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PurposeSince 2011, US authorities have supported the following 2 approaches to healthier body fat composition: the Centers for Disease Control and Prevention National Diabetes Prevention Program's calorie counting (CC) approach and the US Department of Agriculture's MyPlate (adherence to federal nutrition guidelines). The purpose of this study was to compare the effect of CC vs MyPlate approaches on satiety/satiation and on achieving healthier body fat composition among primary care patients.MethodsWe conducted a randomized controlled trial comparing the CC and MyPlate approaches from 2015 to 2017. The adult participants were overweight, of low income, and were mostly Latine (n = 261). For both approaches, community health workers conducted 2 home education visits, 2 group education sessions, and 7 telephone coaching calls over a period of 6 months. Satiation and satiety were the primary patient-centered outcome measures. Waist circumference and body weight were the primary anthropometric measures. Measures were assessed at baseline, 6 months, and 12 months.ResultsSatiation and satiety scores increased for both groups. Waist circumference was significantly decreased in both groups. MyPlate, but not CC, resulted in lower systolic blood pressure at 6 months but not at 12 months. Participants for both MyPlate and CC reported greater quality of life and emotional well-being and high satisfaction with their assigned weight-loss program. The most acculturated participants showed the greatest decreases in waist circumference.ConclusionsA MyPlate-based intervention might be a practical alternative to the more traditional CC approach to promoting satiety and facilitating decreases in central adiposity among low-income, mostly Latine primary care patients.

IntroductionChildhood obesity disproportionately affects low-income women, children, racial/ethnic minorities, and rural populations. To effectively promote sustainable change, healthy eating and active living initiatives should apply individual plus policy, systems, and environmental (I + PSE) approaches.MethodsFour public health maternal and child nutrition teams selected through an application process participated in 12 months of technical assistance (TA) to develop action plans incorporating I + PSE in nutrition programming. TA included: (1) online modules; (2) community of practice (CoP) meetings; and (3) individual coaching sessions. Teams completed midpoint and endpoint surveys to assess TA knowledge and process outcomes. Semi-structured, in-depth interviews conducted post TA were transcribed and content analysis used to characterize themes and sub-themes.ResultsFacilitators to implementing I + PSE approaches included TA delivery through online modules, participation in the CoP, and individual coaching to address barriers to implementation and leadership support. Barriers were time and funding limitations, working in isolation, and lack of infrastructure and self-efficacy. Co-learning helped TA teams overcome stagnancy and promote development of creative solutions. Teams recognized relationship-building as integral to systems development.DiscussionLessons learned occurred across three main areas: relationships, capacity-building, and barriers encountered. Relationship formation takes time and is often not recognized as an asset impacting public health programing. Relationship direction - upstream, downstream, and lateral - affects ability to build organizational and systems capacity. While this study includes a small number of public health nutrition teams, this practice-based research highlights the value of I + PSE TA to tackle complex problems, with reciprocal, multisectoral support to enhance public health nutrition program impact.

BackgroundPrimary care-based behavior change obesity treatment has long featured the Calorie restriction (CC), portion control approach. By contrast, the MyPlate-based obesity treatment approach encourages eating more high-satiety/high-satiation foods and requires no calorie-counting. This report describes study methods of a comparative effectiveness trial of CC versus MyPlate. It also describes baseline findings involving demographic characteristics and their associations with primary outcome measures and covariates, including satiety/satiation, dietary quality and acculturation.MethodsA comparative effectiveness trial was designed to compare the CC approach (n = 130) versus a MyPlate-based approach (n = 131) to treating patient overweight. Intervenors were trained community health workers. The 11 intervention sessions included two in-home health education sessions, two group education sessions, and seven telephone coaching sessions. Questionnaire and anthropometric assessments occurred at baseline, 6- and 12 months; food frequency questionnaires were administered at baseline and 12 months. Participants were overweight adult primary care patients of a federally qualified health center in Long Beach, California. Two measures of satiety/satiation and one measure of post-meal hunger comprised the primary outcome measures. Secondary outcomes included weight, waist circumference, blood pressure, dietary quality, sugary beverage intake, water intake, fruit and vegetable fiber intake, mental health and health-related quality of life. Covariates included age, gender, nativity status (U.S.-born, not U.S.-born), race/ethnicity, education, and acculturation.AnalysisBaseline characteristics were compared using chi square tests. Associations between covariates and outcome measures were evaluated using multiple regression and logistic regression.ResultsTwo thousand eighty-six adult patients were screened, yielding 261 enrollees who were 86% Latino, 8% African American, 4% White and 2% Other. Women predominated (95%). Mean age was 42 years. Most (82%) were foreign-born; 74% chose the Spanish language option. Mean BMI was 33.3 kg/m2; mean weight was 82 kg; mean waist circumference was 102 cm. Mean blood pressure was 122/77 mm. Study arms on key baseline measures did not differ except on dietary quality and sugary beverage intake. Nativity status was significantly associated with dietary quality.ConclusionsThe two treatment arms were well-balanced demographically at baseline. Nativity status is inversely related to dietary quality.Trial registrationNCT02514889 , posted on 8/4/2015.

Objectives. Intake of fruits and vegetables protects against several common chronic diseases, and low income is associated with lower intake. We tested the effectiveness of a subsidy for fruits and vegetables to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Methods. Women who enrolled for postpartum services (n = 602) at 3 WIC sites in Los Angeles were assigned to an intervention (farmers' market or supermarket, both with redeemable food vouchers) or control condition (a minimal nonfood incentive). Interventions were carried out for 6 months, and participants' diets were followed for an additional 6 months. Results. Intervention participants increased their consumption of fruits and vegetables and sustained the increase 6 months after the intervention was terminated (model adjusted [R.sup.2] = .13, P Conclusions. Participants valued fresh fruits and vegetables, and adding them to the WIC food packages will result in increased fruit and vegetable consumption. (Am J Public Health. 2008;98:98-105. doi:10.2105/AJPH.2005.079418)

A survey module used to monitor the prevalence of household food insecurity and hunger in the United States was developed by a broadly based collaborative project with leadership from the USDA and the National Center for Health Statistics (NCHS). It has been administered annually since 1995 as a supplement to the Census Bureau's Current Population Survey (CPS) and is part of the National Health and Nutrition Examination Survey (NHANES) and other national surveys. Spanish is the second most common language in the United States, yet no standardized Spanish-language version of this instrument has yet been sanctioned by the relevant federal agencies. In the CPS, interviewers free-translate the questions while interviewing respondents who prefer to have the interview conducted in Spanish. National prevalence data indicate relatively high rates of food insecurity for Hispanic households, raising the question whether methodological artifacts may contribute to these rates. We analyzed eight Spanish-language versions of the instrument that have been used in published work for variability in wording and phrasing. We then conducted focus groups of low-income Spanish-speaking participants from Mexico, Central America, Puerto Rico and Cuba to refine a single Spanish-language instrument. We also employed professional translators to render the English instrument into 'standard' Spanish; both instruments were then back-translated. The focus group-derived instrument uses simpler language and grammar; its back-translation integrity to the English version was slightly better than the professionally translated version. We provide the instrument for use and further testing by other investigators. J. Nutr. 133: 1192-1197, 2003. KEY WORDS: * food security * Hispanics * Spanish * surveys