How to Increase Muscle Mass: What Does Science Tell Us?

Volpe, Stella Lucia Ph.D., R.D., L.D.N., FACSM

Sitting Time and Mortality from All Causes, Cardiovascular Disease, and Cancer

KATZMARZYK, PETER T.¹; CHURCH, TIMOTHY S.¹; CRAIG, CORA L.²; BOUCHARD, CLAUDE¹

Abstract

Purpose: Although moderate-to-vigorous physical activity is related to premature mortality, the relationship between sedentary behaviors and mortality has not been fully explored and may represent a different paradigm than that associated with lack of exercise. We prospectively examined sitting time and mortality in a representative sample of 17,013 Canadians 18-90 yr of age.

Methods: Evaluation of daily sitting time (almost none of the time, one fourth of the time, half of the time, three fourths of the time, almost all of the time), leisure time physical activity, smoking status, and alcohol consumption was conducted at baseline. Participants were followed prospectively for an average of 12.0 yr for the ascertainment of mortality status.

Results: There were 1832 deaths (759 of cardiovascular disease (CVD) and 547 of cancer) during 204,732 person-yr of follow-up. After adjustment for potential confounders, there was a progressively higher risk of mortality across higher levels of sitting time from all causes (hazard ratios (HR): 1.00, 1.00, 1.11, 1.36, 1.54; P for trend <0.0001) and CVD (HR:1.00, 1.01, 1.22, 1.47, 1.54; P for trend <0.0001) but not cancer. Similar results were obtained when stratified by sex, age, smoking status, and body mass index. Age-adjusted all-cause mortality rates per 10,000 person-yr of follow-up were 87, 86, 105, 130, and 161 (P for trend <0.0001) in physically inactive participants and 75, 69, 76, 98, 105 (P for trend = 0.008) in active participants across sitting time categories.

Conclusions: These data demonstrate a dose-response association between sitting time and mortality from all causes and CVD, independent of leisure time physical activity. In addition to the promotion of moderate-to-vigorous physical activity and a healthy weight, physicians should discourage sitting for extended periods.

http://journals.lww.com/acsm-msse/Fulltext/2009/05000/Sitting_Time_and_Mortality_from_All_Causes,.5.aspx?utm_source=exacttarget&utm_medium=email&utm_term=Article3Button&utm_content=j18&src=Week%2039%20-%20ACSM%20Hot%20Topics%20-%20Sports%20Medicine&et_cid=236215&et_rid=pedronetoribeiro@gmail.com

Predictors of change differ for moderate and vigorous intensity physical activity and for weekdays and weekends: a longitudinal analysis

Kirsten Corder1,2*, Christopher Craggs1,2, Andrew P Jones1,3, Ulf Ekelund2,4, Simon J Griffin1,2
and Esther MF van Sluijs

Abstract
Background: Predictors of physical activity (PA) change are rarely investigated separately for different PA intensities and
for weekdays/weekends. We investigated whether individual-level predictors of one-year change in objectively-measured
physical activity differ for moderate PA (MPA) and vigorous PA (VPA) and for weekends and weekdays.
Methods: Accelerometer-assessed PA (mins) was obtained at baseline and +1 year (n = 875, 41.5% male, Mean ±
SD baseline age: 9.8 ± 0.4 years-old). Potential predictors (n = 38) were assessed at baseline from psychological
(e.g. self-efficacy), socio-cultural (e.g. parent support) and environmental domains (e.g. land use). Associations between
predictors and change in MPA (2000–3999 counts/minute (cpm)) and VPA (≥4000 cpm) separately for weekdays and
weekends were studied using multi-level linear regression. Analyses were adjusted for school clustering, sex and
baseline PA.
Results: Weekend PA declined (MPA decline 4.6 ± 21.8 mins/day; VPA decline: 2.1 ± 20.1 mins/day; both p < 0.001)
whereas weekday PA did not significantly change. Higher baseline PA and being a girl were associated with greater PA
declines in all four outcomes; remaining predictors differed for MPA and VPA and/or weekdays and weekends. Family
logistic support was associated with less of a decline in weekend MPA (CI 95%) 0.15 (0.05, 0.25) and VPA 0.19 (0.09,
0.29), and peer support with less of a decline in weekday MPA 0.18 (0.02, 0.34) and VPA 0.22 (0.06, 0.38).
Conclusions: Results highlight the relevance of investigating predictors of PA change separately for different PA
intensities and for weekdays/weekends. In addition to continued focus on school PA promotion, more effort to target
interventions during weekends, such as in the family and community appears important. Encouraging peer support to
increase weekday PA and targeting parent support for weekend PA may be health promotion priorities.

