Impact of Stress Levels on Eating Behaviors among College Students.
Choi Jinkyung
Nutrients
Weight gain is a common phenomenon among college students, especially those in their first year of university. Transitioning from high school to the college environment might increase perceived stress levels, thus affecting dietary behaviors and metabolism to promote overweight and obesity. The purpose of this study was to investigate the physical activities and dietary behaviors of college students in the context of their perceived stress levels. In addition, the demographic characteristics of the students were compared to ascertain their impact on dietary behaviors. Self-reported questionnaires were distributed to college students on campus in Korea. Perceived stress was measured by the 10-item Perceived Stress Scale (PSS-10), the scores for which were evaluated by independent -tests to compare the dietary behaviors of the high- and low-perceived stress groups. Exploratory factor analysis was performed and Cronbach's alphas were computed to assess the validity and internal consistency of the PSS-10 measurement items. Differences in the physical activities and dietary behaviors of the college students based on demographics such as sex, academic year, and residence type were found. Several dietary behaviors were significantly different between students with low and high perceived stress levels. Students with high perceived stress levels exhibited increased unhealthy dietary behaviors such as ready-prepared meal consumption ( < 0.001). These results suggest that stress management should be offered to college students. In addition, programs should be provided to help first-year students adjust to the college environment in order to promote healthy dietary behaviors.
10.3390/nu12051241
Factors influencing weight management behavior among college students: An application of the Health Belief Model.
PloS one
BACKGROUND:Overweight and obesity have become a significant public health concern in both developing and developed countries. Due to the health implications of weight-reduction behaviors, it is important to explore the factors that predict their occurrence. Therefore, the present study was performed to examine factors affecting the behavioral intention of weight management as well as assess the predictive power of the Health Belief Model (HBM) for body mass index (BMI). METHODS:This cross-sectional study was conducted among 336 female students recruited from dormitories of Tabriz University of Medical Sciences, using quota sampling technique. Data were collected by a structured questionnaire in seven parts (including perceived severity, perceived susceptibility, perceived benefit, perceived barrier, cue to action, self-efficacy in dieting and physical activity, and behavioral intention of weight management), based on the HBM. Structural equation modeling (SEM) was conducted to identify the relationship between HBM constructs and behavioral intention of weight management. Linear regression model was performed to test the ability of the HBM to predict students' BMIs. RESULTS:Higher level of perceived threats (sum of perceived susceptibility and severity) (β = 0.41, P<0.001), perceived benefits (β = 0.19, P = 0.009), self-efficacy in exercise (β = 0.17, P = 0.001), and self-efficacy in dieting (β = 0.16, P = 0.025) scales was significantly related to greater behavioral intention of weight management. Moreover, perceived threat mediated the relationships between perceived cue to action, perceived benefits, self-efficacy in exercise, and weight management practices. The fit indices of the SEM model seemed acceptable. The final regression model explained approximately 40% of variance in BMI (P<0.001). Additionally, perceived severity, barrier, and self-efficacy in dietary life were the significant variables to predict students' BMIs. CONCLUSIONS:These findings suggest that health education programs based on the HBM needs to be integrated in preventive health programs and health interventions strategies to ensure adherence and well-being of the participants.
10.1371/journal.pone.0228058
Exploring Behavioral Risk Factors for Non-communicable Diseases Among Undergraduate Medical Students in Western Gujarat: A Cross-Sectional Study.
