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MINNESOTA ACADEMY OF NUTRITION & DIETETICS 2019 ANNUAL MEETING APRIL 24 – 26, 2019

Project EAT: What has been learned from 20 years of research on what helps diverse young Minnesotans to eat healthy and feel good about their bodies? Nicole Larson, PhD, MPH, RDN, LD School of Public Health, University of Minnesota. MINNESOTA ACADEMY OF NUTRITION & DIETETICS 2019 ANNUAL MEETING

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MINNESOTA ACADEMY OF NUTRITION & DIETETICS 2019 ANNUAL MEETING APRIL 24 – 26, 2019

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  1. Project EAT: What has been learned from 20 years of research on what helps diverse young Minnesotans to eat healthy and feel good about their bodies?Nicole Larson, PhD, MPH, RDN, LDSchool of Public Health, University of Minnesota MINNESOTA ACADEMY OF NUTRITION & DIETETICS 2019 ANNUAL MEETING APRIL 24 – 26, 2019

  2. Funding acknowledgment • Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and Services Administration, Department of Health and Human Services • Grant R40 MC 00125 • Grant R40 MC 00319 • National Heart, Lung, and Blood Institute, National Institutes of Health • Grant R01HL084064 • Grant R01HL093247 • Grant R01HL116892 • Grant R01HL127077 • Grant R35HL139853

  3. Research programteam • Dianne Neumark-Sztainer (PI) • Marla Eisenberg • Jerica Berge • Susan Mason • Daheia Barr-Anderson • Melanie Wall • Katie Loth • Laura Klein

  4. Objectives • Describe what is known regarding disparities in eating and weight-related problems among Minnesota youth and shifts over time during the transition from adolescence to adulthood. • Synthesize recent evidence addressing what supports for healthy eating and weight-related health are of importance to address in counseling the families of adolescents and preparing young people for the transition to adulthood. • Discuss what additional evidence is still needed to better inform the design of messaging, programming, and policies designed to support young people in eating healthy.

  5. Overview • Project EAT: Research aims, study phases, and population samples • Disparities in eating and weight-related problems • Life course trajectories of eating and weight-related behaviors • Supports for healthy eating behaviors • Supports for maintaining a healthy weight and related attitudes • Identifying evidence gaps

  6. Project EAT Research Aims

  7. Conceptual framework guiding program of research: multilevel influences across the life course

  8. What is Project EAT? http://www.sphresearch.umn.edu/epi/project-eat/

  9. Mail & phone surveys with some parents Web & mail surveys with a significant other EAT I-IV Cohort Mail & web surveys with a child BaselineEAT surveys in 31 MN metro schools Focus groups to inform baseline survey EAT-IV follow-up web & mail surveys Project EAT timeline EAT-III follow-up web & mail surveys EAT-II follow-up mail surveys 2002 1996 2018 2000 2004 1998 2016 2012 2006 2008 2014 2010 EAT 2018 follow-up web & mail surveys EAT 2010 surveys in 20 MN metro schools Follow-up 2018 mail, phone, & web surveys with parents Mail & phone surveys with both parents School surveys & neighborhood GIS Neighborhood GIS EAT 2010-2018 Cohort

  10. Where were participants in Project EAT living in 2015-2016? n=1830; of these about 70% are located in the Twin Cities metropolitan area

  11. Project EAT population samples for analysis of secular trends EAT 2010 (2010) 20 schools N=2793 EAT-I (1999) 27 schools N=3072 Full EAT-I Sample 31 schools N=4746

  12. Disparities in weight-related problems: Trends among young people in MN

  13. How have the eating and weight-related behaviors of adolescents changed since the start of the 21st century?

  14. Prevalence of high BMI (>95th percentile) among MN youth: Secular trends % * * * * Neumark-Sztainer, Wall, Larson, Story, Fulkerson, Eisenberg, Hannan. Prev Med. 2012;54:77-81

  15. Prevalence of weight-related behaviors among MN youth: Secular trends * * * * % * Neumark-Sztainer, Wall, Larson, Story, Fulkerson, Eisenberg, Hannan. Prev Med. 2012;54:77-81

  16. Eating Breakfast >5 days/week: Secular trends * * * * * % Sex Ethnicity/race Larson, Story, Eisenberg, Neumark-Sztainer. J AcadNutr Diet. 2016;116:240-250

  17. Eating Breakfast >5 days/week: Secular trends * * * * % School level Socioeconomic status Larson, Story, Eisenberg, Neumark-Sztainer. J AcadNutr Diet. 2016;116:240-250