http://www.ijbnpa.org/content/pdf/1479-5868-10-69.pdf

Reducing high calorie snack food in young adults: a role for social norms and health based messages

Eric Robinson1,2*, Ellis Harris2
, Jason Thomas2
, Paul Aveyard2,3 and Suzanne Higgs

Abstract
Background: Consumption of high calorie junk foods has increased recently, especially among young adults and
higher intake may cause weight gain. There is a need to develop public health approaches to motivate people to
reduce their intake of junk food.
Objective: To assess the effect of health and social norm messages on high calorie snack food intake (a type of
junk food) as a function of usual intake of junk food.
Design: In a between-subjects design, 129 young adults (45 men and 84 women, mean age = 22.4 years, SD = 4.5)
were assigned to one of three conditions: 1) a social norm condition, in which participants saw a message about
the junk food eating habits of others; 2) a health condition, in which participants saw a message outlining the
health benefits of reducing junk food consumption and; 3) a control condition, in which participants saw a nonfood related message. After exposure to the poster messages, participants consumed a snack and the choice and
amount of snack food consumed was examined covertly. We also examined whether usual intake of junk food
moderated the effect of message type on high calorie snack food intake.
Results: The amount of high calorie snack food consumed was significantly lower in both the health and the social
norm message condition compared with the control message condition (36% and 28%, both p < 0.05). There was
no significant difference in snack food or energy intake between the health and social norm message conditions.
There was no evidence that the effect of the messages depended upon usual consumption of junk food.
Conclusions: Messages about the health effects of junk food and social normative messages about intake of junk
food can motivate people to reduce their consumption of high calorie snack food.

http://www.ijbnpa.org/content/pdf/1479-5868-10-73.pdf

Programming Resistance Training for Clients With Type 2 Diabetes Mellitus

Grabert, Derek MS, CSCS*D; Feito, Yuri PhD, MPH, RCEP, CES

Abstract

IMPLEMENTING A RESISTANCE TRAINING PROGRAM FOR CLIENTS WITH TYPE 2 DIABETES POSES SOME DIFFICULTIES, BUT WITH THE PROPER DESIGN, THESE CLIENTS CAN ATTAIN SIGNIFICANT HEALTH AND FITNESS BENEFITS. RESISTANCE TRAINING PROGRAMS SHOULD BE PROGRESSIVE IN INTENSITY AND INDIVIDUALIZED FOR EACH CLIENT TO IMPROVE GLYCEMIC CONTROL, LEAN BODY MASS, AND STRENGTH

http://journals.lww.com/nsca-scj/Abstract/publishahead/Programming_Resistance_Training_for_Clients_With.99601.aspx

What is EPOC and Why is it Useful for Fat Loss?

