Using video chat to eat commensally, i.e. VideoDining, may address eating alone and loneliness, risk factors for malnutrition. We conducted a mixed-methods feasibility and acceptability study to determine if adults aging-in-place could independently VideoDine. We recruited older adults in collaboration with the Office for Aging in a rural community. Participants were asked to use an Amazon EchoShow to VideoDine with family or friends once a week for four weeks. Participants (n=11) were a mean age of 88 and 91% female. Eight participants (73%) VideoDined at least twice. Sessions occurred primarily in the evening (16/25) for an average of 35 minutes. Most participants enjoyed VideoDining and rated sessions easy and comfortable. Facilitators to VideoDining included easy-to-prepare meals and challenges were identifying a partner and scheduling. Office for Aging administrators reported continued use of VideoDining one year later. VideoDining once a week was feasible and acceptable for older adults aging-in-place.

Background Eating alone, social isolation, and loneliness are independent risk factors for lower caloric intake, less variety in the diet, and malnutrition. Virtually dining with another person is a potential method to improve nutritional intake. Objective To determine the feasibility and acceptability of using videochat during mealtimes (VideoDining) in older adults eating meals alone. Study Design, Settings, Participants Single-arm mixed-methods intervention trial of VideoDining once to twice weekly for six sessions. Participants were at least 60 years old, living at home, and eating alone. Each participant received an Amazon EchoShow device, was trained, and paired with one or more dining partners. We collected survey data at baseline and after each VideoDine session and conducted individual semi-structured interviews after the final session. Measurable Outcome/Analysis Overall experience, enjoyment, comfort, and nervousness were self-rated after each session on a scale of 1-10, with higher scores more favorable, except for nervousness (low score favorable). We compared first to last session data using paired t-tests. Interviews were transcribed and then coded using thematic analysis. Results Thirty-three participants enrolled, six dropped out during baseline data collection, and 27 completed all six VideoDine sessions. Participants (n=27) were a mean age of 71.9 years, 77.8% female, and 81.5% White. VideoDining was easy/very easy 95% of the time, and 74.3% of sessions occurred without technical issues. The overall experience, enjoyment, and comfort level were rated highly and increased over the sessions (8.6 to 9.3, p=0.04; 8.8 to 9.6, p=0.07; 9.1 to 9.6, p=0.007), while nervousness decreased (2.4 to 1.3, p=0.04). Participants liked learning videochat, the human connection, and positive anticipation of VideoDining. However, some felt VideoDining was not for them because they were not “shut-in” or preferred to eat in-person. Videodiners identified dining partner mismatch and a scheduled mealtime as the main challenges. Conclusion VideoDining for one to two meals a week was feasible and acceptable for older adults. VideoDining has promise as a novel intervention for improving dietary intake in adults eating alone. Funding USDA Eating alone, social isolation, and loneliness are independent risk factors for lower caloric intake, less variety in the diet, and malnutrition. Virtually dining with another person is a potential method to improve nutritional intake. To determine the feasibility and acceptability of using videochat during mealtimes (VideoDining) in older adults eating meals alone. Single-arm mixed-methods intervention trial of VideoDining once to twice weekly for six sessions. Participants were at least 60 years old, living at home, and eating alone. Each participant received an Amazon EchoShow device, was trained, and paired with one or more dining partners. We collected survey data at baseline and after each VideoDine session and conducted individual semi-structured interviews after the final session. Overall experience, enjoyment, comfort, and nervousness were self-rated after each session on a scale of 1-10, with higher scores more favorable, except for nervousness (low score favorable). We compared first to last session data using paired t-tests. Interviews were transcribed and then coded using thematic analysis. Thirty-three participants enrolled, six dropped out during baseline data collection, and 27 completed all six VideoDine sessions. Participants (n=27) were a mean age of 71.9 years, 77.8% female, and 81.5% White. VideoDining was easy/very easy 95% of the time, and 74.3% of sessions occurred without technical issues. The overall experience, enjoyment, and comfort level were rated highly and increased over the sessions (8.6 to 9.3, p=0.04; 8.8 to 9.6, p=0.07; 9.1 to 9.6, p=0.007), while nervousness decreased (2.4 to 1.3, p=0.04). Participants liked learning videochat, the human connection, and positive anticipation of VideoDining. However, some felt VideoDining was not for them because they were not “shut-in” or preferred to eat in-person. Videodiners identified dining partner mismatch and a scheduled mealtime as the main challenges. VideoDining for one to two meals a week was feasible and acceptable for older adults. VideoDining has promise as a novel intervention for improving dietary intake in adults eating alone.