Cureus
Background The burden of morbidity and death caused by non-communicable diseases (NCDs) such as cancer, diabetes, and cardiovascular disease is a significant global health concern influenced by modifiable behavioral risk factors. In India, the burden of NCDs is particularly high, with medical college students being a vulnerable population. This study aims to bridge the knowledge gap by investigating the prevalence and patterns of behavioral risk factors for NCDs among medical college students. Methodology A cross-sectional study was conducted on medical students in Gujarat. Risk factors for NCDs were assessed using various tools, including the General Health Questionnaire-12 (GHQ-12) for stress, the International Physical Activity Questionnaire-Short Form (IPAQ-SF) for physical activity, the Pittsburgh Sleep Quality Index (PSQI) for sleep quality, the body mass index (BMI) for obesity, and dietary factors. The chi-square test was employed as a statistical tool to determine the association between socio-demographic variables and various risk factors. A p-value of <0.05 was considered statistically significant. Results Among the 400 students surveyed, the prevalence of single behavioral NCD risk factors was as follows: 248 (62%) reported stress (GHQ-12), 215 (54%) experienced poor sleep quality (PSQI), 251 (63%) had low levels of physical activity (IPAQ), 339 (85%) had inadequate fruit and vegetable intake, 97 (24%) consumed extra salt during meals, 163 (41%) were overweight or obese, and 189 (47%) had three or more risk factors for NCDs. In bivariate logistic regression analysis, factors such as age, male gender, urban residence, hostel stay, and lower socioeconomic status were found to be statistically significant (p < 0.05). Conclusion This study reveals an alarming failure of medical colleges to positively influence students' health behaviors, despite their medical knowledge. The high rates of inactivity, stress, poor diet, and obesity among students demonstrate the curriculum's inability to instill preventative lifestyle practices. This omission in training compromises students' own health and their ability to counsel patients on NCD prevention. Urgent reform is needed to integrate health promotion into the curriculum, providing a supportive campus culture focused on wellness. By overlooking students' behaviors, medical colleges gravely disserve these future providers. This evidence compels curriculum reform to develop exemplary physician role models for NCD prevention.
10.7759/cureus.49188
The Influence of Organizational Culture on School-Based Obesity Prevention Interventions: A Systematic Review of the Literature.
Fair Kayla N,Solari Williams Kayce D,Warren Judith,McKyer E Lisako Jones,Ory Marcia G
The Journal of school health
BACKGROUND:Although the influence of organizational culture has been examined on a variety of student outcomes, few studies consider the influence that culture may have on school-based obesity prevention interventions. We present a systematic review of the literature to examine how elements of organizational culture may affect the adoption, implementation, and sustainability of school-based obesity prevention interventions. METHODS:Fourteen studies examining the impact of organizational-level characteristics on school-based obesity prevention interventions were identified through the online databases EBSCO (CINAHL, ERIC, Agricola), Web of Science, Medline (PubMed), and Scopus. RESULTS:Five themes were identified as elements of organizational culture that influence the adoption, implementation, and sustainability of school-based obesity prevention interventions: organizational response to limited resources, value placed on staff training and professional development, internal support, organizational values, and school climate. CONCLUSIONS:Organizational culture can greatly influence the success of school-based obesity interventions. The collection of data related to organizational-level factors may be used to identify strategies for creating and sustaining a supportive environment for obesity prevention interventions in the school setting.
10.1111/josh.12626
Health Literacy Scale and Causal Model of Childhood Overweight.
Intarakamhang Ungsinun,Intarakamhang Patrawut
Journal of research in health sciences
BACKGROUND:WHO focuses on developing health literacy (HL) referring to cognitive and social skills. Our objectives were to develop a scale for evaluating the HL level of Thai childhood overweight, and develop a path model of health behavior (HB) for preventing obesity. STUDY DESIGN:A cross-sectional study. METHODS:This research used a mixed method. Overall, 2,000 school students were aged 9 to 14 yr collected by stratified random sampling from all parts of Thailand in 2014. Data were analyzed by CFA, LISREL. RESULTS:Reliability of HL and HB scale ranged 0.62 to 0.82 and factor loading ranged 0.33 to 0.80, the subjects had low level of HL (60.0%) and fair level of HB (58.4%), and the path model of HB, could be influenced by HL from three paths. Path 1 started from the health knowledge and understanding that directly influenced the eating behavior (effect sized - β was 0.13, P<0.05. Path 2 the health knowledge and understanding that influenced managing their health conditions, media literacy, and making appropriate health-related decision β=0.07, 0.98, and 0.05, respectively. Path 3 the accessing the information and services that influenced communicating for added skills, media literacy, and making appropriate health-related decision β=0.63, 0.93, 0.98, and 0.05. Finally, basic level of HL measured from health knowledge and understanding and accessing the information and services that influenced HB through interactive, and critical level β= 0.76, 0.97, and 0.55, respectively. CONCLUSIONS:HL Scale for Thai childhood overweight should be implemented as a screening tool developing HL by the public policy for health promotion.
