Objectives: To examine whether changes in cardiovascular disease (CVD) risk factors differ by baseline weight status among young adults who maintained or gained weight. Design: Longitudinal cohort study. Subjects: White and African Americans who either maintained (±5 pounds; n=488) or gained (>5 pounds; n=2788) weight over 15 years. Measurements: Anthropometrics and CVD risk factors were measured at baseline (1985–1986) and follow-up. Participants were classified as normal weight (body mass index (BMI) 18.5–24.9 kg/m²) or overweight (BMI ⩾25 kg/m²) at baseline. Multivariable models were stratified by ethnicity and weight change category. Results: Normal weight maintainers tended to have more favorable risk factors at baseline and follow-up than overweight maintainers. Size and direction of 15-year changes in risk factors were similar by weight status, except that in white normal weight maintainers changes in high-density lipoprotein (HDL)-cholesterol (3.3 mg/dl (95% confidence interval (CI): 0.4, 6.3)) and triglycerides (−14.7 mg/dl (−25.8, −3.7)) were more favorable. Weight gain was associated with unfavorable changes in risk factors. Weight gainers normal weight at baseline had less adverse changes in glucose, blood pressure, HDL-cholesterol (whites only) and triglycerides (African Americans only) than overweight gainers. However, normal weight African-American weight gainers had more adverse changes in total (3.1 mg/dl (0.2, 6.1)) and low-density lipoprotein-cholesterol (3.4 mg/dl (0.6, 6.3)). Conclusions: Baseline weight status does not appear to influence the size or direction of risk factor changes among adults who maintained their weight over 15 years. In contrast, weight gain was associated with changes in some risk factors differentially by baseline weight status.

By Kimberly P. Truesdale, June Stevens. ...

The recruitment of participants into community-based randomized controlled trials studying childhood obesity is often challenging, especially from low-income racial/ethnical minorities and when long-term participant commitments are required. This paper describes strategies used to recruit and enroll predominately low-income racial/ethnic minority parents and children into the Childhood Obesity Prevention and Treatment Research (COPTR) consortium. The COPTR consortium has run four independent 3-year, multi-level (individual, family, school, clinic, and community) community-based randomized controlled trials. Two were prevention trials in preschool children and the other two were treatment trials in pre-adolescents and adolescent youth. All trials reported monthly participant recruitment numbers using a standardized method over the projected 18–24 months of recruitment. After randomization of participants was completed, recruitment staff and investigators from each trial retrospectively completed a survey of recruitment strategies and their perceived top three recruitment strategies and barriers. Recruitment was completed in 15–21 months across trials, enrolling a total of 1745 parent-child dyads- out of 6314 screened. The number of children screened per randomized child was 4.6 and 3.5 in the two prevention trials, and 3.1 and 2.5 in the two treatment trials. Recruitment strategies reported included: (1) careful planning, (2) working with trusting community partners, (3) hiring recruitment staff who were culturally sensitive, personality appropriate, and willing to work flexible hours, (4) contacting potential participants actively and repeatedly, (5) recruiting at times and locations convenient for participants, (6) providing incentives to participants to complete baseline measures, (7) using a tracking database, (8) evaluating whether participants understand the activities and expectations of the study, and (9) assessing participants’ motivation for participating. Working with community partners, hiring culturally sensitive staff, and contacting potential participants repeatedly were cited by two trials among their top three strategies. The requirement of a 3-year commitment to the trial was cited by two trials to be among the top three recruitment barriers. Comprehensive strategies that include community partnership support, culturally sensitive recruitment staff, and repeated contacts with potential participants can result in successful recruitment of low-income racial/ethnic minority families into obesity prevention and treatment trials. NET-Works trial: ClinicalTrials.gov, NCT01606891 . Registered on 28 May 2012. GROW trial: ClinicalTrials.gov, NCT01316653 . Registered on 16 March 2011. GOALS trial: ClinicalTrials.gov, NCT01642836 . Registered on 17 July 2012. IMPACT trial: ClinicalTrials.gov, NCT01514279 . Registered on 23 January 2012.

We examined the short-term impact of the North Carolina Healthy Food Small Retailer Program (HFSRP), a legislatively appropriated bill providing funding up to $25,000 to small food retailers for equipment to stock and promote healthier foods, on store-level availability and purchase of healthy foods and beverages, as well as customer dietary patterns, one year post-policy implementation. We evaluated healthy food availability using a validated audit tool, purchases using customer bag-checks, and diet using self-reported questionnaires and skin carotenoid levels, assessed via Veggie Meter™, a non-invasive tool to objectively measure fruit and vegetable consumption. Difference-in-difference analyses were used to examine changes in HFSRP stores versus control stores after 1 year. There were statistically significant improvements in healthy food supply scores (availability), with the Healthy Food Supply HFS score being −0.44 points lower in control stores and 3.13 points higher in HFSRP stores pre/post HFSRP (p = 0.04). However, there were no statistically significant changes in purchases or self-reported consumption or skin carotenoids among customers in HFSRP versus control stores. Additional time or other supports for retailers (e.g., marketing and promotional materials) may be needed for HFSRP implementation to influence purchase and consumption.

In 2016, the North Carolina (NC) Legislature allocated $250,000 to the NC Department of Agriculture, to identify and equip small food retailers to stock healthier foods and beverages in eastern NC food deserts (the NC Healthy Food Small Retailer Program, HFSRP). The purpose of this study was to examine associations between food store environments, shopping patterns, customer purchases, and dietary consumption among corner store customers. We surveyed 479 customers in 16 corner stores regarding demographics, food purchased, shopping patterns, and self-reported fruit, vegetable, and soda consumption. We objectively assessed fruit and vegetable consumption using a non-invasive reflection spectroscopy device to measure skin carotenoids. We examined associations between variables of interest, using Pearson’s correlation coefficients and adjusted linear regression analyses. A majority (66%) of participants were African American, with a mean age of 43 years, and a mean body mass index (BMI) of 30.0 kg/m². There were no significant associations between the healthfulness of food store offerings, customer purchases, or dietary consumption. Participants who said they had purchased fruits and vegetables at the store previously reported higher produce intake (5.70 (4.29) vs. 4.60 (3.28) servings per day, p = 0.021) versus those who had not previously purchased fresh produce. The NC Legislature has allocated another $250,000 to the HFSRP for the 2018 fiscal year. Thus, evaluation results will be important to inform future healthy corner store policies and initiatives.

Few studies have examined the impact of weight history. Extant data from the Atherosclerosis Risk in Communities Study were used to compare risk factors for normal-weight (body mass index: 18.5–24.9 kg/m²) adults with a history of weight loss (n = 775) with those for persons with a history of weight maintenance (n = 5,164). In this 1987–1998 US study, the authors also compared risk factors for preobese (body mass index: 25.0–29.9 kg/m²) adults with a history of weight gain (n = 1,296) versus weight maintenance (n = 6,721). They used mixed-models regression to adjust for ethnicity, gender, age, education, field center, smoking, alcohol consumption, follow-up time, and follow-up body mass index. Compared with adults with a history of weight maintenance, adults with a 3-year history of weight loss had more favorable total and low density lipoprotein cholesterol levels and similar glucose, high density lipoprotein cholesterol, and triglyceride levels. In contrast, preobese adults with a 3-year history of weight gain had equivalent glucose and lipid levels at follow-up compared with adults with a history of weight maintenance. These findings suggest that, in addition to current weight, weight history may impact glucose and lipid levels.