Brad Schoenfeld, MS, CSCS, CSPS, NSCA-CPT

http://www.nsca.com/Education/Videos/What-is-EPOC-and-Why-is-it-Useful-for-Fat-Loss/

The Impact of Physical Education on Obesity among Elementary School Children

John Cawley
3M24 Martha Van Rensselaer Hall Cornell University
Ithaca, NY 14853
USA
E-mail: jhc38@cornell.edu 

John Cawley
Cornell University and IZA
David Frisvold
Emory University
Chad Meyerhoefer
Lehigh University

In response to the dramatic rise in childhood obesity, the Centers for Disease Control (CDC) and other organizations have advocated increasing the time that elementary school children spend in physical education (PE) classes. However, little is known about the effect of PE on child weight. This paper measures that effect by instrumenting for child PE time with state policies, using data from the Early Childhood Longitudinal Study, Kindergarten Cohort (ECLS-K) for 1998-2004. Results from IV models indicate that PE lowers BMI z-score and reduces the probability of obesity among 5th graders (in particular, boys), while the instrument is insufficiently powerful to reliably estimate effects for younger children. This represents some of the first evidence of a causal effect of PE on youth obesity, and thus offers at least some support to the assumptions behind the CDC recommendations. We find no evidence that increased PE time crowds out time in academic courses or has spillovers to achievement test scores. 

http://anon-ftp.iza.org/dp6807.pdf

HIGH-INTENSITY CIRCUIT TRAINING USING BODY WEIGHT: Maximum Results With Minimal Investment

Klika, Brett C.S.C.S., B.S.; Jordan, Chris M.S., C.S.C.S., NSCA-CPT, ACSM HFS/APT

Abstract

LEARNING OBJECTIVE: To understand the health benefits and practical application of a high-intensity circuit training exercise protocol.

http://journals.lww.com/acsm-healthfitness/Fulltext/2013/05000/HIGH_INTENSITY_CIRCUIT_TRAINING_USING_BODY_WEIGHT_.5.aspx

Steps/day translation of the moderate-to-vigorous physical activity guideline for children and adolescents

Marc A Adams (marc.adams@asu.edu)

William D Johnson (William.Johnson@pbrc.edu)

Catrine Tudor-Locke (Catrine.Tudor-Locke@pbrc.edu)

Abstract 

Background 

An evidence-based steps/day translation of U.S. federal guidelines for youth to engage in ≥60 

minutes/day of moderate-to-vigorous physical activity (MVPA) would help health 

researchers, practitioners, and lay professionals charged with increasing youth’s physical 

activity (PA). The purpose of this study was to determine the number of free-living steps/day 

(both raw and adjusted to a pedometer scale) that correctly classified children (6–11 years) 

and adolescents (12–17 years) as meeting the 60-minute MVPA guideline using the 2005–

2006 National Health and Nutrition Examination Survey (NHANES) accelerometer data, and 

to evaluate the 12,000 steps/day recommendation recently adopted by the President’s 

Challenge Physical Activity and Fitness Awards Program. 

Methods 

Analyses were conducted among children (n = 915) and adolescents (n = 1,302) in 2011 and 

2012. Receiver Operating Characteristic (ROC) curve plots and classification statistics 

revealed candidate steps/day cut points that discriminated meeting/not meeting the MVPA 

threshold by age group, gender and different accelerometer activity cut points. The Evenson 

and two Freedson age-specific (3 and 4 METs) cut points were used to define minimum 

MVPA, and optimal steps/day were examined for raw steps and adjusted to a pedometerscale to facilitate translation to lay populations. Results 

For boys and girls (6–11 years) with ≥ 60 minutes/day of MVPA, a range of 11,500–13,500 

uncensored steps/day for children was the optimal range that balanced classification errors. 

For adolescent boys and girls (12–17) with ≥60 minutes/day of MVPA, 11,500–14,000 

uncensored steps/day was optimal. Translation to a pedometer-scaling reduced these 

minimum values by 2,500 step/day to 9,000 steps/day. Area under the curve was ≥84% in all 

analyses. 

Conclusions 

No single study has definitively identified a precise and unyielding steps/day value for youth. 