Abstract Objective Age-related weight gain refers to the gain in adult body weight with age. What makes age-related weight gain a serious public health problem is that the higher the rate of age-related weight gain, the greater the incidence of many weight related diseases such as diabetes, hypertension and heart disease. We examined the efficacy of daily self-weighing to reduce age-related weight gain among university employees. Design: Participants were randomized into two groups. One group (experimental) were given internet-based scales and asked to weigh themselves daily. They received an email reminder if more than three days elapsed between weighings. The other group (control), like the experimental group, was weighed at the beginning and the end of the two-year experimental period. Settings: The initial and final weighing occurred in the Metabolic Unit of the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Participants: The participants were 286 adult employees of a Cornell University Results Using the conventional Intent-to-Treat analysis neither the within subject weight change over time (-0.38kg [-1.27kg, 0.50kg], control: 0.19kg [-0.56kg, 0.93kg]) nor the between groups (0.40kg, p = 0.183) reached statistical significance. However, when the non-compliers from both the experimental and control group were removed, the self-weighers gained significantly less weight than the controls (0.59 kg (p = 0.048)). Analyses controlled for baseline weight, gender, ethnicity, age, education, marital status, weight change the year before the study, and baseline weighing frequency. Conclusion Compliers to daily self-weighing gained significantly less weight over two years than a matched group who did not self-weigh.

Differences in messaging from healthcare and wellness practitioners can lead to consumer confusion and mistrust in nutrition. The regular use of evidence-based nutrition resources by practitioners could improve consistency in patient education. The confidence registered dietitians (RDNs) and non-RDN practitioners have in providing nutrition education and the use of evidence-based nutrition resources in patient education is not known. Objectives: 1) To evaluate how confident RDN and non-RDN practitioners are in providing nutrition education, and 2) to evaluate RDN and non-RDN use of evidence-based nutrition resources. An exploratory, online, cross-sectional study was conducted with a convenience sample of 34 RDNs and 32 non-RDN practitioners. The 15 question survey was tested for face validity and revised accordingly. Recruitment occurred via email and through local and state-wide professional organization list-serves. Confidence questions were measured using Likert scales and were scored from 1 (not at all confident) to 5 (extremely confident). Differences in confidence between groups were determined using Mann-Whitney U tests (P < 0.05). Eighty-five % of RDNs and 31% of non-RDNs felt very or extremely confident in their ability to find evidence-based nutrition information; 65% of RDNs and 31% of non-RDNs felt very or extremely confident in their ability to provide evidence-based nutrition information to their patients. Non-RDNs felt less confident than RDNs both in finding (P < 0.01) and providing (P < 0.01) evidence-based nutrition information. Forty-one % of non-RDNs reported providing nutrition education to more than a quarter of their patients over the past year. More than 60% of RDNs and more than 70% of non-RDNs reported being unfamiliar with or never using multiple resources for evidence-based nutrition information, including Cochrane, Nutrition Evidence Systematic Reviews, and Practice-based Evidence in Nutrition. The majority of RDNs and a third of non-RDNs felt highly confident in their ability to find and provide evidence-based nutrition information. However, more than half of RDNs and non-RDNs reported being unfamiliar with or never using multiple resources for evidence-based nutrition information. College at Oneonta Foundation and the SUNY Oneonta Alumni Association.

