The Importance of School-based Healthy Living Initiatives: Introducing the Health and Wellness Academy Concept

Childhood Obesity Body Mass Index and Gut Microbiome: A Cluster Randomized Controlled Pilot Feasibility Study

Background: Prebiotic fiber has been examined as a way to foster gut bacteria less associated with obesity. Tests of prebiotic fiber in reducing obesity have occurred mainly in animals, adults, and Caucasians when the highest obesity rates are in African American and Latinx youth. Response to prebiotic fiber is determined by the pre-existing intestinal microbiota. The type of microbiota varies based on diet and physical activity (PA), so it is important to examine acceptability and response to prebiotic fiber in those most at risk for obesity. Methods: This cluster randomized controlled feasibility trial included an online program designed to improve diet and PA along with administration of prebiotic fiber for 12 weeks in 123 4th and 5th grade students where 98% were eligible for free or reduced fee lunch. Of these 56% were male; 71% Latinx; 15% African American; and 14% Other. Results: A decrease in body fat (BF) was associated with higher pre-test BF. Lower BMI was associated with a decrease in fecal Tenericutes and an increase in Actinobacteria. Conclusion: Prebiotic fiber was evaluated in additional studies. Determining those most responsive to prebiotic fiber can also permit individual recommendations for greater inclusion in usual diet choices.

Medication therapy management lifestyle and wellness program for patients in rural Arizona

BACKGROUND

Pharmacist-provided medication therapy management (MTM) services have demonstrated improved clinical outcomes for patients. MTM services could incorporate additional lifestyle and wellness counseling to potentially enhance health care for underserved patients.

OBJECTIVE

To report the outcomes of a new pharmacist-provided MTM lifestyle and wellness counseling program for underserved rural Arizonans with diabetes and/or hypertension.

METHODS

A community health center referred rural Arizonans with type 2 diabetes and/or hypertension to the MTM pharmacist for telephonic MTM lifestyle and wellness counseling between July 2020 and June 2023. Data were collected on clinical characteristics, adherence issues, and pharmacist recommendations. A nurse reviewed the patients' electronic health record to determine which recommendations had been accepted by the primary care provider after 90 days. Summary statistics were computed.

RESULTS

For 93 patients in the program, pharmacists identified many drug-drug interactions, adverse drug reactions, utilization/cost concerns, and recommended preventative vaccines. Pharmacists provided counseling for exercise, nutrition, laboratory values, and disease state education. Twenty-nine patients reported missing any doses of their medications in the past 2 weeks. Patients used a variety of methods to remind them to take their medications. A total of 309 recommendations were made by the pharmacist averaging 3.3 ± 1.4 per patient. Of these, 113 (36.6%) were accepted within 90 days. The most common recommendations made were screening needed (n = 77) and vaccination due (n = 70). The most frequently accepted recommendations by the patients' provider were reinforcing lifestyle/disease self-management strategies (61.7%) and decreasing medication dose (60.0%).

CONCLUSION

This novel MTM lifestyle and wellness counseling program demonstrated some success for underserved Arizonans with diabetes and/or hypertension. Over one-third of recommendations made by the pharmacist to the patients' primary care provider were accepted, which is encouraging in showing the value of this program but suggests further work is needed to act upon them or understand why they are not implemented.

Knowing your audience: A narrative review of culturally tailored health programs for youth

Health education is more effective when the providers/educators are knowledgeable about the population in which the education is being disseminated in and cognizant of the cultural influences on these areas of health. Simply put - "know your audience!" Because culture is who we are and what we are, it would be remis to ignore the richness of cultural foods, movement, and other health patterns. Embracing culture in its relationship to health is important. Health educators should be utilizing cultural variability and meeting the needs of specific populations. If lifestyle patterns are to be assimilated into daily practices, the behaviors must be meaningful and culturally relevant. When programs are tailored and implemented in youth and young adults, health education can take a proactive preventative role. This paper provides a perspective for approaching programming for youth, important components for tailoring educational programs, and a narrative review of educational health initiatives that seek to tailor their interventions towards youth. While programs do exist for youth, there is a need for improvement. If healthy living behaviors are to be assimilated into the cultural richness of the community in which the program is implemented, meeting the needs of youth through engaging relevant lessons is crucial.

Cultural influences on dietary choices

Food choices and dietary behaviors are inherently complex and influenced by numerous interconnected factors including individual preferences such as taste, meal timing, and social interactions, alongside external elements like affordability, cultural norms, marketing, and policy environments. The physical contexts of food consumption - homes, schools, workplaces, and neighborhoods- further shape these behaviors, as do societal expectations and generational food literacy. Underpinning these dynamics are food systems, which are influenced by health, ethical, and sustainability considerations throughout the food production and consumption continuum. Cultural influences, encompassing traditions, rituals, and shared beliefs, play a pivotal role in shaping dietary practices. Distinctions between "cultural food" and "food culture" illustrate the deep integration of cuisine within identity and daily life. Historical events, globalization, and modernization have reshaped food traditions, leading to the adoption of new eating patterns and the erosion of others. Religion, socioeconomic status, and social networks also critically impact dietary behaviors, while contemporary challenges such as the nutrition transition and fast-food culture contribute to rising chronic disease burdens. Addressing these issues requires culturally tailored interventions and a focus on food environments, integrating modern tools like social media to promote healthier, community-oriented behaviors while recognizing the social and emotional roles of food.