Considering the other evidence to date, we propose a reasonable ‘rule of thumb’ value of ≥

11,500 accelerometer-determined steps/day for both children and adolescents (and both 

genders), accepting that more is better. For practical applications, 9,000 steps/day appears to 

be a more pedometer-friendly value. 

http://www.ijbnpa.org/content/pdf/1479-5868-10-49.pdf

Motivational interviewing and problem solving treatment to reduce type 2 diabetes and cardiovascular disease risk in real life: a randomized controlled trial

Jeroen Lakerveld (j.lakerveld@vumc.nl)
Sandra D Bot (s.bot@vumc.nl)
Mai J Chinapaw (m.chinapaw@vumc.nl)
Maurits W van Tulder (maurits.van.tulder@falw.vu.nl)
Piet J Kostense (pj.kostense@vumc.nl)
Jacqueline M Dekker (jm.dekker@vumc.nl)
Giel Nijpels (g.nijpels@vumc.nl)


Abstract
Background
Intensive lifestyle interventions in well-controlled settings are effective in lowering the risk
of chronic diseases such as type 2 diabetes (T2DM) and cardiovascular diseases (CVD), but
there are still no effective lifestyle interventions for everyday practice. In the Hoorn
Prevention Study we aimed to assess the effectiveness of a primary care based lifestyle
intervention to reduce the estimated risk of developing T2DM and for CVD mortality, and to
motivate changes in lifestyle behaviors.
Methods
The Hoorn Prevention Study is a parallel group randomized controlled trial, implemented in
the region of West-Friesland, the Netherlands. 622 adults with ≥10% estimated risk of T2DM
and/or CVD mortality were randomly assigned and monitored over a period of 12 months.
The intervention group (n=314) received a theory-based lifestyle intervention based on an
innovative combination of motivational interviewing and problem solving treatment,
provided by trained practice nurses in 12 general practices. The control group (n=308)
received existing health brochures. Primary outcomes was the estimated diabetes risk
according to the formula of the Atherosclerosis Risk In Communities (ARIC) Study, and the
estimated risk for CVD mortality according to the Systematic COronary Risk Evaluation
(SCORE) formula. Secondary outcomes included lifestyle behavior (diet, physical activity
and smoking). The research assistants, the principal investigator and the general practitioners
were blinded to group assignment. Linear and logistic regression analysis was applied to
examine the between-group differences in each outcome measure, adjusted for baseline
values.
Results
536 (86.2%) of the 622 participants (age 43.5 years) completed the 6-month follow-up, and
502 (81.2%) completed the 12-month follow-up. The mean baseline T2DM risk was 18.9%
(SD 8.2) and the mean CVD mortality risk was 3.8% (SD 3.0). The intervention group
participated in a median of 2 sessions. Intention-to-treat analyses showed no significant
differences in outcomes between the two groups at 6 or 12-months follow-up.
Conclusions
The lifestyle intervention was not more effective than health brochures in reducing risk
scores for T2DM and CVD or improving lifestyle behavior in an at-risk population.
Trial registration
Current Controlled Trials: ISRCTN59358434



http://www.ijbnpa.org/content/pdf/1479-5868-10-47.pdf

Walking Versus Running for Hypertension, Cholesterol, and Diabetes Mellitus Risk Reduction

1. Paul T. Williams, 
2. Paul D. Thompson

Abstract

Objective—To test whether equivalent energy expenditure by moderate-intensity (eg, walking) and vigorous-intensity exercise (eg, running) provides equivalent health benefits.

