Understanding Barriers to Dietary Guideline Adherence

Understanding Barriers to Dietary Guideline Adherence

SUNDAY, OCTOBER 7 Research & Practice Innovations: Strategies for Lifestyle Changes Part 1 In Pursuit of the “Goldilocks Principle” - Finding the Rig...

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Research & Practice Innovations: Strategies for Lifestyle Changes Part 1 In Pursuit of the “Goldilocks Principle” - Finding the Right Fit Community-Level Intervention for Overweight Children: The YMCA and Seattle Children's Hospital Experience with Act! Actively Changing Together Author(s): M. Jones Verbovski,1 H. Greves Grow,2 L. Liu,2 P. Hencz,3 L. Gregerson,2 C. Larison2; 1Clinical Nutrition, Seattle Children’s Hospital, Seattle, WA, 2Seattle Children’s Research Institute, Seattle, WA, 3Seattle Children’s Hospital, Seattle, WA Learning Outcome: Describe the challenges and successes of an ongoing community based program addressing childhood obesity while effectively sustaining program impact and availability season after season. For many families, perceived extremes of intensive weight loss programs may be aversive. Since 2004, the ACT! Actively Changing Together program has aimed to strike a balance or “just right” level of participation to engage diverse, low-income families in healthy behavior changes, while also being affordable to continually operate in the community. Improvement efforts are ongoing to develop a sustainable model focused on secondary prevention. We evaluated outcomes after changes to the program were made to increase sustainability, reach more youth and reduce costs. Between 2010-2011, youth aged 8-14 years and their parents enrolling in ACT! at 10 geographically and demographically diverse sites were eligible for this pre-post study. Groups met 90 minutes weekly for 12 weeks. Outcome measures assessed pre and post program included BMI z-score, health behaviors, quality of life (PedsQL), and fitness. Process measures included attendance and satisfaction. Group means were compared by paired T-test. From 100 youth, 73% percent completed the program (attending week 11⫹). Complete pre-post data were available for 62 youth and 65 parents. BMI z-score decreased for 37% of youth, and stabilized for 48%. Parents’ report of their home nutrition and activity environments and role modeling behaviors improved (p⬍0.01). PedsQL youth (p⬍0.01) and parent (p⬍0.01) reports also improved. Overall results were comparable to data from the longer, more resource-intensive program (30 sessions). We found promising health and behavioral improvements among ACT! participants in a shorter version of our original program. ACT! successfully engaged families and can be readily disseminated in similar settings. Funding Disclosure: Combined support from Seattle Children’s Hospital Obesity Program and NIH grant 5 K23 DK081734-03, PI : H. Mollie Grow

Group Nutrition Counseling Is More Efficient and Equally Effective as Individual Counseling in Promoting Weight Loss Prior to Bariatric Surgery Author(s): E. Liskov, L. Mastroianni, M. Moser; Food and Nutritional Services, Yale New Haven Hosp., New Haven, CT Learning Outcome: To identify efficient and effective ways of delivering required nutrition counseling in preparation for bariatric surgery. Background: Clients seeking bariatric surgery are often required to have six months preparatory nutrition counseling before their medical insurance company will approve surgery. This can be a significant health care expense that has variable insurance coverage. At our hospital-based outpatient clinic, registered dietitians had difficulties accommodating the high volume of prebariatric surgery clients via individual counseling sessions. To increase efficiency, we began teaching group classes in May 2010. Methods: This study compared the efficacy of six months nutrition counseling, via weight change, for clients seen individually versus in a group format. Records were reviewed from 2009 for individually counseled clients and from 2010-2011 for group clients. Multiple regression analysis that controlled for age and gender was used to determine statistical significance of the weight change based upon visit type. Results: The mean weight loss was 3.5 kg ⫾ 6.02 for individually counseled clients (n⫽ 48; 37 female, 11 male) versus 1.35 kg ⫾ 5.79 for group format clients (n⫽ 47; 37 female, 10 male). There was no statistically significant difference in weight lost between the two groups (p ⫽ 0.06; 95% confidence interval). Group counseling resulted in a healthcare dollar savings of $360 per client. Also, registered dietitians improved efficiency by saving almost 2 hours of counseling time per pre-operative bariatric client seen in group format versus individual counseling sessions. Conclusion: We conclude that group nutrition counseling in preparation for bariatric surgery is more efficient and cost-effective than individual counseling and does not compromise weight loss results. Funding Disclosure: None

