Purpose: Few studies have examined the impact of school-based obesity prevention programs on disordered eating outcomes. We evaluated disordered eating outcomes across three school-based randomized controlled obesity intervention trials.

Methods: Study 1 (n=355), Study 2 (n=302), and Study 3 (n=240) were six-month interventions implemented during participants’ physical education (PE) class. All participants were recruited from a Houston, Texas charter school district and self-identified as Hispanic-American. The intervention arm of Study 1 (delivered by PE teachers and peer mentors) and Study 2 (delivered by trained research staff) included physical activity, nutrition, and behavioral modification components. In both studies, the comparison condition consisted of the same intervention delivered by trained PE teachers. The intervention arm of Study 3 included physical activity and behavioral modification (no nutrition) delivered by trained research staff, and was compared to PE class as usual. Body dissatisfaction and purging/restriction behaviors were measured at baseline and six months using the Modified Kids Eating Disorder Survey, a validated tool for this population. Controlling for age, gender, and baseline BMIz, three separate ANCOVA models were developed to examine differences in body dissatisfaction and purging/restriction between groups over time. Models were stratified by weight status.

Results: Across studies, participants’ mean age ranged from 11.9-12.9 years, 52-58% of participants were female, and 46-57% had overweight/obesity at baseline. There were no significant differences in body dissatisfaction over time between conditions in any of the three studies. There were also no differences in purging/restriction behaviors among participants with overweight/obesity (Study 1: F(1, 157)=0.93, p=0.34; Study 2: F(1, 152)=3.34, p=0.07; Study 3: F(1, 106)=1.59, p=0.21) or among participants with healthy weight status in Study 1 (F(1, 168)=0.003, p=0.96) or Study 2 (F(1, 140)=1.41, p=0.24). However, among individuals with healthy weight status in Study 3, intervention arm participants had significantly worsened purging/restriction relative to comparison condition participants (F(1, 124)=4.04, p=0.047).

Conclusions: School-based obesity programs should consider potential adverse consequences, particularly among students with healthy weight. Comparison of interventions across these studies can help identify intervention aspects that may be protective against disordered eating behaviors among Hispanic adolescents while improving weight status.

Purpose: The Mediterranean dietary (MedDiet) pattern has been shown to lower systemic inflammation and risk of metabolic syndrome. Responders to the 9/11 World Trade Center (WTC) disaster suffer from high levels of post-traumatic stress disorder (PTSD) and other chronic conditions such as obesity, increased systemic inflammation, and cardiovascular disease; however, despite this increased risk no nutrition intervention studies have been conducted among WTC responders.

Methods: We conducted a pilot randomized controlled trial, among WTC responders (age 45-65 years) with PTSD who were overweight or obese. Participants (N=62; males: 87%) were randomly assigned to intervention (MedDiet n=31) or control (usual nutrition counseling n=31) conditions. The 10-week MedDiet intervention included weekly online nutrition education sessions through the Web and smart phones, motivational text messages, goal setting/teach-back questions, and online cooking lessons, while both groups received three in-person counseling sessions. Baseline, post-intervention (n=93% retention), and 3-month follow-up (73% retention) data (blood collection, anthropometrics, electronic surveys, MedDiet survey, and PTSD checklist score were collected. For continuous outcomes, between-group comparisons were conducted using nonparametric Wilcoxon rank sum tests, and pre-post within-group comparisons were conducted using Wilcoxon signed rank tests.

Results: Both groups experienced a significant increase in median MedDiet score (p<0.0001) and decrease in oxidized LDL at post- and 3-month follow-up (FU). Compared to the control group, the intervention group had significant improvements in waist circumference at post- and 3-month up FU (p<0.0001), a decrease in Hemoglobin A1c (HA1c) at post- (p_grpdiff=0.019) and 3-month FU (p_grpdiff=0.039) and a significant decrease in omega-6/omega-3 ratio at post-intervention (p_grpdiff =0.029). There was a clinically significant decrease in the PCL score for both groups at post- and FU measurements(p=<0.0001).

Conclusion: The WTC-HP Nutrition study involved a high-dose remote communication/education coupled with personal counseling targeting nutrition-related personal, behavioral, and home environmental factors. The goal was to improve weight status, systemic inflammation, and symptoms of PTSD. Both groups experienced some positive outcomes, however the MedDiet group experienced the best overall outcomes including improved mental health. The results of this trial may inform the design of future larger scale interventions.

Funding Source: CDC/NIOSH U01OH012057 (PI: Arcan)

www.clinicaltrials.gov:  NCT05138198

Purpose:  Long distance heavy goods vehicle (HGV) drivers’ working environment provides limited opportunities for a healthy lifestyle with unhealthy lifestyle behaviours prevalent in this occupational group. Consequently, HGV drivers exhibit higher than nationally representative rates of obesity, and obesity-related co-morbidities, and are underserved in terms of health promotion initiatives. The purpose of this study was to evaluate the effectiveness of the multicomponent ‘Structured Health Intervention For Truckers’ (SHIFT), compared to usual care, at 6-months follow-up.

Methods: We conducted a two-arm cluster RCT in transport sites throughout the Midlands, UK. The 6-month SHIFT programme included a group-based interactive 6-hour education and behaviour change session, health coach support and equipment provision (Fitbit^® and resistance bands/balls to facilitate a ‘cab workout’). Clusters were randomised following baseline measurements to either the SHIFT or usual practice control arm. The primary outcome was device-assessed physical activity, expressed as mean number of steps/days, at 6-months. Secondary outcomes included: device-assessed sitting, physical activity intensity and sleep; cardiometabolic health, diet, mental wellbeing and work-related psychosocial variables. Data were analysed using mixed-effect linear regression models using a complete-case population.

Results: 382 HGV drivers (mean±SD age: 48.4±9.4 years, BMI: 30.4±5.1 kg/m², 99% male) were recruited across 25 clusters (depots), and randomised (at the cluster level) into either the SHIFT (12 clusters, n=183) or control (13 clusters, n=199) arms. At 6-months, 209 (55%) participants provided primary outcome data. Significant differences in mean daily steps were found between groups, in favour of the SHIFT arm (adjusted mean difference: 1008 steps/day, 95% CI: 145-1871, p=0.022). Favourable differences were also seen in the SHIFT group, relative to the control group, in time spent sitting (-24 mins/day, 95% CI: -43 - -6), and moderate-to-vigorous PA (6 mins/day, 95% CI: 0.3-11). Differences were largely driven by behavioural changes on non-workdays. No differences were observed between groups in the other secondary outcomes.

Conclusions: The SHIFT programme led to a clinically meaningful difference in daily steps, between trial arms, at 6-months. The programme offers potential to be incorporated into driver training courses to promote activity in this at-risk, underserved, and hard-to-reach essential occupational group.

Trial registration: ISRCTN10483894.