To characterize the prevalence of food insecurity among college students with and without disabilities. Cross-sectional data were collected between 2018–2020 at a mid-size, northeast public university as part of the ongoing College Health and Nutrition Assessment Survey. An online survey collected self-reported data, including food security and disability status. Food security status was measured via the U.S Household Food Security Survey Module 6-Item Short Form, and categorized into very low, low, marginal, and high food security. Disability status was categorized into yes or no via affirmative answers to either one of two items related to limitations or use of specialized equipment. Chi-square was used to assess the differences in food insecurity prevalence among students with and without disabilities. The sample (n = 880) was 60.6% female, predominately white (94.3%), and had a mean age of 19 ± 1.2 years. One out of seven students (14.6%) reported a disability; 18.6% reported low or very low food security (13.2% and 5.5% respectively) and 81.4% reported high or marginal food security (67.6% and 13.8%, respectively). Students with a disability reported higher rates of food insecurity vs. those without a disability (35.9% vs. 16.0%, P < 0.001). Among students with a disability, 12.8% reported very low food security and 23.1% reported low food security, compared to 4.3% and 11.7%, respectively, among those students without disabilities. College students with disabilities experienced far greater rates of food insecurity than students without disabilities. Further research, including qualitative work, can help to understand and develop better supports for this underserved segment of the college population. The New Hampshire Agriculture Experiment Station and the USDA National Institute of Food and Agriculture Hatch Project 1010738.

BACKGROUND Lifestyle interventions are the first-line treatment for obesity, but participant weight loss is typically low. OBJECTIVES We evaluated the efficacy of an alternative lifestyle intervention [Healthy Weight for Living (HWL)] compared with a modified Diabetes Prevention Program (m-DPP). HWL was based on a revised health behavior change model emphasizing hunger management and the development of healthy food preferences. m-DPP was a standard Diabetes Prevention Program implemented with counselor time matched to HWL. Participants were adult dependents of military personnel and had overweight or obesity. METHODS Participants were randomly assigned to HWL (n = 121) or m-DPP (n = 117), delivered primarily by group videoconference with additional midweek emails. The primary outcome was 12-mo weight change. Secondary outcomes included 6-mo changes in cardiometabolic risk factors and diet. Intention-to-treat (ITT) and complete case (CC) analyses were performed using linear mixed models. RESULTS Retention did not differ between groups (72% and 66% for HWL and m-DPP at 12 mo, respectively; P = 0.30). Mean ± SE adjusted 12-mo weight loss in the ITT cohort was 7.46 ± 0.85 kg for HWL and 7.32 ± 0.87 kg for m-DPP (P = 0.91); in the CC cohort, it was 7.83 ± 0.82 kg for HWL and 6.86 ± 0.88 kg for m-DPP (P = 0.43). Thirty-eight percent of HWL and 30% of m-DPP completers achieved ≥10% weight loss (P = 0.32). Improvements in systolic blood pressure, LDL cholesterol, triglycerides, fasting glucose, general health, sleep, and mood were similar across groups; improvements in diastolic blood pressure were greater in m-DPP. Adjusted group mean reductions in energy intake were not significantly different between groups, but HWL participants were more adherent to their dietary prescription for lower glycemic index and high fiber and protein (P = 0.05 to <0.001 for ITT). CONCLUSIONS HWL and m-DPP showed equivalent and clinically impactful mean weight loss with cardiometabolic benefits. These results identify an alternative approach for behavioral treatment of overweight and obesity.This trial was registered at clinicaltrials.gov as NCT02348853.

