Samantha M. Sundermeir

Healthcare worker burnout is pervasive and negatively impacts practitioner and patient health. Lifestyle medicine (LM) is a burgeoning field that uses ther

Background: Digital interventions for obesity have demonstrated efficacy in obesity prevention and management. The emergence of smartphones and ubiquitous apps such as WeChat represents potential modality to enhance the reach, sustainability, and cost-effectiveness of such interventions. By the end of the first quarter of 2024, WeChat had approximately 1.36 billion monthly active users, accounting for 96.5% of China’s population. The use of this platform for obesity interventions has been validated in multiple Chinese trials, most published in Chinese language journals. Objective: We aim to synthesize the existing evidence on obesity interventions delivered through WeChat to generate implications for future intervention design and development, thereby reaching an international audience. Methods: We conducted a scoping review of PubMed and China National Knowledge Infrastructure using search terms including “WeChat,” “obesity,” “weight,” “BMI,” “waist circumference,” “hip circumference,” “waist-to-hip ratio,” “body fat,” “skin fold thickness,” and these Chinese equivalents “weixin,” “feipang,” “tizhong,” “tizhongzhishu,” “yaowei,” “tunwei,” “yaotunbi,” “tizhi,” and “pizhehoudu.” We included only original research studies, theses, or dissertations with measurable outcomes that used WeChat functions as intervention strategies. Study quality was assessed using the National Institutes of Health Quality Assessment Tool, with specific tools selected based on study design. Descriptive statistics were applied, with categorical variables summarized as frequencies and percentages (n, %) to report study distribution. Results: Our scoping review based on PubMed and China National Knowledge Infrastructure identified 665 initial records, among which 43 studies met eligibility criteria and were included for data extraction to characterize intervention details. Results indicated effectiveness in 86.0% (37/43) of studies, with WeChat-assisted obesity interventions achieving significant short- and long-term weight loss measured by objective outcomes (body weight, BMI, waist circumference, hip circumference, waist-to-hip ratio, and body fat percentage). However, formative research informing intervention design was insufficient. Common methodological limitations included lack of randomization and blinding (42/43, 97.7%) and unreported intervention compliance metrics (39/43, 92.0%). Functionally, interventions primarily used “WeChat group” and “Official Account”—public accounts that provide health education, diet or physical activity logging, and other features. Conclusions: Overall, WeChat represents a promising platform for obesity interventions; however, current apps fail to leverage its full features (eg, online payment and live streaming). Key limitations include methodological heterogeneity and cultural specificity, which were addressed through narrative synthesis stratified by study types. Future research should incorporate the formative phase and use more rigorous methodologies such as randomized controlled trials to optimize intervention design and delivery via this modality.

Objective: To investigate the relationship between US containment measures during the COVID-19 pandemic and household food insecurity. Design: To investigate these relationships, we developed a framework linking COVID-19-related containment policies with different domains of food security and then used multilevel random effects models to examine associations between state-level containment policies and household food security. Our framework depicts theorised linkages between stringency policies and five domains of food security (availability, physical access, economic access, acceptability in meeting preferences and agency, which includes both self-efficacy and infrastructure). We used US national data from a representative survey data from the National Food Access and COVID research Team that was fielded in July–August 2020 and April 2021. Containment policy measures came from the Oxford Stringency Index and included policies such as stay-at-home orders, closing of public transit and workplace closures. Setting: The USA. Participants: 3071 adult individuals from the National Food Access and COVID research Team survey. Results: We found no significant associations between state-level containment policies and overall food insecurity at the state level or any of the individual domains of food insecurity. Conclusions: This research suggests that while food insecurity across all domains was a significant problem during the studied phases of the pandemic, it was not associated with these containment measures. Therefore, impacts may have been successfully mitigated, likely through a suite of policies aimed at maintaining food security, including the declaration of food workers as essential and the expansion of federal nutrition programmes.

Background: Lifestyle medicine (LM) is an evidence-based field of medicine that is effective in treating and preventing leading causes of morbidity and mortality. Despite demonstrated impact, few physicians and other healthcare professionals regularly implement LM. Continuing education may be an effective avenue for improving practitioner knowledge, confidence, and practice of LM, but there is a gap in the understanding of how educational content and strategies can be utilized to effectively increase LM adoption. The purpose of this study is to identify educational strategies that facilitate the implementation of LM in health systems (HS). Methods: Eight US HSs participated in this multiple case study. We conducted in-depth, semi-structured interviews (n = 68 total; 6–8 within each HS) with HS employees leading and delivering LM programs. Interviews included questions about LM implementation and educational strategies. Transcripts were analyzed following the framework analysis approach. Strength of endorsement was assessed through quantitative and qualitative analysis. Results: Four topic areas were identified as critical content for effective continuing education in LM. The need for further education in behavior change counseling received the strongest endorsement. Other topics included LM definition and evidence, referral opportunities, and business development skills. Ten types of continuing educational strategies were identified that facilitate LM. There was the strongest endorsement for pilot programs, employee wellness, and interpersonal educational activities, including peer-learning, communities-of-practice, and supervisor-learning/mentorship. Conclusion: Continuing education can facilitate LM implementation in HSs. Educational strategies should emphasize training that builds skills in behavior change counseling, leverages employee wellness pilot programs, and nurtures interpersonal learning.

