Integration of Healthy Eating Habits and Physical Activity through Nutrition Care Process to Tackle the Obesity Epidemic: A Narrative Review of the Evidence

Background: Obesity is a rising global health problem which is already at epidemic proportions. Effective methods of treatment are required and should be imparted by efficient means to dietitians and other health professionals dealing with weight management. Research shows that behavioral modification techniques are the most effective way to achieve and maintain a healthy weight compared to diet and physical activity alone. Aim: This narrative review focusses on diet and physical activity behavioral modification techniques to promote effective weight management for sedentary and active adults using the Nutrition Care Process (NCP). Methods: PubMed, Scopus, Embase, Science Direct, Web of Science and Pro-Quest databases were searched for relevant articles. Results: A healthy eating habit is one of the contributing factors to improved health. Physical activities also help improve and maintain one’s health. This article discusses the importance of eating habits and physical activities among school students. In addition, health issues related to eating habits and the practice of physical activities are also highlighted. Overall, the results revealed that healthy eating habits and regular physical activities help in maintaining good health. Conclusion: NCP is a systematic approach to provide high-quality nutrition care. Using the NCP does not mean that all clients get the same care. Use of a care process provides a framework for the dietitian to individualize care, taking into account clients’ needs and values, and using the best evidence available to make decisions. Keywords: obesity, weight control, physical activity, nutrition knowledge, eating habits, nutrition care process

Evaluation of the Healthy Eating Food Index (HEFI)-2019 measuring adherence to Canada's Food Guide 2019 recommendations on healthy food choices

The objective of this study was to evaluate the construct validity and reliability of the Healthy Eating Food Index-2019 (HEFI-2019), which was developed to measure adherence to Canada’s Food Guide 2019 (CFG) recommendations on healthy food choices. Dietary intake data from 24-hour dietary recalls in the 2015 Canadian Community Health Survey - Nutrition were used for that purpose. Multidimensionality was examined using principal component analysis. Mean scores were compared among subgroups of the population. The association between scores and energy intake was assessed using Pearson correlations. Cronbach’s alpha was calculated to assess reliability. The estimated mean HEFI-2019 score (/80) was 43.1 (95%CI, 42.7 to 43.6) among Canadians 2 years and older. The first and 99th percentiles were 22.1 and 62.9 points. The mean HEFI-2019 score for smokers was 7.1 points lower than for non-smokers (95%CI, -8.4 to -5.8). The HEFI-2019 was weakly correlated with energy intake (r=-0.13; 95%CI, -0.20 to -0.06). The principal components analysis revealed at least 4 dimensions. Cronbach’s alpha was 0.66 (95%CI, 0.63 to 0.69). Evidence of construct validity and internal consistency support the use of the HEFI-2019 to assess adherence to CFG-2019’s recommendations on healthy food choices. Novelty: • Examination of the Health Eating Food Index (HEFI)-2019’s psychometric properties is needed prior to implementation • Analyses support the construct validity and internal consistency of the HEFI-2019 • Interpretation of the total HEFI-2019 score must be accompanied by its components’ scores, considering it assesses multiple dimensions of food choices

Development of the Healthy Eating Food Index (HEFI)-2019 measuring adherence to Canada's Food Guide 2019 recommendations on healthy food choices

The release of Canada’s Food Guide (CFG) in 2019 by Health Canada prompted the development of indices to measure adherence to these updated dietary recommendations for Canadians. This study describes the development and scoring standards of the Healthy Eating Food Index (HEFI)-2019, which is intended to measure alignment of eating patterns with CFG-2019 recommendations on food choices among Canadians aged 2 years and older. Alignment with the intent of each key recommendation in the CFG-2019 was the primary principle guiding the development of the HEFI-2019. Additional considerations included previously published indices, data on Canadians’ dietary intakes from the 2015 Canadian Community Health Survey (CCHS) – Nutrition, and expert judgement. The HEFI-2019 includes 10 components: Vegetables and fruits (20 points), Whole-grain foods (5 points), Grain foods ratio (5 points), Protein foods (5 points), Plant-based protein foods (5 points), Beverages (10 points), Fatty acids ratio (5 points), Saturated fats (5 points), Free sugars (10 points), and Sodium (10 points). All components are expressed as ratios (e.g., proportions of total foods, total beverages, or total energy). The HEFI-2019 score has a maximum of 80 points. Potential uses of the HEFI-2019 include research as well as monitoring and surveillance of food choices in population-based surveys. Novelty: ● The Healthy Eating Food Index-2019 was developed to measure adherence to the 2019 Canada's Food Guide recommendations on healthy food choices. ● The HEFI-2019 includes 10 components, of which 5 are based on foods, 1 on beverages and 4 on nutrients, for a total of 80 points.

