Kristie Rupp

Purpose: In young women with obesity, we sought to explore their: (1) psychosocial health; (2) perceptions of their and engagement in current health behaviors; (2) motivation to change their health behaviors; and (3) desired characteristics of a health behavior intervention. Approach: Convergent-parallel mixed methods study. Setting: Focus groups were conducted over zoom. Participants: 34 young women with obesity (M ± SD; age = 23.79 ± 4.22 years; BMI = 35.66 ± 5.56 kg/m ² ; 41.2% non-Hispanic White). Method: Quantitative data were collected via Qualtrics prior to focus groups. We conducted 8 semi-structured focus groups (2-7 participants per group; 32-93 minutes) to address the pre-specified objectives. Results: Participants reported poor psychosocial health, with 100% meeting the cut-point indicative of significant depressive symptoms and 79.4% for clinically meaningful anxiety. Participants expressed the interconnectedness of their physical and mental health and desire to improve consistency in their eating and physical activity behaviors. However, participants did not want to emphasize weight loss as the primary focus of a health behavior intervention. Preferences for the characteristics of a health behavior intervention were in support of a hybrid format, with in-person meetings focusing on active engagement (e.g., cooking classes). Conclusions: Our findings support shifting the focus from a weight-normative to a weight inclusive approach to health behavior interventions to meet the needs and preferences of young women with obesity.

Purpose: To explore associations between adolescent’s concern for their body weight/shape/size and engagement in unhealthy weight control behaviors (UWCBs). Design: Secondary data analysis. Setting: 2022 National Survey of Children’s Health. Subjects: Analyses included 23 357 (51.8% male) adolescents, ages 10-17 years (mean 13.8 ± 2.3 years). Measures: Reported concern for body weight/shape/size, and UWCBs including skipping meals/ fasting; low interest in food; picky eating; binge eating, purging; diet pills; and over-exercising. Analysis: Logistic regression models assessed the odds of engaging in UWCBs by reported concern for body weight/shape/size. Results: Engagement in UCWBs was low with 21.1% reporting picky eating, 13.5% fasting, 11.7% low interest in food, 5.3% binge eating, and P ’s < 0.05) of engaging in all UCWB outcomes except for using diet pills or laxatives, which was only significant for adolescents who reported being very concerned (OR = 12.74; CI: [19.16, 36.94]). Further, after stratification by gender and age, there was a significant p-for trend ( P ’s < 0.05), in engagement in UWCBs by concern for body weight/shape/size except for using diet pills or laxatives in 10-11- and 12-14-year-olds. Conclusion: Expressing concern for body weight/image/size is associated with an increased likelihood of engaging in UCWB in adolescents, regardless of gender or stage of adolescence.

Purpose: To explore the relationships between weight status, weight perceptions, and perceptions of the body positivity movement on social media. Design: Cross-sectional. Setting: Online through the Qualtrics platform. Subjects: Participants (N = 521; mean 26.6 ± 5.1 years) were recruited using Qualtrics online panels. Measures: The study survey included questions about participant demographics, weight status, and weight perception. Subjects rated 6 study-specific viewpoint questions about the body positivity movement on a 5pt Likert scale. Analysis: Multinomial logistic regression models adjusted for relevant confounders assessed the associations between objective weight status, perceived weight status, and perceptions of the body positivity movement. Results: Objective weight status was not associated with perceptions of the body positivity movement. Perceptions of weight status were associated with perceptions of the body positivity movement in young women, with those that perceived themselves as overweight more likely (OR = 1.67, P < 0.05) to disagree with the statement that “the body positivity makes people less likely to lose weight.”. However, young women that perceived themselves as having a lower weight status were less likely (OR = 0.54, P < 0.05) to agree with the statement that “the body positivity movement empowered women” as well as “being inclusive of people of all sizes” (OR = 0.56, P < 0.05). Conclusion: Weight perception, rather than objective weight status, may be a stronger predictor of weight bias and views of the body positivity movement.

The COVID-19 pandemic led to unprecedented changes in people’s lifestyles across the United States, but the extent to which the pandemic affected health behaviors of children and adolescents (i.e., physical activity, screen-time, and sleep) is not well understood. These behaviors hold particular significance because of their association with health outcomes. Purpose: The purpose of this study was to examine whether engagement in health behaviors changed from pre-pandemic (2019) to during the pandemic (2020). Methods: The combined 2019-2020 National Survey of Children’s Health (NSCH) was used to inform this study. The NSCH is an annual survey designed to provide national estimates of key indicators of childhood health and well-being. Physical activity (number of days/week with >60 min of activity), screen-time (hours/day of TV viewing and computer use), and sleep (hours/day) were assessed by parental report. Adjusted binomial and multinomial logistic regression models were used to determine the association between survey year and health behaviors. Results: Children and adolescents were 36% more likely to be physically inactive in 2020 compared to 2019. Additionally, children and adolescents were 14% more likely to meet sleep guidelines and 39% less likely to meet screen-time guidelines in 2020 compared to 2019, independent of age, sex, race/ethnicity, and poverty level. Children (6-13 year) and adolescents (14-17 years) were 10% and 15% less likely to get below the recommended amount of sleep in 2020 compared to 2019, respectively. Conclusion: Prevalence of meeting sleep guidelines increased among children and adolescents in 2020 but decreased for physical activity and screen-time. Initiatives targeting activity and screen-time may be urgently needed. Whether rates of these health behaviors return to pre-pandemic levels over the next few years should be closely assessed.