Dollar stores are the fastest-growing type of food retailer in the United States, prompting policy action across the country related to their perceived negative impact on the communities they serve. However, there is little existing research that explores community member perceptions of dollar stores, which is critical to inform new, equitable policies. To address this gap in Baltimore City, Maryland, where dollar store density is high, we aimed to describe community member perceptions of dollar stores in terms of their role in the broader community. We used thematic analysis to construct themes from community member in-depth interviews ( n = 16) and one community member workshop ( n = 21) to understand how dollar stores are viewed in the context of the broader Baltimore City community. Six key themes were generated: (1) dollar stores contribute to neighborhood “blight,” (2) better retail is needed, (3) dollar stores meet certain community needs, (4) dollar stores do not invest enough in the community, (5) dollar stores vary in location and stock depending on race-based neighborhood qualities, and (6) product quality is low. Overall, participants acknowledged that dollar stores meet certain needs in communities in which there are few alternative retail options, but many did not view them as a benefit and desired to have other retailers instead. Participants also discussed the lack of dollar store investment in the communities they serve, and the low quality of food and non-food products offered. Future policy development should include community member perspectives to understand local context and align policies with community priorities.

Objective. Diet-related disease is rising, disproportionately affecting minority communities in which small food retail stores swamp supermarkets. Barriers to healthy food access were exacerbated by the pandemic. We examined the following: (1) individual- and household-level factors in a sample of Baltimore community members who regularly shop at corner stores and (2) how these factors are associated with indicators of dietary quality. Design. Cross-sectional data were collected using an online survey to capture sociodemographics, anthropometrics, and food sourcing, spending, and consumption patterns. Concurrent quantitative and qualitative analyses were conducted in Stata 18 and ATLAS.ti. Setting. This study was set in Baltimore, Maryland, USA. Participants. The participants included adults (n = 127) living or working in Baltimore who identified as regular customers of their neighborhood corner store. Results. The respondents were majority Black and low-income, with a high prevalence of food insecurity (62.2%) and overweight/obesity (66.9%). Most (82.76%) shopped in their neighborhood corner store weekly. One-third (33.4%) of beverage calories were attributed to sugar-sweetened beverages, and few met the recommended servings for fruits and vegetables or fiber (27.2% and 10.4%, respectively). Being Black and not owning a home were associated with lower beverage and fiber intake, and not owning a home was also associated with lower fruit and vegetable intake. Food insecurity was associated with higher beverage intake, while WIC enrollment was associated with higher fruit and vegetable and fiber intakes. Open-ended responses contextualized post-pandemic food sourcing and consumption in this setting. Conclusions. This paper helps characterize the consumers of a complex urban food system. The findings will inform future strategies for consumer-engaged improvement of local food environments.

Introduction: There are currently over 50 dollar stores in Baltimore City, Maryland. Community perceptions of over-saturation and resulting neighborhood impacts have garnered recent attention. A Maryland State Senate Bill required further study of dollar stores in Baltimore City to inform future policy. Therefore, the over-arching goal of this study was to generate community-informed policy recommendations for the Baltimore City Council.Methods: Three methods of data collection were used: (1) in-depth interviews with community members, retail staff/owners, dollar store staff, and policy makers; (2) an online survey of Baltimore City residents; and (3) workshop with community members and one with policy makers. Triangulation across data sources, discussion amongst the research team, and member checking were used to generate the top four policy options: a conditional use ordinance, a community benefits agreements, a dispersal ordinance, and a staple foods ordinance.Results: There was strong support for policies that encourage dollar stores to better align with community priorities (e.g., improving store cleanliness and appearance, increasing availability of healthy foods), as opposed to closing or banning dollar stores entirely. There was also strong support for policies that would empower communities to participate in determining the role of dollar stores in their neighborhoods, for example through a conditional use ordinance or community benefits agreement. Key concerns included policy enforcement, given the additional funding required, and current limited capacity at the city government level. Strategies to address such challenges were generated including implementing business licenses at the city level, linking new ordinances to dollar store leases and permits, and encouraging dollar store participation in federal and local programs to more feasibly stock healthier food items (e.g., fresh produce). Dissatisfaction was expressed regarding a lack of policy options to address the existing dollar stores, not just new dollar stores entering the City.Discussion: This study is the first of its kind to assess community support for dollar store policies at the local level, and serves to inform policies that improve dollar stores. A report of these findings was provided to Baltimore City Council to inform new, community-supported dollar store policies.