- Email: [email protected]
Overweight and Eating Disorders among Patients with Psycho-Active Substance Dependence
MONDAY, OCTOBER 8
Poster Session: Food/Nutrition Science; Education; Management; Food Services/Culinary; Research An Examination of the Development, Components and Evaluation of HospitalBased Pediatric Overweight and Obesity Treatment Programs
Reliability, Validity, Sensitivity and Usefulness Testing of Dietetic Specific Monitoring and Evaluation Indicators and Measurement Scales
Author(s): C. Natarian, J. Christaldi; Nutrition and Dietetics, Marywood Univ., Scranton, PA
Author(s): M. Manogue,1 D. Thompson,2 P. Landers1; 1Nutritional Sciences, The Univ. of Oklahoma Hlth. Sci. Ctr., Oklahoma City, OK, 2Biostatistics and Epidemiology, The Univ. of Oklahoma Hlth. Sci. Ctr., Oklahoma City, OK
Learning Outcome: Discuss components of current hospital pediatric overweight/obesity treatment programs and examine how their effectiveness is being monitored. Approximately 17% of United States (US) children and adolescents are obese. Hospital treatment programs help combat this epidemic; however, there appears to be no systematic way of creating the programs and there is a lack of standardized program evaluation. For this study, a brief questionnaire was developed and sent to hospitals from the US News Best Children’s Hospitals 2011-2012 (N⫽25), to examine the characteristics of pediatric obesity treatment programs, particularly querying components, barriers and outcomes. The results indicated 77.8% of hospitals created their own programs with 35.3% testing and approving the program before implementation and 83.3% including a registered dietitian as a director or part of the team. Common program elements included nutrition education, physical activity and behavior modification; however, self-efficacy and social support were poorly represented components (36.8 and 42.1%, respectively). The only universal expectation was physical activity; a small percentage did not include improved nutrition-related knowledge as an expectation (11.1%). Program outcomes included weight loss and improved nutrition-related knowledge in 82.4% of programs. Though some commonalities existed between programs, there were also many discrepancies between the programs. Furthermore, certain components, expectations, goals and outcomes most recommended by current research, were poorly represented. Since programs varied in which essential elements were lacking, there appears to be a need for a more standardized reference for professionals to follow when creating and improving their programs. Registered dietitians need to be at the forefront in helping develop and implement pediatric obesity treatment guidelines that encompass the most current research available. Funding Disclosure: None.
Measuring Eating Competence: Congruence between Two Satter Inventories Supports Supplanting the Original Version with the Low-Income Adaptation Author(s): B. A. Lohse, K. N. Arnold; Nutritional Sciences, The Pennsylvania State Univ., University Park, PA Learning Outcome: Participants will describe considerations for choosing a specific inventory to measure eating competence. Background: Eating competence (EC), a bio-psychosocial cluster of eating/food attitudes and behaviors, is measured with either ecSI or ecSI/LI inventories validated for general or low-income adults, respectively. Twelve items are identical for both versions; 4 are unique to each inventory. Two versions complicate assessment of EC across studies; therefore congruence between them in middle class adults was examined. Methods: Participants (n⫽132) were parents from 7 private preschools, mostly white, non-Hispanic (89%) with college degrees (85%). Mean age was 35.8 ⫾ 5.3 years. Only responses from the 99 who indicated never or rarely worrying about money for food and/or no current/past history of food assistance were used. Results: Linear regression revealed ecSI score (mean 32.69⫾6.70) predicted 99.8% of the ecSI/LI score (mean 32.93⫾6.95). Absolute differences between ecSI and ecSI/LI scores ranged from 0 (28%) to 5 (1%). Scores differed by 1 point for 44%. Only 2 were classified as EC (i.e., total score ⱖ 32) by one inventory and not the other. Borderline scores were not vulnerable because EC for 6 of the 7 with ecSI/LI scores from 31 to 33 was congruently classified. Examination of each of the 4 unique items affirmed all as equally discrepant. Correlations between versions for total score (r⫽.98) and the 4 survey items (range r⫽0.32 to 0.71) were significant at P ⱕ 0.001). ecSI/LI was confirmed as more sensitive than ecSI for those with a low-income marker. Conclusion: ecSI/LI can supplant ecSI use in a general population. Renaming the ecSI/LI to ecSI 2.0 is suggested.
