Examination of Nutrition Literacy and Quality of Self-monitoring in Behavioral Weight Loss

Association of health literacy and general self-efficacy with emergency department visits for unclear abdominal pain after bariatric surgery

INTRODUCTION

Emergency department visits are common following bariatric surgery and may be partially preventable. Health literacy and general self-efficacy are factors that may influence health-seeking behaviors in these patients. This study aimed to assess whether health literacy and general self-efficacy are associated with an increased frequency of emergency department visits after bariatric surgery.

METHODS

Patients who underwent bariatric surgery at a single hospital from 2018 to 2020 were evaluated for their health literacy and general self-efficacy levels before surgery. Data on emergency department visits within the patient's residential region were evaluated over a three-year period, with repeated emergency department visits for abdominal pain as the primary outcome.

RESULTS

During the follow-up period, 69 of 231 patients (29.9%) had at least one emergency department visit for abdominal pain, and 20 patients (8.7%) had three or more visits. Inadequate functional health literacy (OR 5.56, 95% CI 1.80-17.19, p = 0.003) and inadequate communicative and critical health literacy (OR 10.48, 95% CI 3.13-35.08, p < 0.001) were both significantly associated with an increased risk of repeated emergency department visits over the three-year period. No significant association was found between low general self-efficacy and the frequency of emergency department visits.

CONCLUSIONS

Inadequate health literacy is associated with an increased risk of repeated emergency department visits for abdominal pain following bariatric surgery.

Nutrition literacy is associated with general obesity, abdominal obesity, and body fat percentage obesity

Background

Obesity is associated with unhealthy eating behavior among adults. Nutrition literacy (NL) is an important determinant of eating behavior. This study investigated the association of NL with general obesity, abdominal obesity, and body fat percentage (BFP) obesity among adults.

Methods

This study was a cross-sectional survey on the Nutrition Literacy and Obesity, conducted in Bengbu City, China (May to July 2023). The Short-Form Nutrition Literacy scale was used to evaluate the NL of adults. General obesity was defined as a body mass index of ≥28 kg/m2. Abdominal obesity was defined as a waist circumference of ≥90 cm in men and ≥85 cm in women. BFP obesity was defined as a BFP of ≥30% in men and ≥42% in women. Binary logistic regression analysis was performed to identify the correlations of NL with general obesity, abdominal obesity, and BFP obesity in adults. Subgroup analyses and interaction tests were also performed.

Results

Participants with a high level of NL had low odds of general obesity (odds ratio [OR]: 0.66; 95% confidence interval [CI]: 0.43-0.99), abdominal obesity (OR: 0.63; 95% CI: 0.46-0.87), and BFP obesity (OR: 0.55; 95% CI: 0.35-0.87). In subgroup analyses and interaction tests, age significantly influenced the negative correlations of NL with abdominal obesity and BFP obesity (p for interaction <0.05), but not general obesity (p for interaction >0.05). Moreover, sex and smoking status significantly influenced the negative correlations of NL with general obesity and abdominal obesity (p for interaction <0.05), but not BFP obesity (p for interaction >0.05), and drinking status significantly influenced the negative correlations of NL with abdominal obesity (p for interaction <0.05), but not general obesity and BFP obesity (p for interaction >0.05). However, marital status did not significantly influence the correlation of NL with obesity (p for interaction >0.05).

Conclusion

Our findings highlight that adults with high levels of NL have low odds of general obesity, abdominal obesity, and BFP obesity. Age, sex, smoking status, and drinking status influence the correlation between NL and obesity. The results indicate the importance of NL in the prevention and management of obesity in adults. To effectively address the challenges of adult obesity management, public health practitioners should tailor nutrition education and skill training programs to specific demographic profiles.