Adolescent Obesity Prevention in Saudi Arabia: Co-identifying Actionable Priorities for Interventions.
Frontiers in public health
Background:Childhood obesity is a serious issue in the Kingdom of Saudi Arabia, but there is no known community intervention. The aim of the study was to use a participatory approach to obtain the perspectives of students, school staff and Ministry of Education (MoE) representatives and parents on important and feasible intervention opportunities for school-based obesity prevention for adolescent girls. Method:The study was conducted in two intermediate schools for girls (13-15 years old) in Jeddah that were purposefully identified with the support of the MoE. Group concept mapping, a mixed method approach, was conducted with 19 adults which included staff from the MoE and schools, school canteen suppliers and mothers. Adults generated statements in response to two prompts (P); P1 " and P2 " Photovoice-enhanced concept mapping was used with students ( = 15 students) to capture adolescent perspectives on what influences their dietary and physical activity habits. Students generated statements' using their own photographs. Stakeholders, both adult and students, sorted the statements into themes and rated each statement for relative importance and feasibility. Multidimensional scaling and hierarchical cluster analyses were used to produce concept maps with the input from students and adults. Result:Adults generated 35 statements in response to P1 and identified five themes that influenced adolescent obesity including "Home Environment," "Lifestyle," "School Environment," "Community," "Biology." They generated 42 statements in relation to P2 and identified four themes including "Ministry of Education Support," "School Environment," "Public health programmes" and "Wider environmental influences." Students generated 42 statements from 39 pictures. They identified five themes that influenced their dietary and physical activity habits-"Role of Government," "School Environment," "Home Environment," "Retail Environment" and "Cultural Practices." Both groups identified several common important and feasible actions with a strong emphasis on improving the school environment, in particular food provision, with MoE support. Exemplar corresponding statements from adults were " and " and from students were " Lack of correspondence related to students' emphasis on access to both healthy foods and physical activity in schools and the wider environment (e.g. retail environments), while adults emphasized school-based education and food provision. After further consultations, both stakeholder groups agreed on improving access to healthy foods in the canteen. Conclusions:Students and school and MoE staff jointly agreed that a canteen-based intervention was important and feasible to improve dietary habits and thus help to prevent obesity among adolescent girls. This was the first time a participatory approach was used with students for intervention development in Saudi Arabia. A co-development approach may have value to improve their school food environments.
10.3389/fpubh.2022.863765
How men receive and utilise partner support when trying to change their diet and physical activity within a men's weight management programme.
Tripathee Sheela,Sweeting Helen,Chambers Stephanie,Maclean Alice
BMC public health
BACKGROUND:The impacts of interventions designed to change health behaviours are potentially affected by the complex social systems in which they are embedded. This study uses Scottish data to explore how men receive and utilise partner support when attempting to change dietary practices and physical activity within the context of Football Fans in Training (FFIT), a gender-sensitised weight management and healthy living programme for men who are overweight/obese. METHODS:Separate semi-structured face-to-face interviews were conducted with 20 men and their cohabiting female partners (total n = 40), 3-12 months after the men had completed FFIT. Data were thematically analysed and individual interviews were combined for dyadic analysis. RESULTS:Men's and women's accounts suggested variations in men's need for, and utilisation of, partner support in order to make changes to dietary practices and physical activity. There were also differences in descriptions of women's involvement in men's behaviour changes. Typologies were developed categorising men as 'resolute', 'reliant'/'receptive' and 'non-responsive' and women as 'very involved', 'partially involved' and 'not involved'. Men were more reliant, and women more involved, in changes to dietary practices compared to physical activity. The role of partner involvement in promoting men's behaviour change seemed contingent on men's resoluteness, or their reliance on the partner support. CONCLUSIONS:These results highlight how interactions between men's resoluteness/reliance on cohabiting female partners and the partners' involvement impact the extent to which female partners influence men's changes to dietary practices and physical activity following a weight loss intervention. Understanding this interaction could increase the impact of health interventions aimed at one individual's behaviour by considering other family members' roles in facilitating those changes. The typologies developed for this study might contribute towards the development of behaviour change theories within the cohabiting couple context.
