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Primary care practitioners (PCPs) have been encouraged to screen all adults for obesity and to offer behavioral weight loss counseling to the affected individuals. However, there is limited research and guidance on how to provide such intervention in primary care settings. This led the National Heart, Lung and Blood Institute in 2005 to issue a request for applications to investigate the management of obesity in routine clinical care. Three institutions were funded under a cooperative agreement to undertake the practice-based opportunities for weight reduction (POWER) trials. The present article reviews selected randomized controlled trials, published before the initiation of POWER, and then provides a detailed overview of the rationale, methods and results of the POWER trial conducted at the University of Pennsylvania (POWER-UP). POWER-UP's findings are briefly compared with those from the two other POWER trials, conducted at Johns Hopkins University and Harvard University/Washington University. The methods of delivering behavioral weight loss counseling differed markedly across the three trials, as captured by an algorithm presented in the article. Delivery methods ranged from having medical assistants and PCPs from the practices provide counseling to using a commercially available call center, coordinated with an interactive website. Evaluation of the efficacy of primary care-based weight loss interventions must be considered in light of costs, as discussed in relation to the recent treatment model proposed by the Centers for Medicare and Medicaid Services. [ABSTRACT FROM AUTHOR]

Objective:To investigate the effects of three weight loss interventions on cardiometabolic risk factors, including blood pressure, lipids, glucose and markers of insulin resistance and inflammation. We also examined whether categories of incremental weight change conferred greater improvements on these parameters.Methods:This 2-year trial was conducted in a primary care setting and included 390 obese participants who were randomly assigned to one of three interventions: (1) Usual Care (quarterly primary care provider (PCP) visits that included education about weight management); (2) Brief Lifestyle Counseling (quarterly PCP visits plus monthly behavioral counseling provided by a trained auxiliary health-care provider); or (3) Enhanced Brief Lifestyle Counseling (the same care as described for the previous intervention, plus weight loss medications or meal replacements). The primary outcome was change in cardiometabolic risk factors among groups.Results:At month 24, participants in Enhanced Brief Lifestyle Counseling lost significantly more weight than those in Usual Care (4.6 vs 1.7 kg), with no other significant differences between groups. Enhanced Brief Lifestyle Counseling produced significantly greater improvements in high-density lipoprotein (HDL) cholesterol and triglyceride levels at one or more assessments, compared with the other two interventions. Markers of insulin resistance also improved significantly more in this group throughout the 2 years. Collapsing across the three groups, greater weight loss was associated with greater improvements in triglycerides, HDL cholesterol and markers of insulin resistance and inflammation at month 24, but was not significantly associated with reductions in blood pressure, total cholesterol and low-density lipoprotein cholesterol at any time.Conclusions:Enhanced Brief Lifestyle Counseling, which produced the largest weight loss, was generally associated with the greatest improvements in cardiovascular risk factors. These findings suggest that an intensive weight loss intervention, delivered in a primary care setting, can help obese individuals improve some cardiometabolic risk factors. [ABSTRACT FROM AUTHOR]

OBJECTIVE:To examine changes in eating behaviors and physical activity, as well as predictors of weight loss success, in obese adults who participated in a 2-year behavioral weight loss intervention conducted in a primary care setting.DESIGN:A longitudinal, randomized controlled, multisite trial.SUBJECTS:Three hundred ninety obese (body mass index, 30-50 kg m-2) adults, 21 years, in the Philadelphia region.METHODS:Participants were assigned to one of three interventions: (1) Usual Care (quarterly primary care provider (PCP) visits that included education on diet and exercise); (2) Brief Lifestyle Counseling (quarterly PCP visits plus monthly lifestyle counseling (LC) sessions about behavioral weight control); or (3) Enhanced Brief LC (the previous intervention with a choice of meal replacements or weight loss medication).RESULTS:At month 24, participants in both Brief LC and Enhanced Brief LC reported significantly greater improvements in mean (±s.e.) dietary restraint than those in Usual Care (4.4±0.5, 4.8±0.5 and 2.8±0.5, respectively; both P-values0.016). The percentage of calories from fat, along with fruit and vegetable consumption, did not differ significantly among the three groups. At month 24, both the Brief LC and Enhanced Brief LC groups reported significantly greater increases than usual care in energy expenditure (kcal per week) from moderately vigorous activity (+593.4±175.9, +415.4±179.6 and −70.4±185.5 kcal per week, respectively; both P-values0.037). The strongest predictor of weight loss at month 6 (partial R2=33.4%, P<0.0001) and at month 24 (partial R2=19.3%, P<0.001) was food records completed during the first 6 months. Participants who achieved a 5% weight loss at month 6 had 4.7 times greater odds of maintaining a 5% weight loss at month 24.CONCLUSIONS:A behavioral weight loss intervention delivered in a primary care setting can result in significant weight loss, with corresponding improvements in eating restraint and energy expenditure. Moreover, completion of food records, along with weight loss at month 6, is a strong predictor of long-term weight loss. [ABSTRACT FROM AUTHOR]