Approach and Results—We used the National Runners’ (n=33 060) and Walkers’ (n=15 945) Health Study cohorts to examine the effect of differences in exercise mode and thereby exercise intensity on coronary heart disease (CHD) risk factors. Baseline expenditure (metabolic equivant hours per day [METh/d]) was compared with self-reported, physician-diagnosed incident hypertension, hypercholesterolemia, diabetes mellitus, and CHD during 6.2 years follow-up. Running significantly decreased the risks for incident hypertension by 4.2% (P<10⁻⁷), hypercholesterolemia by 4.3% (P<10⁻¹⁴), diabetes mellitus by 12.1% (P<10⁻⁵), and CHD by 4.5% per METh/d (P=0.05). The corresponding reductions for walking were 7.2% (P<10⁻⁶), 7.0% (P<10⁻⁸), 12.3% (P<10⁻⁴), and 9.3% (P=0.01). Relative to <1.8 METh/d, the risk reductions for 1.8 to 3.6, 3.6 to 5.4, 5.4 to 7.2, and ≥7.2 METh/d were as follows: (1) 10.1%, 17.7%, 25.1%, and 34.9% from running and 14.0%, 23.8%, 21.8%, and 38.3% from walking for hypercholesterolemia; (2) 19.7%, 19.4%, 26.8%, and 39.8% from running and 14.7%, 19.1%, 23.6%, and 13.3% from walking for hypertension; and (3) 43.5%, 44.1%, 47.7%, and 68.2% from running, and 34.1%, 44.2% and 23.6% from walking for diabetes mellitus (walking >5.4 METh/d excluded for too few cases). The risk reductions were not significantly different for running than walking for diabetes mellitus (P=0.94), hypertension (P=0.06), or CHD (P=0.26), and only marginally greater for walking than running for hypercholesterolemia (P=0.04).

Conclusions—Equivalent energy expenditures by moderate (walking) and vigorous (running) exercise produced similar risk reductions for hypertension, hypercholesterolemia, diabetes mellitus, and possibly CHD.

http://atvb.ahajournals.org/content/33/5/1085.short

http://atvb.ahajournals.org/content/suppl/2013/04/04/ATVBAHA.112.300878.DC2/ATV201776_Supplemental_Material1.pdf

Motivation, self-determination, and long-term weight control

Pedro J Teixeira,¹ Marlene N Silva,¹ Jutta Mata,¹ António L Palmeira,² and David Markland³

Abstract

This article explores the topics of motivation and self-regulation in the context of weight management and related behaviors. We focus on the role of a qualitative approach to address motivation - not only considering the level but also type of motivation - in weight control and related behaviors. We critically discuss the operationalization of motivation in current weight control programs, present a complementary approach to understanding motivation based on self-determination theory, and review empirical findings from weight control studies that have used self-determination theory measures and assessed their association with weight outcomes. Weight loss studies which used Motivational Interviewing (MI) are also reviewed, considering MI's focus on enhancing internal motivation. We hypothesize that current weight control interventions may have been less successful with weight maintenance in part due to their relative disregard of qualitative dimensions of motivation, such as level of perceived autonomy, often resulting in a motivational disconnect between weight loss and weight-related behaviors. We suggest that if individuals fully endorse weight loss-related behavioral goals and feel not just competent but also autonomous about reaching them, as suggested by self-determination theory, their efforts are more likely to result in long-lasting behavior change.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312817/

Self-Regulation, Motivation, and Psychosocial Factors in Weight Management

Pedro J. Teixeira, ^{1 ,*} Jutta Mata, ² Geoffrey C. Williams, ³ Amy A. Gorin, ⁴ and Simone Lemieux ⁵

Author information ► Article notes ► Copyright and License information ►

Any attempt to self-regulate one's body weight takes place at the intersection of the external environment and innate biological predispositions that, especially when combined, can be highly conducive to energy surpluses and excessive fat mass accretion. Prominent examples of such factors are high availability of calorie dense, palatable foods, economical constraints that negatively influence lifestyle choices, and the human predisposition for liking sweet and fatty foods. As a consequence, it is no surprise that the majority of individuals have become overweight or obese, apparently “losing control” and “succumbing” to these external and internal obesogenic pressures. At the same time, it is known that behaviors related to body weight regulation, namely, physical activity and diet, are generally within the reach of voluntary control and regulation, as evidenced by studies of successful weight loss maintainers who report dramatic changes in their lifestyles despite being surrounded by seemingly obesogenic environments [1]. These improvements have frequently been linked to individuals finding new ways of relating to one's weight and lifestyle, new self-perceptions, motives, goals, emotional responses, habits, and so forth (e.g., [2–4]). This apparent paradox is reinforced by a frequent tension between population-level (“environmental,” “political”) versus individual-level (“motivational,” “self-regulatory”) approaches to addressing the problem of obesity, which may be misguided; both will likely be necessary and one can inform the other.