Kuhns was the first to suggest that theories in science do not develop in small increments but rather in major leaps to paradigms that examine the same question through very different perspectives. Theories on the mechanism responsible for control of human food intake fall into Kuhn’s description. This article describes how the two major theories of the control of food intake in humans, the Glucostatic Theory, and the Lipostatic Theory, showed initial promise as explanations, but later deteriorated with the slow accumulation experimental data. The locus of theories considered eating behavior as a part of physiological system that regulates the storage of energy on the body. We challenge this fundamental belief with data which suggests that we must be ready to accept a major change in the way we think about eating behavior if we are ever to decrease the prevalence of obesity.

Objective: To assess the effectiveness of a peer-led single-session intervention targeting the sociocultural pressures of body image. Participants: New members of 13 sororities at one university. Methods: Participants were randomized by sorority into the intervention (n = 207) or wait list control (n = 264). Online surveys were administered at baseline and one month to assess social determinants of body image, body image dissatisfaction (BID), and body appreciation. Multiple logistic and linear regression analyses compared changes over time between groups. Results: We observed significant improvements in overall sociocultural pressures of body image (p = .001) and the subscales of Norms (p < .001) and Perceived Norms (p = .009) of eating and exercise behaviors. Change in BID and body appreciation did not differ between groups. Conclusion: A one-hour peer-led community-level intervention can lead to positive changes in sociocultural pressures in new initiates to a sorority.

Background The Patient Activated Learning System (PALS) is a free web-based patient application platform designed for low literacy audiences. Evidence-based information is presented in single-objective webpages, with content ranging from pharmacological treatment to behavioral approaches to disease prevention and management. Multidisciplinary collaboration that includes nutrition education program stakeholders may benefit PALS nutrition content development. Objective Pilot methods to develop and evaluate acceptability of PALS nutrition pages with a team of physicians, nutrition researchers, and Expanded Food and Nutrition Education Program (EFNEP) educators and participants. Study Design, Setting, Participants We conducted a feasibility and acceptability study with convenience samples of geographically dispersed EFNEP educators and participants in New York. We identified commonly asked cardiovascular disease (CVD) related nutrition questions using two online surveys of educators (n = 12, n = 45), then used a rapid systematic review of relevant scientific evidence and practice guidelines to generate PALS pages. We assessed page acceptability in focus groups with educators (n = 10) and interviews with participants (n = 12). Measurable Outcome/Analysis Educator-generated questions were grouped thematically, condensed, and rated based on perceived relevance. Researchers iteratively coded focus group and interview transcripts, independently summarized feedback, and met to discuss acceptability-related findings. Results Educators identified 33 common CVD-related nutrition questions; highest rated questions informed development of 4 PALS pages about coconut oil, saturated and unsaturated fat, and fiber. Educators reported the pages were clear, concise, and acceptable for educators and participants. The combination of text and figures addressed a range of learning needs, and educators appreciated the behaviorally focused content. Most EFNEP participants found the content relevant, easily digestible, and helpful. Incorporating practical information in colorful figures was particularly appealing. Participants demonstrated an understanding of the content. Most would return to PALS, citing clarity and trustworthiness of information provided. Conclusions The multidisciplinary team successfully engaged EFNEP stakeholders in the development and review of evidence-based nutrition online information, which helped generate relevant, clear, appealing, and trustworthy content. Lessons learned can inform development of PALS content and may apply to other eHealth platforms. Funding Cornell Center for Health Equity

Proteins and its building blocks, amino acids, have many physiological roles in the body. While some amino acids can be synthesized endogenously, exogenous protein and amino acids are necessary to maintain homeostasis. Because skeletal muscle contains a large portion of endogenous protein and plays important roles in movement, regulation, and metabolism, imbalanced protein and amino acid availability may result in clinical conditions including skeletal muscle atrophy, impaired muscle growth or regrowth, and functional decline. Aging is associated with changes in protein metabolism and multiple physiological and functional alterations in the skeletal muscle that are accentuated by decreased dietary protein intake and impaired anabolic responses to stimuli. Inactivity and chronically elevated inflammation of the skeletal muscle can initiate and/or augment pathological remodeling of the tissue (i.e., increase of fat and fibrotic tissues and atrophy of the muscle). Defining an adequate amount of dietary protein that is appropriate to maintain the availability of amino acids for biological needs is necessary but is still widely debated for older adults. This chapter will provide (i) an overview of dietary protein and amino acids and their role in skeletal muscle health; (ii) an overview of skeletal muscle structure and function and the deterioration of muscle that occurs with advancing age; (iii) a discussion of the relationship between protein/amino acid metabolism and skeletal muscle decline with aging; and (iv) a brief discussion of optimal protein intakes for older adults to maintain skeletal muscle health in aging.

