Marjorie R. Freedman

Popular Diets: Correlation to Health, Nutrition, and Obesity

OBJECTIVE To examine the association between a range of health and nutrition indicators and popular diets. DESIGN The Continuing Survey of Food Intake by Individuals (CSFII) 1994-1996 data were used to examine the relationship between prototype popular diets and diet quality as measured by the healthy eating index (HEI), consumption patterns, and body mass index (BMI). The prototype diets included vegetarian (no meat, poultry, or fish on day of survey) and non-vegetarian. The nonvegetarian group was further subdivided into low carbohydrate (less than 30% of energy from carbohydrate), medium (30% to 55%), and high (greater than 55% of energy). Within the high carbohydrate group, participants were classified as having Pyramid or non-Pyramid eating patterns. The Pyramid group was defined as 30% or less of energy from fat and at least one serving from the five major food groups in the USDA Food Guide Pyramid. Finally, the non-Pyramid group was further subdivided into low fat (less than 15% of energy from fat) and moderate fat (15% to 30% of energy from fat). In addition, a review of the published scientific literature was conducted; all studies identified were included in the review. SUBJECTS 10,014 adults, aged 19 years and older, from the 1994-1996 CSFII were included in the analyses of extant data. More than 200 individual studies were included in the review of the literature. RESULTS Analyses of the CSFII indicate that diet quality as measured by HEI was highest for the high carbohydrate Pyramid group (82.9) and lowest for the low carbohydrate group (44.6). Energy intakes were low for the vegetarians (1,606 kcals) and high carbohydrate/low fat group (1360 kcals). BMIs were lowest for women in the vegetarian group (24.6) and the high carbohydrate/low fat group (24.4); for men, the lowest BMIs were observed for vegetarians (25.2) and the high carbohydrate Pyramid group (25.2). Review of the literature suggests that weight loss is independent of diet composition. Energy restriction is the key variable associated with weight reduction in the short term. CONCLUSIONS Diets that are high in carbohydrate and low to moderate in fat tend to be lower in energy. The lowest energy intakes were observed for those on a vegetarian diet. The diet quality as measured by HEI was highest for the high carbohydrate groups and lowest for the low carbohydrate groups. The BMIs were significantly lower for men and women on the high carbohydrate diet; the highest BMIs were noted for those on a low carbohydrate diet.

Reducing Portion Size Reduces Food Intake and Plate Waste

As portion size (PS) increases, so does food intake. The effect of decreasing PS on food intake in a nonlaboratory setting is unknown. This 5‐week study sought to determine whether decreasing PS resulted in decreased intake of the same food, and if so, at what point further PS reductions might lack benefit. It also assessed effects of PS reduction on food production and waste in a university all‐you‐can‐eat dining facility (DF). Subjects were primarily freshmen who regularly ate lunch at the DF, and self‐selected French fries (FF) presented in individual paper bags, portioned originally at 88 g, and decreased ∼15 g/week for 3 weeks. Diners were covertly observed choosing one or more bags. Total FF production and plate waste (PW) were determined daily. Decreasing PS resulted in significant decreases in consumption per diner (P < 0.05) and PW (P < 0.05), and nonsignificant decreases in total FF consumption and production. PS was positively correlated with consumption per diner (r = 0.897, P = 0.001) and PW (r = 0.852, P = 0.001), but inversely correlated with number of diners choosing ≥2 bags (r = −0.809, P = 0.003). Total FF production was positively correlated with PW (r = 0.728, P = 0.011). This study shows that reducing PS of a particular item in an all‐you‐can‐eat environment results in reduced intake of that food for most individuals, and that reducing PS reduces PW and food production.

Body Awareness, Eating Attitudes, and Spiritual Beliefs of Women Practicing Yoga

This research evaluated attitudes about body image and eating in women practicing postural yoga. Study 1 described scores from questionnaires on variables related to body awareness, intuitive eating, spirituality, and reasons for practicing. Scores were favorable on all measures with significant correlations (p < .01) among all main variables except between spiritual readiness and intuitive eating, and between BMI and both body awareness and spiritual readiness. Reasons for practicing did not affect scores. Study 2 evaluated interviews in a sub-sample. Qualitative data reported improvements in body satisfaction and disordered eating due in part to yoga and its associated spirituality.