Various perspectives can be taken to address obesity prevention and treatment. One is that obesity, at a population level, is largely “caused” by environmental factors and consequently it should primarily be tackled with public health measures [5]. Other views, informed by advances in molecular biology, tend to favor approaches rooted in the genetics of obesity (e.g., prevention by early risk diagnosis) [6] and/or pharmacological solutions to treat the most prevalent forms of obesity [7]. Lately, interventions derived from applying principles of behavioral economics have come forth with solutions based on “nudges” and small changes in contextual “default conditions,” as they bypass individuals' volition, biases, and errors in judgment [8]. While other perspectives exist (e.g., [9, 10]), this special issue is a statement that exploring psychological determinants of health behavior such as reasons, goals, expectations, values, beliefs, or self-perceptions - and getting individuals more (and better) motivated in self-managing their health, remain important aspects to address in fighting obesity. While, in concept, no one disputes that motivational factors or, more generally, psychosocial processes are relevant to understanding why people behave the way they do, in regards to their health, this topic has sometimes been presented as “old news” in obesity research, which is premature. We believe that a more productive stance is one that recognizes that a multitude of perspectives and solutions must be effectively integrated in order to more successfully fight obesity [11].

Environmental change may be slow to implement, can be very expensive, is often stalled by industries with competing interests, and can have unpredictable and even paradoxical outcomes, all of which makes research in this area a formidable challenge [12]. Furthermore, social and economical conditions will evolve, and many people will move across different physical and cultural environments through the course of their lives (sometimes for long periods), which could limit the efficacy of some environmental interventions. Therefore, it is crucial to also improve existing strategies and develop new strategies that help people better navigate obesogenic environments, wherever and whenever they exist, by maximizing their own self-regulatory resources. Again, a critical point is that population-based initiatives to fight obesity can and should be informed by “individual-level” research (e.g., mass, internet-based campaigns to promote fruits and vegetables which apply sound theory-based motivational principles); similarly, “individual-level” interventions (e.g., primary care consultations) should be mindful of research findings in areas such as the impact of the built environment of physical activity or how contextual “nudges” impact health-related decisions and behavior. Regardless, all these initiatives must be supported by focused, high-quality research that seeks to understand why, how, and under which conditions children, adolescents, and adults are more likely to remain at, or achieve healthful levels of body weight. This special issue aims to make a contribution to this research.

The 14 articles published in this special issue underline the importance of psychological factors in the context of body weight self-regulation. For instance, L. Karhunen and colleagues [13] show that psychobehavioral factors are more important for weight regulation than individual satiety levels or diet characteristics, whereas E. A. Dennis and colleagues [14] point out the difficulty of maintaining weight during freshman year at college, even with explicit training in self-regulation skills. C. Bégin and colleagues [15] demonstrate that self-regulation during weight loss attempts systematically differs between women with lower and higher depressive symptoms, underlining the importance of psychological health and wellbeing as a prerequisite in self-regulation of health behaviors.

Three articles investigate the role of self-perceived weight in adolescents. R. C. Krauss and colleagues [16] show that accuracy differences in weight perceptions explain some of the weight disparities between adolescents of different ethnic groups in the US. K. Ojala and colleagues [17] report that overweight boys and girls in Finland accurately perceived their weight as higher and had a lower body image than normal-weight children. Importantly, adolescents who perceived themselves as being overweight despite being in a healthy weight range were more likely to actually be overweight 11 years later [18].