Healthy Eating in K-12 Schools: Assessing Readiness and Capacity to Guide SNAP-Ed Programming in Ohio

OBJECTIVE

Identify themes essential to implementing policy, system, and environmental (PSE) interventions within kindergarten to 12th-grade (K-12) settings and provide associated indicators of readiness and capacity to support healthy eating PSE work among Supplemental Nutrition Assistance Program-Education (SNAP-Ed) practitioners in Ohio.

DESIGN

Interview data were collected in Ohio from December, 2020 to May, 2021.

PARTICIPANTS

Ohio SNAP-Ed practitioners (n = 12), community residents with low income (n = 26), and K-12 experts statewide (n = 10) and nationally (n = 3).

PHENOMENON OF INTEREST

Healthy eating PSE implementation.

ANALYSIS

We conducted a qualitative analysis to identify themes and indicators related to implementing healthy eating PSEs in schools. During virtual consensus conferences (December, 2021-April, 2022), themes and indicators were sorted and ranked by perceived importance to PSE implementation.

RESULTS

Four themes and 14 indicators were identified. Expert-derived weights quantified the themes' importance to PSE implementation efforts in K-12. Themes included: (1) school system support and capacity (weight 0.372), (2) school food environment (0.278), (3) SNAP-Ed practitioner capacity and resources (0.192), and (4) familial influence and awareness (0.158).

CONCLUSIONS AND IMPLICATIONS

Findings provide guidance for tailoring healthy eating PSEs in K-12 schools using local levels of readiness and capacity. Results highlight targeted areas of focus to support the implementation of healthy eating PSE interventions in K-12 schools through SNAP-Ed programming in diverse contexts. Future research is needed on the applicability of these findings based on feedback from school district staff and community members with children in different school settings.

Novel Approaches to Addressing the US Physical Inactivity and Obesity Pandemics: An Opportunity for Religious Organizations

BACKGROUND

Physical inactivity and obesity crises persist in the United States despite substantial mitigation efforts. The primary goal of this analysis is to determine whether the geographic concentration of religious institutions overlaps with geographic patterns for physical inactivity and obesity prevalence.

METHODS

We obtained 2021 county-level, age-adjusted physical inactivity ("no leisure time physical activity") and obesity prevalence from the 2023 Centers for Disease Control and Prevention PLACES database. Data on number of congregations per 100,000 individuals and adherents as a percentage of the population were obtained from the 2020 US Religion Census. The American Nations regional cultures model was obtained from the Nationhood Lab.

RESULTS

On a national level, all correlations were statistically significant between health factors and religious infrastructure-higher physical inactivity and obesity were related to more congregations per 100,000 population on a county level. The strength of correlations between congregations per 100,000 county population and both physical inactivity and obesity prevalence was greatest in the American Nations model's Deep South and Tidewater regions.

CONCLUSIONS

Approaches to addressing the pandemics of unhealthy lifestyle-related health factors of physical inactivity and obesity in the United States have, in large part, been unsuccessful. Church-based healthy lifestyle programs, particularly in areas where a high concentration of congregations align with high physical inactivity and obesity, may offer a novel and effective approach to addressing this issue.

Retracted: Body Mass Index and Gut Microbiome: A Cluster-Randomized, Controlled, Pilot Feasibility Study

The Editor-in-Chief of Childhood Obesity officially retracts the article entitled, "Body Mass Index and Gut Microbiome: A Cluster-Randomized, Controlled, Pilot Feasibility Study," by Frenn M, Salzman N, Lam V, Holtz M, Moosreiner A, and Garnier M. (Child Obes. 2023 Feb 2 ahead of print. doi: 10.1089/chi.2022.0171). After the Online Now (epub) publication of the paper, the Editor of the journal received an email from a reader with concerns regarding fundamental flaws in the study. The journal's Editor-in-Chief provided this letter to the authors of the article and provided an opportunity to respond. The authors addressed several of the comments but defended their main analysis. The Editor made the decision to retract the paper based on the following: (a) the distinction between a weakness or limitation in research vs invalid or incorrect methods is important; (b) weaknesses and limitations can be addressed by acknowledging them, whereas errors merit correction of the scientific record; and (c) the author response did not indicate that their original paper used correct and valid methods and it was therefore judged to be unreliable and meriting retraction. The Editor-in-Chief of Childhood Obesity asked highly experienced statisticians to re-review the paper in conjunction with the complainant's statements. The statisticians all are considered experts in their field and familiar with the issue being debated and have no affiliation or relationship with the complainants or the authors. After carefully examining the article, the statisticians agreed that flaws exist, most importantly that clustering and nesting should be accounted for in the statistical analysis given the cluster randomized design, thereby rendering the results biased and invalid. Based on the statisticians' assessments of the published article and the authors' reanalysis, the Editor of Childhood Obesity is no longer confident in the results and, though the authors are not in agreement, officially retracts the article from the literature. See the official Retraction Notice (10.1089/chi.2022.0171.retract) to view the original letter from the complainant, and the authors' responses, which are included as supplemental material for clarity.