10.1186/s12889-020-8213-z
Effectiveness of a Weight Loss Program Using Digital Health in Adolescents and Preadolescents.
Childhood obesity (Print)
To identify an efficacious intervention on treating adolescents with overweight and obesity, this might result in health benefits. Adolescents with overweight or obesity aged 10-17 years with BMI percentile ≥85th were included in this historical observational analysis. Subjects used an entirely remote weight loss program combining mobile applications, frequent self-weighing, and calorie restriction with meal replacement. Body weight changes were evaluated at 42, 60, 90, and 120 days using different metrics including absolute body weight, BMI, and BMI z-score. Chi-square or Fisher exact tests (categorical variables) and Student's -test (continuous variables) were used to compare subjects. In total, 2,825 participants, mean age 14.4 ± 2.2 years, (54.8% girls), were included from October 27, 2016, to December 31, 2017, in mainland China; 1355 (48.0%) had a baseline BMI percentile ≥97th. Mean BMI and BMI z-score were 29.20 ± 4.44 kg/m and 1.89 ± 0.42, respectively. At day 120, mean reduction in body weight, BMI, and BMI z-score was 8.6 ± 0.63 kg, 3.13 ± 0.21 kg/m, and 0.42 ± 0.03; 71.4% had lost ≥5% body weight, 69.4% of boys and 73.2% of girls, respectively. Compared with boys, girls achieved greater reduction on BMI z-score at all intervals ( < 0.004 for all comparisons). Higher BMI percentile at baseline and increased frequency of use of the mobile application were directly associated with more significant weight loss. An entirely remote digital weight loss program is effective in facilitating weight loss in adolescents with overweight or obesity in the short term and mid term.
10.1089/chi.2020.0317
Psychosocial Predictors of Physical Activity Change Among College Students in an Obesity Prevention Trial.
Arigo Danielle,Rohde Paul,Shaw Heather,Stice Eric
Journal of physical activity & health
BACKGROUND:Moderate-to-vigorous physical activity (MVPA) is critical for maintaining a healthy weight, although little is known about psychological barriers to maintaining MVPA in at-risk groups. Identifying characteristics associated with poor MVPA maintenance in obesity prevention programs could improve participant outcomes. METHODS:Toward this end, we examined predictors of MVPA in an obesity prevention trial for college students at risk for weight gain (n = 333; 72% female, mean BMI = 23.4 kg/m). Participants engaged in 1 of 3 weight control interventions and in 4 assessments over 12-month follow-up (ie, measured height/weight, self-reports of psychosocial characteristics, 4 days of accelerometer wear). RESULTS:Multilevel modeling analyses showed that across conditions, participants decreased total MVPA minutes per week over 12 months (B = -5.48, P < .01). Baseline self-report scores for both impulsiveness and cognitive dissonance regarding engaging in unhealthy behaviors negatively predicted MVPA over time. Participants higher (vs. lower) in baseline impulsiveness (B = -6.89, P = .03) and dissonance (B = -4.10, P = .04) began the study with more MVPA minutes, but showed sharper declines over time. CONCLUSIONS:Targeted MVPA-focused intervention for students who show elevated impulsiveness and cognitive dissonance may improve both MVPA and weight control outcomes for these individuals.
10.1123/jpah.2016-0515
Binge eating and weight loss behaviors of overweight and obese college students.
