Deirdra Chester, PhD, RD Obesity Research Coordinator Food
Intake and Energy Regulation Laboratory USDA ARS BHNRC The HEALTH
Study
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David before his visit to the US
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David just before leaving for Italy
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The Healthy Eating and Lifestyle for Total Health (HEALTH)
Study Prevalence of obesity in the US has doubled in the recent
decades. Nearly 1/3 of adults are obese (BMI>30). Overweight
among children is high and has been increasing in prevalence since
the mid 1970s. (Troiano et al, 1995; Ogden et al, 2002) An
estimated 16% of children and adolescents are overweight.
Introduction
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Why the Dietary Guidelines (DG) The 2005 DG for Americans
provides science-based advice to promote health and reduce risk for
major chronic diseases through diet and physical activity. The DG
provide food-based recommendations to meet nutrient requirements,
as well as recommendations for regular physical activity that
together, are designed to promote energy balance. The federal food
guidance based on the DG focuses on dietary intake patterns (also
referred to as food intake patterns) in which the recommendations
are integrated as a health promoting way for Americans. There is a
need to understand what barriers prevent adherence and what
facilitators promote adherence in order to counsel patients and
help the population adhere to the DG.
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Background Research continues to show that many segments of the
US population are not meeting the diet recommendations in the
Dietary Guidelines (Reeves, 2000; Walker et al., 2007; Casagrande
et al.,2007) This is particularly true for some sub-populations
such as Latinos who often are also at higher risk for heart
disease, cancer, stroke, and diabetes (Hayes-Bautisti et al., web;
CaDHS, web) yet whose population is increasing in the United
States, such that in 2001 over half of the births in California
were to Latino mothers (CaDHS, web). In addition, African Americans
are a population group who are at increased risk of heart disease,
cancer, stroke, and diabetes. Poor nutrition is linked to not only
the high levels of chronic disease in Latinos and African Americans
but also poor health outcomes in the general population
(DHHS,2005)
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Eating Behaviors, Context, and Body Weight
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Restaurant Food Consumption In 1994-1995, 57% of Americans
consumed at least one food item away from home on any given day,
compared to 43% in 1977 -1978 (Lin et al, 1999). Meals away from
home increased with age, from 18% for preschoolers to 26% for
school-age children, and 27 30% for adolescents. Fast-food
restaurants accounted for more than half of away- from-home meals
(Lin et al, 1998). The increasing proportion of household food
income spent on food away from home may help to explain the rising
prevalence of obesity in the US.
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Beverage Consumption Soft drink consumption has been replacing
more nutritious beverages such as milk and possibly fruit juices
among adolescents (Harnack et al, 1999). The proportion of
adolescent boys and girls consuming soft drinks daily increased by
74% and 65%, respectively, while milk consumption decreased over
the same period. Consumption of soft drinks increased dramatically
among adolescents from 1977-79 to 1994 (Borrud et al, 1996).
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Portion Sizes The typical fast food hamburger in 1957 contained
1 oz of cooked meat, compared to up to 6 oz in 1997. The average
soda was 8 ounces in 1957, vs. 32 to 64 ounces in 1997. The average
theatre popcorn was 3 cups in 1957 vs. 16 cups (medium size) in
1997. Adults consumed more food when served portions 1 times larger
than a standard portion size. 5-y-old children consumed greater
amounts of food when presented with larger portions.
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Meal Type and Frequency Ninety-eight percent of students
reported at least three daily eating occasions, and more than 50%
reported five or more (Burghardt, 1995). The percentage eating
snacks increased from 60% in 1977-78 to 75% in 1994-1995 (Cross et
al, 1994). Nearly all children 1 to 19 years of age reported eating
at least one snack per day (CSFII, 1994) and 36% of all children
consumed at least four or more different daily snacks (Cross et al,
1994). Children who consumed breakfast had significantly better
Healthy Eating Index (HEI) scores for grains, fruits, milk
products, and variety than children who did not (Bowman et al,
1998).
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Family Meals Eating dinner as a family has been associated with
higher quality diet (Cross et al, 1994). Greater frequency of
participation in family dinner associated with higher consumption
of fruit and vegetables, fiber, folate, calcium, iron, Vitamins B6,
B12, C and E, lower consumption of saturated and trans fatty acids,
soda, and fried foods (Gillman et al, 2000).
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Dietary Quality Americans eating has improved since 1989
(Bowman et al, 1998) Despite this positive trend, only 12% of
Americans had a diet that could be considered good. Dietary Variety
Individuals who consumed the greatest variety of foods from all
food groups had the most adequate nutrient intake (Kant et al,
1993).
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Physical Activity Many adults may need up to 60 minutes of
moderate to vigorous physical activity on most days to prevent
unhealthy weight gain. Children need at least 60 minutes of
moderate to vigorous physical activity on most days for maintenance
of good health and fitness and for healthy weight during
growth.
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Study Purpose The primary goal of the project is to identify
barriers and facilitators related to DG (MyPyramid) adherence
profiles and examine how differential profiles of adherence relate
to obesity. The inclusion of 3 major Racial-Ethnic Group (REG)
across 6 sites will provide information that will be valuable in
conducting future translational research for developing
interventions to combat obesity. Objectives: 1: To construct
conceptually, culturally, linguistically and measurement equivalent
surveys for caregivers and children to assess DG adherence barriers
and facilitators for the most prevalent US racial/ethnic groups
(REG) including African-(AA), European- (EA) and Hispanic-American
(HA). 2: To examine barriers and facilitators of DG adherence and
other factors as they relate to dietary behavior and body mass
index (BMI) by administering the surveys to cross-sections of the
US population in 6 geographic locations..
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Proposed Overall Design and Sequence of Activities NGT
Preparation & Questions Development (Barriers and Facilitators)
Conduct NGT Sessions with Caregivers and Children Response
Distillation and Survey Item Development Administer Pilot Surveys
and Conduct Psychometric Analyses Administer Cross-Sectional
Surveys Conduct Analyses to Examine Relationship b/w DG Adherence
and: (1) Barriers and Facilitators and (2) BMI in caregivers and
children from 6 Geographic Locations served by USDA Human Nutrition
Research Sites
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Beltsville Human Nutrition Research Center Where are we now?
African Americans European Americans 5 th Graders in public school
in Prince Georges County, MD Caregivers Cognitive Interview Nominal
Group Technique
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Phase II Barriers and Facilitators Survey (BAFS) Physical
Activity Body Composition Demographics Household Food Practices
Food Security Mood States Neighborhood Environmental Walkability
Scale (NEWS) Acculturation Parenting Dimensions Inventory
(PDI-S)
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Hypothesis Individuals with greater DG adherence perceive fewer
barriers and more facilitators compared to those with less DG
adherence Barriers and facilitators associated with DG adherence
differ by age, gender, racial/ethnic (REG) group, SES, geographic
location, and other physical, psychological and cultural factors.
Full adherence with the DG will occur in less than 5% of a diverse
sample of the population. Substantial (> 80%) adherence with the
DG occurs in less than 20% of the US population studied. BMI and
other body composition measures are associated with DG
adherence.
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Potential Benefits Identification and description of current DG
adherence profiles as a lifestyle package. Provide insights
regarding important relationships between weight status (obesity),
profiles of DG adherence, factors that influence adherence, and how
these relationships systematically vary as a lifestyle package.
Many factors influence barriers and facilitators including age,
gender, REG and SES. Understanding the barriers and facilitators of
the DG.