lifestyle intervention and financial counseling groups were approximately 87% food secure with improvements observed in self-esteem and total quality of life scores.

Plate waste of adults in the United States measured in free-living conditions

We analyze food-item level data collected from 50 adults from the United States using the Remote Food Photography Method® to provide the first estimates of plate waste gathered from adults across multiple consecutive meals and days in free-living conditions, and during laboratory-based meals with fixed food items and quantities. We find average plate waste in free-living conditions is 5.6 grams (7.7 kcals) per item and that 3.3% of all food selected is returned as plate waste, where the percent waste figure is substantially lower than previously published plate waste estimates gathered primarily from dine-out settings in the United States such as buffets and institutional settings with limited-choice meals (e.g., school cafeterias). Plate waste from the same participants during the laboratory-based meals is significantly higher with an average of 203.2 grams of solid plate waste per meal (531.3 kcals) or 39.1% of the food provided, which is similar to the plate waste percentages found reported in some school cafeteria settings. The amount of plate waste generated in free-living conditions is significantly positively associated with portion size selected for an item. In a multivariate analysis that controls for macronutrient profile, items selected from the vegetables, fats/oils/dressings, and grains categories are associated with significantly greater amounts of plate waste per item. We find no significant associations between free-living plate waste and gender, age, race or body mass index but find that women leave more plate waste in the lab meal where portion sizes are pre-determined by the researcher and similar for all respondents. We discuss possible implications of these findings for programs focused on reducing plate waste and food waste among consumers.

Reliability and Validity of a Novel Internet-Based Battery to Assess Mood and Cognitive Function in the Elderly

Dementia is a chronic condition in the elderly and depression is often a concurrent symptom. As populations continue to age, accessible and useful tools to screen for cognitive function and its associated symptoms in elderly populations are needed. The aim of this study was to test the reliability and validity of a new internet-based assessment battery for screening mood and cognitive function in an elderly population. Specifically, the Helping Hand Technology (HHT) assessments for depression (HHT-D) and global cognitive function (HHT-G) were evaluated in a sample of 57 elderly participants (22 male, 35 female) aged 59-85 years. The study sample was categorized into three groups: 1) dementia (n = 8; Mini-Mental State Exam (MMSE) score 10-24), 2) mild cognitive impairment (n = 24; MMSE score 25-28), and 3) control (n = 25; MMSE score 29-30). Test-retest reliability (Pearson correlation coefficient, r) and internal consistency reliability (Cronbachs alpha, α) of the HHT-D and HHT-G were assessed. Validity of the HHT-D and HHT-G was tested via comparison (Pearson r) to commonly used pencil-and-paper based assessments: HHT-D versus the Geriatric Depression Scale (GDS) and HHT-G versus the MMSE. Good test-retest (r = 0.80; p < 0.0001) and acceptable internal consistency reliability (α= 0.73) of the HHT-D were established. Moderate support for the validity of the HHT-D was obtained (r = 0.60 between the HHT-D and GDS; p < 0.0001). Results indicated good test-retest (r = 0.87; p < 0.0001) and acceptable internal consistency reliability (α= 0.70) of the HHT-G. Validity of the HHT-G was supported (r = 0.71 between the HHT-G and MMSE; p < 0.0001). In summary, the HHT-D and HHT-G were found to be reliable and valid computerized assessments to screen for depression and cognitive status, respectively, in an elderly sample.