Jennifer J. Otten

Effects of Television Viewing Reduction on Energy Intake and Expenditure in Overweight and Obese Adults: A Randomized Controlled Trial

BACKGROUND The average adult watches almost 5 hours of television (TV) per day, an amount associated with increased risks for obesity. This trial examines the effects of TV reduction on energy intake (EI), energy expenditure (EE), energy balance, body mass index (BMI), (calculated as weight in kilograms divided by height in meters squared), and sleep in overweight and obese adults. METHODS Randomized controlled trial of 36 adults with a BMI of 25 to 50 who self-reported a minimum of 3 h/d of TV viewing. Participants were enrolled in home-based protocols from January through July 2008. After a 3-week observation phase, participants were stratified by BMI and randomized to an observation-only control group (n = 16) or an intervention group (n = 20) for 3 additional weeks. The intervention consisted of reducing TV viewing by 50% of each participants objectively measured baseline enforced by an electronic lock-out system. RESULTS Although not statistically significant, both groups reduced their EI (-125 kcal/d [95% CI, -303 to 52] vs -38 [95% CI, -265 to 190]) (P = .52) for intervention and control group participants, respectively, where CI indicates confidence interval. The intervention group significantly increased EE (119 kcal/d [95% CI, 23 to 215]) compared with controls (-95 kcal/d [95% CI, -254 to 65]) (P = .02). Energy balance was negative in the intervention group between phases (-244 kcal/d [95% CI, -459 to -30]) but positive in controls (57 kcal/d [95% CI, -216 to 330]) (P = .07). The intervention group showed a greater reduction in BMI (-0.25 [95% CI, -0.45 to -0.05] vs -0.06 [95% CI, -0.43 to 0.31] in controls) (P = .33). There was no change in sleep. CONCLUSION Reducing TV viewing in our sample produced a statistically significant increase in EE but no apparent change in EI after 3 weeks of intervention. Trial Registration clinicaltrials.gov Identifier: NCT00622050.

Micronutrient quality of weight-loss diets that focus on macronutrients: results from the A TO Z study

BACKGROUND Information on the micronutrient quality of alternative weight-loss diets is limited, despite the significant public health relevance. OBJECTIVE Micronutrient intake was compared between overweight or obese women randomly assigned to 4 popular diets that varied primarily in macronutrient distribution. DESIGN Dietary data were collected from women in the Atkins (n = 73), Zone (n = 73), LEARN (Lifestyle, Exercise, Attitudes, Relationships, Nutrition) (n = 73), and Ornish (n = 72) diet groups by using 3-d, unannounced 24-h recalls at baseline and after 8 wk of instruction. Nutrient intakes were compared between groups at 8 wk and within groups for 8-wk changes in risk of micronutrient inadequacy. RESULTS At 8 wk, significant differences were observed between groups for all macronutrients and for many micronutrients (P < 0.0001). Energy intake decreased from baseline in all 4 groups but was similar between groups. At 8 wk, a significant proportion of individuals shifted to intakes associated with risk of inadequacy (P < 0.05) in the Atkins group for thiamine, folic acid, vitamin C, iron, and magnesium; in the LEARN group for vitamin E, thiamine, and magnesium; and in the Ornish group for vitamins E and B-12 and zinc. In contrast, for the Zone group, the risk of inadequacy significantly decreased for vitamins A, E, K, and C (P < 0.05), and no significant increases in risk of inadequacy were observed for other micronutrients. CONCLUSIONS Weight-loss diets that focus on macronutrient composition should attend to the overall quality of the diet, including the adequacy of micronutrient intakes. Concerning calorie-restricted diets, there may be a micronutrient advantage to diets providing moderately low carbohydrate amounts and that contain nutrient-dense foods.

Food Marketing to Children Through Toys: Response of Restaurants to the First U.S. Toy Ordinance

BACKGROUND On August 9, 2010, Santa Clara County CA became the first U.S. jurisdiction to implement an ordinance that prohibits the distribution of toys and other incentives to children in conjunction with meals, foods, or beverages that do not meet minimal nutritional criteria. Restaurants had many different options for complying with this ordinance, such as introducing more healthful menu options, reformulating current menu items, or changing marketing or toy distribution practices. PURPOSE To assess how ordinance-affected restaurants changed their child menus, marketing, and toy distribution practices relative to non-affected restaurants. METHODS Childrens menu items and child-directed marketing and toy distribution practices were examined before and at two time points after ordinance implementation (from July through November 2010) at ordinance-affected fast-food restaurants compared with demographically matched unaffected same-chain restaurants using the Childrens Menu Assessment tool. RESULTS Affected restaurants showed a 2.8- to 3.4-fold improvement in Childrens Menu Assessment scores from pre- to post-ordinance with minimal changes at unaffected restaurants. Response to the ordinance varied by restaurant. Improvements were seen in on-site nutritional guidance; promotion of healthy meals, beverages, and side items; and toy marketing and distribution activities. CONCLUSIONS The ordinance appears to have positively influenced marketing of healthful menu items and toys as well as toy distribution practices at ordinance-affected restaurants, but did not affect the number of healthful food items offered.

