Authors
E.D. Clarke, J. Stanford, M. Gómez Martín and C.E. Collins

Corresponding Author: Jordan Stanford, email: jordan.stanford@newcastle.edu.au; Phone: (02) 4055 0724
Presenting Author: L/Professor Clare Collins

Abstract
Purpose: The objectives of this review were twofold: (1) to synthesise evidence from interventions based on Health at Every Size (HAES)® principles concerning dietary, physical, and/or psychological health outcomes in people with overweight and obesity, and (2) to report between-group differences by comparing HAES® interventions with control interventions when assessing the impact of HAES® interventions on health and related outcomes.
Methods: Six databases were searched from their inception until November 2022 to find studies that met the following criteria: the studies were conducted on adults who are overweight or obese, used HAES®-based interventions compared to control interventions, and reported dietary, physical and/or psychological outcomes. We extracted data on between-group differences and assessed the risk of bias using ROB2. Outcomes with at least three studies reporting the same or comparable data were included in random-effects meta-analyses.
Results/findings: Out of 128 studies that were identified, 19 full-text articles were included in the analysis. These articles comprised 10 unique studies, of which 6 were published since 2017. All studies were conducted in females only. The results of the meta-analysis showed that there was a significant reduction in susceptibility to hunger in the HAES® intervention groups as compared to the control interventions (P=0.005). However, there was no significant difference (P>0.05) observed between the HAES® interventions and control groups for anthropometric, psychological or cardiometabolic outcomes such as total cholesterol, HDL cholesterol, triglycerides, systolic or diastolic blood pressure.
Conclusions: HAES® interventions had similar results to other control interventions relating to anthropometric and cardiometabolic outcomes. HAES® interventions had a significant benefit in reducing susceptibility to hunger. The decision to use a HAES®-based intervention should be personalised to meet individual needs and goals. Further research in more diverse populations is required using standardised outcome measures to facilitate future meta-analyses.

Purpose: Special Olympics (SO) is an international sport organization that reaches over 3 million athletes with intellectual disabilities (ID) worldwide. SO promotes health and fitness among people with ID through programming, education, and advocacy. The 2023 SO World Summer Games represented a unique opportunity to examine health among a global sample of athletes with ID. This study examined self-reported health behaviors and self-rated health among athletes with ID across seven regions: Africa, Asia Pacific, East Asia, Europe Eurasia, Latin America, Middle East/North Africa, and North America.

Methods: A lifestyle survey was developed to gather information on self-reported health behaviors directly from athletes competing at the World Games in Berlin, Germany. The survey included questions on physical activity (PA), sedentary behavior, nutrition, sleep, and self-rated health. Adults with ID and content experts reviewed the instrument and provided feedback on questions, response options, wording, and format. The survey was translated into seven languages and completed electronically on a tablet with support from a coach/caregiver if needed.

Results: A total of 443 athletes representing all seven global regions and 90 countries completed the survey. Half of respondents (50.1%) completed the survey in English. The proportion of athletes engaging in 30+ min/day of moderate PA on 5+ days/week ranged from 6.6% (East Asia) to 26.0% (North America); 8.0% (Asia Pacific) to 22.4% (Latin America) participated in 30+ min/day of vigorous PA 5+ days/week; 48.5% (East Asia) to 76.0% (Latin America) consumed 5+ fruits/day; 28.1% (East Asia) to 60.7% (Latin America) consumed 5+ vegetables/day; 5.1% (Africa) to 19.2% (North America) reported sitting for 8+ hours/day; and 73.5% (Middel East) to 90.9% (East Asia) slept for 7+ hours/night. Athletes reporting that their health was good-excellent ranged from 75.4% (Latin America) to 96% (Asia Pacific).

Conclusions: These findings represent a step toward understanding global differences in PA, nutrition, and health as reported directly by athletes with ID. With further refinement of the SO lifestyle survey, there is potential to gather information from large global samples of people with ID and determine priorities for targeted health promotion.