Early Childhood Feeding: Assessing Knowledge, Attitude, and Practices of Multi-Ethnic Child-Care Providers

Early childhood is a critical period for shaping and influencing feeding and lifestyle behaviors that have implications for future weight and health. With more women in the workforce, families have become reliant on child care. Thus, the child-feeding relationship has become a shared responsibility between the parent and child-care provider. Little is known about the impact of child-care providers on development of early childhood feeding behaviors and subsequent risk for obesity, especially in the Hispanic ethnic group. This research examined child-feeding attitudes, practices, and knowledge of multi-ethnic home-based and center-based child-care providers. Questionnaires were completed by a convenience sample of 72 providers, 50 of whom completed a pre- and post-test on child-feeding knowledge after receiving a 90-minute class based on Satters division of responsibility feeding model during the spring of 2008. Results indicate many providers had practices consistent with this model. However, substantial differences were reported by Hispanic providers, who were statistically more likely to encourage children to finish meals before dessert, prepare foods they perceived as well-liked by children, coach children to eat foods perceived as appropriate, and not eat with children during meals. A substantial increase in knowledge from 73% correct at pretest to 82% at post-test was noted, with a substantial increase in knowledge on five of 13 questions. However, knowledge was not always congruent with behavior. This study points to differences among providers based on ethnicity, and strongly recommends recruiting Hispanic child-care providers to participate in educational programs and community efforts to prevent obesity.

Diet patterns of first, second and third generation Greek-American women

Typical and pregnancy diet patterns of 135 first, second and third generation Greek‐American women of Sacramento, California, are reported. Significant differences were found in fourteen instances between respondent generation, composition of meals and timing of food intake. Older first generation women consumed less bread and cereals at the morning meal during pregnancy in the belief that restriction produces a lower birth weight baby. More second and third generation women increased bread and cereal consumption during pregnancy in the conviction that such foods were beneficial in promoting good health. Differences identified when comparing typical versus pregnancy dietary patterns support the positive relationship between foods in specific groups consumed and respondent generation, reinforcing the need for awareness of the latter when providing nutritional advice. Foods believed especially good during pregnancy included milk; vegetables such as dandelion, chicory and mustard greens; meats such as lamb a...

Obesity and Food Choices Among Faculty and Staff at a Large Urban University

Abstract Objective: In order to address increasing health care costs associated with obesity, this study sought to determine prevalence of overweight and obesity and examine eating behaviors, food choices, health beliefs, and attitudes of university employees. Participants and Methods: An online survey was distributed to > 3,800 faculty and staff at a large public metropolitan university in Winter 2008. Results: Almost half (48%) of 806 respondents were classified as overweight or obese. Compared to those with normal weights, overweight and obese respondents consumed fewer fruits and vegetables (p < .05), were less confident in making healthful food choices (p < .001), and were more influenced by food choices available in on-campus dining facilities (p < .05). Conclusions: Obesity among university employees warrants attention. Because these employees have less self-efficacy and consume less healthful diets than their normal weight colleagues, universities need to improve on-campus access to healthful foods.

Development, Evaluation, and Validation of Environmental Assessment Tools to Evaluate the College Nutrition Environment

Abstract Objective: To develop, evaluate, and validate 2 nutrition environment assessment tools (surveys), for specific use in combating overweight on college/university campuses. Participants and Methods: Invitations to complete surveys were e-mailed to food service and health center directors at 47 universities, Winter 2008. Overall response rate was 48%. Responses from the 39 individuals who completed tool evaluations at the end of each survey were analyzed. Follow-up interviews and site visits performed through Summer 2008 validated responses. Results: The majority of respondents (64%) indicated tools were effective at assessing their nutrition environments; 78% believed these types of assessment tools to be important to their school. Conclusion: Food service and health center directors support use of nutrition environment assessment tools and found them effective at clarifying existing nutrition programs, policies, and food offerings on their campuses. Conducting assessments using these tools could improve university nutrition environments by identifying areas needing improvement.

