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PubMed | Center for Human Nutrition, Global Obesity Prevention Center and Harvard University
Type: Journal Article | Journal: PloS one | Year: 2016

To describe the food environments experienced by American Indians living on tribal lands in California.Geocoded statewide food business data were used to define and categorize existing food vendors into healthy, unhealthy, and intermediate composite categories. Distance to and density of each of the composite food vendor categories for tribal lands and nontribal lands were compared using multivariate linear regression. Quantitative results were concurrently triangulated with qualitative data from in-depth interviews with tribal members (n = 24).After adjusting for census tract-level urbanicity and per capita income, results indicate there were significantly fewer healthy food outlets per square mile for tribal areas compared to non-tribal areas. Density of unhealthy outlets was not significantly different for tribal versus non-tribal areas. Tribal members perceived their food environment negatively and reported barriers to the acquisition of healthy food.Urbanicity and per capita income do not completely account for disparities in food environments among American Indians tribal lands compared to nontribal lands. This disparity in access to healthy food may present a barrier to acting on the intention to consume healthy food.


PubMed | Global Obesity Prevention Center
Type: | Journal: The Journal of adolescent health : official publication of the Society for Adolescent Medicine | Year: 2016

To investigate agreement and associations between parent and youth acknowledgment of home food rules, youth eating behaviors, and measures of body composition and excess weight.Parent-youth dyads (N= 413) completed the rules for eating at home scale (Active Where Survey) and reported dietary intake. Trained research staff obtained anthropometric data. Linear regression analyses separately evaluated relationships between youth and parent acknowledgment of rules and youth-reported eating behaviors and anthropometric outcomes. Food rules were evaluated as a 12-item scale and individually.Score on the food rule scale was positively associated with fruit and vegetable servings by youth acknowledgment only (= .09, p= .006), and not with anthropometric outcomes. The rule no desserts except fruit was positively associated with fruit and vegetable servings by youth (= .72, p= .002) and parent (= .53, p= .03) acknowledgment. The rules no second helpings at meals and limited fast food were positively associated with body mass index z-score by youth (= .38, p=.002; = .32, p= .02, respectively) and parent (= .74, p < .001; = .41, p= .006, respectively) acknowledgment, with similar results for waist circumference z-score and percent body fat.Inverse associations between specific food rules and healthful eating behaviors but positive associations with anthropometric outcomes suggest potentially bidirectional relationships between food rule implementation and youth weight. Future studies should disentangle how food rules guide youth behavior in the context of youth weight status.