A Mediation Model of Food Literacy: A Potential Relationship between Body Image Dissatisfaction and Body Mass Index

Background and Objectives: The global rise in obesity presents a significant public health challenge, with Turkey exhibiting one of the highest obesity rates in Europe. Body image dissatisfaction (BID) and lower food literacy (FL) have been associated with obesity, yet their interplay remains underexplored. This study aimed to investigate the relationship between body mass index (BMI), body image dissatisfaction, and FL in adults in Turkey. Materials and Methods: In total, 759 women and 419 men aged 18-64 years old were included in this study. The mean age was 31.34 ± 11.92. A total of 1178 participants completed an online questionnaire assessing anthropometric measurements, BID, using the Stunkard Figure Rating Scale, and FL, using a validated questionnaire. The data were analyzed using descriptive statistics, correlation analysis, and mediation analysis to explore the relationships between variables in SPSS 24.0. Results: Women desired to be thinner more frequently than men, and those with negative BID were predominantly individuals with overweight or obesity. Moreover, those with higher FL scores were more likely to be satisfied with their bodies. Correlation analysis demonstrated a negative relationship between BMI and FL (r = -0.94; p = 0.001) and a positive relationship between BMI and BID (r = 0.628; p < 0.001). Mediation analysis revealed that FL mediated the relationship between BID and BMI (β = -2.281; lower limit = -3.334, upper limit = -1.228). Conclusions: The findings highlight the importance of addressing BID and enhancing FL to mitigate obesity risk factors. This study contributes to understanding the complex interplay between BID, FL, and obesity, providing insights for public health interventions aimed at obesity prevention and management.

The Effect of Sociodemographic and Anthropometric Variables on Nutritional Knowledge and Nutrition Literacy

Nutrition literacy, which is one of the important components of health literacy, includes basic nutritional information and understanding, interpreting and having the ability to make healthy decisions on nutrition-related issues. This study aims to dwell upon the relationship between sociodemographic and anthropometric variables and nutritional knowledge and nutrition literacy. A total of 1600 people aged 19-64 years, 934 women and 666 men, voluntarily participated in the research in the capital city of Turkey. The mean age is 28.2 ± 10.9 years. More than half of the participants (57.4%) have a university graduate/postgraduate education level, and 66.2% are unemployed. This cross-sectional study evaluated demographic information, anthropometric measurements, nutritional information and nutrition literacy. Nearly all the respondents (94.6%) were determined to have sufficient nutrition literacy. Body mass index (BMI) and age were negatively associated with nutrition literacy, whilst nutrition knowledge was positively associated. Respondents with nutrition education at school had the highest nutrition knowledge and nutrition literacy scores, and primary school graduates had the lowest. Participants who received nutrition education scored higher in all the subgroups of the GNKQ. Age, gender, marital status, education status, employment status, BMI and nutrition education were significantly associated with nutrition literacy. The results will be useful in developing food and nutrition policies that will pave the way for making decisions on the most useful themes of health and nutrition campaigns.

An educational intervention to improve health and nutrition literacy in hypertensive patients in Greece

BACKGROUND

Suboptimal control of blood pressure (BP) is a public health challenge in Greece. This educational intervention attempts to improve health literacy (HL) and nutrition literacy (NL) in primary healthcare (PHC) patients with hypertension (HTN).

MATERIALS AND METHODS

This was a proof-of-concept (PoC) educational intervention. Twenty-four patients with HTN and low or medium levels of HL agreed to participate in this 6-week educational intervention. The program was delivered by a general practitioner (GP) in group A and by a qualified nurse in group B. Group C was the control group. The levels of HL of NL, adherence to the Mediterranean diet, and perceived stress were assessed using the European Health Literacy Survey Questionnaire 16 (HLS_EU_Q16) and part B (reading a medication label) of the High Blood Pressure-Health Literacy Scale (HBP-HLS), the Nutrition Literacy Scale-Greek (NLS-Gr), the Mediterranean Diet Adherence Screener (MEDAS), and the Perceived Stress Scale (PSS-14), respectively, together with certain socioeconomic, dietary, and lifestyle characteristics. The Kruskal-Wallis and Wilcoxon nonparametric, the Chi-square, and the McNemar-Bowker tests were used. The analysis was done with the STATA software, version 14 (MP & Associates, Sparta, Greece).

RESULTS

No statistically significant differences were found in the total score of HL and NL before and after the intervention; however, the results indicate a slight improvement in HL and NL levels in the two intervention groups, together with small improvements in knowledge and behaviors related to HTN and dietary salt. A trend of improvement in the MEDAS levels in the GP's group and the HBP-HLS levels in the nurse's group was also reported.

