Weight-Related Psychological Inflexibility as a Mediator Between Weight Self-Stigma and Health-Related Outcomes

Weight self-stigma, the internalization of negative societal stereotypes, is a problem amongst populations with high weight. Weight self-stigma is associated with psychological inflexibility and maladaptive health-related behaviors. In this study, we explore how weight-related psychological inflexibility may influence weight self-stigma and health-related outcomes in 79 adults with high weight. Participants were primarily white (92.4%) and female (82.3%), with an average age of 39.56 and average body mass index of 33.78. The present study uses baseline, self-report data from a larger trial. Results indicate that weight self-stigma was negatively correlated with maladaptive eating behaviors, weight, and mental health. Weight-related psychological inflexibility was found as a significant mediator for the relationship between weight self-stigma and emotional eating, sedentary behavior, and mental health. Weight-related psychological inflexibility did not mediate the relationships between weight self-stigma and other eating measures and physical activity. These results support targeting weight-related psychological inflexibility and weight self-stigma in interventions

A Randomized Controlled Trial of Online Acceptance and Commitment Therapy to Improve Diet and Physical Activity Among Adults Who Are Overweight/Obese

Background: Acceptance and commitment therapy (ACT) has shown benefit for improving diet, physical activity, and weight among adults who are overweight and obese. However, research to date in this area has primarily evaluated ACT delivered through in-person interventions, which has more limited access relative to online formats. Purpose: The present study evaluated an online guided self-help program that integrated ACT with nutrition education to improve healthy eating and physical activity. Methods: A sample of 79 adults who were overweight/obese were randomized to receive the 8-week ACT on Health program plus weekly phone coaching or to a waitlist. Results: Participants completed 5.5 ACT sessions on average (out of 8) and reported moderately high program satisfaction. Participants in the ACT condition improved significantly more than the waitlist at posttreatment on the primary outcome of healthy eating index (HEI; based on 24-hour recall assessments) and almost all secondary outcomes assessing self-reported eating behaviors, weight, mental health, weight self-stigma, and psychological inflexibility. However, no intervention effects were found for self-reported physical activity. At 8-week follow-up, improvements were maintained for most outcomes in the ACT condition, but not for the HEI. Improvements in psychological inflexibility mediated treatment effects on some outcomes, but not HEI or weight. Conclusions: Overall, delivering ACT through online guided self-help combined with nutrition education appears promising for improving healthy eating, weight, and self-stigma, but results for physical activity and long-term behavior change are unclear, possibly due to limitations in the ACT on Health program

A Qualitative Evaluation of Double Up Food Bucks Farmers’ Market Incentive Program Access

Objective Explore factors affecting access to and use of Double Up Food Bucks (DUFB), a farmers’ market program that doubles Supplemental Nutrition Assistance Program benefits for use toward the purchase of fruits and vegetables (FV). Design Focus groups. Setting Metro and nonmetro counties in Utah and western Upstate New York. Participants Nine groups composed of 62 low-income adults (3–9/group). Phenomena of Interest Satisfaction with, barriers to, and facilitators of program use; suggestions for improvement. Analysis Transcribed verbatim and coded thematically in NVivo 11 software according to template analysis. Results Program satisfaction was high and driven by FV affordability, perceived support of local farmers, positive market experiences, and high-quality FV. Primary barriers to using DUFB were lack of program information and inconvenient accessibility. Insufficient program communication was a consistent problem that elicited numerous suggestions regarding expansion of program marketing. Emergent topics included issues related to the token-based administration of DUFB and debate regarding stigma experienced during DUFB participation. Conclusions and Implications Results suggest that although DUFB elicits many points of satisfaction among users, program reach may be limited owing to insufficient program marketing. Even among satisfied users, discussion of barriers was extensive, indicating that program reach and impact may be bolstered by efforts to improve program accessibility

The Provision of Assistance Does Not Substantially Impact the Accuracy of 24-Hour Dietary Recalls Completed Using the Automated Self-Administered 24-H Dietary Assessment Tool Among Women With Low Incomes

Background: Evidence is lacking informing the use of the Automated Self-Administered 24-h Dietary Assessment Tool (ASA24) with populations characterized by low income. Objective: This study was conducted among women with low incomes to evaluate the accuracy of ASA24 recalls completed independently and with assistance. Methods: Three hundred and two women, aged ≥18 y and with incomes below the Supplemental Nutrition Assistance Program thresholds, served themselves from a buffet; amounts taken as well as plate waste were unobtrusively weighed to enable calculation of true intake for 3 meals. The following day, women completed ASA24-2016 independently (n = 148) or with assistance from a trained paraprofessional in a small group (n = 154). Regression modeling examined differences by condition in agreement between true and reported foods; energy, nutrient, and food group intakes; and portion sizes. Results: Participants who completed ASA24 independently and those who received assistance reported matches for 71.9% and 73.5% (P = 0.56) of items truly consumed, respectively. Exclusions (consumed but not reported) were highest for lunch (at which participants consumed approximately 2 times the number of distinct foods and beverages compared with breakfast and dinner). Commonly excluded foods were additions to main dishes (e.g., tomatoes in salad). On average, excluded foods contributed 43.6 g (46.2 kcal) and 40.1 g (43.2 kcal) among those in the independent and assisted conditions, respectively. Gaps between true and reported intake were different between conditions for folate and iron. Within conditions, significant gaps were observed for protein, vitamin D, and meat (both conditions); vitamin A, iron, and magnesium (independent); and folate, calcium, and vegetables (assisted). For foods and beverages for which matches were reported, no difference in the gap between true and reported portion sizes was observed by condition (P = 0.22). Conclusions: ASA24 performed relatively well among women with low incomes; however, accuracy was somewhat lower than previously observed among adults with a range of incomes. The provision of assistance did not significantly impact accuracy

Pilot Test of an Online ASA24 Training With EFNEP Educators

The purpose of this study was to evaluate the acceptability and usability of an online training to prepare Expanded Food and Nutrition Education Program (EFNEP) educators to collect 24-hr dietary recalls using the Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24). Fifty-eight educators in 17 states were recruited to take the training; 29 completed the online training, assisted two individuals in completing a 24-hr recall using ASA24, and completed a survey about their experiences. The sample included 26 respondents. The majority (n = 16; 61.5%) of the sample was EFNEP educators with college education. The majority of the respondents indicated that they found the readings and videos acceptable for learning (n = 21; 80.7%). Half of the participants (n = 13) felt prepared to collect data using ASA24. The majority (n = 22; 84.6%) had positive feedback about the training content. The training may be acceptable for preparing EFNEP educators with at least some college education to collect 24-hr recalls using ASA24. Because of potential bias due to self-selection and nonresponse, the training has been revised and is now intended to be used to train trainers of EFNEP paraprofessionals