News Article | March 8, 2016
Site: news.yahoo.com

In reaction to model Ashley Graham gracing the cover of Sports Illustrated's latest swimsuit issue, former Sports Illustrated cover girl and supermodel Cheryl Tiegs sounded not so positive about women with larger waistlines. "I don't like it that we're talking about full-figured women, because it's glamorizing them, and your waist should be smaller than 35 [inches]," Tiegs said in an interview with E! on the red carpet of the 13th Annual Global Green USA pre-Oscar party. She has since clarified her response in a letter published by The Huffington Post, explaining that she did not mean to attack Graham personally and that she, herself, has a 37-inch waist. Celebrity feuds aside, Tiegs' reaction left many people curious about whether a 35-inch waist is a true marker of health. Experts say that, as with most medical guidelines, the facts are complicated. "Like any type of clinical cutoff, it's the result of these larger-scale studies," said Dr. Bruce Y. Lee, director of the Global Obesity Prevention Center and associate professor of international health at Johns Hopkins University, in an interview with Live Science. "Any cutoff is not an absolute, hard cutoff. It's not as if someone at 34.9 is different from someone at 35.1." Rules of thumb like this one represent data that's often distilled from thousands of people, and are meant as generalizations, Lee said. [Your Heart Health: 5 Numbers to Know] In the case of the 35-inch waist, the number gained substantial support from a study published in Circulation that used data from the large and long-running Nurses' Health Study, which followed a group of nearly 45,000 U.S. women over 16 years. The finding was published in 2008. The women in the study who had waists larger than 35 inches had almost double the risk of dying from heart disease, compared with those whose waists were under 28 inches, the researchers said. And the women in the study who had the largest waist circumference also had a much higher risk of dying from cancer or any other cause, than women with the smallest waists. All of the health risks increased steadily as waist circumference increased. Too much fat around the waist, which researchers sometimes call "central obesity," is also associated with an increased risk of developing type 2 diabetes and hypertension, Lee said. The average waist size of U.S women ages 20 and over is 37.5 inches, according to the Centers for Disease Control and Prevention. No one is sure why abdominal fat is more problematic for health than fat elsewhere in the body, but it does seem to act differently. Some experts have suggested that these fat cells around the waistline may interfere with the normal balance of hormones, negatively affecting insulin sensitivity, blood sugar and blood pressure. As a result of this and other research, the American Heart Association and the National Heart, Lung, and Blood Institute tell people to aim for a waist circumference smaller than 35 inches for women, and 40 inches for men. The International Diabetes Foundation goes further, setting a waistline goal of 31.5 inches for European women and 37 inches for European men. The groups' recommended waist sizes for Asian populations are slightly smaller, and it has yet to gather enough data to set specific standards for other ethnic groups. So should you panic if you measure 37 inches around the middle? Probably not, said Lisa Harnack, professor and co-director of the University of Minnesota Obesity Prevention Center, in an interview with Live Science. "There are actually quite a few risk factors for heart disease and type 2 diabetes, and this is just one of them," she said. [The Best Way to Lose Weight Safely] Waist circumference is one of many measures of health and, similar to body mass index (BMI), it can't tell us much on it's own. "The real issue is that each of these measurements is only a single view into the person," Lee said. He likened singular health measurements to a pinhole in a box where the patient is inside. Each only allows a small view into the person's overall health, and no single measurement can show all the important information. Both Harnack and Lee agreed that people can be overweight and healthy, just as people can be thin and unhealthy. However, going back to the general rule, a person's health will very likely be improved if he or she falls within the guidelines for a healthy waist circumference, they said. Copyright 2016 LiveScience, a Purch company. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.


Bartsch S.M.,Public Health Computational and Operations Research PHICOR | Umscheid C.A.,University of Pennsylvania | Nachamkin I.,University of Pennsylvania | Hamilton K.,University of Pennsylvania | And 2 more authors.
Clinical Microbiology and Infection | Year: 2015

Accurate diagnosis of Clostridium difficile infection (CDI) is essential to effectively managing patients and preventing transmission. Despite the availability of several diagnostic tests, the optimal strategy is debatable and their economic values are unknown. We modified our previously existing C.difficile simulation model to determine the economic value of different CDI diagnostic approaches from the hospital perspective. We evaluated four diagnostic methods for a patient suspected of having CDI: 1) toxin A/B enzyme immunoassay, 2) glutamate dehydrogenase (GDH) antigen/toxin AB combined in one test, 3) nucleic acid amplification test (NAAT), and 4) GDH antigen/toxin AB combination test with NAAT confirmation of indeterminate results. Sensitivity analysis varied the proportion of those tested with clinically significant diarrhoea, the probability of CDI, NAAT cost and CDI treatment delay resulting from a false-negative test, length of stay and diagnostic sensitivity and specificity. The GDH/toxin AB plus NAAT approach leads to the timeliest treatment with the fewest unnecessary treatments given, resulted in the best bed management and generated the lowest cost. The NAAT-alone approach also leads to timely treatment. The GDH/toxin AB diagnostic (without NAAT confirmation) approach resulted in a large number of delayed treatments, but results in the fewest secondary colonisations. Results were robust to the sensitivity analysis. Choosing the right diagnostic approach is a matter of cost and test accuracy. GDH/toxin AB plus NAAT diagnosis led to the timeliest treatment and was the least costly. © 2014 European Society of Clinical Microbiology and Infectious Diseases.