CONCLUSION

A slight improvement in HL and NL levels in the two intervention groups has been reported, and the changes, however, were not statistically significant.

Association Between Nutrition Literacy and Overweight/Obesity of Adolescents: A Cross–Sectional Study in Chongqing, China

Objective

The burden of overweight and obesity in adolescents is increasing rapidly. This study aimed to assess the association between nutrition literacy and overweight/obesity among adolescents in China.

Methods

This cross–sectional online study involving adolescents aged 10–18 years was conducted in September 2020 in 239 schools in Chongqing China. Overweight and obese adolescents were determined based on the International Obesity Task Force's recommended age–sex specific body mass index cutoff points. Nutrition literacy was measured using the “Nutrition literacy scale for middle school students in Chongqing (CM–NLS).” The CM–NLS included three subdomains (functional nutritional literacy, interactive nutrition literacy, and critical nutrition literacy). Multinomial logistic regression model was used to examine the association.

Results

A total of 18,176 adolescents (49.8% girls) were included. The prevalence of overweight and obesity was 9.6% and 17.0%, respectively. Compared with those having a low nutrition literacy score (below median), those with a high score were less likely to be overweight and obese. The odds ratio (95% CI) for overweight was 0.87 (0.79–0.97) (nutrition literacy) and 0.81 (0.73–0.90) (functional nutritional literacy). The corresponding figures for obesity were 0.84 (0.77–0.91) and 0.73 (0.67–0.80), respectively. Significant interaction existed between grade and nutrition literacy. The inverse association between nutrition literacy and overweight/obesity was significant among those in senior school but not among those in junior high school.

Conclusion

Nutrition literacy was inversely associated with overweight/obesity among adolescents, especially those attending senior high schools.

The relation of grit to weight loss maintenance outcomes

Biological, genetic, and environmental factors make weight loss very difficult. Acceptance-based behavioral treatment (ABT) supplements standard behavioral treatments (BT) for obesity by teaching skills to accept the discomfort inherent to weight control behaviors and prioritize long-term, values-based goals. Grit, the ability to persevere in goal pursuit, overlaps conceptually with ABT principles and may predict outcomes in ABT. During a randomized controlled trial comparing three weight loss interventions (BT, BT with an emphasis on physical activity [BT+PA], ABT with an emphasis on physical activity [ABT+PA]), this study examined if grit predicted weight loss, intervention engagement (session attendance and dietary self-monitoring), and perceived intervention effectiveness, and whether intervention condition moderated these relationships. Participants (N=309) with overweight/obesity enrolled in an 18-month weight loss intervention completed the Short Grit Scale at baseline. Weight and PA were measured at baseline, during the intervention (12 and 18 months), and at follow-up (24 and 36 months). Session attendance and dietary self-monitoring were assessed throughout the intervention, and perceived intervention effectiveness at end-of-intervention. The relation of grit to several outcomes depended on condition. In ABT+PA, but not BT or BT+PA, lower grit related to higher weight loss at 12 and 24 months, session attendance, and perceived intervention effectiveness. Grit was not related to PA or dietary self-monitoring in any condition. ABT's focus on building skills to facilitate long-term goal pursuit may be unique and beneficial to those with lower grit. Those with higher grit may already possess ABT-consistent skills and benefit less from ABT. Research on trait-level characteristics like grit in relation to weight must be cautious not to reinforce weight bias; rather, this work suggests that an evidence-based intervention (ABT) may be well-suited to those with lower grit levels seeking weight loss.

Agrifood consumer competency and organic food purchase intentions according to food-related lifestyle: based on data the 2019 Consumer Behavior Survey for Food

BACKGROUND/OBJECTIVES

The increased consumers’ interests in health and food safety have increased the demand for organic foods. Many studies have been performed on consumers’ purchase intentions for organic foods and their influencing factors, and various studies have shown that the prices of organic foods and the consumers’ willingness to pay are important influencing factors. This study examined the payment value of organic foods and agrifood consumer competency index according to the food-related lifestyles in South Korean consumers.