Learning Outcome: Practitioners will apply standardized language appropriately into practice. Background: The next step in advancing the field of dietetics and ensuring its place in healthcare is to validate the standardized language and create valid and reliable scales to be used in electronic health records (EHRs). These scales must reflect the standardized language accurately so practitioners can continue to provide high-quality care in an electronic format. Methods: Intraclass Correlation Coefficients (ICCs) were used to test proposed scales for evaluation of progress, deviation, and intake as related to assessment and monitoring/ evaluation terms. Subjects were recruited from dietetic practice groups, using an email message sent to the listserv administrators. Case studies were written according to the Nutrition Care Process utilizing standardized language. At the baseline visit, data were presented by domain areas including food/nutrition-related history, anthropometric measures, biochemical data/medical tests and procedures and nutrition-focused physical findings. There were two follow-up visits with additional data for the domain areas. Participants were also allowed to make comments after each question. Results: ICCs ranged from 0.22 for LDL cholesterol to 0.74 for weight loss. Qualitative results indicated two primary themes: 1) the need for established reference standards to be included when determining progress/regression on scales; and 2) the reasons why participants preferred either the three-or five-point scale for evaluating specific terms. Conclusion: Additional research related to reliability and validity of progress and regression scales is needed to determine which scales are appropriate for use with the standardized language. Reference standards may need to be provided in the International Dietetics and Nutritional Terminology Manual. Funding Disclosure: Grant-The Academy of Nutrition and Dietetics Nutrition Care ProcessStandardized Language Committee.
Overweight and Eating Disorders among Patients with Psycho-Active Substance Dependence Author(s): M. Kruseman,1 A. Berchtold,2 C. Chuard,1 B. Broers,3 Y. Khazaal,4 R. Manghi,4 J. Gaspoz3; 1Nutrition and Dietetics department, Univ. of Applied Sci. Western Switzerland, Geneva - Carouge, Switzerland, 2Institute of Social sciences, Univ. of Lausanne, Lausanne, Switzerland, 3Department of community medicine, primary care and emergency medicine, Univ. Hosp. of Geneva, Geneva, Switzerland, 4Division of addictology, Department of mental health and psychiatry, Univ. Hosp. of Geneva, Geneva, Switzerland Learning Outcome: Participants will understand the association between eating behaviors and substance abuse in a context of a detoxification program. Overweight patients and substance abusers share craving, obsessive thinking, loss of control and relief following substance/food use. Similar neurobiological substrates are involved in the reward response after consumption of food or psycho-active substances. Our goal was to characterise eating patterns among patients with substance dependence according to corpulence, and to determine if overweight or eating disorders were associated with relapse. In a University Hospital setting, 123 consecutive patients (51 BMI⬎25) who entered a detoxification program were followed up to 3 months or relapse. All measurements (weight, height, validated questionnaires on eating behaviors) were performed by one trained dietitian between July 2009 and January 2011. Multiple correspondance analysis was performed for patients with complete data at baseline (n⫽117) and 1 month (n⫽83). At baseline, detoxification from drugs was related with obesity, nibbling, night eating syndrome (NES) and younger age. Detoxification from alcohol was related with older age and the absence of eating disorders. Cognitive restraint and eating restriction, strongly related at baseline, were also associated with binge eating disorder (BED) after one month, whereas nibbling and NES were no longer associated with obesity. Overweight patients were not more likely to relapse. There was no association between eating disorders and relapse, but prevalence of problematic eating patterns decreased among abstinent patients. Overweight and disordered eating are common among patients with substance abuse. Fear of weight gain and BED should be addressed during detoxification as they became strongly related after one month. Funding Disclosure: Swiss National Science Foundation, grant n⬚ 13DPD6-121818.
Funding Disclosure: SNAP-Ed FNS/USDA and Ellyn Satter Foundation, Inc.