Summary: Moderate‐intensity physical activity is recommended for inactive adults with overweight/obesity (OW/OB). The objective of this study is to determine if differences exist in the selection of moderate intensity between inactive adults with juvenile‐onset (JO) and adult‐onset (AO) OW/OB. Participants (JO = 18, AO = 20) were stratified by onset and completed two separate 20‐minute moderate‐intensity exercise sessions on a treadmill and cycle ergometer (randomized order). Multiple linear regression was used to determine whether exercise intensity (average METS, % age‐predicted HR_max), self‐reported pleasure or exertion differed by onset, controlling for age and gender. On the treadmill, JO and AO participants selected an average intensity of (mean [SD]) 3.5 (0.9) and 3.7 (0.9) METS, and 64.0 (7.7) and 64.9 (7.5) % of age‐predicted HR_max, respectively. On the cycle, JO and AO participants selected an average intensity of 3.3 (0.9) and 3.3 (1.0) METS, and 65.2 (8.8) and 60.7 (7.2) % of age‐predicted HR_max. After adjustment, participant intensity selection did not significantly differ by obesity onset when walking or cycling. There were no significant differences in pleasure or perceived exertion by onset, however, perception of exertion was on the high‐end of moderate for both the cycle (13.0, 12.5) and treadmill (12.0, 12.1), in JO and AO participants, respectively. Perception of moderate intensity did not differ by obesity onset. Self‐selected intensity was at the low end of moderate for walking and cycling.

Purpose: To determine whether perceived changes (i.e. perception of engagement during the pandemic relative to pre-pandemic) in specific health behaviors differ by weight status (i.e. healthy weight, overweight, obese). Design: Cross-sectional. Recruitment took place between June-August 2020, via social media posts and Qualtrics online panels. Setting: Participants completed the survey online through the Qualtrics platform. Sample: Analyses included N = 502 participants (≥18 years); 45.2% healthy weight (n = 227), 28.5% overweight (n = 143), and 26.3% obese (n = 132). Measures: Study-specific survey items included questions about demographics and perceived changes in health behaviors. Analysis: Logistic regression models, adjusted for age, race, ethnicity, gender, education, and COVID-19 diagnosis, assessed the odds of perceiving changes in health behaviors considered a risk for weight gain. Results: Participants with obesity, but not overweight, were significantly more likely to report deleterious changes to health behaviors compared to healthy weight peers, including: (1) decreased fruit/vegetable consumption [adjusted odds ratio (AOR) = 1.92; 95% confidence interval (CI): (1.13, 3.26)]; (2) increased processed food consumption [AOR = 1.85; 95%CI: (1.15, 3.00)]; (3) increased caloric intake [AOR = 1.66; 95% CI: (1.06, 2.61)]; (4) decreased physical activity [AOR = 2.07; 95%CI: (1.31, 3.28)]; and (5) deterioration in sleep quality [AOR = 2.07; 95%CI: (1.32, 3.25)]. Conclusion: Our findings suggest that adults with obesity may be at greater risk for unhealthy behaviors during a period of prolonged social distancing, potentially exacerbating the obesity epidemic.

To examine health behaviors associated with overweight/obesity by race/ethnicity at a diverse urban college. Participants: 270 undergraduates (77.0% female; 26.7% non-Hispanic white) and median bod...

Background: Adolescents with obesity are more likely to experience bullying in comparison to their healthy weight peers. However, it is unclear whether adolescents with obesity are more likely to perpetuate bullying or be both, a bully perpetrator and a bully victim. The purpose of this analysis was to examine differences in bully perpetration, victimization, and both (perpetration and victimization) by BMI classification in a nationally representative sample of adolescents. Methods: Analyses included 31,770 adolescents, ages 10–17, from the combined 2016–2017 National Survey of Children's Health. Adolescents were grouped by BMI classification; outcome variables included bullying, difficulty making new friends, excessive arguing, depression, and behavioral conduct problems. Logistic regression models, adjusted for age, sex, race, household income, highest level of education in the household, and attention-deficit/hyperactivity disorder assessed the odds of each outcome comparing healthy weight to adolescents with overweight and obesity. Results: Adolescents with overweight and obesity had greater odds of experiencing bullying behaviors: bully victim [odds ratio (OR) = 1.34 and 2.03] and both bully perpetrator and victim (OR = 1.37 and 2.01) (p's < 0.05), respectively, in comparison to healthy weight peers. Adolescents with overweight or obesity involved in bullying behaviors had significantly higher odds of behavioral conduct problems, depression, arguing excessively, and having difficulty making friends compared to adolescents with overweight or obesity who were neither a bully perpetrator nor victim (p's < 0.05). Conclusions: To promote overall health and well-being among adolescents with overweight and obesity, effort should be made to mitigate engagement in and/or victimization from bullying and associated behavioral or depressive symptoms.