AbstractObjectiveTo assess the effects of food supplementation on improving working memory and additional measures including cerebral blood flow in children at risk of undernutrition.DesignRandomized controlled trial.Setting10 villages in Guinea-Bissau.Participants1059 children aged 15 months to 7 years; children younger than 4 were the primary population.InterventionsSupervised isocaloric servings (≈1300 kJ, five mornings each week, 23 weeks) of a new food supplement (NEWSUP, high in plant polyphenols and omega 3 fatty acids, within a wide variety and high fortification of micronutrients, and a high protein content), or a fortified blended food (FBF) used in nutrition programs, or a control meal (traditional rice breakfast).Main outcome measurementsThe primary outcome was working memory, a core executive function predicting long term academic achievement. Additional outcomes were hemoglobin concentration, growth, body composition, and index of cerebral blood flow (CBFi). In addition to an intention-to-treat analysis, a predefined per protocol analysis was conducted in children who consumed at least 75% of the supplement (820/925, 89%). The primary outcome was assessed by a multivariable Poisson model; other outcomes were assessed by multivariable linear mixed models.ResultsAmong children younger than 4, randomization to NEWSUP increased working memory compared with the control meal (rate ratio 1.20, 95% confidence interval 1.02 to 1.41, P=0.03), with a larger effect in the per protocol population (1.25, 1.06 to 1.47, P=0.009). NEWSUP also increased hemoglobin concentration among children with anemia (adjusted mean difference 0.65 g/dL, 95% confidence interval 0.23 to 1.07, P=0.003) compared with the control meal, decreased body mass index z score gain (−0.23, −0.43 to −0.02, P=0.03), and increased lean tissue accretion (2.98 cm2, 0.04 to 5.92, P=0.046) with less fat (−5.82 cm2, −11.28 to −0.36, P=0.04) compared with FBF. Additionally, NEWSUP increased CBFi compared with the control meal and FBF in both age groups combined (1.14 mm2/s×10−8, 0.10 to 2.23, P=0.04 for both comparisons). Among children aged 4 and older, NEWSUP had no significant effect on working memory or anemia, but increased lean tissue compared with FBF (4.31 cm2, 0.34 to 8.28, P=0.03).ConclusionsChildhood undernutrition is associated with long term impairment in cognition. Contrary to current understanding, supplementary feeding for 23 weeks could improve executive function, brain health, and nutritional status in vulnerable young children living in low income countries. Further research is needed to optimize nutritional prescriptions for regenerative improvements in cognitive function, and to test effectiveness in other vulnerable groups.Trial registrationClinicalTrials.gov NCT03017209.

Food cravings are a desire for specific foods which, if uncontrolled may lead to excess energy intake and weight gain. However, information on the relation between food cravings, dietary intake, and indices of metabolic health is limited. This study used baseline data from females (n = 229; aged 40.9 ± 0.7 years; BMI 34.7 ± 6.4 kg/m2) who were dependents of active duty and retired military personnel, and enrolled in the Healthy Families Healthy Forces weight loss and maintenance study. Measures obtained included food cravings using the Food Craving Questionnaire-Trait (which provides a habitual and stable measure of food cravings), dietary composition and eating patterns from three 24-h dietary recalls and the Stanford 7-day Physical Activity Recall, body composition from anthropometric measures, cardiometabolic risk factors from blood measures, and demographic information from questionnaires. Linear, quantile, or logistic regression models were used to examine the association of total food craving scores on dietary intake, and indices of metabolic health. In individuals reporting plausible energy intake (n = 146; 2210 ± kcals/day) higher food craving scores were associated with a lower diet quality (P < 0.05), higher eating frequency (P = 0.02), longer daily eating interval (P < 0.05), and a lower likelihood of following a time restricted eating pattern (P = 0.02). Food cravings were also positively associated with BMI (P = 0.03) and waist circumference (P = 0.01), but not with measures of cardiometabolic risk (LDL, HDL, total cholesterol:HDL, triglycerides, glucose, glycated hemoglobin, insulin and C-reactive protein concentrations, blood pressure, metabolic syndrome). Our findings of significant associations of food cravings with lower diet quality, poor eating patterns, and unfavorable body composition strongly support efforts of targeting cravings in behavioral programs for weight management.

