Joanne P. Ikeda

The National Weight Control Registry: A Critique

This article is a critique of the claim that the National Weight Control Registry provides data showing that a significant number of adults in the United States have achieved permanent weight loss. We believe that promoting calorie-restricted dieting for the purpose of weight loss is misleading and futile. We advocate the adoption of a health-at-every-size (HAES) approach to weight management, focusing on the achievement and maintenance of lifestyle changes that improve metabolic indicators of health.

Food habits of the hmong living in central California

Abstract In order to design more effective nutrition education programs for the over 50,000 Hmong who have immigrated to Central California from Southeast Asia, a study of their food habits was undertaken. Focus interviews were conducted with key informants working in the Hmong community. Using information from these interviews, two questionnaires were constructed to gather specific information on cultural food habits. Trained bilingual paraprofessionals administered the questionnaires, gathered demographic data, and took 24-hour food recalls from 205 volunteer, low-income Hmong home-makers about to be enrolled in the EFNEP Program in San Joaquin, Merced, and Fresno counties. Results of the study include a descriptive summary of eating patterns, staple foods, food preparation, familiar and unfamiliar foods, food procurement, food handling, perceptions and beliefs regarding body size and health, and expressed food and nutrition needs and interests. Computer nutrient analysis of the food recalls from non-pregnant subjects (N-142) revealed intakes of less than 80% of the 1989 RDA for riboflavin, calcium, iron, magnesium, and zinc. Pregnant subjects (N = 63) had low intakes of these nutrients, as well as of vitamins B-6 and folacin.

Culturally Relevant Nutrition Education Improves Dietary Quality Among WIC-Eligible Vietnamese Immigrants

OBJECTIVE To provide culturally appropriate nutrition education to improve the diets of Vietnamese women. DESIGN A total of 152 homemakers were recruited to participate in a nutrition education project, with 76 receiving the intervention and 76 serving as the control group. SUBJECTS/SETTING Non-English-speaking women eligible for the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) with incomes below 185% of the poverty level living in 5 California counties. INTERVENTION Bicultural, bilingual Vietnamese-American nutrition education assistants taught 5 to 7 lessons in the Vietnamese language using nutrition education materials written in the Vietnamese language by 2 bilingual, bicultural nutritionists. MAIN OUTCOME MEASURES Twenty-four-hour food recalls were obtained before and after the 8-week interval on the treatment and control groups. STATISTICAL ANALYSIS To examine if there were changes over time in nutrient intake and nutrient density within groups, matched pair t tests were done. Analysis of covariance techniques determined differences between groups. McNemar tests determined if, within groups, there were changes over time in food groups consumed. Chi-square techniques determined changes between groups. RESULTS Over time, the number of treatment group participants who had at least one serving from each food group (P <.01), and who had the recommended number of servings from each food group (P <.05), significantly increased in comparison to the control group. Over time, the dietary nutrient density of calcium, riboflavin, and vitamin B6 (P <.05), as well as potassium (P <.01), of treatment group participants significantly improved in comparison to the control group. IMPLICATIONS With training, bilingual, bicultural women can effectively deliver culturally relevant nutrition education to their peers.

DIETARY APPROACHES TO THE TREATMENT OF THE OVERWEIGHT PEDIATRIC PATIENT

A review of recently published studies on the dieting practices of children and adolescents examines the impact those practices are having on the overall health of youth who are overweight and those who are not. Recommendations for improving the nutritional quality of childrens diets are made based on the food consumption patterns of youngsters ages 2 to 18 years. If implemented, these recommendations would lower calories, fat, saturated fat, and cholesterol, while improving nutrient density. Guidelines for the treatment of childhood overweight from four organizations are presented in chart form.

Baseline Correlates of Insulin Resistance in Inner City High‐BMI African‐American Children

To characterize the influence of diet‐, physical activity–, and self‐esteem‐related factors on insulin resistance in 8–10‐year‐old African‐American (AA) children with BMI greater than the 85th percentile who were screened to participate in a community‐based type 2 diabetes mellitus (T2DM) prevention trial. In 165 subjects, fasting glucose‐ and insulin‐derived values for homeostasis model assessment of insulin resistance (HOMA‐IR) assessed insulin resistance. Body fatness was calculated following bioelectrical impedance analysis, and fitness was measured using laps from a 20‐m shuttle run. Child questionnaires assessed physical activity, dietary habits, and self‐esteem. Pubertal staging was assessed using serum levels of sex hormones. Parent questionnaires assessed family demographics, family health, and family food and physical activity habits. Girls had significantly higher percent body fat but similar anthropometric measures compared with boys, whereas boys spent more time in high‐intensity activities than girls. Scores for self‐perceived behavior were higher for girls than for boys; and girls desired a more slender body. Girls had significantly higher insulin resistance (HOMA‐IR), compared with boys (P < 0.01). Adjusting for age, sex, pubertal stage, socioeconomic index (SE index), and family history of diabetes, multivariate regression analysis showed that children with higher waist circumference (WC) (P < 0.001) and lower Harters scholastic competence (SC) scale (P = 0.044) had higher insulin resistance. WC and selected self‐esteem parameters predicted insulin resistance in high‐BMI AA children. The risk of T2DM may be reduced in these children by targeting these factors.