Objective:This study investigated changes in the quality of life of men and women who participated in a primary care-based weight loss intervention program.Methods:Participants were enrolled in a 2-year randomized clinical trial (POWER-UP) conducted at the University of Pennsylvania and in six affiliated primary care practices. Inclusion criteria included the presence of obesity (body mass index of 30-50 kg m−2) and at least two components of the metabolic syndrome.Main Outcome Measures:Quality of life was assessed by three measures: the Short Form Health Survey (SF-12); the Impact of Weight on Quality of Life-Lite; and the EuroQol-5D.Results:Six months after the onset of treatment, and with a mean weight loss of 3.9±0.3 kg, participants reported significant improvements on all measures of interest with the exception of the Mental Component Score of the SF-12. These changes remained significantly improved from baseline to month 24, with the exception of the EuroQol-5D. Many of these improvements were correlated with the magnitude of weight loss and, for the most part, were consistent across gender and ethnic group.Conclusions:Individuals with obesity and components of the metabolic syndrome reported significant improvements in most domains of the quality of life with a modest weight loss of 3.7% of initial weight, which was achieved within the first 6 months of treatment. The majority of these improvements were maintained at month 24, when participants had lost 3.0% of their weight. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic brought about significant life disruptions among healthcare workers (HCWs), including changes in weight, eating habits, and physical activity. This qualitative study sought to evaluate the initial and longitudinal effects of health habits among HCWs throughout the pandemic. Data were collected through Qualtrics surveys at three points over a 2-year period with questions asking participants ( n = 234) to describe whether they experienced changes in weight, eating behaviors, and physical activity and why they believe these changes occurred. The open-ended responses were analyzed following the summative content analysis approach. Four key themes emerged: (1) problematic eating patterns and habits, (2) disruptions in physical activity, (3) alterations in work environment and schedule, and (4) declines in mental health. Respondent reflections highlight the immediate and long-term pandemic-related effects on weight status for some, attributed to alterations in routines and health habits. Other HCWs reported a "reset" or indicated their habits may have been initially disrupted but normalized or improved over the 2-year time span. Findings underscore the need for strategies that support the physical and mental health of healthcare workers.

Purpose: The familial food environment is influenced by many factors, including food insecurity, food accessibility, and foods accepted by the family. These factors can facilitate or hinder caregivers' ability to support a healthy home food environment. The aim of this research was to explore the barriers to, perspectives on, and nutrition education needs identified by food-insecure parents which would then inform a community-based nutrition education program., Methods: A qualitative study used focus group data that were recorded, transcribed verbatim, and analyzed using a constant comparison approach to categorize the emerging themes., Results: Emergent themes: (1) Cooking confidence deficit; (2) Healthy meal preparation barriers; (3) Healthy meal acceptance barriers; (4) Meal planning, management, and adaptability. These themes suggest that supporting a healthy home food environment is connected to both food knowledge and competencies, known as food literacy., Conclusion: Food literacy competency should be assessed before nutrition education program implementation within community settings., Competing Interests: Competing interestsThe authors declare no competing interests.Conflict of interestThe authors declared no competing interests., (© The Author(s), under exclusive licence to Springer Nature Switzerland AG 2023, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

The COVID-19 pandemic required schools to transition courses to an online platform. This shift to Emergency Remote Teaching (ERT) created gaps in the literature about its impact on students. The purpose of this study was to test the relationship between learner and instructional attributes and learner satisfaction with ERT. A modified version of the Student Satisfaction Survey assessed learner and instructional attributes and learner satisfaction among a convenience sample of 12 graduate and 83 undergraduate nursing students. Open-ended questions assessed students' responses to their satisfaction with ERT. Multiple regression analysis was used to test associations of learner and instructional attributes with student satisfaction. Overall satisfaction with ERT was neutral with a mean of 2.76 on a 1 to 5 scale; students rated instructional attributes higher with a mean of 3.64. Instructional engagement/technology use (single factor) and learner technology competence were associated with student satisfaction, beta = 0.93(0.09), p <.001; beta = 0.24(0.09), p  = .008, respectively. Between-class technology use and prior experience with online courses were not associated with student satisfaction, beta = -0.08(0.09), p  = .379, beta = 0.26(0.15), p  = .079, respectively. Qualitative findings revealed faculty engagement was a major determinant in learner satisfaction with ERT. Supporting faculty competence for the use of technology may increase learner satisfaction with ERT., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.)