Purpose: To examine the association between sleep behaviors and moderate (MPA) / vigorous physical activity (VPA) and determine whether race/ethnicity moderates this association.

Methods: Demographics, physical activity, and sleep behaviors for a sample of 14,284 U.S. participants were collected via interviews/questionnaires as part of the National Health and Nutrition Examination Survey 2013-2020. Chi-square and t-test determined bivariate associations, while logistic regression models assessed age and gender-adjusted associations of sleep behaviors with VPA and MPA. Subgroup analyses examined whether race/ethnicity moderated the above associations.

Results: Participants were, on average, 47.4 years old (SD=18.9); 51.1% female, 33.5% White, 11.5% Hispanic, 24% Black, 23.3% engaged in VPA, and 41.4% in MPA. Sleep duration, snoring, and breath cessation were positively associated with VPA (p<0.0001), while the same sleep behaviors and trouble sleeping were also positively associated with MPA (p<0.0001). Those engaging in VPA had 20% higher odds of having trouble sleeping [OR=1.2; 95% CI: 1.10,1.32], 37% higher odds of snoring frequently [OR=1.37; 95% CI: 1.22,1.53], and a 31% higher odds of breath cessation while asleep [OR=1.31; 95% CI: 1.17,1.48] compared to non-VPA participants. Similarly, MPA participants had 33% higher odds of having trouble sleeping [OR=1.33; 95% CI: 1.23,1.43], 45.5% higher odds of snoring frequently [OR=1.45; 95% CI: 1.33,1.59], and a 34% higher odds of breath cessation while asleep [OR=1.34; 95% CI: 1.21,1.48]. Subgroup analyses indicated that Hispanics engaging in VPA and MPA had relatively higher odds of snoring ≥5 times/week compared to other races (p<0.05), while Blacks engaging in VPA and Whites engaging in MPA had higher odds of breath cessation ≥5 times/week compared to other races (p<0.05).

Conclusion: This study highlights the importance of physical activity rigor in predicting sleep behaviors across individuals of various ages and genders. Race may moderate the relationship between sleep behaviors and vigorous/moderate physical activity, necessitating further longitudinal investigation to understand its role in sleep health and care.

Background: The burden of cardiovascular disease (CVD) continues to increase in sub-Saharan Africa, as the global CVD death rate is projected to rise to an estimated 22.7 million in 2030. Understanding community- and individual-level perceptions of vulnerability to CVD risk factors can inform the development of acceptable and sustainable population-based CVD prevention interventions.
Methods: We utilized citizen science and a semi-structured questionnaire to explore what participants in low-income (rural/urban) settings in South Africa, Malawi, and Ethiopia considered as the main ‘high-risk factors’ for CVD, and ways to mitigate these factors. The study participants ranked the most popular risk factors among eight factors that they had indicated viz. nutrition (diet-related factors), substance use (tobacco, drug, simulants), litter (hygiene/sanitation), emotional factors (stress, loss of relative/job, sickness, anger, inadequate sleep), crime (crime, violence, abuse), physical inactivity (inadequate or lack of activity), poverty-related (poor housing, unemployment), and obesity (overweight, body image). Thematic analyses were undertaken using a systematic citizen science method. Results are presented using bubble graphs based on weighted proportions (ranking) of key risk factors indicated by participants.
Results: The main CVD risk factors of concern to participants were not the usual conventional risk factors. An overall weighted ranking of indicated ‘high risk factors’ for the three countries (combined) showed that substance use, nutrition, litter, and emotional factors were ranked highest, in that order. In individual countries, nutrition, substance use, and litter were ranked highest, with rankings differing by rural/urban settings. In each country, physical inactivity was ranked as low risk, while diet-related factors and litter were commonly ranked as high. Crime/violence was ranked as moderately high risk in South African townships. Suggested strategies to mitigate the risk factors included, addressing the litter challenge, access to junk/unhealthy food, alcohol and tobacco use, and crime.
Conclusion: Although regular physical activity has been demonstrated to be a key mutable risk factor for CVD, residents from these three African countries ranked it low compared to seven other risk factors. There is a critical need to align setting-specific interventions with community-related perceptions of risk factors for CVD to support equitable participation in physical activity for all.

