Perceived intrinsic, social, and environmental barriers for weight management in older Hispanic/Latino adults with obesity

A better diet quality based on the Healthy Eating Index-2020 is associated with lower energy intake and age but not with a pre-diabetes/T2DM diagnosis among Hispanic women with overweight/obesity

Low diet quality is related to obesity and type 2 diabetes mellitus (T2DM) risk among Hispanic women. This cross-sectional study compared diet quality among Hispanic women with overweight/obesity based on their T2DM diagnosis (pre-diabetes/T2DM group, n = 104 vs no diagnosis, at-risk group, n = 84). It was hypothesized that having a pre-diabetes or T2DM diagnosis would be associated with better diet quality based on the Healthy Eating Index (HEI)-2020 score. Means were compared using a 2-sample t-test for parametric and Kruskal-Wallis for non-parametric variables. Women with pre-diabetes/T2DM reported a lower intake of total energy (1378 ± 557 vs 1644 ± 703 kcal; P = .004) and cholesterol (228 ± 140 vs 299 ± 216 mg; P = .007). Total HEI score was higher for pre-diabetes/T2DM than the at-risk group (64 ± 8 vs 62 ± 9; P = .027). Among all participants, adequacy subscores were excellent for whole fruits, greens & beans, total proteins, and seafood and plant proteins, good for total fruits (77%); fair for total vegetables and fatty acids (64% for both); and poor for whole grains, and dairy (20% and 53%, respectively). Moderation subscores were very good for added sugars (89%), good for saturated fats (78%), and poor for refined grains, and sodium (44% and 33%, respectively). Compared to the at-risk group, women with pre-diabetes/T2DM had higher fatty acid ratio scores (7 ± 2 vs 6 ± 3, P = .039). Multiple linear regression revealed that pre-diabetes/T2DM did not significantly impact diet quality, but energy intake and age did. Overall, HEI subscores underscore the need to improve diet quality through key food groups in Hispanic women with overweight/obesity, regardless of T2DM status.

A qualitative study of perceived barriers and facilitators to interrupting sedentary behavior among adults living with obesity

Introduction

Both obesity and sedentary behavior (SB) are associated with negative health consequences including cardiovascular disease, diabetes, certain cancers and all-cause mortality. To date, perceived barriers and facilitators to interrupting SB in adults living with obesity have not been identified.

Objective

This study aimed to identify these perceived barriers and facilitators by conducting a behavioral analysis underpinned by the theoretical domains framework (TDF) and the Capability, Opportunity, Motivation-Behavior (COM-B) model to enhance knowledge and inform future intervention development.

Methods

A purposive and snowball sample (N = 21) of adults living with obesity took part in semi-structured interviews, guided by the TDF, to investigate perceived barriers or facilitators to interrupt SB. Transcribed interviews were inductively coded using reflexive thematic analysis. Key themes and subthemes were generated by grouping similar and recurring codes. Finally, subthemes were mapped to the TDF and COM-B.

Results

Five key themes were identified, which influence SB across all domains of living. These relate to (i) physical and mental wellbeing; (ii) motivational readiness; (iii) roles, responsibilities and support; (iv) weight bias and stigma; and (v) the environment. These themes were then deductively mapped to all 14 TDF domains and all six of the COM-B constructs.

Conclusion

A complex interplay of individual, societal and policy factors contributes to the development and habituation of SB patterns in adults living with obesity. Factors identified in this study could assist in the development of interventions, strategies and policies designed to interrupt or reduce sedentary behavior in this population.