Relationship Between Self-report and an Objective Measure of Television-viewing Time in Adults

This study compared self‐reported television (TV)‐viewing time with an objective measure obtained by an electronic TV monitor. As part of a larger study, 40 overweight and obese adults (BMI: 31.7 ± 5.4 kg/m2; 53% obese; mean age 41.4 ± 13.0) self‐reported TV‐viewing time at study entry as the response to the question, “How many hours do you watch TV per day, on average?” Objective TV‐viewing time was measured in min/day over 3 weeks/subject using electronic monitors. Self‐reported viewing time was 4.3 ± 1.3 h/day (mean ± s.d.) (range: 3.0–8.0 h/day) vs. 4.9 ± 2.6 h/day (0.8–13.3 h/day) recorded by the electronic TV monitor. Subjects underestimated their viewing time by 0.6 ± 2.3 h/day (95% confidence interval = −1.34, 0.13), or 4.3 h/week. Slightly over half of the subjects (58%) underestimated their viewing time; 47.5% were within 1 h/day, and 72.5% were within 2 h/day of self‐reported viewing time. Large errors were rare in this group, suggesting that a simple self‐report measure of TV time may be useful for characterizing viewing behavior, although objective measurement adds precision that may be useful in certain settings.

The Stanford Healthy Neighborhood Discovery Tool: A Computerized Tool to Assess Active Living Environments

BACKGROUND The built environment can influence physical activity, particularly among older populations with impaired mobility. Existing tools to assess environmental features associated with walkability are often cumbersome, require extensive training, and are not readily available for use by community residents. PURPOSE This project aimed to develop and evaluate the utility of a computerized, tablet-based participatory tool designed to engage older residents in identifying neighborhood elements that affect active living opportunities. METHODS Following formative testing, the tool was used by older adults (aged ≥65 years, in 2011) to record common walking routes (tracked using built-in GPS) and geocoded audio narratives and photographs of the local neighborhood environment. Residents (N=27; 73% women; 77% with some college education; 42% used assistive devices) from three low-income communal senior housing sites used the tool while navigating their usual walking route in their neighborhood. Data were analyzed in 2012. RESULTS Elements (from 464 audio narratives and photographs) identified as affecting active living were commensurate with the existing literature (e.g., sidewalk features, aesthetics, parks/playgrounds, crosswalks). However, within each housing site, the profile of environmental elements identified was distinct, reflecting the importance of granular-level information collected by the tool. Additionally, consensus among residents was reached regarding which elements affected active living opportunities. CONCLUSIONS This tool serves to complement other assessments and assist decision makers in consensus-building processes for environmental change.

Effect of the Healthy Hunger-Free Kids Act on the Nutritional Quality of Meals Selected by Students and School Lunch Participation Rates

IMPORTANCE Effective policies have potential to improve diet and reduce obesity. School food policies reach most children in the United States. OBJECTIVE To assess the nutritional quality of foods chosen by students and meal participation rates before and after the implementation of new school meal standards authorized through the Healthy Hunger-Free Kids Act. DESIGN, SETTING, AND PARTICIPANTS This descriptive, longitudinal study examined changes in the nutritional quality of 1,741,630 school meals at 3 middle schools and 3 high schools in an urban school district in Washington state. Seventy two hundred students are enrolled in the district; 54% are eligible for free and reduced-price meals. Student food selection data were collected daily from January 2011 through January 2014 during the 16 months prior to and the 15 months after implementation of the Healthy Hunger-Free Kids Act. EXPOSURE The Healthy Hunger-Free Kids Act. MAIN OUTCOMES AND MEASURES Nutritional quality was assessed by calculating monthly mean adequacy ratio and energy density of the foods selected by students each day. Six nutrients were included in the mean adequacy ratio calculations: calcium, vitamin C, vitamin A, iron, fiber, and protein. Monthly school meal participation was calculated as the mean number of daily meals served divided by student enrollment. Mean monthly values of mean adequacy ratio, energy density, and participation were compared before and after policy implementation. RESULTS After implementation of the Healthy Hunger-Free Kids Act, change was associated with significant improvement in the nutritional quality of foods chosen by students, as measured by increased mean adequacy ratio from a mean of 58.7 (range, 49.6-63.1) prior to policy implementation to 75.6 (range, 68.7-81.8) after policy implementation and decreased energy density from a mean of 1.65 (range, 1.53-1.82) to 1.44 (range, 1.29-1.61), respectively. There was negligible difference in student meal participation following implementation of the new meal standards with 47% meal participation (range, 40.4%-49.5%) meal participation prior to the implemented policy and 46% participation (range, 39.1%-48.2%) afterward. CONCLUSIONS AND RELEVANCE Food policy in the form of improved nutrition standards was associated with the selection of foods that are higher in nutrients that are of importance in adolescence and lower in energy density. Implementation of the new meal standards was not associated with a negative effect on student meal participation. In this district, meal standards effectively changed the quality of foods selected by children.