Engaging Youth Voices To Create Supportive School Environments For Healthy Eating And Physical Activity

Background: The Students As LifeStyle Activists (SALSA) Program is an effective Australian peer-led leadership program offered to high schools. SALSA Youth Voices (SYV) is a novel extension of the SALSA program, providing SALSA Peer Leaders with an opportunity to further develop leadership skills, and to design and implement an intervention to promote healthy eating and physical activity within their school. The objectives of this study were to 1) measure the acceptability of the SYV program, 2) determine skills gained by peer leaders from participating in SYV, and 3) determine whether peer leaders successfully implemented a student-designed healthy eating/physical activity intervention. Methods: Schools which participated in the SALSA program in 2019 were invited to a Leadership Day workshop (Term 3) where SALSA Peer Leaders identified and planned an activity to promote healthy eating and/or physical activity at their school, and an Action Day (Term 4) where peer leaders presented their interventions to 100 health and education professionals. Peer leaders completed two brief online surveys at the end of the Leadership Day and upon registration at the Action Day. Results: Eighty-four peer leaders (aged 14–15 years) from seven high schools in western Sydney (mean Index of Community Socio-Educational Advantage (ICSEA) = 951) participated in SYV. Peer leaders reported their involvement with the SYV program as positive, with 68% rating it as “very valuable”. Skills gained by the peer leaders included teamwork (90%), communication (85%), leadership (77%) and confidence (65%). Peer leaders planned and devised interventions included installing water refill stations, improving school gyms, redesigning girls’ sports shorts, and other strategies to engage girls in physical activity. Most peer leaders reported their intervention was successfully implemented and sustainable in their school. Conclusions: SYV provides a unique leadership opportunity for students from socio-economically disadvantaged areas to be effective agents of change to create opportunities for students to participate in physical activity and improve healthy food options at school.

Nutrition Interventions Addressing Structural Racism: A Scoping Review

African Americans experience high rates of obesity and food insecurity in part due to structural racism, or overlapping discriminatory systems and practices in housing, education, employment, health care, and other settings. Nutrition education and nutrition-focused policy, systems, and environmental changes may be able to address structural racism in the food environment. This scoping review aimed to summarize the available literature regarding nutrition interventions for African Americans that address structural racism in the food environment and compare them to the “Getting to Equity in Obesity Prevention” framework of suggested interventions. An electronic literature search was conducted with the assistance of a research librarian encompassing 6 databases—MEDLINE, PyscINFO, Agricola, ERIC, SocINDEX, and ProQuest Dissertations & Theses. A total of 30 sources were identified detailing interventions addressing structural barriers to healthy eating. The majority of nutrition interventions addressing structural racism consisted of policy, systems, and/or environmental changes in combination with nutrition education, strategies focused on proximal causes of racial health disparities. Only two articles each targeted the “reduce deterrents” and “improve social and economic resources” aspects of the framework, interventions which may be better suited to addressing structural racism in the food environment. Because African Americans experience high rates of obesity and food insecurity and encounter structural barriers to healthy eating in the food environment, researchers and public health professionals should address this gap in the literature.

Determinants of Preference and Consumption of Healthy Food in Children

According to recent findings, action is urgently needed to promote healthy eating habits among children, especially to increase daily consumption of fresh fruits and vegetables [...]