Three articles examine physical activity, a health behavior central in weight management. E. Guérin and M. S. Fortier [19] showed how situational motivation and perceived exercise intensity predict changes in positive affect following physical activity. D. S. Buchan and colleagues [20] reviewed current psychological models for increasing physical activity levels and describe the need for more ecological models. M. L. Segar and colleagues [21] show that framing physical activity as a way to positively influence daily well-being enhanced body image and perceptions about the physical activity experience in overweight women.

Three articles investigate the role of the social environment for self-regulation of bodyweight, particularly, the role of parents in children's and adolescents' weight management. K. P. Jakubowski and colleagues [22] showed that parental readiness to change weight control behaviors was predictive of adolescents' body mass index at treatment end. In their review, L. A. Frankel and S. O. Hughes [23] made interesting connections, applying the literature on parental influence on their children's emotion regulation to parental influence on self-regulation of energy intake in children. These articles point to the importance of the interaction of the social environment (parents) with the self-regulation of weight-related behaviors in children and adolescents. S. B. Gesell and colleagues [24] report on a different aspect of the parent-child relation in the context of weight management. They show that over the course of a three-month obesity prevention trial parents form new social ties with parents of children with similar body types. Thus, parents of obese children were more likely to become friends with parents of other obese children and parents of normal-weight children would befriend parents of other normal-weight children more often.

Another central topic in self-regulation is an individual's motivation. Two articles examined the role of external motivation, namely, monetary incentives for weight regulation. M. M. Crane and colleagues [25] showed somewhat surprisingly that small monetary incentives did not influence autonomous or controlled motivation for participation in a 1-year weight loss trial. In contrast, the findings by A. C. Moller and colleagues [26] demonstrate that participants in a three-week health behavior improvement program who reported being more motivated by a monetary incentive had higher body weight at 17 weeks followup. Finally, J. Y. Breland and colleagues [27] suggest the Common-Sense Model of Self-Regulation as a framework for organizing existent tools and creating new means to improve long-term weight regulation.

We believe this special Issue will enhance our understanding of psychological—especially motivational and self-regulatory—factors in weight management and, collectively, provide an interesting snapshot of research in this area, with a good share of innovative empirical findings (e.g., [18, 23, 26]) and fresh conceptual discussions (e.g., [20, 23, 27]).

As a final note, it is important to remember, especially when dealing with issues involving individual self-regulation, that our society protects human freedom of choice. Biomedical ethics, the legal system in the US, and medical professionalism protect patient autonomy in health care and in research studies and have recently agreed that it should be a primary outcome of all health care interactions ([28–31]). The need to respect patient autonomy in all health care interventions is mandated and thus is not a choice for whether practitioners, policy makers, or researchers will support it in a particular intervention. Thus, more research is needed to understand how autonomous self-regulation is affected by public health messaging, clinical and community programs, food industry advertising, economic rewards and punishments, and genetics. Also, health care is delivered in a free choice paradigm; thus, interventions must focus on helping participants to choose options that help them maintain their weight or weight loss and which they want to continue to choose after the intervention's end. To determine the success of an intervention, researchers are strongly encouraged to document the effect of their interventions for a period of at least 6 months after the intervention ends. For obesity, known for its high recidivism, this period might be even longer.

Pedro J. Teixeira

Jutta Mata

Geoffrey C. Williams

Amy A. Gorin

Simone Lemieux

Go to:

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Articles from Journal of Obesity are provided here courtesy of Hindawi Publishing Corporation

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3503363/

Healthy School Lunches Cut Kids' Obesity Rates

By Nancy Walsh, Staff Writer, MedPage Today

Published: April 08, 2013

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse PlannerChildren residing in states with stringent nutritional standards for school meals had lower rates of obesity than those living in states with more lax regulations, researchers reported.

In states where school meal nutritional requirements fell below those currently recommended by the USDA, rates of obesity were doubled among children consuming reduced-price or free meals compared with children not eating school-provided lunches (26% versus 13.9%), according to Daniel R. Taber, PhD, and colleagues from the University of Illinois at Chicago.