Kelly-Weeder Susan,Phillips Kathryn,Leonard Kelly,Veroneau Margaret
Journal of the American Association of Nurse Practitioners
PURPOSE:To investigate binge eating (BE) and weight-related behaviors in overweight and obese college students. DATA SOURCES:This was a secondary analysis of data from 487 overweight and obese college-age students from a private university in the northeastern United States. CONCLUSIONS:BE was reported by 34.9% of students. Only 6.2% of participants reported the use of compensatory behaviors (i.e., self-induced vomiting, laxative, or diuretic use) to prevent weight gain. BE was associated with smoking and exercising to lose weight. Gender differences emerged from the data as women were more likely to report being obese, the use of compensatory behaviors, and to perceive themselves as moderately or extremely overweight. IMPLICATIONS FOR PRACTICE:BE is a significant problem on college campuses and is associated with the development of obesity and eating disorders. Nurse practitioners (NPs) are in an excellent position to effect change in this population through their frequent contact with young adults in community and school-based venues. NPs are well-prepared to identify at-risk college students and provide them with individualized care, education, and support.
10.1002/2327-6924.12070
Face-to-Face and Online Networks: College Students' Experiences in a Weight-Loss Trial.
Merchant Gina,Weibel Nadir,Pina Laura,Griswold William G,Fowler James H,Ayala Guadalupe X,Gallo Linda C,Hollan James,Patrick Kevin
Journal of health communication
This study aimed to understand how college students participating in a 2-year randomized controlled trial (Project SMART: Social and Mobile Approach to Reduce Weight; N = 404) engaged their social networks and used social and mobile technologies to try and lose weight. Participants in the present study (n = 20 treatment, n = 18 control) were approached after a measurement visit and administered semi-structured interviews. Interviews were analyzed using principles from grounded theory. Treatment group participants appreciated the timely support provided by the study and the integration of content across multiple technologies. Participants in both groups reported using non-study-designed apps to help them lose weight, and many participants knew one another outside of the study. Individuals talked about weight-loss goals with their friends face to face and felt accountable to follow through with their intentions. Although seeing others' success online motivated many, there was a range of perceived acceptability in talking about personal health-related information on social media. The findings from this qualitative study can inform intervention trials using social and mobile technologies to promote weight loss. For example, weight-loss trials should measure participants' use of direct-to-consumer technologies and interconnectivity so that treatment effects can be isolated and cross-contamination accounted for.
10.1080/10810730.2016.1250847
Exploring the potential for internet-based interventions for treatment of overweight and obesity in college students.
Schwartz Jennifer,Richardson Chris G
Global health promotion
OBJECTIVE:To assess the use of internet-enabled technology for seeking health information and resources in overweight/obese college students. PARTICIPANTS:College students (N = 706) in Vancouver, Canada surveyed in April 2012. METHODS:An online survey assessed socio-demographics, health behaviors, and use of internet-enabled technology. RESULTS:Eating habits, dieting and/or exercising to lose weight, and weight satisfaction differed by weight status (all p < 0.05). Of overweight/obese participants, 48% reported they would use online student health resources. When seeking general health information, 91% would use websites; 45% would use online videos; and 75% trusted information from government or health organizations. CONCLUSIONS:Overweight/obesity is prevalent among college students. The majority of overweight/obese students reported trying to lose weight and would use the internet for health information, especially if a website is associated with a health organization. The internet is a cost-effective channel for screening coupled with the delivery of tailored, evidence-based interventions for college students.
10.1177/1757975914547546
Intervention of childhood and adolescents obesity in Shantou city.