SUBJECTS/METHODS

A cross-sectional analysis was performed using the 2019 Consumer Behavior Survey for Food. A total of 6,176 participants aged 19 to 74 years (male: 2,783, female: 3,393) were included in the analysis.

RESULTS

Three factors were extracted by factor analysis (rational consumption-seeking type, convenience-seeking type, and health, and safety-seeking type) to explain the consumers’ food-related lifestyles. The results of cluster analysis suggested that consumers were classified into 3 food-related lifestyles as the ‘exploratory consumers’ (n = 2,485), ‘safety-seeking consumers’ (n = 1,544), and ‘passive consumers’ (n = 2,147). Exploratory consumers showed a significantly higher willingness to pay for imported organic foods (P < 0.05). Safety-seeking consumers had a significantly higher willingness to pay for domestic organic foods (P < 0.05). For the agrifood consumer competency index, exploratory consumers had the highest score, followed in order by safety-seeking consumers and passive consumers.

CONCLUSIONS

These results provide basic data in understanding consumption tendency for organic foods and agrifoods based on food-related lifestyles of South Korean consumers.

Weight-Related Information Avoidance Prospectively Predicts Poorer Self-Monitoring and Engagement in a Behavioral Weight Loss Intervention

BACKGROUND

Self-monitoring is a key component of behavioral weight loss (BWL) interventions. Past research suggests that individuals may avoid self-monitoring in certain contexts (e.g., skipping self-weighing after higher-than-usual calorie intake). However, no studies have attempted to quantify individuals' inclination to avoid information about their weight control ("weight-related information avoidance"; WIA) or prospectively examined its implications for treatment engagement and outcomes in BWL programs.

PURPOSE

Characterize WIA using a validated questionnaire among adults enrolled in BWL treatment and examine whether WIA prospectively predicts self-monitoring adherence, session attendance, treatment discontinuation, or weight loss.

METHODS

Participants (N = 87; MBMI = 34.9 kg/m2, 83% female) completed a measure of WIA prior to starting a 12 week, group-based BWL intervention. Participants were given digital self-monitoring tools and instructed to self-monitor their food intake daily, physical activity daily, and body weight weekly (Weeks 1-10) and then daily (Weeks 11-12). Session attendance and treatment discontinuation were recorded. Weight was measured in-clinic pretreatment and posttreatment.

RESULTS

While mean WIA was low (M = 2.23, standard deviation [SD] = 0.95; potential scale range: 1-7), greater WIA predicted poorer attendance (r = -.23; p = .03) and poorer self-monitoring of physical activity (r = -.28; p = .009) and body weight (r = -.32; p = .003). WIA did not predict food monitoring (p = .08), treatment discontinuation (p = .09), or 12 week weight loss (p = .91).

CONCLUSIONS

Greater WIA, as assessed via a brief questionnaire, may place individuals at risk for poorer self-monitoring and treatment engagement during BWL. Further research on the implications of WIA in the context of weight management is warranted, including evaluation of correlates, moderators, and mechanisms of action of WIA.

CLINICAL TRIAL REGISTRATION

NCT03337139.

Applying a Multi-Dimensional Digital Food and Nutrition Literacy Model to Inform Research and Policies to Enable Adults in the U.S. Supplemental Nutrition Assistance Program to Make Healthy Purchases in the Online Food Retail Ecosystem

The United States (U.S.) Department of Agriculture (USDA)-administered Supplemental Nutrition Assistance Program (SNAP) made substantial changes in response to the coronavirus disease 2019 (COVID-19) pandemic. These changes highlight the need to identify the digital literacy skills and capacities of SNAP adults to purchase healthy groceries online. We conducted a scoping review of four electronic databases, Google and Google Scholar to identify studies that measured food and nutrition literacy outcomes for U.S. adults. We applied a multi-dimensional digital food and nutrition literacy (MDFNL) model to assess six literacy levels and components. Of 18 studies published from 2006-2021, all measured functional and interactive literacy but no study measured communicative, critical, translational, or digital literacy. Six studies examined SNAP or SNAP-Education outcomes. Adults with higher food or nutrition literacy scores had better cognitive, behavioral, food security and health outcomes. We suggest how these findings may inform research, policies, and actions to strengthen the multi-dimensional literacy skills of SNAP participants and SNAP-eligible adults to support healthy purchases in the online food retail ecosystem.