BACKGROUND:Emerging research indicates that eating timing may influence dietary intake and metabolic health. However, studies to date have not examined the association of multiple measures of eating timing with both dietary intake and metabolic health in adults with overweight and obesity. OBJECTIVE:To examine the association of multiple measures of eating timing with dietary intake (ie, dietary composition, diet quality, and eating frequency) and metabolic health (ie, body composition and cardiometabolic risk). DESIGN:This is a cross-sectional analysis of baseline data from a weight loss and maintenance intervention collected from May 2015 to January 2018. PARTICIPANTS/SETTING:Participants were women with overweight or obesity who were dependents of active duty and retired military personnel (N = 229; mean ± standard error, BMI = 34.7 ± 0.4 kg/m2, age = 40.9 ± 0.7 years). The study was conducted at military installations in Massachusetts, Connecticut, New York, Colorado, and Kentucky. MAIN OUTCOME MEASURES:Eating timing variables examined included daily eating interval (time between first and last eating occasion), time-restricted eating (≤11 hours daily eating interval), early energy eaters (eating ≥60% of energy during the first half of time awake), and bedtime eaters (eating within 2 hours of bedtime). STATISTICAL ANALYSIS:The main analysis was limited to those reporting plausible energy intake (64% of total sample [n = 146]). Linear, quantile, or logistic regression models were used to determine the association of eating timing with measures of dietary intake and metabolic health. RESULTS:In individuals reporting plausible energy intake, each additional 1 hour in daily eating interval was associated with 53 kcal higher energy intake, higher glycemic load, eating frequency, and waist circumference (P < 0.05 for all). Significant associations were observed for: time-restricted eating and a lower energy intake, glycemic load, and eating frequency; early energy eating and higher carbohydrate intake; bedtime eating and a higher energy intake, glycemic load, and eating frequency. CONCLUSIONS:These findings lend support for the mechanistic targeting of eating timing in behavioral interventions aimed at improving dietary intake and body composition.

INTRODUCTION:Effective, standardized, and easily accessible weight management programs are urgently needed for military beneficiaries. Videoconference interventions have the potential for widespread scaling, and can provide both real time interaction and flexibility in delivery times regardless of location, but there is little information on their effectiveness and acceptability. MATERIALS AND METHODS:This study as part of a larger weight loss trial describes the videoconference adaption of Group Lifestyle Balance (GLB) program, a community group-based Diabetes Prevention Program intervention, and provides a comparison of weight loss and meeting attendance between in-person and videoconference delivery modes over 12 weeks in adult family members of military service members. Forty-three participants were enrolled from two military installations and received either the videoconference-adapted or an in-person GLB program in a non-randomized trial design. Differences in program attendance and percent weight lost at 12 weeks were compared by independent samples t-tests and nonparametric methods. Group differences in the percentage of weight lost over the 12-week period were analyzed using a linear mixed model. RESULTS:All GLB intervention components were successfully delivered by videoconference with minor adaptations for the different delivery mechanism. Participant retention was 70% and 96% in the in-person and videoconference groups, respectively (p = 0.04). Completing participants in both groups lost a significant percent body weight over the 12 week intervention (p < 0.001) and there was no difference in percent body weight after 12 weeks of intervention (6.2 ± 3.2% and 5.3 ± 3.4% for in-person and videoconference at 12 weeks, respectively; p = 0.60). CONCLUSION:This study describes the first videoconference adaption of the GLB program for use in military families. Attrition was lower in the videoconference group, and there were a similar levels of weight loss in both groups regardless of delivery modality. Videoconference weight loss interventions are effective and feasible for scaling to support healthy weight management in military as well as civilian populations.

Objective To measure the energy content of frequently ordered meals from full service and fast food restaurants in five countries and compare values with US data. Design Cross sectional survey. Setting 223 meals from 111 randomly selected full service and fast food restaurants serving popular cuisines in Brazil, China, Finland, Ghana, and India were the primary sampling unit; 10 meals from five worksite canteens were also studied in Finland. The observational unit was frequently ordered meals in selected restaurants. Main outcome measure Meal energy content, measured by bomb calorimetry. Results Compared with the US, weighted mean energy of restaurant meals was lower only in China (719 (95% confidence interval 646 to 799) kcal versus 1088 (1002 to 1181) kcal; P<0.001). In analysis of variance models, fast food contained 33% less energy than full service meals (P<0.001). In Finland, worksite canteens provided 25% less energy than full service and fast food restaurants (mean 880 (SD 156) versus 1166 (298); P=0.009). Country, restaurant type, number of meal components, and meal weight predicted meal energy in a factorial analysis of variance (R 2 =0.62, P<0.001). Ninety four per cent of full service meals and 72% of fast food meals contained at least 600 kcal. Modeling indicated that, except in China, consuming current servings of a full service and a fast food meal daily would supply between 70% and 120% of the daily energy requirements for a sedentary woman, without additional meals, drinks, snacks, appetizers, or desserts. Conclusion Very high dietary energy content of both full service and fast food restaurant meals is a widespread phenomenon that is probably supporting global obesity and provides a valid intervention target.