Guo Haiting,Zeng Xiaoshan,Zhuang Qiaoyu,Zheng Yubin,Chen Shenren
Obesity research & clinical practice
OBJECTIVES:The purpose of this study was to evaluate the effects of multicomponent school based intervention constituted of diet modification, regular exercise and psychosocial consultation on body status in overweight and obese children and adolescents. And to come up with an appropriate intervention protocol for controlling children and adolescents obesity in Shantou city. METHODS:Two schools were randomised to intervention group and control group respectively. A total of 41 students enrolled were diagnosed as overweight or obese. Twenty-six students of the intervention group completed the one-year intervention programme consisted of diet modification, regular exercise and psychological consultation except two of them were transferred to another school. The differences of BMI, anthropometric measures, metabolic profile and the scores of questionnaire and the scale were compared to evaluate the effects of the intervention programme. RESULTS:After one-year intervention, it observed in the intervention group that BMI-Z score, WHR and WHtR had significant improvements, and there was a nonsignificant trend (P=0.053) for a decrease in BMI-P. Fasting plasma glucose, cholesterol (CH) and low-density-lipoprotein cholesterol (LDL-C) levels in the intervention group showed nonsignificant trend for a decrease (PFPG=0.084, PCH=0.057, PLDLC=0.098), compared with a significant increase of triglycerides (TG) and LDL-C levels in the control group (PTG=0.041, PLDL-C=0.038). There were some positive dietary, physical activity, or sedentary behaviour changes found in the students of the intervention group as the scores of the questionnaire got significant improvement (P=0.04). CONCLUSIONS:Our one-year multicomponent school-based intervention programme did have positive effects to some extents on health state and lifestyle behaviour of overweight and obese children and adolescents, which indicated that it is feasible and important to implement such a school-based intervention programme in Shantou city.
10.1016/j.orcp.2014.11.006
Moderators of two dual eating disorder and obesity prevention programs.
Stice Eric,Desjardins Christopher D,Shaw Heather,Rohde Paul
Behaviour research and therapy
Few trials have investigated factors that moderate the effects of eating disorder and obesity prevention programs, which may inform inclusion criteria and intervention refinements. We examined factors hypothesized to moderate the effects of the Healthy Weight eating disorder/obesity prevention program that promotes gradual healthy changes, and Project Health that adds cognitive dissonance activities. College students at risk for both outcomes because of weight concerns (N = 364, 72% female) were randomized to these interventions or an educational video condition, completing pretest, posttest, and 6, 12, and 24-month follow-up assessments. Healthy Weight and Project Health produced significantly larger reductions in eating disorder symptoms versus video controls for individuals with higher negative affect, emotional eating, dietary fat/sugar intake, and perceived pressure to be thin. Project Health also produced significantly less increases in BMI versus video controls for individuals with lower negative affect. Results suggest that these interventions produce larger eating disorder symptom reductions for individuals at elevated risk for eating pathology but hint that weight gain prevention effects may be attenuated by elevated negative affect. Results imply that larger eating disorder symptom reductions will result when implemented with individuals with both weight concerns and one of the additionally identified risk factors.
10.1016/j.brat.2019.04.002
Personalized versus generic digital weight loss interventions delivered on university campuses: a 6-month cost-benefit analysis.
Translational behavioral medicine
Cost-effectiveness analyses of weight loss programs for university students can inform administrator decision-making. This study quantifies and compares the costs and cost-effectiveness of implementing two digitally-delivered weight loss interventions designed for university populations. Healthy Body Healthy U (HBHU) was a randomized controlled trial comparing TAILORED (personalized) versus TARGETED (generic) weight loss interventions adapted specifically for young adults to a CONTROL intervention. Participants (N = 459; 23.3 ± 4.4 years; mean BMI 31.2 ± 4.4 kg/m2) were recruited from two universities. Implementation costs were examined from a payer (i.e., university) perspective, comparing both the average cost effectiveness ratio (ACER) and the incremental cost effectiveness ratio (ICER) of the two interventions. Cost-effectiveness measures were calculated for changes in body weight, abdominal circumference, HDL cholesterol, systolic and diastolic blood pressure, and HbA1c. The overall 6-month implementation costs were $105.66 per person for the TAILORED intervention and $91.44 per person for the TARGETED intervention. The ACER for weight change was $107.82 for the TAILORED and $179.29 for the TARGETED interventions. The ICER comparing TAILORED with TARGETED for change in body weight was $5.05, and was even lower ($2.28) when including only those with overweight and not obesity. The ICERs for change in abdominal circumference, HDL cholesterol, systolic and diastolic blood pressure, and HbA1c were $3.49, $59.37, $1.57, $2.64, and $47.49, respectively. The TAILORED intervention was generally more cost-effective compared with the TARGETED intervention, particularly among those with overweight. Young adults with obesity may require more resource-intensive precision-based approaches.