Infant-feeding practices of low-income Vietnamese American women

Healthy People 2010 breastfeeding goals include 50% exclusive breastfeeding at 6 months. In California, US, Santa Clara County Women, Infants, and Children (SCCWIC) data indicated Asian participants had low (5.6%) 6-month breastfeeding rates. To examine infant-feeding practices, Vietnamese breastfeeding peer counselors surveyed 133 Vietnamese SCCWIC participants (≥ 18 years old, nonpregnant, < 28 months postpartum) using a structured questionnaire regarding intentions, attitudes, and subjective norms toward breastfeeding. Results indicated that 75% initiated breastfeeding in the hospital (33% exclusively, 42% partially), and 25% exclusively formula fed. At survey time, 49% had terminated breastfeeding (average duration 4.4 months). Feeding intentions during pregnancy predicted feeding method used (P < .001). Most prenatal advice was from SCCWIC employees, friends, and doctors who supported breastfeeding. Most postnatal advice was from nurses who supported breastfeeding and bottle-feeding equally. Stronger control beliefs, peer counseling, and education were correlated with breastfeeding (P < .001). Improved postdelivery hospital advice may further increase breastfeeding initiation and duration. J Hum Lact . 24(4):406-414. Entre las metas de Healthy People 2010 están el 50% de lactancia materna exclusiva a los 6 meses. Datos del programa WIC del condado de Santa Clara (SCCWIC) indicaron bajos índices de lactancia materna a los 6 meses (5.6%) entre las participantes asiáticas. Madres consejeras de lactancia vietnamitas encuestaron 133 participantes vietnamitas del programa SCCWIC (>18 años, no embarazadas, <28 meses postparto) usando un cuestionario estructurado en relación a las intenciones, actitudes y normas subjetivas hacia la lactancia materna. Los resultados indicaron que 75% iniciaron la lactancia materna en el hospital (33% exclusivamente, 42% parcial); 25% alimentación exclusiva con formula. Al momento de la encuesta, 49% habían suspendido la lactancia materna (promedio de duración 4.4 meses). La intención de alimentación infantil durante el embarazo predijo el método utilizado (p<0.001). La mayoría de los consejos fueron de empleados del programa SCCWIC, amigos y doctores que apoyaron la lactancia materna. La mayoría de los consejos postnatales fueron de enfermeras que apoyaban la lactancia materna y la alimentación con biberón igualmente. Fuertes creencias de control, conserjería de madres y educación se correlacionaron con la lactancia materna (p<0.001). Una mejor conserjería después de la salida del hospital puede aumentar la iniciación y la duración de la lactancia materna.

A “Healthy Pizza Kitchen” Nutrition Education Program at a Children's Health Museum

For nutrition education to be successful in changing behavior, schools, families, and communities must participate in or provide a variety of diverse, creative, accessible, and culturally appropriate programs. One venue forprovisionofnutritioneducation is a health and science education center that has exhibits and special programs not found in an average school. Establishing relationships with these organizations could greatly enhance a school health curriculum. Although nutrition information, displays, and programming are often found in these centers, studies examining whether provision of nutrition education in these venues increases knowledge or changes behavior are lacking. The purpose of this study, based on Social Cognitive Theory, was to evaluate the effectiveness of a field trip to an interactive healthmuseum with a hands-on ‘‘Healthy Pizza Kitchen’’ (HPK) exhibit in teaching basic nutrition concepts relating to MyPyramid and creating balanced meals to multi-ethnic fifth-grade students.

Examining a New “Pay-as-You-Go” Community-Supported Agriculture (CSA) Model: A Case Study

In the traditional community-supported agriculture (CSA) model, members “pay up-front” for a seasonal subscription to the farm and receive, in return, a weekly box of farm-fresh produce. Long-term sustainability depends on high levels of member retention and/or recruitment. Low retention rates have led some CSAs to offer non-produce items, to allow customers to choose box contents, or to use a “pay-as-you-go” model. This research aimed to provide insight into the viability of a flexible pay-as-you-go CSA by examining member characteristics, motivations for joining and maintaining membership, and dietary behavior. An anonymous e-mail-linked survey was sent to current and former J&P Organics farm CSA subscribers. A total of 536 respondents were placed into 4 groups based on ordering frequency (ranging from weekly to fewer than 1 box per month). This study’s findings strongly indicate that a flexible pay-as-you-go CSA subscription model would increase CSA subscriber membership and possibly frequency of ordering, especially for those likely to order a box less frequently than every week but who in other ways (demographics, motivations, satisfaction levels, length of subscription) are similar to the traditional pay up-front subscriber.