Background: Increasing portion size has been shown to increase energy intake. However, little is known about the effect of reducing portion size on subsequent consumption and the consequent energy intake. Objective: The purpose of this study was to examine the effect of decreasing portion size of an entree on the amount of dessert consumed as a following course. Methods: A total of 81 participants were instructed to consume a lunch entree and dessert ad libitum. The participants were given the same entree and dessert on the same day of the week for four consecutive weeks. However, the entree was reduced to 90%, 85%, 80%, and 75% of the amount they consumed in the first week of the study. Participants were randomized into four groups and were served the reduced entree according to a Latin square design. Dessert was consumed ad libitum. In addition, subjects' hunger and satiety levels were assessed before the entree, after the entree, and after dessert. Results: Reducing portion size had no effect on the amount of dessert consumed despite the finding that measures of hunger and satiety indicated that participants experienced increased hunger at 80% and 75% portion reductions. Conclusions: Reduction in the portion size of an entree by up to 25% did not increase the amount of dessert consumed, despite an increase in perceived hunger at lower portion sizes. Further investigation is needed to study how much further portion size could be reduced with a sustained decrease in energy intake without compensation, as well as to examine potential interventions for portion control that could reduce daily energy intake.

Abstract Loneliness and a loss of commensality contribute to the decline in nutritional status observed in older adults. The use of video chatting while dining, i.e. “VideoDining”, provides an opportunity for older adults to eat with another person virtually while dining at home. We tested the acceptability and feasibility of VideoDining in older adults receiving Meals on Wheels (MOW) and explored whether it changed meal intake. Participants were recruited from a rural county in NY and ate their MOW meal while VideoDining with a companion diner at a different location. To assess acceptability, we conducted semi-structured qualitative interviews with each participant and companion diners completed a written survey. The amount of the VideoDining meal consumed was compared to usual intake from three days of food records. 140 MOW clients were contacted,13 agreed to participate and 10 completed the VideoDining experience. Barriers to participation included being uncomfortable with the technology, lack of internet service and illness. Participants were 80% female, 100% white, and all lived alone. Average meal length was 39 minutes and 40% ate more than usual, 30% ate the same, and 30% ate less. Reasons for eating less included being nervous and eating when not their usual mealtime. All participants reported they would VideoDine again and companion diners rated the overall experience a 9.2 out of 10. Older adults are able to VideoDine with a new acquaintance and have a positive experience. Further study is needed to determine if VideoDining can increase dietary intake and decrease loneliness in older adults.

To assess the precision of the biological control of energy intake we performed a systematic review of studies that measured acute changes in human food intake in response to energetic errors. The imposed errors were grouped into the following categories of studies: alternate day fasting, changes in diet composition, exercise, meal skipping, overfeeding, energy substitutes, underfeeding and changes in portion size. Seven hundred thirty-nine studies published between 1980 and 2017 were identified from which the data from 592 groups from 200 studies were extracted and subjected to analysis consisting of a total of 13,203 participants. For each category of imposing an energetic error, an Energetic Error was calculated as (Observed Mean Energy Intake – Expected Mean Energy Intake)/Expected Mean Energy Intake. In no category of studies was the Energetic Error equal to zero. In studies where participants were expected to increase energy intake, the increase was not sufficient to overcome the deficit. Similarly, in studies where a reduction in energy intake was expected, the reduction was insufficient to restore energy balance to zero. The average energetic error resulting from imposed energetic challenges is about twenty-four percent, a value sufficiently large to account for the increase in body weight observed in the U.S. population over the past 50 years.