Gluten-free (GF) eating patterns are frequently perceived to be healthier than gluten-containing (GC) ones, but there has been very little research to evaluate this viewpoint. The effect of GF eating patterns on dietary composition was assessed using two independent approaches. One approach compared macronutrients and typical shortfall nutrients between MyPlate example menus developed with either GC or equivalent GF foods. In this analysis, the GF menus were significantly lower in protein, magnesium, potassium, vitamin E, folate, and sodium (p = 0.002⁻0.03), with suggestive trends towards lower calcium and higher fat (p = 0.06⁻0.08). The second approach was a meta-analysis of seven studies comparing information on the nutrient intakes of adults with celiac disease following a GF diet with control subjects eating a GC diet, and differences were evaluated using paired t-tests or Wilcoxon Signed rank tests. In this analysis, consuming a GF diet was associated with higher energy and fat intakes, and lower fiber and folate intakes compared to controls (p < 0.001 to p = 0.03). After adjusting for heterogeneity and accounting for the large mean effect size (-0.88 ± 0.09), the lower fiber remained significant (p < 0.001). These combined analyses indicate that GF diets are not nutritionally superior except for sodium, and in several respects are actually worse.

Excess health care costs for treatment of noncommunicable diseases caused by obesity are now $200 billion/year. In addition, obesity reduces workforce productivity, and increases risks for disability and accidents. The executive branch of government can potentially influence obesity through many mechanisms, including policies for health care, feeding assistance programs, dietary guidelines, industry subsidies or tax breaks for weight management programs, farm subsidies for different types of agricultural products, diet‐physical activity policies for government employees and the military, and funding for obesity research. Despite this powerful connection between national administrations and the likely ability of the U.S. to manage its obesity epidemic, little is known about the relationship between obesity and voting patterns. We examined the association of rates of obesity with voting patterns in the 2016 presidential election to explore the political ramifications of this challenging disease.Data on rates of obesity across states and Washington D.C. were drawn from CDC data. Voting patterns in the 2016 election, the percent of the population in different racial/ethnic categories, and median income were taken from public records. There was a strong positive association between rate of obesity and percent of votes received by the Republican presidential candidate (Spearman's correlation coefficient=0.755, P<0.001), and a negative association of rate of obesity with percent of votes received by the Democrat presidential (Spearman's correlation coefficient=0.553, P<0.001). In regression models adding median income and percent ethnic minorities as covariates, percent of votes received by the Republican candidate remained a strong and highly significant predictor of percent obesity.The underlying reasons for the robust association of obesity and republican voting, independent of income and ethnic minority populations, are not known. However, regional food consumption patterns, eating habits and lifestyle are likely to important, given the dominant role of these factors in the development and maintenance of obesity, as well as rates of educational attainment and rural versus urban environments.These results confirm and extend associations of republication voting and rates of obesity documented in previous elections. Reducing health care costs and increasing employment were common agenda items during the 2016 presidential election. Even a 5–10% weight loss reduces health care costs and employee absenteeism within two years. By using a combination of executive actions and increased research funding, obesity reduction is likely to provide a quick return on investment that supports multiple political priorities.