In contrast, the difference in rates of obesity was much less pronounced in states exceeding the USDA nutritional standards (21.1% versus 17.4%), the researchers reported online in JAMA Pediatrics.

"In short, the study found an association between more stringent school meal standards and more favorable weight status, especially among low-income students," Marion Nestle, PhD, of New York University in New York City, wrote in an accompanying editorial.

More than 65 years ago, the National School Lunch Program was established to help meet the nutritional needs of children, and today some 30 million receive the lunches, either paying full price or at subsidized cost depending on family income.

In recent years, however, the program has been criticized for its quality, and some have argued that it has played a part in the pediatric obesity epidemic.

In answer to these challenges, the USDA established revised standards in 2012, calling for more vegetables, fruits, low-fat milk, and whole grains to be included in the meals, and for limits on calories and trans fats.

However, some states had already enacted laws requiring healthier meals. To see if those regulations had had any effect on childhood obesity rates, Taber's team compared 2006-2007 obesity rates in those states with rates in states with looser requirements.

Their analysis included 4,870 middle-school students in 40 states.

A total of 2,350 children paid full price for their lunches, 1,570 received the lunches at lower or no cost, and 950 didn't participate in the lunch program.

In an unadjusted analysis, the rate of obesity for those having a reduced-price lunch was 25.2%, while rates for those paying full price or not eating the school lunches were 16.3% and 14.3%, respectively.

Even after adjusting for socioeconomics, race, location, and other between-state variables, the prevalence was 3.7 points higher for the reduced-price group compared with children not participating in the lunch program.

Further analysis comparing obesity rates according to state nutrition requirements confirmed a decrease of 12.3 percentage points (95% CI −21.5 to −3) in the difference in obesity rates between children receiving subsidized lunches and those not eating school lunches in states exceeding USDA nutrition standards.

Similarly, the difference in mean percentile of body mass index between children in the reduced-price lunch group and nonparticipating children was lower in states with stringent requirements (β = −0.11, 95% CI −17.7 to −4.3).

The researchers also considered whether children in the more stringent states compensated by purchasing more unhealthy "competitive" sweet or salty snacks and sweetened beverages from widely available vending machines, and found little evidence to support this.

Nonetheless, they noted, "unless school meal laws are accompanied by nutrition education and initiatives to limit energy-dense competitive foods and beverages, then even the most stringent school meal standards may be undermined by competitive foods."

In her editorial, Nestle argued that some members of Congress have objected to the new USDA regulations on school meals -- largely at the behest of the food industry.

"Although the USDA based its nutrition standards on studies by the Institute of Medicine, when it comes to school food, politics trumps science," she wrote.

For instance, Congress has since forbidden the USDA from placing a limit on the number of servings of potatoes that are permissible and has insisted that the tomato sauce on pizza be considered a vegetable serving.

"Increasing evidence confirms that school-based dietary interventions can help promote healthier eating patterns and body weights, especially among children likely to bear the greatest consequences of obesity," Nestle observed.

"Objections to school nutrition standards must be recognized for what they do: place the financial health of food companies and their supporters in Congress above the health of the nation's children," she stated.

The study was limited by being cross-sectional and the possibility of confounding by factors at the state level.

The study was funded by the Robert Wood Johnson Foundation and the National Heart, Lung and Blood Institute.

The authors reported no conflicts of interest.

Primary source: JAMA Pediatrics
Source reference:
Taber D, et al "Association between state laws governing school meal nutrition content and student weight status: implications for new USDA school meal standards" JAMA Pediatr 2013; DOI: 10.1001/jamapediatrics.2013.399.

Additional source: JAMA Pediatrics
Source reference:
Nestle M "School meals: a starting point for countering childhood obesity" JAMA Pediatr 2013; DOI: 10.1001/jamapediatrics.2013.404.

http://www.medpagetoday.com/Pediatrics/Obesity/38327