Title: Development of a food literacy scale for Puerto Rico focusing on environmental sustainability and nutrition

Authors: Lisa Poirier (corresponding author, presenter), Cesar Ostolaza, Juliana Cienfuegos, Joel Gittelsohn, Uriyoan Colon-Ramos

Purpose: Food literacy (FL) is a person or group’s knowledge, skills, and attitudes regarding food. Previous research has shown that FL and its constructs are context specific. Due to the growing importance of climate change and its effect on the food system in Puerto Rico, this project set out to create a FL scale focusing on environmental sustainability and nutrition.

Methods: The research team adapted a FL survey developed in Korea that had high validity on environmental sustainability and nutrition constructs. Questions were excluded or added to the survey if they were not relevant or if there was a gap in relation to the cultural context of Puerto Rico (PR). Selected questions were presented to a panel of PR food system experts who rated each question regarding their opinion on the wording and relevance to PR context. A survey with a section including the final 14 food literacy questions was distributed to a convenience sample of 1,505 PR adult citizens. Exploratory factor analysis was used to determine the number of constructs, calculation of Cronbach’s alpha (α) was used for reliability testing and descriptive statistics were used to summarize scores.

Results: 993 participants completed the food literacy portion of the survey. Principal-component factor analysis identified three factors. These factors are Understanding of Food Labeling (UFL) with 5 questions (α =0.78), Nutrition Knowledge (NK) with 3 questions (α =0.66), and Environmental Sustainability (ES) with 6 questions (α = 0.82). A summative score was created for each concept and in total. A higher score indicates a higher level of agreement with the statements in each question. The average score for each section out of each total were: 18.23/25, 12.32/15, 20.96/30, and 51.50/70 for UFL, NK, ES, and the total score, respectively.

Conclusions: This FL survey with constructs on environmental sustainability and healthy diet practices could be considered reliable and valid in the Puerto Rican context. Future work may use this scale to help understand food related issues and concerns given the importance of the nexus climate change and nutrition.

Purpose: This study aimed to describe the factors that influenced the adoption of sustainable food system practices among farmers participating in the Gus Schumacher Nutrition Incentive Program (GusNIP). GusNIP is a federal initiative that funds nutrition incentive (NI) projects across the United States (U.S.) to provide financial incentives to increase fruit and vegetable (FV) intake among people with low-income. Several GusNIP projects rely on farmers to provide FV to participants.

Methods: Guided by the Sustainable Food Systems Framework and the Diffusion of Innovation theory (DoI), semi-structured in-depth interviews (n=15; target n=20-25) were conducted with farmers. Farmer recruitment was conducted by leveraging existing partnerships with GusNIP-funded projects across the U.S. (n=6). The characteristics of farmers sought included high potential for implementing sustainable practices such as adoption of regenerative farming and interest in economic and climate/environmental impacts. Codebook development and coding (inductive and deductive) involved an iterative, team-based approach and were refined as interviews were conducted. Applied thematic analysis was used to identify salient themes; data collection is still in process and will occur until saturation has been met.

Results/findings: Preliminary findings guided by DoI suggest that farmers participating in GusNIP projects are likely early innovators of sustainable farming, where decision making involves a balance of economic, environmental, and social impacts. Farmers appreciated any sales from NI projects but also noted barriers in participation and recommendations to improve existing NI models. For example, farmers experienced minor administrative issues such as problems with incentive redemption or policies around eligible food products. Nearly all farmers mentioned one major benefit of NI participation which was the ability to support populations with low-income that would not have been able to access locally grown food.

Conclusions: The intersection of nutrition, agriculture, and climate impact is emerging as an important area of study. This study highlights perspectives from small farmers which are crucial to help inform food systems research, both in the U.S. and globally. Current study findings offer GusNIP-specific recommendations to better support farmers and suggest ways that federal funding can bolster farmer resiliency to address environmental and related vulnerabilities.