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https://doi.org/10.1370/afm.3150 INTRODUCTION Obesity is a serious global public health problem. (1,2) Veterans and racial and ethnic minority groups experience considerable disparities in obesity rates (2-4) and are thus at higher [...], PURPOSE We undertook a trial to test the efficacy of a technology-assisted health coaching intervention for weight management, called Goals for Eating and Moving (GEM), within primary care. METHODS This cluster-randomized controlled trial enrolled 19 primary care teams with 63 clinicians; 9 teams were randomized to GEM and 10 to enhanced usual care (EUC). The GEM intervention included 1 in-person and up to 12 telephone-delivered coaching sessions. Coaches supported goal setting and engagement with weight management programs, facilitated by a software tool. Patients in the EUC arm received educational handouts. We enrolled patients who spoke English or Spanish, were aged 18 to 69 years, and either were overweight (body mass index 25-29 kg/[m.sup.2]) with a weight-related comorbidity or had obesity (body mass index [greater than or equal to] 30 kg/[m.sup.2]). The primary outcome (weight change at 12 months) and exploratory outcomes (eg, program attendance, diet, physical activity) were analyzed according to intention to treat. RESULTS We enrolled 489 patients (220 in the GEM arm, 269 in the EUC arm). Their mean (SD) age was 49.8 (12.1) years; 44% were male, 41% Hispanic, and 44% non- Hispanic Black. At 12 months, the mean adjusted weight change (standard error) was -1.4 (0.8) kg in the GEM arm vs -0.8 (1.6) kg in the EUC arm, a nonsignificant difference (P =.48). There were no statistically significant differences in secondary outcomes. Exploratory analyses showed that the GEM arm had a greater change than the EUC arm in mean number of weekly minutes of moderate to vigorous physical activity other than walking, a finding that may warrant further exploration. CONCLUSIONS The GEM intervention did not achieve clinically important weight loss in primary care. Although this was a negative study possibly affected by health system resource limitations and disruptions, its findings can guide the development of similar interventions. Future studies could explore the efficacy of higher-intensity interventions and interventions that include medication and bariatric surgery options, in addition to lifestyle modification. Key words: obesity; overweight; comorbidity; health coaching; motivation; self-management; primary care; lifestyle; goal setting; diet; weight loss; physical activity; veterans; ethnic and racial minorities; vulnerable populations; barriers; practice-based research; health informatics

Some individuals' understanding of informed consent (IC) information may improve with electronic delivery, but others may benefit from face-to-face (F2F). This randomized, multisite study explores how individuals from diverse backgrounds understand electronic IC documents versus F2F, their confidence in understanding, and enrollment in research. A total of 501 patients at two U.S. biobanks with diverse populations participated. There were no overall differences between electronic and F2F understanding, but F2F predicted higher confidence in understanding and enrollment. Ethnicity and a higher educational level predicted higher understanding and confidence. Study findings suggest that electronic consent may lead to better understanding for non-Hispanic patients of higher socioeconomic status. F2F processes may lead to better understanding and higher enrollment of patients from Hispanic and lower socioeconomic levels. Researchers should carefully consider how they implement electronic IC processes and whether to maintain an F2F process to better address the needs and limitations of some populations. [ABSTRACT FROM AUTHOR]

The detection of founder pathogenic variants, those observed in high frequency only in a group of individuals with increased inter-relatedness, can help improve delivery of health care for that community. We identified 16 groups with shared ancestry, based on genomic segments that are shared through identity by descent (IBD), in New York City using the genomic data of 25,366 residents from the All Of Us Research Program and the Mount Sinai Bio Me biobank. From these groups we defined 8 as founder populations, mostly communities currently under-represented in medical genomics research, such as Puerto Rican, Garifuna and Filipino/Pacific Islanders. The enrichment analysis of ClinVar pathogenic or likely pathogenic (P/LP) variants in each group identified 202 of these damaging variants across the 8 founder populations. We confirmed disease-causing variants previously reported to occur at increased frequencies in Ashkenazi Jewish and Puerto Rican genetic ancestry groups, but most of the damaging variants identified have not been previously associated with any such founder populations, and most of these founder populations have not been described to have increased prevalence of the associated rare disease. Twenty-five of 51 variants meeting Tier 2 clinical screening criteria (1/100 carrier frequency within these founder groups) have never previously been reported. We show how population structure studies can provide insights into rare diseases disproportionately affecting under-represented founder populations, delivering a health care benefit but also a potential source of stigmatization of these communities, who should be part of the decision-making about implementation into health care delivery.