10.1093/tbm/ibac081
Implementing School-Based Policies to Prevent Obesity: Cluster Randomized Trial.
Ickovics Jeannette R,Duffany Kathleen O'Connor,Shebl Fatma M,Peters Sue M,Read Margaret A,Gilstad-Hayden Kathryn R,Schwartz Marlene B
American journal of preventive medicine
INTRODUCTION:Healthier school environments can benefit students, and school wellness policies may result in meaningful enhancements. Schools participating in federal child nutrition programs must implement wellness policies as mandated by law. The primary study objective is to assess effectiveness of implementing school-based nutrition and physical activity policies on student BMI trajectories. STUDY DESIGN:Cluster randomized trial using 2 × 2 factorial design. SETTING/PARTICIPANTS:Twelve randomly selected schools in an urban district. Students were followed for 3 years through middle school, fifth to eighth grades (2011-2015, n=595 students, 92.3% participation, 85.2% retention). INTERVENTION:Specific to randomized condition, support was provided for implementation of nutrition policies (e.g., alternatives to food-based rewards/celebrations) and physical activity policies (e.g., opportunities for physical activity during/after school). MAIN OUTCOME MEASURES:Sex-/age-adjusted BMI percentile and BMI z-score; behavioral indicators. Data collected via standardized protocols. RESULTS:Analyses followed intention-to-treat principles, with planned secondary analyses (conducted 2016-2018). Students at schools randomized to receive support for nutrition policy implementation had healthier BMI trajectories over time (F=3.20, p=0.02), with a greater magnitude over time and cumulatively significant effects 3 years post-intervention (β=-2.40, p=0.04). Overall, students at schools randomized to receive the nutrition intervention had an increase in BMI percentile of <1%, compared with students in other conditions, whereas BMI percentile increased 3%-4%. There was no difference in student BMI between those in schools with and without physical activity policy implementation. Examining behavioral correlates in eighth grade, students at schools randomized to the nutrition condition consumed fewer unhealthy foods and sugar-sweetened beverages, and ate less frequently at fast-food restaurants (all p<0.03). CONCLUSIONS:This cluster randomized trial demonstrated effectiveness of providing support for implementation of school-based nutrition policies, but not physical activity policies, to limit BMI increases among middle school students. Results can guide future school interventions. TRIAL REGISTRATION:This study is registered at www.clinicaltrials.gov NCT02043626.
10.1016/j.amepre.2018.08.026
Development of a weight bias reduction intervention for third-year nursing students.
Oliver Tracy L,Qi Bing-Bing,Diewald Lisa K,Shenkman Rebecca,Kaufmann Peter G
Clinical obesity
To explore whether case-based learning will enhance a weight bias reduction (WBR) programme among nursing students to improve their attitudes and beliefs towards persons with obesity. A cluster-randomized controlled trial (CRT) among 13 medical-surgical clinical practicum groups consisting of six to eight third-year baccalaureate nursing students was conducted to compare a WBR training enhanced by case-based learning (WBR-I, n = 7) with a standard WBR control group (n = 6). All participants completed the Attitudes Towards Obese Persons (ATOP) and Beliefs About Obese Persons (BAOP) questionnaires before the randomized assignment and at the end of the 14-week semester. The BAOP scores of participants in the WBR-I group were significantly improved compared to controls (26.68 ± 7.85 and 22.93 ± 2.80, respectively; F = 18.23; p = .001 (<.01) indicating improved beliefs about the controllability of obesity. There were no significant changes to attitudes about individuals with obesity, as indicated by the ATOP scores. The findings of this pilot study suggest that a more intensive WBR programme that includes case-based learning scenarios that elicit critical thinking coupled with a standard WBR programme may reduce some aspects of weight bias.
10.1111/cob.12498
A staged approach to address youth unresponsive to initial obesity intervention: a randomized clinical trial.