Current Activities Centered on Healthy Living and Recommendations for the Future: A Position Statement from the HL-PIVOT Network

We continue to increase our cognizance and recognition of the importance of healthy living (HL) behaviors and HL medicine (HLM) to prevent and treat chronic disease. The continually unfolding events precipitated by the coronavirus disease 2019 (COVID-19) pandemic have further highlighted the importance of HL behaviors, as indicated by the characteristics of those who have been hospitalized and died from this viral infection. There has already been recognition that leading a healthy lifestyle, prior to the COVID-19 pandemic, may have a substantial protective effect in those who become infected with the virus. Now more than ever, HL behaviors and HLM are essential and must be promoted with a renewed vigor across the globe. In response to the rapidly evolving world since the beginning of the COVID-19 pandemic, and the clear need to change lifestyle behaviors to promote human resilience and quality of life, the HL for Pandemic Event Protection (HL-PIVOT) network was established. The 4 major areas of focus for the network are: (1) knowledge discovery and dissemination; (2) education; (3) policy; (4) implementation. This HL-PIVOT network position statement provides a current synopsis of the major focus areas of the network, including leading research in the field of HL behaviors and HLM, examples of best practices in education, policy, and implementation, and recommendations for the future.

Cardiac Rehabilitation: A Bibliometric Review From 2001 to 2020

Cardiovascular disease (CVD) is a serious threat to global public health due to its high prevalence and disability rate. Meanwhile, cardiac rehabilitation (CR) has attracted increasing attention for its positive effects on the cardiovascular system. There is overwhelming evidence that CR for patients with CVD is effective in reducing cardiovascular morbidity and mortality. To learn more about the development of CR, 5,567 papers about CR and related research were retrieved in the Web of Science Core Collection from 2001 to 2020. Then, these publications were scientometrically analyzed based on CiteSpace in terms of spatiotemporal distribution, author distribution, subject categories, topic distribution, and references. The results can be elaborated from three aspects. Firstly, the number of annual publications related to CR has increased year by year in general over the past two decades. Secondly, a co-occurrence analysis of the output countries and authors shows that a few developed countries such as the United States, Canada, and the UK are the most active in carrying out CR and where regional academic communities represented by Sherry Grace and Ross Arena were formed. Thirdly, an analysis of the subject categories and topic distribution of the papers reveals that CR is a typical interdiscipline with a wide range of disciplines involved, including clinical medicine, basic medicine, public health management, and sports science. The research topics cover the participants and implementers, components, and the objectives and requirements of CR. The current research hotspots are the three core modalities of CR, namely patient education, exercise training and mental support, as well as mobile health (mHealth) dependent on computer science. In conclusion, this work has provided some useful information for acquiring knowledge about CR, including identifying potential collaborators for researchers interested in CR, and discovering research trends and hot topics in CR, which can offer some guidance for more extensive and in-depth CR-related studies in the future.

Natural Extracts to Augment Energy Expenditure as a Complementary Approach to Tackle Obesity and Associated Metabolic Alterations

Obesity is the epidemic of the 21st century. In developing countries, the prevalence of obesity continues to rise, and obesity is occurring at younger ages. Obesity and associated metabolic stress disrupt the whole-body physiology. Adipocytes are critical components of the systemic metabolic control, functioning as an endocrine organ. The enlarged adipocytes during obesity recruit macrophages promoting chronic inflammation and insulin resistance. Together with the genetic susceptibility (single nucleotide polymorphisms, SNP) and metabolic alterations at the molecular level, it has been highlighted that key modifiable risk factors, such as those related to lifestyle, contribute to the development of obesity. In this scenario, urgent therapeutic options are needed, including not only pharmacotherapy but also nutrients, bioactive compounds, and natural extracts to reverse the metabolic alterations associated with obesity. Herein, we first summarize the main targetable processes to tackle obesity, including activation of thermogenesis in brown adipose tissue (BAT) and in white adipose tissue (WAT-browning), and the promotion of energy expenditure and/or fatty acid oxidation (FAO) in muscles. Then, we perform a screening of 20 natural extracts (EFSA approved) to determine their potential in the activation of FAO and/or thermogenesis, as well as the increase in respiratory capacity. By means of innovative technologies, such as the study of their effects on cell bioenergetics (Seahorse bioanalyzer), we end up with the selection of four extracts with potential application to ameliorate the deleterious effects of obesity and the chronic associated inflammation.