Type 2 diabetes self-management schemas across diverse health literacy levels: a qualitative investigation

OBJECTIVE

The aim of this study was to explore how people with diabetes and diverse health literacy levels conceptualise their experience and efforts to engage in self-management behaviours (their self-management 'schemas').

DESIGN

A qualitative design was applied.

METHODS

Twenty-six people in Sydney, Australia, took part in semi-structured interviews, which were audio-recorded and coded using Framework analysis.

RESULTS

Half the participants (54%) had limited health literacy, whereas 38% adequate health literacy (using Newest Vital Sign). Regardless of health literacy, people described how monitoring increased self-management awareness and signalled periods of low self-management ('lulls'). Accounts of monitoring to sustain motivation were more apparent for participants with adequate health literacy. Most participants described simple and flexible rules (e.g. use artificial sweeteners; eat in moderation). Two schemas related to 'lulls': a 'problem-solving orientation' depicted lulls as inevitable and was associated with varied coping strategies; a 'willpower orientation' attributed lulls to lack of 'willpower,' and described willpower as a main coping strategy.

CONCLUSION

There is considerable variation in how people think about their diabetes self-management and the strategies they use. Health literacy may contribute to some of this variation. Self-management interventions could benefit from depicting motivation as fluctuating and challenging ideas about willpower and self-blame.

Self-Monitoring via Digital Health in Weight Loss Interventions: A Systematic Review Among Adults with Overweight or Obesity

OBJECTIVE

Self-monitoring is a core component of behavioral obesity treatment, but it is unknown how digital health has been used for self-monitoring, what engagement rates are achieved in these interventions, and how self-monitoring and weight loss are related.

METHODS

This systematic review examined digital self-monitoring in behavioral weight loss interventions among adults with overweight or obesity. Six databases (PubMed, Embase, Scopus, PsycInfo, CINAHL, and ProQuest Dissertations & Theses) were searched for randomized controlled trials with interventions ≥ 12 weeks, weight outcomes ≥ 6 months, and outcomes on self-monitoring engagement and their relationship to weight loss.

RESULTS

Thirty-nine studies from 2009 to 2019 met inclusion criteria. Among the 67 interventions with digital self-monitoring, weight was tracked in 72% of them, diet in 81%, and physical activity in 82%. Websites were the most common self-monitoring modality, followed by mobile applications, wearables, electronic scales, and, finally, text messaging. Few interventions had digital self-monitoring engagement rates ≥ 75% of days. Rates were higher in digital- than in paper-based arms in 21 out of 34 comparisons and lower in just 2. Interventions with counseling had similar rates to standalone interventions. Greater digital self-monitoring was linked to weight loss in 74% of occurrences.

CONCLUSIONS

Self-monitoring via digital health is consistently associated with weight loss in behavioral obesity treatment.

Health literacy as a determinant of childhood and adult obesity: a systematic review

OBJECTIVES

To assess whether Health Literacy (HL) acts as a determinant of obesity in adults and children by synthesizing the results of recent scientific evidence.

CONTENT

This is a systematic qualitative review following the MOOSE guidelines. A systematic, computer-assisted literature search via PubMed scientific database, between January 1st, 2000, and September 30th 2020, was conducted. Only cross-sectional epidemiologic research studies that were published in the English language, investigating HL's possible role as a determinant of childhood and adult obesity, were included.

SUMMARY

After screening 725 citations from the PubMed database, 39 (n=39) studies in total were included in this literature review; Four (n=4) studies were conducted in the children population, seven (n=7) studies were performed in children-parent/caregiver dyads, and 28 studies (n=28) enrolled adults. There is significant evidence that HL knowledge and skills determine the consequent management of obesity and BMI rates in children and adult populations.

OUTLOOK

Despite policies and action plans put in place by countries globally, overweight and obesity continue to be a pressing public health issue and one of the critical drivers of non-communicable diseases, constituting a health, social and economic burden worldwide. Health Literacy as an essential health policy and promotion agenda item and a critical empowerment strategy could increase children's and adults' control over their overall health and awareness to overcome obesity issues. Initiatives to improve HL levels could be useful tools in managing the obesity epidemic, starting from integrating HL in the school curriculum and further in family and community action plans.