International journal of obesity (2005)
BACKGROUND/OBJECTIVE:Maintenance interventions inherently require BMI improvement to maintain. This overlooks individuals initially unresponsive to obesity interventions. Staged pediatric clinical treatment guidelines were adapted to the school setting to develop an escalated treatment option for individuals initially unresponsive. This staged randomized controlled trial examined differences between escalated treatment (Take CHARGE!) and a maintenance program (PE Planners). Take CHARGE was hypothesized to have greater improvements in BMI as a percentage of the 95th BMI Percentile (%BMIp95) than PE Planners. SUBJECTS/METHODS:From 2018 to 2020, 171 middle and high schoolers (BMI Percentile ≥ 85) were recruited from a Houston school district to participate in a staged obesity intervention in their physical education (PE) class. After receiving a semester-long intensive lifestyle intervention (ILI) with established efficacy, all participants were randomized to Take CHARGE (n = 85) or PE Planners (n = 86). Take CHARGE escalated the behavioral treatment of obesity received in ILI with more frequent individual sessions, additional opportunities for parental and school staff involvement, and increased mentorship from trained college students. PE Planners allowed participants to decide how they wanted to be active in PE class. Mixed linear modeling examined %BMIp95 overtime between groups. This trial was registered at ClinicalTrials.gov (#NCT04362280). RESULTS:Participants were 13.63 ± 1.32 years old; 59% were female, and 85% were Hispanic. Among those initially unresponsive to ILI, Take CHARGE had significantly greater decreases in %BMIp95 than PE Planners (β = -0.01, p < 0.01). Conversely, among those initially responsive, Take CHARGE had significantly smaller decreases in %BMIp95 than PE Planners (β = 0.02, p < 0.05). Intention-to-treat analysis had similar results. CONCLUSIONS:Participant outcomes in semester two differed based on initial response. Individuals responsive to initial intervention were most likely to benefit from a maintenance intervention and those initially unresponsive benefited more from escalated treatment. This indicates the need for staged intervention protocols to better address obesity in the school setting.
10.1038/s41366-021-00940-0
Effects of time-restricted feeding and walking exercise on the physical health of female college students with hidden obesity: a randomized trial.
Frontiers in public health
Purpose:Time-restricted feeding (TRF) is an emerging dietary pattern with many potential effects. This study focused on the effects of TRF and walking on the physical health of female college students with hidden obesity. Methods:A total of 77 female college students with hidden obesity, aged 18-22 years, were randomly assigned to a control group (CON, = 19), time-restricted feeding group (TRF, = 19), exercise group (EXE, = 20), and TRF combined with exercise group (TRF + EXE, = 19). The interventions lasted for 8 weeks. Tests assessing body shape, body composition, bone mineral density, blood lipid levels, and blood pressure were performed before and after the intervention. Results:(1) Intragroup comparison before and after the intervention revealed that the TRF, EXE, and TRF + EXE groups had significantly reduced body weight ( < 0.01), body mass index (BMI) ( < 0.05), and lean tissue mass (LTM) ( < 0.01) but increased total cholesterol (TC) levels ( < 0.05) after the intervention. Body fat percentage (BF%) increased considerably in the EXE and TRF + EXE groups ( < 0.01). (2) Post-intervention comparisons of body weight, BMI, LTM, adipose tissue mass (ATM), total bone mineral density (TBMD), blood lipid levels, and blood pressure between the intervention groups (TRF, EXE, and TRF + EXE) and the CON group showed no significant differences ( > 0.05). (3) A comparison of the changes between the groups before and after the intervention showed significant decreases in body weight in the TRF and TRF + EXE groups ( < 0.05) and in both BMI and LTM in the TRF, EXE, and TRF + EXE groups ( < 0.05) compared to those in the CON group. The BF% change in the EXE and TRF + EXE groups were significantly greater than that in the TRF group ( < 0.01). Conclusion:TRF effectively decreased body weight and BMI in female college students with hidden obesity. However, increased blood lipid levels and decreased LTM levels were also observed. The effects of TRF combined with exercise were not superior to those of TRF or walking alone in terms of body weight, body mass index, body composition, TBMD, or blood lipid levels. Therefore, TRF cannot be considered the best option for fat reduction in female college students with hidden obesity.
10.3389/fpubh.2023.1020887