Anderson Steeves E.,University of Tennessee at Knoxville | Jones-Smith J.,Global Obesity Prevention Center | Hopkins L.,Global Obesity Prevention Center | Gittelsohn J.,Global Obesity Prevention Center
Journal of Nutrition Education and Behavior | Year: 2016

Objective: Evidence of associations between social support and dietary intake among adolescents is mixed. This study examines relationships between social support for healthy and unhealthy eating from friends and parents, and associations with diet quality. Design: Cross-sectional analysis of survey data. Setting: Baltimore, MD. Participants: 296 youth aged 9-15 years, 53% female, 91% African American, participating in the B'More Healthy Communities for Kids study. Main Outcome Measure(s): Primary dependent variable: diet quality measured using Healthy Eating Index 2010 (HEI) overall score, calculated from the Block Kids Food Frequency Questionnaire. Independent variables: Social support from parents and friends for healthy eating (4 questions analyzed as a scale) and unhealthy eating (3 questions analyzed individually), age, gender, race, and household income, reported via questionnaire. Analysis: Adjusted multiple linear regressions (α, P < .05). Results: Friend and parent support for healthy eating did not have statistically significant relationships with overall HEI scores. Youth who reported their parents offering high-fat foods or sweets more frequently had lower overall HEI scores (β = -1.65; SE = 0.52; 95% confidence interval, -2.66 to -0.63). Conclusions and Implications: These results are novel and demonstrate the need for additional studies examining support for unhealthy eating. These preliminary findings may be relevant to researchers as they develop family-based nutrition interventions. © 2016 Society for Nutrition Education and Behavior.


PubMed | University of Tennessee at Knoxville and Global Obesity Prevention Center
Type: Journal Article | Journal: Journal of nutrition education and behavior | Year: 2016

Evidence of associations between social support and dietary intake among adolescents is mixed. This study examines relationships between social support for healthy and unhealthy eating from friends and parents, and associations with diet quality.Cross-sectional analysis of survey data.Baltimore, MD.296 youth aged 9-15years, 53% female, 91% African American, participating in the BMore Healthy Communities for Kids study.Primary dependent variable: diet quality measured using Healthy Eating Index 2010 (HEI) overall score, calculated from the Block Kids Food Frequency Questionnaire.Social support from parents and friends for healthy eating (4 questions analyzed as a scale) and unhealthy eating (3 questions analyzed individually), age, gender, race, and household income, reported via questionnaire.Adjusted multiple linear regressions (, P<.05).Friend and parent support for healthy eating did not have statistically significant relationships with overall HEI scores. Youth who reported their parents offering high-fat foods or sweets more frequently had lower overall HEI scores (=-1.65; SE=0.52; 95% confidence interval, -2.66 to -0.63).These results are novel and demonstrate the need for additional studies examining support for unhealthy eating. These preliminary findings may be relevant to researchers as they develop family-based nutrition interventions.


Chen H.-J.,National Yang Ming University | Chen H.-J.,Global Obesity Prevention Center | Wang Y.,Global Obesity Prevention Center | Wang Y.,State University of New York at Buffalo
Journal of Adolescent Health | Year: 2016

Purpose Little is known about the relationship between changes in food store environment and children's obesity risk in the United States. This study examines children's weight status associated with the changes in the quantity of food stores in their neighborhoods. Methods A nationally representative cohort of schoolchildren in the United States was followed from fifth grade in 2004 to eighth grade in 2007 (n = 7,090). In 2004 and 2007, children's body mass index (BMI) was directly measured in schools. ZIP Code Business Patterns data from the Census Bureau in 2004 and 2007 characterized the numbers of food stores in every ZIP code area by type of store: supermarkets, limited-service restaurants, small-size grocery, and convenience stores. Baseline and change in the numbers of stores were the major exposures of interest. Results Girls living in neighborhoods with three or more supermarkets had a lower BMI 3 years later (by -.62 kg/m2; 95% confidence interval = -1.05 to -.18) than did those living in neighborhoods without any supermarkets. Girls living in neighborhoods with many limited-service restaurants had a greater BMI 3 years later (by 1.02 kg/m2; 95% confidence interval =.36-1.68) than did those living in neighborhoods with less than or equal to one limited-service restaurant. Exposure to a decreased quantity of small-size grocery stores in neighborhoods was associated with girls' lower BMI by eighth grade. Conclusions The longitudinal association between neighborhood food environment and children's BMI differed by gender. For girls, supermarkets in neighborhoods seemed protective against obesity, whereas small-size grocery stores and limited-service restaurants in neighborhoods increased obesity risk. There was no significant longitudinal finding for boys. © 2016 Society for Adolescent Health and Medicine. All rights reserved.