Division of Nutritional Sciences at Cornell University and National Institute for Food and Agriculture FCF Hatch Grant.

Background (Background, Rationale, Prior Research, and/or Theory): The majority (59%) of young adults use the social media application Instagram. Objective: To describe food-related (FR) posts viewed by young adults on their Instagram accounts and explore associations with their dietary intake. Study Design, Setting, Participants, Intervention: Descriptive study of 30 undergraduate students identified as regular Instagram users. Outcome Measures and Analysis: We collected surveys and interviews of dietary intake (REAP) and FR posts viewed on Instagram. All FR posts in the past 24 hours were screen-captured and an ASA24 dietary recall completed. Each FR post was described and categorized based on the food content and context of the post. Categories were not mutually exclusive. Spearman correlations and Kruskal-Wallis tests were used to explore associations between FR posts and dietary intake. Results: Participants were 83.3% female, 46.7% White and 36.7% Asian. A median of 15 FR posts (25–75%, 5.8–29.8) were viewed per day accounting for 8.9% of posts. FR posts were primarily food alone (60.4%) with people in 22% of images, advertisements accounting for 14.3%, eating out conveyed in 33.5% and homemade foods in 17.4%. The foods represented in the FR posts were most often sweets (31.9%), fruits (28.3%), vegetables (27.6%), and fast food (9%). Eighty-seven percent of participants consumed at least one food item similar to a FR post food viewed in the same 24 hours. Healthy eating pattern REAP scores associated with the percentage of FR posts viewed (r = 0.38, P = .040). There were no associations between intake of fruits, vegetables, or sugars with the number of FR posts containing similar foods. Self-reported unhealthy/somewhat healthy eaters viewed 3 times more FR posts of eating out vs healthy eaters (46.7% vs. 14.3%, P = .001). Conclusions and Implications: Undergraduates who are regular Instagram users view both unhealthy and healthy FR posts on their Instagram feeds. Healthier eaters view relatively more FR posts and fewer posts of eating out as compared to less healthier eaters. Funding: None.