Brief reportFood Marketing to Children Through Toys: Response of Restaurants to the First U.S. Toy Ordinance

BACKGROUND On August 9, 2010, Santa Clara County CA became the first U.S. jurisdiction to implement an ordinance that prohibits the distribution of toys and other incentives to children in conjunction with meals, foods, or beverages that do not meet minimal nutritional criteria. Restaurants had many different options for complying with this ordinance, such as introducing more healthful menu options, reformulating current menu items, or changing marketing or toy distribution practices. PURPOSE To assess how ordinance-affected restaurants changed their child menus, marketing, and toy distribution practices relative to non-affected restaurants. METHODS Childrens menu items and child-directed marketing and toy distribution practices were examined before and at two time points after ordinance implementation (from July through November 2010) at ordinance-affected fast-food restaurants compared with demographically matched unaffected same-chain restaurants using the Childrens Menu Assessment tool. RESULTS Affected restaurants showed a 2.8- to 3.4-fold improvement in Childrens Menu Assessment scores from pre- to post-ordinance with minimal changes at unaffected restaurants. Response to the ordinance varied by restaurant. Improvements were seen in on-site nutritional guidance; promotion of healthy meals, beverages, and side items; and toy marketing and distribution activities. CONCLUSIONS The ordinance appears to have positively influenced marketing of healthful menu items and toys as well as toy distribution practices at ordinance-affected restaurants, but did not affect the number of healthful food items offered.

Adherence to a low-fat vs. low-carbohydrate diet differs by insulin resistance status.

Previous research shows diminished weight loss success in insulin‐resistant (IR) women assigned to a low‐fat (LF) diet compared to those assigned to a low‐carbohydrate (LC) diet. These secondary analyses examined the relationship between insulin‐resistance status and dietary adherence to either a LF‐diet or LC‐diet among 81 free‐living, overweight/obese women [age = 41.9 ± 5.7 years; body mass index (BMI) = 32.6 ± 3.6 kg/m2]. This study found differential adherence by insulin‐resistance status only to a LF‐diet, not a LC‐diet. IR participants were less likely to adhere and lose weight on a LF‐diet compared to insulin‐sensitive (IS) participants assigned to the same diet. There were no significant differences between IR and IS participants assigned to LC‐diet in relative adherence or weight loss. These results suggest that insulin resistance status may affect dietary adherence to weight loss diets, resulting in higher recidivism and diminished weight loss success of IR participants advised to follow LF‐diets for weight loss.

Infographics And Public Policy: Using Data Visualization To Convey Complex Information

Data visualization combines principles from psychology, usability, graphic design, and statistics to highlight important data in accessible and appealing formats. Doing so helps bridge knowledge producers with knowledge users, who are often inundated with information and increasingly pressed for time.

Neighborhood Eating and Activity Advocacy Teams (NEAAT): engaging older adults in policy activities to improve food and physical environments.

ABSTRACTLocal food and physical activity environments are known to impact health, and older adults are generally more vulnerable to health-related environmental impacts due to poorer physical function and mobility impairments. There is a need to develop cost-conscious, community-focused strategies that impact local food and physical activity environment policies. Engaging older adult community residents in assessment and advocacy activities is one avenue to address this need. We describe the Neighborhood Eating and Activity Advocacy Team project, a community-based participatory project in low-income communal housing settings in San Mateo County, CA, as one method for engaging older adults in food and physical activity environment and policy change. Methods and strategies used by the “community action teams” to generate relevant neighborhood environmental data, build coalitions, prioritize complex issues, and advocate for change are presented. Advocacy groups are feasible among older adults to improve food and physical activity environments.