Gittelsohn J.,Global Obesity Prevention Center | Trude A.,Global Obesity Prevention Center
Journal of Nutritional Science and Vitaminology | Year: 2015

Innovative approaches are needed to impact obesity and other diet-related chronic diseases, including tested interventions at the environmental and policy levels. We have conducted multi-level community trials in low-income minority settings in the United States and other countries that test interventions to improve the food environment, support policy, and reduce the risk for developing obesity and other diet-related chronic diseases. All studies have examined change from pre- to post-study, comparing an intervention with a comparison group. Our results have shown consistent positive effects of these trials on consumer psychosocial factors, food purchasing, food preparation and diet, and, in some instances, obesity. We have recently implemented a systems science model to support programs and policies to improve urban food environments. Environmental interventions are a promising approach for addressing the global obesity epidemic due to their wide reach. Further work is needed to disseminate, expand and sustain these initiatives through policy at the city, state and federal levels. © 2015, Center for Academic Publications Japan. All rights reserved.


PubMed | Global Obesity Prevention Center
Type: Journal Article | Journal: The Journal of nutrition | Year: 2016

The price of food has long been considered one of the major factors that affects food choices. However, the price metric (e.g., the price of food per calorie or the price of food per gram) that individuals predominantly use when making food choices is unclear. Understanding which price metric is used is especially important for studying individuals with severe budget constraints because food price then becomes even more important in food choice.We assessed which price metric is used by low-income individuals in deciding what to eat.With the use of data from NHANES and the USDA Food and Nutrient Database for Dietary Studies, we created an agent-based model that simulated an environment representing the US population, wherein individuals were modeled as agents with a specific weight, age, and income. In our model, agents made dietary food choices while meeting their budget limits with the use of 1 of 3 different metrics for decision making: energy cost (price per calorie), unit price (price per gram), and serving price (price per serving). The food consumption patterns generated by our model were compared to 3 independent data sets.The food choice behaviors observed in 2 of the data sets were found to be closest to the simulated dietary patterns generated by the price per calorie metric. The behaviors observed in the third data set were equidistant from the patterns generated by price per calorie and price per serving metrics, whereas results generated by the price per gram metric were further away.Our simulations suggest that dietary food choice based on price per calorie best matches actual consumption patterns and may therefore be the most salient price metric for low-income populations.


PubMed | Global Obesity Prevention Center
Type: | Journal: Journal of nutritional science and vitaminology | Year: 2015

Innovative approaches are needed to impact obesity and other diet-related chronic diseases, including tested interventions at the environmental and policy levels. We have conducted multi-level community trials in low-income minority settings in the United States and other countries that test interventions to improve the food environment, support policy, and reduce the risk for developing obesity and other diet-related chronic diseases. All studies have examined change from pre- to post-study, comparing an intervention with a comparison group. Our results have shown consistent positive effects of these trials on consumer psychosocial factors, food purchasing, food preparation and diet, and, in some instances, obesity. We have recently implemented a systems science model to support programs and policies to improve urban food environments. Environmental interventions are a promising approach for addressing the global obesity epidemic due to their wide reach. Further work is needed to disseminate, expand and sustain these initiatives through policy at the city, state and federal levels.

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