Background: A minority of American youth meet CDC lifestyle behavior recommendations. Children in the Bronx face barriers to healthy behaviors amplified by COVID-19. This research evaluated baseline behavior among distinct cohorts attending afterschool programming before and after the COVID-19 shutdown. Methods: Three Bronx public schools collected demographic and behavior data at the start of the 2021-2022 school year. This was compared to baseline data from students during the 2016-2017 and 2017-2018 school years at 1 school. Results: During the 2016-2017 and 2017-2018 school years, 76 students completed lifestyle behaviors questionnaires. During the 2021-2022 school year 89 students completed questionnaires. Participants surveyed after the COVID-19 shutdown drank more sweetened beverages (Median (IQR) = 3 (2-5) cups/day vs 2 (1-4) cups/day, P = .029) than those surveyed before the pandemic. Changes to the distribution of sleep (8 (7.5-9) hours/day vs 8 (6-9) hours/day, P = .005) and fast food consumption (1 (0 to 2-3) times/week vs 1 (1 to 2-3) times/week), P = .004) without changes in medians were also observed. PA hours completed weekly trended toward significant decline (4 (2-5) hours/week vs 3 (2-5) hours/week, P = .09). Conclusions: Changes in behaviors including sleep, physical activity, and sweetened beverage and fast food consumption observed after the COVID-19 shutdown highlight the importance of robust programming to promote healthy lifestyle behaviors in youth., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2024 The Author(s).)

Background: A minority of American youth meet CDC physical activity (PA) recommendations; children in the Bronx face additional structural barriers to engaging in PA. The B'N Fit Power expansion draws on pilot programming to increase the proportion of middle school students who engage in one hour of daily PA. The COVID-19 pandemic presented additional obstacles, including increased food insecurity and suspension of organized PA programming. This research aimed to evaluate differences in baseline target behavior attainment before and after the start of the COVID-19 pandemic to inform future programming to help children reduce their risk of obesity., Methods: Afterschool program leaders at three Bronx public schools collected demographic and target behavior data at baseline and attendance data throughout the school year., Results: During the 2016-2017 and 2017-2018 school years, 76 students enrolled and completed one year of programming, which was administered at a single site (61 % Hispanic, 46% female). Of these, 76 (100%) completed a baseline target behaviors questionnaire. During the 2021-2022 school year, 417 students enrolled and completed one year of programming at one of the three sites (70% Hispanic, 48% female). 89 (21%) completed a baseline target behaviors questionnaire. Participants surveyed after the start of the COVID-19 pandemic reported drinking more sugar-sweetened beverages (Median=3 daily, IQR 2-5), sleeping less (Median=8 hours daily, IQR 6-9 hours), and consuming fast food more frequently (Median=1 time weekly, IQR 0 times weekly-2 to 3 times weekly) than those surveyed prior to the start of the pandemic. The number of PA hours completed each week trended toward significant decline (Median=3, IQR 2-5, p=0.09) in students tracked after the start of the pandemic., Conclusions: The attainment of several target behaviors among school children linked to the reduction of childhood obesity declined during the COVID-19 pandemic. These findings can be applied to enhancing existing real-world afterschool PA programming., Competing Interests: Competing interests The authors have no conflict of interest to disclose, and the authors have no financial relationships relevant to this article to disclose.