  18. Intake of energy-dense snack foods and sugary drinks: Secular trends • Decreased intake in overall sample • Snack foods: 1999=2.6 servings/day, 2010=2.2 servings/day • Sugary drinks: 1999=1.2 servings/day, 2010=0.8 servings/day • Similar trend observed in all sociodemographic groups • Intake was highest at both time points among subgroups • Ethnicity/race identified as Black, Native American, or mixed/other • Socioeconomic status categorized as low or low-middle Larson, Story, Eisenberg, Neumark-Sztainer. J AcadNutr Diet. 2016;116:240-250

  19. Fast-food restaurant use: Secular trends • Frequency decreased modestly among adolescents and maternal caregivers • Adolescents: 1999=25%, 2010=19% • Maternal caregivers: 1999=17%, 2010=11% • Fast food frequency remained highest (about 2 times/week) and did not decrease among Black or Native American young people. • Fast food intake did not decrease over time among the lowest socioeconomic status group and was most frequent among youth in this group in 2010 (1.8 times/week). • Frequent fast food purchases (3+ times/wk) for family meals did not decline overall; however, large decreases occurred among Hispanic families • Population sample: 1999=17%, 2010-11% • Hispanic families: 1999=18%, 2010=6% Larson, Hannan, Fulkerson, Laska, Eisenberg, Neumark-Sztainer. Am J Public Health. 2014;104:e62-e69.

  20. Frequent family meals (>5 days/week): Secular trends % of sample Sex Ethnicity/race Neumark-Sztainer, Wall, Fulkerson, Larson. J Adolesc Health. 2013;52:201-206.

  21. Frequent family meals (>5 days/week): Secular trends * % of sample School level Socioeconomic status Neumark-Sztainer, Wall, Fulkerson, Larson. J Adolesc Health. 2013;52:201-206.

  22. Weight-related health across the life course: Adolescence to young adulthood

  23. How do you expect physical activity and dietary patterns to change as young people enter adulthood?

  24. Trends in low, moderate-to-vigorous physical activity (%) from adolescence (Wave 1) to young adulthood (Wave 4) at 5-year intervals % P<.001 Neumark-Sztainer, Wall, Chen, Larson, Christoph, Sherwood. Am J Prev Med. 2018;55(2):133-141

  25. Trends in high fast food intake (%) from adolescence (Wave 1) to young adulthood (Wave 4) at 5-year intervals % Wave Neumark-Sztainer, Wall, Chen, Larson, Christoph, Sherwood. Am J Prev Med. 2018;55(2):133-141

  26. Fruit intake: Percentage of participants meeting MyPlate recommendations % of sample Christoph, Larson, Winkler, Wall, Neumark-Sztainer. Am J ClinNutr. In press.

  27. Vegetable intake: Percentage of participants meeting MyPlate recommendations % of sample Christoph, Larson, Winkler, Wall, Neumark-Sztainer. Am J ClinNutr. In press.

  28. Whole grain intake: Percentage of participants meeting MyPlate recommendations % of sample Christoph, Larson, Winkler, Wall, Neumark-Sztainer. Am J ClinNutr. In press.

  29. Dairy intake: Percentage of participants meeting MyPlate recommendations % of sample Christoph, Larson, Winkler, Wall, Neumark-Sztainer. Am J ClinNutr. In press.

  30. Dietary intake in adulthood (30+ years) by adolescent intake • Participants’ dietary intake tracked over the 15-y developmental transition • Females within each quartile of adolescent dietary intake had higher intakes as compared to males within the same quartile rank • Participants who started in the lowest quartiles as adolescents generally continued to have the lowest mean intake for each marker in adulthood Christoph, Larson, Winkler, Wall, Neumark-Sztainer. Am J ClinNutr. In press.

  31. Vegetable intake in adulthood (30+ years) by adolescent intake Average # of daily servings Christoph, Larson, Winkler, Wall, Neumark-Sztainer. Am J ClinNutr. In press.

  32. How do you expect weight control attitudes and behaviors to change as young people enter adulthood?

  33. Trends in high body dissatisfaction (%) from adolescence (Wave 1) to young adulthood (Wave 4) at 5-year intervals % P=.001 Neumark-Sztainer, Wall, Chen, Larson, Christoph, Sherwood. Am J Prev Med. 2018;55(2):133-141

  34. Trends in past-year dieting (%) from adolescence (Wave 1) to young adulthood (Wave 4) at 5-year intervals P<.001 % Haynos, Wall, Chen, Wang, Loth, Neumark-Sztainer. Int J Eat Disord. 2018;51:1090-1097.