Healthy food consumed during early childhood provides the nutrients needed for physical health, cognition and learning throughout life. Current literature suggests the majority of American children do not consume a healthy diet, this is found to be especially prevalent in low income and minority communities. Published nutrition interventions attempting to change children's preferences have generally been successful in improving health knowledge but have had limited success in changing food consumption patterns. We developed a new intervention for improving eating habits of preschool children, specifically using play‐based activities to improve the acceptance of healthy foods by young children via repeated exposure and familiarity. Thirty‐eight predominately minority children, aged 2.9–4.2 years old, from two classrooms in a Boston early childhood education program are participating in a pilot study to test the new intervention. Half of the children are in the intervention classroom, which receives 8 weeks of food‐related activities and target foods substituted for usual classroom activities and foods. The other half are in the control classroom, which is an assessment‐only group with no intervention. The intervention activities are 20–40 minutes in length per day and focus on familiarizing children with the target foods through games, art, cooking, gardening and tasting. The target foods are green leafy vegetables, carrots, tomatoes, whole grains, berries, grapes, apples, and a fortified bar providing nutrients and phytochemicals anticipated to be beneficial for cognition. The study is currently ongoing. The primary outcome is food intake during snacks and lunch in the classroom, made at baseline and endline for both classrooms and during the intervention weeks in the intervention classroom. Additional outcomes include children's food preferences, height, weight, hemoglobin, carotenoids, and cognitive function. Programs that effectively facilitate acceptance of nutritious foods by young children are urgently needed and would have substantial value in improving the health and possibly also the cognition of American children.

Up to 48% of older adults may be at increased nutrition risk. This is a concern as the number of older adults is projected to double by 2030 and obesity is suspected to rise to over 20% in the same population. The purpose of this analysis is to examine the impact of a diet and exercise intervention on diet quality in obese women in an urban setting. There were 26 women with mean age of 65.3 ± 8.1 years and BMI of 38.0 ±4.6 kg/m2 who completed a community based diet and exercise intervention. Seventeen women, 65% African‐American, were assigned to the intervention group (EXD) and participated in 12 weeks of Tai Chi (TC), resistance training (RT), and behavioral based diet intervention. Nine women were assigned to the control group (CON). The Dietary Screening Tool (DST) was used to assess diet quality; higher scores indicate better quality. Using an independent t‐test the EXD group had a significantly higher diet quality compared to the CON group (66.5 ± 10.2 vs. 53.5 ± 13.8; p=0.025) at post ‐intervention. Results from this analysis indicate that a behaviorally‐based diet, TC, and RT intervention may result in improved diet quality, however further research is needed.Grant Funding Source: College of Environment and Life Sciences Community Access to Research and Extension Services, USDA

Obesity is a major health problem in the USA, especially in minority populations over the age of 60 years, and the aging process can cause adverse effects on physical function. Previous research has shown that Tai Chi, resistance training (RT), and diet result in overall health improvements. However, the combination of these specific interventions has yet to be translated to obese older women in an urban setting. The purpose of this study was to examine a combined intervention on the primary outcomes of physical function and body composition. Using a nonrandomized design, 26 obese women (65.2±8.1years) completed a 12-week intervention; participants were assigned to an intervention (EXD) group or a control (CON) group. The EXD group (n=17) participated in Tai Chi, RT, and a dietary session. The CON group (n=9) was asked to continue their normal lifestyle. Timed up and go (TUG) time was reduced by0.64±2.1seconds (P=0.04) in the EXD group while the CON group saw a borderline significant increase of 0.71 sec (P=0.051). The combined intervention helped improve performance on TUG time, but there were no significant increases in other body composition or function measures.

Resilience is the ability to recover after a physical, emotional, financial, or social challenge. Limited research exists on the impact of dietary and physical activity interventions on resiliency. Fifty‐four obese, older women were recruited at two senior centers for a 16‐week community‐based intervention study that implemented a modified Dietary Approaches to Stop Hypertension (DASH) diet and Tai Chi (TC) exercise. At baseline, participants’ mean age was 68.2±7.7 years, with BMI of 35.4±4.3 kg/m2, and total cholesterol of 200.7±33.1 mg/dL. The mean Dietary Screening Tool (DST) score was 67.3±10.6 and the mean physical resiliency scale score was 12.96 ± 2.09. Significance was set at p<0.05. There was no significant difference at baseline between waitlist control (WC) and intervention (DASH‐TC) participants in any of the reported variables. One‐way repeated measures ANOVA comparing baseline to post‐intervention was significant for total DST score, BMI, waist circumference, systolic and diastolic blood pressure, and glucose; all with a large effect size. There was no significant interaction effect between WC and DASH‐TC groups in terms of physical resiliency; this may be related to a possible Hawthorne effect. The combination of DASH diet plus TC didn't seem to impact resiliency in this population. However, further research is needed to verify these results in larger, more diverse populations.