Understanding Barriers to Dietary Guideline Adherence Author(s): L. Jahns,1 M. Bogle,2 D. Chester,3 K. Laugero,4 K. Tucker,5 T. Nicklas6; 1 USDA/ARS, Grand Forks, ND, 2USDA/ARS Retired, Little Rock, AR, 3USDA/ARS, Beltsville, MD, 4USDA/ARS, Davis, CA, 5Northeastern Univ., Boston, MA, 6Baylor Coll. of Med., Houston, TX Learning Outcome: To list three key barriers to following the Dietary Guidelines for Americans (DGA). Research Outcome: The majority of the population does not meet recommendations for consumption of dairy (D), whole grains (WG), fruits (F), and vegetables (V). The goal was to understand barriers to Dietary Guidelines for Americans (DGA) adherence for four nutrient-rich food groups in children and adults across six Human Nutrition Research Center sites. Methods: 137 adults (34% AA; 31% EA; 35% HA) and 155 children (33% AA; 34% EA; 33% HA) participated in 47 Nominal Group Technique (NGT) sessions. NGT is a qualitative method of data collection. NGT includes weighted ranking of responses, enabling a group to generate and prioritize a large number of issues within a structure that gives everyone an equal voice. Results: Core barriers specific to adults were lack of preparation skills/recipes (WG, D, V); did not grow up eating it (D, F, V); spoilage/ripeness and cost (WG, F); cultural issues (WG) and health, i.e. lactose intolerance (D). In children, barriers were competing foods, i.e. junk foods/fast foods (WG, D, F, V); lack of exposure (V) and, availability (F). Core barriers common to both children and adults were disliking the taste (D, WG, V); and lack of knowledge of food sources/health benefits/portion sizes (WG). Conclusions: Children and adults described several overlapping and food group-specific barriers to increasing consumption of D, WG, F, and V. Programs for improving DGA adherence may be improved through integration of consumer-derived information about DGA adherence. Funding Disclosure: None

Food Insecurity Is Related to Cooking Self-Efficacy and Perceived Food Preparation Resources among College Students Author(s): A. Gaines,1 L. L. Knol,2 C. A. Robb,3 S. M. Sickler4; 1The Univ. of Alabama, Dept. of Hlth. Sci., Tuscaloosa, AL, 2Human Nutrition and Hospitality Management, The Univ. of Alabama, Tuscaloosa, AL, 3Consumer Sciences, The Univ. of Alabama, Tuscaloosa, AL, 4 Clothing, Textiles, and Interior Design, The Univ. of Alabama, Tuscaloosa, AL Learning Outcome: Following the session, participants should be able to explain the relationship of food insecurity with cooking self-efficacy and perceived food preparation resources. Background: There are limited data on the prevalence and determinants of food insecurity among post-secondary students. Students may be at risk due to restricted discretionary funds, ineligibility for federal food assistance programs, and underdeveloped food and financial management skills. The purpose of this study was to investigate the relationship of food security with cooking self-efficacy and perceived food preparation skills and resources among college students. Methods: Undergraduate students (n⫽598) in a large, public university completed an in-class questionnaire that included the US Adult Food Security Survey Module, items assessing cooking self-efficacy, and questions regarding perceived adequacy of food preparation skills and resources. Probit analysis was used to investigate the relationship between food security and cooking self-efficacy, skills, and resources while controlling for gender, race/ethnicity, age, campus meal plan participation, and receipt of food assistance within the past year. Results: Although the majority of the population (64.1%) was food secure, 21.2%, 9.1% and 5.7% of students were classified as marginally food secure, low food secure, and very low food secure, respectively. Food insecurity increased with age (p⬍0.001) and was more common among students receiving food assistance (p⫽0.001). As food insecurity increased, students reported decreases in self-efficacy for cooking cost-effective, nutritious meals (p⫽0.004), self-reported cooking skills (p⫽0.003), money to buy food (p⬍0.001), and time to prepare food (p⫽0.001). Conclusions: The prevalence of food insecurity among this sample of college students is higher than the national average, suggesting the need for improved student support systems and increased food and financial skill development opportunities. Funding Disclosure: None

September 2012 Suppl 3—Abstracts Volume 112 Number 9