ObjectiveTo describe the content and meaning of food-related posts on social media.Design, Setting, and ParticipantsA descriptive cross-sectional study using a mixed-methods approach. Regular users of Facebook were recruited from a university in central New York to complete an online survey using their Facebook accounts.Outcome Measures and AnalysisA survey was developed to collect data on social media use and food-related posts on Facebook. The three most recent food-related posts viewed by participants were analyzed qualitatively using the constant comparative method to identify main themes related to content and meaning of the posts. Each food-related post was also coded as healthy or unhealthy according to the 2010 Dietary Guidelines for Americans.ResultsParticipants (n=50) were 66% female, 61.7% white, and had a mean age of 20.5 years (S.D.=1.2). An average of 6.1 food-related posts (S.D.=4.7) were viewed in 12 hours. Of the 107 food-related posts analyzed, most were pictures (59.8%) or text (23.3%) and 75% were unhealthy. For content, 34.6% of posts were sweets, 27.1% depicted restaurants/eating out, and 25.2% showed social events with food. The main themes identified for the meaning of the posts were to share extraordinary food, food-related social events, eating-out, emotions about food and food advice (recipes, how-tos). Subthemes of “extraordinary food” included desserts/treats, pretty food, homemade food, cultural food, and oversized portions.Conclusions and ImplicationsIn college students, food-related posts viewed on Facebook predominantly consist of unhealthy foods and are meant to share extraordinary foods, emotions and events related to eating, and information about food preparation. Further research is needed to determine the impact of these communications on food choices, intake, and eating behaviors.FundingCornell University ObjectiveTo describe the content and meaning of food-related posts on social media. To describe the content and meaning of food-related posts on social media. Design, Setting, and ParticipantsA descriptive cross-sectional study using a mixed-methods approach. Regular users of Facebook were recruited from a university in central New York to complete an online survey using their Facebook accounts. A descriptive cross-sectional study using a mixed-methods approach. Regular users of Facebook were recruited from a university in central New York to complete an online survey using their Facebook accounts. Outcome Measures and AnalysisA survey was developed to collect data on social media use and food-related posts on Facebook. The three most recent food-related posts viewed by participants were analyzed qualitatively using the constant comparative method to identify main themes related to content and meaning of the posts. Each food-related post was also coded as healthy or unhealthy according to the 2010 Dietary Guidelines for Americans. A survey was developed to collect data on social media use and food-related posts on Facebook. The three most recent food-related posts viewed by participants were analyzed qualitatively using the constant comparative method to identify main themes related to content and meaning of the posts. Each food-related post was also coded as healthy or unhealthy according to the 2010 Dietary Guidelines for Americans. ResultsParticipants (n=50) were 66% female, 61.7% white, and had a mean age of 20.5 years (S.D.=1.2). An average of 6.1 food-related posts (S.D.=4.7) were viewed in 12 hours. Of the 107 food-related posts analyzed, most were pictures (59.8%) or text (23.3%) and 75% were unhealthy. For content, 34.6% of posts were sweets, 27.1% depicted restaurants/eating out, and 25.2% showed social events with food. The main themes identified for the meaning of the posts were to share extraordinary food, food-related social events, eating-out, emotions about food and food advice (recipes, how-tos). Subthemes of “extraordinary food” included desserts/treats, pretty food, homemade food, cultural food, and oversized portions. Participants (n=50) were 66% female, 61.7% white, and had a mean age of 20.5 years (S.D.=1.2). An average of 6.1 food-related posts (S.D.=4.7) were viewed in 12 hours. Of the 107 food-related posts analyzed, most were pictures (59.8%) or text (23.3%) and 75% were unhealthy. For content, 34.6% of posts were sweets, 27.1% depicted restaurants/eating out, and 25.2% showed social events with food. The main themes identified for the meaning of the posts were to share extraordinary food, food-related social events, eating-out, emotions about food and food advice (recipes, how-tos). Subthemes of “extraordinary food” included desserts/treats, pretty food, homemade food, cultural food, and oversized portions. Conclusions and ImplicationsIn college students, food-related posts viewed on Facebook predominantly consist of unhealthy foods and are meant to share extraordinary foods, emotions and events related to eating, and information about food preparation. Further research is needed to determine the impact of these communications on food choices, intake, and eating behaviors. In college students, food-related posts viewed on Facebook predominantly consist of unhealthy foods and are meant to share extraordinary foods, emotions and events related to eating, and information about food preparation. Further research is needed to determine the impact of these communications on food choices, intake, and eating behaviors.

The objective of this study was to explore the perceived benefits of engaging in health behavior change from the viewpoint of overweight and obese Latinos with severe mental illness (SMI) enrolled in the U.S. Qualitative, semistructured interviews were conducted with 20 obese Latinos with SMI who were enrolled in a randomized trial evaluating the effectiveness of a motivational health promotion intervention adapted for persons with SMI. Overweight and obese Latino participants believed that engaging in health behavior change would have both physical and mental health benefits, including chronic disease management, changes in weight and body composition, and increased self-esteem. Interventions that explicitly link physical activity and healthy eating to improvements in mental health and well-being may motivate Latinos with SMI to adopt health behavior change.

Current efforts to reduce the increased risk of premature death from preventable cardiovascular disease among adults with serious mental illness (SMI) through lifestyle change have had limited success. Engaging informal support systems to promote healthy behaviors in everyday life may increase the effectiveness of health promotion interventions targeting this at-risk population. In-depth semistructured interviews were conducted with 10 fitness trainers serving adults with SMI in a health promotion program at community mental health centers to explore their perspectives on the potential of enlisting support from significant others for health behavior change. Trainers reported that the majority of participants had a relative or significant other who influenced their health behaviors, and they saw potential value in involving them in efforts to improve health outcomes by extending support into participants' daily lives. They did not feel qualified to work with families of individuals with mental illness, but they were willing to partner with providers who had experience in this area. Social workers who practice with families could play a critical role on health promotion teams addressing cardiovascular risk in adults with SMI by using their skills and experiences to engage families in supporting a relative through the process of health behavior change.