Two approaches to adolescent weight reduction

Abstract As part of our community weight control program for adolescents, we offered two different 14-week treatment approaches: a behavioral approach without energy restriction and a behavioral approach combined with energy restriction. We recruited 50 youths 14 to 16 years old and up to 55 percent above ideal weight. Twenty-seven participants completed the program and were available for 1-year follow-up. In comparison to ideal body weight, 3 gained weight, 12 maintained, and 12 lost during the program. At the 1-year follow-up, 11 had lost weight compared with initial weight; 7 of these subjects had also lost weight during the program, and the other 4 had maintained or gained weight during the program. We found no difference in the results of the two approaches. Comparison of pre- and posttest results revealed significant improvement in knowledge about weight control among those who completed the program. We found a strong positive correlation between gain in cognitive knowledge and drop in percent overweight. Parti ipants indicated that the program had been most helpful by increasing individual awareness of eating and exercise habits.

Influence of body dissatisfaction on 1-year change in nutrient intake of overweight and obese inner-city African American children

This analysis aimed to examine the relationship of baseline body dissatisfaction with 1-year change in nutrient intake of inner-city, overweight and obese, African American children. This is a secondary analysis of 1-year pre-post data available for a convenience sample of 88 children. After adjusting for baseline intake of dietary variables and intervention group status, baseline body dissatisfaction was associated with 1-year increases in intake of energy, and all macronutrients in girls, but not in boys. These relationships were not substantially altered after adjusting for baseline BMIz and global self-worth. After including all adjustment factors, increasing baseline body dissatisfaction in girls was associated with 1-year increased intake of total energy, total sugars, total fat, discretionary fat, and total carbohydrates. This analysis suggests that, in girls but not necessarily in boys, body dissatisfaction might need to be targeted during interventions that aim to improve nutrient intake.

Evaluating the Impact of Nutrition Programs on Psychosocial Health

I have always felt that we, ie, nutrition educators, need to evaluate the impact our programs have on psychological and social components of health. How many of us have evaluated changes in self-efficacy, perceived control, and expectations with regard to attitudes, habits, and behavioral intentions? It is also rare to find those of us who have used instruments to assess changes in self-esteem, body image, and body satisfaction. Just before my retirement from UC Berkeley, a group of us completed a 5-year study attempting to reduce the risk of type 2 diabetes in African American children ages 8 to 10 years old. This study was unique in that we assessed changes in a wide variety of factors, such as insulin resistance, body fatness, fitness, physical activity, pubertal stage, dietary habits, family health, family food and physical activity habits, and childrens selfesteem. One of the specific goals of the intervention was to improve the self-esteem of the children. Our results showed that improvements in insulin resistance measures were significantly related with improved measures of self-esteem. Our conclusion was, ‘‘Improving the selfesteem and hence self-perception of ones ability could be an important first step in achieving the dietary and physical activity behavioral modifications needed to decrease the risk for T2DM.’’ If you or a graduate student is in need of a worthy project, consider conducting a search to identify valid and reliable indicators of psychological and social health that can be used in the evaluation of nutrition education programs. Publishing a short description of each instrument, what it assesses, where it can be found, and how one obtains permission to use it would be invaluable to the profession. A model of this type of article can be found in this journal! Read ‘‘Psychosocial Measures Used to Assess the Effectiveness of School-based Nutrition Education Programs.’’

Californians face weight and health care crisis

T United States is facing a health care crisis that will only worsen if current trends in childhood and teen overweight and obesity are not reversed. National estimates from the 19992002 National Health and Nutrition Examination Survey reveal that more than 15% of children and teens from 6 to 19 years old are overweight. Increasing across all social and ethnic populations, rates of childhood obesity are generally highest for Latino and Native American children of both sexes and for African American girls. While some children may be more genetically susceptible to becoming overweight, all children are at risk for poor quality diets and a sedentary lifestyle. These trends are particularly alarming because the same ethnic groups most vulnerable to obesity may also be genetically more susceptible to type 2 diabetes. Correlated with the obesity trend, rates of diabetes have increased dramatically in the past decade. The prevalence of diabetes nationwide has increased 33% in this period — and its incidence in California has increased by 67%. This increase is due in part to aging of the population, and also to improved screening and detection. In addition, type 2 diabetes, once considered “adult-onset,” is now being diagnosed among children and teens. The economic implications of these trends are profound. A report by the former U.S. Surgeon General put the economic cost of obesity in the United States at about

Evaluating the Effectiveness of a One Day Workshop to Enhance Health Professionals’ Skills In Dealing With Children And Weight Issues: Children & Weight: What Health Professionals Can Do

117 billion in 2000 — second only to tobacco as a cause of increased national health care expenditures. The current estimated direct and indirect costs of diabetes to the nation are over