Nefertiti Durant

Myths, Presumptions, and Facts about Obesity

BACKGROUND Many beliefs about obesity persist in the absence of supporting scientific evidence (presumptions); some persist despite contradicting evidence (myths). The promulgation of unsupported beliefs may yield poorly informed policy decisions, inaccurate clinical and public health recommendations, and an unproductive allocation of research resources and may divert attention away from useful, evidence-based information. METHODS Using Internet searches of popular media and scientific literature, we identified, reviewed, and classified obesity-related myths and presumptions. We also examined facts that are well supported by evidence, with an emphasis on those that have practical implications for public health, policy, or clinical recommendations. RESULTS We identified seven obesity-related myths concerning the effects of small sustained increases in energy intake or expenditure, establishment of realistic goals for weight loss, rapid weight loss, weight-loss readiness, physical-education classes, breast-feeding, and energy expended during sexual activity. We also identified six presumptions about the purported effects of regularly eating breakfast, early childhood experiences, eating fruits and vegetables, weight cycling, snacking, and the built (i.e., human-made) environment. Finally, we identified nine evidence-supported facts that are relevant for the formulation of sound public health, policy, or clinical recommendations. CONCLUSIONS False and scientifically unsupported beliefs about obesity are pervasive in both scientific literature and the popular press. (Funded by the National Institutes of Health.).

Neighborhood Environment Walkability Scale for Youth (NEWS-Y): Reliability and Relationship With Physical Activity

OBJECTIVES To examine the psychometric properties of the Neighborhood Environment Walkability Scale-Youth (NEWS-Y) and explore its associations with context-specific and overall physical activity (PA) among youth. METHODS In 2005, parents of children ages 5-11 (n=116), parents of adolescents ages 12-18 (n=171), and adolescents ages 12-18 (n=171) from Boston, Cincinnati, and San Diego, completed NEWS-Y surveys regarding perceived land use mix-diversity, recreation facility availability, pedestrian/automobile traffic safety, crime safety, aesthetics, walking/cycling facilities, street connectivity, land use mix-access, and residential density. A standardized neighborhood environment score was derived. Self-reported activity in the street and in parks, and walking to parks, shops, school, and overall physical activity were assessed. RESULTS The NEWS-Y subscales had acceptable test-retest reliability (ICC range .56-.87). Being active in a park, walking to a park, walking to shops, and walking to school were related to multiple environmental attributes in all three participant groups. Total neighborhood environment, recreation facilities, walking and cycling facilities, and land use mix-access had the most consistent relationships with specific types of activity. CONCLUSIONS The NEWS-Y has acceptable reliability and subscales were significantly correlated with specific types of youth PA. The NEWS-Y can be used to examine neighborhood environment correlates of youth PA.

Community Food Environment, Home Food Environment, and Fruit and Vegetable Intake of Children and Adolescents

OBJECTIVES To determine (1) reliability of new food environment measures; (2) association between home food environment and fruit and vegetable (FV) intake; and (3) association between community and home food environment. METHODS In 2005, a cross-sectional survey was conducted with readministration to assess test-retest reliability. Adolescents, parents of adolescents, and parents of children (n = 458) were surveyed in San Diego, Boston, and Cincinnati. RESULTS Most subscales had acceptable reliability. Fruit and vegetable intake was positively associated with availability of healthful food (r = 0.15-0.27), FV (r = 0.22-0.34), and ratio of more-healthful/less-healthful food in the home (r = 0.23-0.31) and was negatively associated with less-healthful food in the home (r = -0.17 to -0.18). Home food environment was associated with household income but not with community food environment. CONCLUSIONS AND IMPLICATIONS A more healthful home food environment was related to youth FV intake. Higher income households had more healthful food in the home. The potential influence of neighborhood food outlets warrants further study.

Internet interventions to support lifestyle modification for diabetes management: a systematic review of the evidence.

BACKGROUND The Internet presents a widely accessible, 24-h means to promote chronic disease management. The objective of this review is to identify studies that used Internet based interventions to promote lifestyle modification among adults with type 2 diabetes. METHODS We searched PubMed using the terms: [internet, computer, phone, smartphone, mhealth, mobile health, web based, telehealth, social media, text messages] combined with [diabetes management and diabetes control] through January 2013. Studies were included if they described an Internet intervention, targeted adults with type 2 diabetes, focused on lifestyle modification, and included an evaluation component with behavioral outcomes. RESULTS Of the 2803 papers identified, nine met inclusion criteria. Two studies demonstrated improvements in diet and/or physical activity and two studies demonstrated improvements in glycemic control comparing web-based intervention with control. Successful studies were theory-based, included interactive components with tracking and personalized feedback, and provided opportunities for peer support. Website utilization declined over time in all studies that reported on it. Few studies focused on high risk, underserved populations. CONCLUSION Web-based strategies provide a viable option for facilitating diabetes self-management. Future research is needed on the use of web-based interventions in underserved communities and studies examining website utilization patterns and engagement over time.

Adolescent screen time and rules to limit screen time in the home.

PURPOSE To investigate associations between adolescent screen time behaviors, screen time rules, and presence of electronic media in the bedrooms of adolescents. METHODS Parents and adolescents (N = 160 dyads) from the cities of Boston, Cincinnati, and San Diego were asked to complete a questionnaire which included questions related to demographics, screen time rules, availability of media devices, and screen time behavior. Separate multiple regression models were used for adolescent and parent reports to test correlates of adolescent television (TV) watching, video game play, and computer usage for entertainment. RESULTS Data from adolescents indicated that rules for watching TV, computer usage, and total number of screen time rules were significantly correlated with time spent watching TV (β = -.22, p < .01), playing video or computer games (β = -.18, p < .05), and using the Internet and/or computer for entertainment (β = -.18, p < .05), respectively. Data from parents indicated that TV rules were significantly associated with lower rates of TV viewing, and parent-adolescent agreement on rules strengthened this relationship. Data from parents as well as adolescents indicated that the presence of a TV in the bedroom was positively associated with TV viewing time (β = .18 and .24, p < .05, respectively). Adolescent data indicated a positive association between having at least one video game system in the bedroom and time spent playing video games (β = .19, p < .05). CONCLUSION Having clear rules, setting limits on screen time, and not having screen-based media in the bedroom were associated with fewer hours of screen time for adolescents.