September 2012 Suppl 3—Abstracts Volume 112 Number 9
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
A-63
Poster Session: Food/Nutrition Science; Education; Management; Food Services/Culinary; Research An Examination of the Development, Components and Evaluation of HospitalBased Pediatric Overweight and Obesity Treatment Programs
Reliability, Validity, Sensitivity and Usefulness Testing of Dietetic Specific Monitoring and Evaluation Indicators and Measurement Scales
Author(s): C. Natarian, J. Christaldi; Nutrition and Dietetics, Marywood Univ., Scranton, PA
Author(s): M. Manogue,1 D. Thompson,2 P. Landers1; 1Nutritional Sciences, The Univ. of Oklahoma Hlth. Sci. Ctr., Oklahoma City, OK, 2Biostatistics and Epidemiology, The Univ. of Oklahoma Hlth. Sci. Ctr., Oklahoma City, OK
Learning Outcome: Discuss components of current hospital pediatric overweight/obesity treatment programs and examine how their effectiveness is being monitored. Approximately 17% of United States (US) children and adolescents are obese. Hospital treatment programs help combat this epidemic; however, there appears to be no systematic way of creating the programs and there is a lack of standardized program evaluation. For this study, a brief questionnaire was developed and sent to hospitals from the US News Best Children’s Hospitals 2011-2012 (N⫽25), to examine the characteristics of pediatric obesity treatment programs, particularly querying components, barriers and outcomes. The results indicated 77.8% of hospitals created their own programs with 35.3% testing and approving the program before implementation and 83.3% including a registered dietitian as a director or part of the team. Common program elements included nutrition education, physical activity and behavior modification; however, self-efficacy and social support were poorly represented components (36.8 and 42.1%, respectively). The only universal expectation was physical activity; a small percentage did not include improved nutrition-related knowledge as an expectation (11.1%). Program outcomes included weight loss and improved nutrition-related knowledge in 82.4% of programs. Though some commonalities existed between programs, there were also many discrepancies between the programs. Furthermore, certain components, expectations, goals and outcomes most recommended by current research, were poorly represented. Since programs varied in which essential elements were lacking, there appears to be a need for a more standardized reference for professionals to follow when creating and improving their programs. Registered dietitians need to be at the forefront in helping develop and implement pediatric obesity treatment guidelines that encompass the most current research available. Funding Disclosure: None.
Measuring Eating Competence: Congruence between Two Satter Inventories Supports Supplanting the Original Version with the Low-Income Adaptation Author(s): B. A. Lohse, K. N. Arnold; Nutritional Sciences, The Pennsylvania State Univ., University Park, PA Learning Outcome: Participants will describe considerations for choosing a specific inventory to measure eating competence. Background: Eating competence (EC), a bio-psychosocial cluster of eating/food attitudes and behaviors, is measured with either ecSI or ecSI/LI inventories validated for general or low-income adults, respectively. Twelve items are identical for both versions; 4 are unique to each inventory. Two versions complicate assessment of EC across studies; therefore congruence between them in middle class adults was examined. Methods: Participants (n⫽132) were parents from 7 private preschools, mostly white, non-Hispanic (89%) with college degrees (85%). Mean age was 35.8 ⫾ 5.3 years. Only responses from the 99 who indicated never or rarely worrying about money for food and/or no current/past history of food assistance were used. Results: Linear regression revealed ecSI score (mean 32.69⫾6.70) predicted 99.8% of the ecSI/LI score (mean 32.93⫾6.95). Absolute differences between ecSI and ecSI/LI scores ranged from 0 (28%) to 5 (1%). Scores differed by 1 point for 44%. Only 2 were classified as EC (i.e., total score ⱖ 32) by one inventory and not the other. Borderline scores were not vulnerable because EC for 6 of the 7 with ecSI/LI scores from 31 to 33 was congruently classified. Examination of each of the 4 unique items affirmed all as equally discrepant. Correlations between versions for total score (r⫽.98) and the 4 survey items (range r⫽0.32 to 0.71) were significant at P ⱕ 0.001). ecSI/LI was confirmed as more sensitive than ecSI for those with a low-income marker. Conclusion: ecSI/LI can supplant ecSI use in a general population. Renaming the ecSI/LI to ecSI 2.0 is suggested.