  35. Trends in unhealthy weight control behaviors (%) from adolescence (Wave 1) to young adulthood (Wave 4) at 5-year intervals % Neumark-Sztainer, Wall, Chen, Larson, Christoph, Sherwood. Am J Prev Med. 2018;55(2):133-141

  36. Trends in extreme weight control behaviors (%) from adolescence (Wave 1) to young adulthood (Wave 4) at 5-year intervals % Haynos, Wall, Chen, Wang, Loth, Neumark-Sztainer. Int J Eat Disord. 2018;51:1090-1097.

  37. Trends in obesity prevalence (%) from adolescence (Wave 1) to young adulthood (Wave 4) at 5-year intervals % P<.001 Neumark-Sztainer, Wall, Chen, Larson, Christoph, Sherwood. Am J Prev Med. 2018;55(2):133-141

  38. Neumark-Sztainer, Wall, Chen, Larson, Christoph, Sherwood. Am J Prev Med. 2018;55(2):133-141

  39. Building the evidence: Recommendations for health care providers and families

  40. Recommendations for health care providers • Inform adolescents that dieting, and particularly unhealthy weight control behaviors, may be counterproductive. Instead, encourage behaviors that can be maintained on a regular basis. • Do not use body dissatisfaction as a motivator for change. Instead, help adolescents to care for their bodies so that they will want to nurture them through healthy eating, activity, and positive self-talk. • Encourage families to have regular, and enjoyable, family meals. • Encourage families to talk less about weight and do more to help adolescents achieve a weight that is healthy for them. • Assume overweight adolescents have experienced weight-related stigma and address with adolescents and their families. Neumark-Sztainer D. Journal of Adolescent Health. 2009;44:206-213 J. Adolesc. Health. 2009;44(3):206-213.

  41. Recommendations for families of adolescents • Model healthy behaviors for your child(ren) e.g., Avoid dieting, or at least unhealthy dieting behaviors • Provide an environment that makes it easy for your child(ren) to make healthy choices e.g., Make healthy food choices readily available • Focus less on weight, instead focus on behaviors and overall health e.g., Encourage your child(ren) to adopt healthy behaviors without focusing on weight loss • Provide a supportive environment with lots of talking and even more listening e.g., When your child talks about fat, find out what’s really going on Neumark-Sztainer. “I’m, Like, SO Fat!” Helping your teen make healthy choices about eating and exercise in a weight-obsessed world. New York; The Guilford Press, 2005

  42. What type(s) of nutrition advice do you most often provide to families and young people to prepare them for the transition to adulthood?

  43. Developments in understanding what is needed to support healthy eating behaviors

  44. Family, home, and neighborhood supports for healthy eating Adolescent eating behavior & dietary intake Home healthful food availability Parent healthy food modeling Parent encouragement of healthy eating Focus on healthy behavior vs weight Frequent family meals Child involvement in food preparation Warm parent-child communication High family functioning Adult eating behavior & parenting practices

  45. Home environment profiles: adolescent fruit & vegetable intake HIGH healthy home food availability LOW healthy home food availability Average # of daily servings Loth, MacLehose, Larson, Berge, Neumark-Sztainer. Appetite. 2016;96:80-86.

  46. Home environment profiles: adolescent intake of low nutrient, energy dense snack foods HIGH healthy home food availability LOW healthy home food availability * * Average # of daily servings Loth, MacLehose, Larson, Berge, Neumark-Sztainer. Appetite. 2016;96:80-86.

  47. Home environment profiles: adolescent intake of sugar-sweetened beverages HIGH healthy home food availability LOW healthy home food availability * Average # of daily servings * Loth, MacLehose, Larson, Berge, Neumark-Sztainer. Appetite. 2016;96:80-86.

  48. Family meals, parenting practices, & adolescent fruit & vegetable intake (mean servings/day) Watts, Loth, Berge, Larson, Neumark-Sztainer. J AcadNutr Diet. 2017;117:707-714.

  49. Healthful neighborhoods enhance the positive influence of supportive families on FV intake Family environment: (high family functioning, frequent family meals, parent encouraging healthful eating) Neighborhood environment: (low density of fast food, nearby supermarket) X Berge, Wall, Larson, Forsyth, Bauer, Neumark-Sztainer. Health and Place. 2014;26:69-77.

  50. How many times did you help make dinner for your family in the past week? • Who usually prepares food for your family? • Mothers: 88.3% • Fathers: 40.4% % Adolescent involvement Berge, MacLehose, Larson, Laska, Neumark-Sztainer. J Adolesc Health. 2016;59(5):530-536.

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