Orthorexia nervosa risk and associated factors among Chilean nutrition students: a pilot study

Background Orthorexia nervosa (ON) is characterized by an excessive, obsessive concern with healthy eating generating psychological complications and even malnutrition at a caloric and protein level. Current evidence suggests that people with greater food knowledge are the most likely to be affected, placing nutrition students as a populational risk group. Since there are no nationwide studies dealing with orthorexia nervosa in this risk group, the present pilot study intends to identify risk factors for orthorexia nervosa in a sample of Nutrition and Dietetics students in Chile. Method A descriptive cross-sectional pilot study was done on 90 Nutrition and Dietetics students from a Chilean university, representing 70% of its population. The ORTHO-11-ES instrument was applied to determine ON risk, along with consulting about attitudinal, physical-clinical and social variables. Statistical tests were performed in GraphPad PRISM 8.0®, applying probability ratios and personal correlation, between the sociodemographic variables and the risk of orthorexia nervosa. This study was approved by the university Ethics Committee based on the Helsinki Declaration. Results 23.3% of the studied population was at risk of suffering ON. Associated variables were being in the second year of their major (OR 2.22), coming from a charter school (OR 3.00) and cohabitation being limited to ≤ 1 person (OR 2.47). Particularly, declared physical activity limits are associated to the risk of suffering ON (Sedentary OR 2.42, Heavy OR 3.53), as well as time spent on the social network Instagram (< 1 h OR 2.77, > 3 h OR 1.80). Conclusions There is an ON risk prevalence of 23.3% in the present pilot sample under study, indicating that years of study, cohabitation, secondary educational establishment, physical activity and Instagram use constitute associated factors for the studied condition. Some results vary from international evidence, describing a dual nature in the variables for Instagram time and declared physical activity for ON risk. This study needs replication in more representative samples and longitudinal character with control groups which can confirm the studied elements as ON risk factors. Plain English summary Orthorexia nervosa (ON) is an expression created to indicate a possible new eating disorder characterized by excessive and obsessive preoccupation with healthy eating. Some of its most distinctive traits include marked anxiety over food, exaggerated fear over the appearance of some diseases and shame about physical appearance. This ultimately impacts food choice, planning, acquisition, preparation and consumption, creating psychological complications along with some associated with malnutrition. Considering that Nutrition students are an at-risk group, the present pilot study evaluated its prevalence and associated factors in a specific sample in Chile. Conditions associated with the risk of orthorexia nervosa identified in the present study include: number of hours spent using Instagram, limited cohabitation, extreme physical activity, and number of years in the major. These results should be taken cautiously, with their association confirmed in follow-up studies.

Developing and implementing a new methodology to test the affordability of currently popular weight loss diet meal plans and healthy eating principles

Background Weight loss diets continue to rise in popularity; however, the associated costs are seldom reported. Certain weight loss diets may be unaffordable and differ from their traditional nutrition composition to include non-conventional premium products. In contrast, healthy eating principles such as the Australian Guide to Healthy Eating (AGHE) and the Mediterranean Diet (MedDiet) place an emphasis on fresh produce and staple foods but are sometimes thought to be unaffordable. A new methodology was piloted to assess the cost of weight loss diets using seven meal plans. Methods Seven meal plans were analysed to quantify the absolute grams required of all ingredients across seven days and multiplied by the cost of the ingredient per gram to determine the total cost of each ingredient based on unit size and price. The weekly grocery shopping cost was determined through summation of all ingredients and their entire unit size to compare weekly costs. Results Weekly meal plans (absolute grams) cost between $93-193AUD. The AGHE meal plan was the least expensive and 8 Weeks to Wow was the most expensive. Weekly grocery shopping of entire units cost between $345-$625AUD, over $100AUD greater than the spending of an average Australian ($237AUD/week). Conclusions The financial feasibility for long-term sustainment of weight loss diets may be questionable for groups including low-income earners and low socioeconomic status. Further, when dietary patterns are adapted for weight loss, or followed by consumers, deviations from foundational principles tend to occur which may influence overall cost.