Health and nutrition literacy in adults: Links with lifestyle factors and obesity

BACKGROUND: Low Health Literacy (HL) and Nutrition Literacy (NL) are associated with serious negative health outcomes. OBJECTIVES: The aim of this study was to investigate certain lifestyle factors and obesity, in relation to HL and NL. METHODS: This cross-sectional study was conducted in the urban area of the Attica region, in Greece. The sample consisted of 1281 individuals, aged ≥18 years. HL, NL sociodemographic characteristics and lifestyle factors (physical activity, smoking status, alcohol consumption,) were assessed. Mann-Whitney U, the Kruskall Wallis, Pearson chi-square tests and multiple linear regression models were used. RESULTS: Linear regression analysis has shown that smoking, alcohol consumption and physical activity, were associated with HL levels (–1.573 points for ex-smokers in comparison to smokers, p = 0.035, –1.349 points for alcohol consumers in comparison to non-consumers, p = 0.006 and 1.544 points for physically active individuals to non-active, p = 0.001). With respect to NL levels, it was also not associated with any of these factors. Obesity was not associated with HL and NL levels. CONCLUSIONS: Certain lifestyle factors, including physical activity, are predicting factors of HL levels, in Greek adults. The results contribute to the understanding of the relationship between lifestyle factors and HL and should be taken into account when HL policies are designed.

Consistent self-monitoring in a commercial app-based intervention for weight loss: results from a randomized trial

Self-monitoring is the strongest predictor of success in lifestyle interventions for obesity. In this secondary analysis of the GoalTracker trial, we describe outcomes of consistently self-monitoring in a standalone weight loss intervention. The 12-week intervention focused on daily self-monitoring of diet and/or body weight in a commercial app (MyFitnessPal). Participants (N = 100; 21-65 years; BMI 25-45 kg/m²) were categorized as Consistent Trackers if they tracked ≥ 6 out of 7 days for at least 75% of the targeted weeks. One-fourth of participants were Consistent Trackers. This subset was more likely to be married or living with a partner, be non-Hispanic White, and have higher health literacy than Inconsistent Trackers (ps < .05). Consistent tracking was associated with greater weight change than inconsistent tracking at 1 month (mean difference [95% CI] - 1.11 kg [- 2.12, - 0.10]), 3 months (- 2.42 kg [- 3.80, - 1.04]), and 6 months (- 2.13 kg [- 3.99, - 0.27]). Over 3 times as many Consistent Trackers as Inconsistent Trackers achieved ≥ 5% weight loss at 3 months (48 vs. 13%) and at 6 months (54 vs. 15%; ps < .001). Though causality cannot be determined by the present study, tracking weight and/or diet nearly every day per week for 12 weeks in a commercial app may serve as an effective strategy for weight loss. Strategies are needed to promote greater consistency in tracking.

Combined Amylin/GLP-1 pharmacotherapy to promote and sustain long-lasting weight loss

A growing appreciation of the overlapping neuroendocrine mechanisms controlling energy balance has highlighted combination therapies as a promising strategy to enhance sustained weight loss. Here, we investigated whether amylin- and glucagon-like-peptide-1 (GLP-1)-based combination therapies produce greater food intake- and body weight-suppressive effects compared to monotherapies in both lean and diet-induced obese (DIO) rats. In chow-maintained rats, systemic amylin and GLP-1 combine to reduce meal size. Furthermore, the amylin and GLP-1 analogs salmon calcitonin (sCT) and liraglutide produce synergistic-like reductions in 24 hours energy intake and body weight. The administration of sCT with liraglutide also led to a significant enhancement in cFos-activation in the dorsal-vagal-complex (DVC) compared to mono-therapy, suggesting an activation of distinct, yet overlapping neural substrates in this critical energy balance hub. In DIO animals, long-term daily administration of this combination therapy, specifically in a stepwise manner, results in reduced energy intake and greater body weight loss over time when compared to chronic mono- and combined-treated groups, without affecting GLP-1 receptor, preproglucagon or amylin-receptor gene expression in the DVC.