Learning Outcome: Practitioners will apply standardized language appropriately into practice. Background: The next step in advancing the field of dietetics and ensuring its place in healthcare is to validate the standardized language and create valid and reliable scales to be used in electronic health records (EHRs). These scales must reflect the standardized language accurately so practitioners can continue to provide high-quality care in an electronic format. Methods: Intraclass Correlation Coefficients (ICCs) were used to test proposed scales for evaluation of progress, deviation, and intake as related to assessment and monitoring/ evaluation terms. Subjects were recruited from dietetic practice groups, using an email message sent to the listserv administrators. Case studies were written according to the Nutrition Care Process utilizing standardized language. At the baseline visit, data were presented by domain areas including food/nutrition-related history, anthropometric measures, biochemical data/medical tests and procedures and nutrition-focused physical findings. There were two follow-up visits with additional data for the domain areas. Participants were also allowed to make comments after each question. Results: ICCs ranged from 0.22 for LDL cholesterol to 0.74 for weight loss. Qualitative results indicated two primary themes: 1) the need for established reference standards to be included when determining progress/regression on scales; and 2) the reasons why participants preferred either the three-or five-point scale for evaluating specific terms. Conclusion: Additional research related to reliability and validity of progress and regression scales is needed to determine which scales are appropriate for use with the standardized language. Reference standards may need to be provided in the International Dietetics and Nutritional Terminology Manual. Funding Disclosure: Grant-The Academy of Nutrition and Dietetics Nutrition Care ProcessStandardized Language Committee.
Overweight and Eating Disorders among Patients with Psycho-Active Substance Dependence Author(s): M. Kruseman,1 A. Berchtold,2 C. Chuard,1 B. Broers,3 Y. Khazaal,4 R. Manghi,4 J. Gaspoz3; 1Nutrition and Dietetics department, Univ. of Applied Sci. Western Switzerland, Geneva - Carouge, Switzerland, 2Institute of Social sciences, Univ. of Lausanne, Lausanne, Switzerland, 3Department of community medicine, primary care and emergency medicine, Univ. Hosp. of Geneva, Geneva, Switzerland, 4Division of addictology, Department of mental health and psychiatry, Univ. Hosp. of Geneva, Geneva, Switzerland Learning Outcome: Participants will understand the association between eating behaviors and substance abuse in a context of a detoxification program. Overweight patients and substance abusers share craving, obsessive thinking, loss of control and relief following substance/food use. Similar neurobiological substrates are involved in the reward response after consumption of food or psycho-active substances. Our goal was to characterise eating patterns among patients with substance dependence according to corpulence, and to determine if overweight or eating disorders were associated with relapse. In a University Hospital setting, 123 consecutive patients (51 BMI⬎25) who entered a detoxification program were followed up to 3 months or relapse. All measurements (weight, height, validated questionnaires on eating behaviors) were performed by one trained dietitian between July 2009 and January 2011. Multiple correspondance analysis was performed for patients with complete data at baseline (n⫽117) and 1 month (n⫽83). At baseline, detoxification from drugs was related with obesity, nibbling, night eating syndrome (NES) and younger age. Detoxification from alcohol was related with older age and the absence of eating disorders. Cognitive restraint and eating restriction, strongly related at baseline, were also associated with binge eating disorder (BED) after one month, whereas nibbling and NES were no longer associated with obesity. Overweight patients were not more likely to relapse. There was no association between eating disorders and relapse, but prevalence of problematic eating patterns decreased among abstinent patients. Overweight and disordered eating are common among patients with substance abuse. Fear of weight gain and BED should be addressed during detoxification as they became strongly related after one month. Funding Disclosure: Swiss National Science Foundation, grant n⬚ 13DPD6-121818.
Funding Disclosure: SNAP-Ed FNS/USDA and Ellyn Satter Foundation, Inc.
September 2012 Suppl 3—Abstracts Volume 112 Number 9
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
A-63