Relation of School Environment and Policy to Adolescent Physical Activity

BACKGROUND Physical activity (PA) declines as children and adolescents age. The purpose of this study was to examine how specific school factors relate to youth PA, TV viewing, and body mass index (BMI). METHODS A sample of 12- to 18-year-old adolescents in 3 cities (N = 165, 53% females, mean age 14.6 +/- 1.7 years, 44% nonwhite) completed surveys assessing days of physical education (PE) class per week, school equipment accessibility, after-school supervised PA, and after-school field access. Regression analyses were conducted to examine relationships between these school factors and PA at school facilities open to the public (never active vs active), overall PA level (days per week physically active for 60 minutes), BMI z score, and TV watching (hours per week). RESULTS Adjusting for demographics, days of PE per week and access to school fields after school were correlated with overall PA (beta= 0.286, p = .002, semipartial correlation .236 and beta= 0.801, p = .016, semipartial correlation .186, respectively). The association between after-school field access and overall PA was mediated by use of publicly accessible school facilities for PA. After-school supervised PA and school PA equipment were not associated with overall PA. In adjusted regression analyses including all school factors, days of PE remained correlated to overall PA independent of other school factors (beta= 0.264, p = .007, semipartial correlation = .136). There were no associations between school factors and BMI or TV watching. CONCLUSIONS Based on these study findings, PE is a promising intervention to address improving overall adolescent PA within the school setting.

Internet-Based Physical Activity Interventions

This article provides a comprehensive review of Internet– and Website–based physical activity interventions targeting adult populations. Search procedures identified 72 unique Internet-based physical activity interventions published in peer-reviewed journals. Participants of the studies were predominately White, middle-aged (mean age = 43.3 years), and female (65.9%). Intervention durations ranged from 2 weeks to 13 months (median = 12 weeks). Forty-six of the studies were randomized controlled trials, 21 were randomized trials without a control condition, 2 were non–randomized controlled trials, and 3 used a single-group design. The majority of studies (n = 68) assessed outcomes immediately following the end of the intervention period, and 16 studies provided delayed postintervention assessments. Forty-four of the 72 studies (61.1%) reported significant increases in physical activity. Future directions for Internet-based physical activity interventions include increasing representation of minority and male populations in Internet-based efforts, conducting delayed postintervention follow-up assessments, and incorporating emerging technologies (ie, cellular and Smartphones) into Internet-based physical activity efforts.

Weighing the Evidence of Common Beliefs in Obesity Research

Obesity is a topic on which many views are strongly held in the absence of scientific evidence to support those views, and some views are strongly held despite evidence to contradict those views. We refer to the former as “presumptions” and the latter as “myths.” Here, we present nine myths and 10 presumptions surrounding the effects of rapid weight loss; setting realistic goals in weight loss therapy; stage of change or readiness to lose weight; physical education classes; breastfeeding; daily self-weighing; genetic contribution to obesity; the “Freshman 15”; food deserts; regularly eating (versus skipping) breakfast; eating close to bedtime; eating more fruits and vegetables; weight cycling (i.e., yo-yo dieting); snacking; built environment; reducing screen time in childhood obesity; portion size; participation in family mealtime; and drinking water as a means of weight loss. For each of these, we describe the belief and present evidence that the belief is widely held or stated, reasons to support the conjecture that the belief might be true, evidence to directly support or refute the belief, and findings from randomized controlled trials, if available. We conclude with a discussion of the implications of these determinations, conjecture on why so many myths and presumptions exist, and suggestions for limiting the spread of these and other unsubstantiated beliefs about the obesity domain.

Perceived weight discrimination in the CARDIA study: differences by race, sex, and weight status

To examine self‐reported weight discrimination and differences based on race, sex, and BMI in a biracial cohort of community‐based middle‐aged adults.

Current treatment approaches to overweight in adolescents

Purpose of review The prevalence of overweight among adolescents aged 12 to 19 in the United States has steadily increased since the 1960s. The purpose of this review is to familiarize primary care clinicians with the most recent primary care, pharmacotherapy, and surgical options for the treatment of overweight in adolescence. Recent findings Initial treatment of the overweight adolescent should involve a comprehensive approach that facilitates changes in diet, exercise, and behavior that engage the entire family as participants and role models. For adolescents in whom a comprehensive program of diet, exercise, and behavior modification is unsuccessful, referral to a multidisciplinary team to explore further options, which may include medication and bariatric surgery, should be considered. Experience with medication for use in weight loss and bariatric surgery in adolescents is limited. Currently, two medications, orlistat and sibutramine, have been approved by the United States Food and Drug Administration for long-term use in adolescents. Bariatric surgery is currently recommended only for adolescents who are severely overweight (body mass index ≥40) and have comorbid conditions. This intervention should be considered only after failure of other comprehensive interventions and intense medical and psychologic evaluation by a specialty referral center. Summary More research is needed to clarify the roles and timing of diet, exercise, behavior modification, pharmacotherapy, and surgical intervention. Also, long-term studies are needed to further determine the benefits and risks of pharmacotherapy and bariatric surgery in adolescents.