Background: A Curriculum Embedded Weight Sensitivity Training program (CeWebs) was integrated into an undergraduate nursing course to improve attitudes and beliefs toward individuals with obesity., Method: A one-group repeated measures study was conducted to compare students' pretest and posttest attitudes and beliefs using the Attitudes Toward Obese Persons (ATOP) and Beliefs About Obese Persons (BAOP) at the beginning and end of the semester., Results: Comparison of pretraining and posttraining scores of 125 junior nursing students on ATOP (73.96 ± 15.02 and 84.59 ± 15.39, respectively) indicated a significant increase in scores (p < .01), which reflects more positive attitudes. Comparison of pretraining and posttraining BAOP scores (18.20 ± 6.84 and 22.22 ± 7.87, respectively) indicated a significant (p < .01) increase in scores, indicating beliefs that obesity is not controllable., Conclusion: These findings suggest that embedding weight sensitivity training into undergraduate nursing curricula may improve attitudes and beliefs toward patients with obesity. [J Nurs Educ. 2020;59(8):453-456.]., (Copyright 2020, SLACK Incorporated.)

Objective: To explore perceived barriers to healthy eating within a food-insecure community that relies on an emergency food pantry., Methods: A qualitative descriptive study was conducted using focus groups within an emergency food pantry located in southeastern Pennsylvania. Eleven female participants were recruited from the food pantry to serve as focus group participants and key community informants. Focus group transcripts were transcribed, coded, and analyzed using a constant comparative method., Results: Four themes regarding perceived barriers to healthy eating were identified: (1) knowledge, (2) resources, (3) special dietary needs, and (4) culture and family influences., Conclusions and Implications: Emergent themes from the focus groups identified the perceived barriers to healthy eating within a food-insecure community. These findings may be essential for informing the development of future nutrition education programs and for promoting health in low-income communities., (Copyright © 2019 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

Background: Children in the United States (US) are frequently exposed to advertisements for high-fat, high-sugar (HFHS) foods, which is linked to greater demand for and consumption of those foods. Restricting advertisements for HFHS foods may be a viable obesity prevention strategy-however, public support for policy change is unclear., Methods: A secondary analysis of the 2012 Annenberg National Health Communication Survey was conducted. Respondents (N = 1838) were 53.2% female, mean age 50.0 ± 16.5 years. Race/ethnic composition was 76.8% white, 7.4% black, 9.2% Hispanic, and 6.6% other. The percentage of respondents supporting and opposing the regulation was calculated and logistic regression models identified predictors of support. Potential predictors included sociodemographic variables, attitudes towards other health regulations (e.g., smoking bans in public places), and various health behaviors (e.g., fruit and vegetable intake)., Results: A total of 56.3% of respondents supported or strongly supported advertisement restrictions, while only 8.2% strongly opposed. Approximately 20% had no opinion. Greatest support was found among respondents who supported smoking bans in public settings (OR = 4.3), who supported banning trans fats in restaurants (OR = 1.7), and who were older (OR = 1.7)., Conclusion: The US adult population appears to have an appetite for restricting HFHS advertising to children, with more than half the populace supporting such a policy in 2012. This may be an opportune time to implement and rigorously evaluate such childhood obesity prevention strategies.

ClC chloride channels are important in diverse physiological functions such as transepithelial transport, cell volume regulation, excitability, and acidification of intracellular organelles. We have investigated the expression of CLC-7 in oocytes from Xenopus laevis with the two electrode voltage clamp technique and Western blot analysis. Using a specific antibody against CLC-7, we found an approximately 80 kDa protein in oocytes, previously injected with CLC-7-cRNA. In voltage clamp experiments on ClC-7-cRNA-injected oocytes, no current changes were detected at normal pH (7.4). However, acidification of the Ringer solution to pH values between 6 and 4 revealed strong currents which reversed at about -15 mV (30 mV positive to the normal resting potential) and showed strong outward rectification. We therefore suggest that ClC-7 in oocytes is a functional chloride current at acidic pH. Since ClC-7 is also found in neuronal tissues and was upregulated in a rat pain model, we suggest a role of CLC-7 also for nociception and pain., (©2002 Elsevier Science (USA).)