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Examining the association between intervention-related changes in diet, physical activity, and weight as moderated by the food and physical activity environments among rural, Southern adults
  • Published Date:
    Jun 09 2017
  • Source:
    J Acad Nutr Diet. 117(10):1618-1627.
Filetype[PDF-359.15 KB]

  • Alternative Title:
    J Acad Nutr Diet
  • Description:
    Background Few studies have been conducted in rural areas assessing the influence of community-level environmental factors on residents’ success improving lifestyle behaviors. Objective To examine whether 6-month changes in diet, physical activity, and weight were moderated by the food and physical activity environment in a rural adult population receiving an intervention designed to improve diet and physical activity. Design We examined associations between self-reported and objectively-measured changes in diet, physical activity, and weight, and perceived and objectively-measured food and physical activity environments. Participants were followed for 6 months. Participants/Setting Participants were enrolled in the Heart Healthy Lenoir (HHL) Project, a lifestyle intervention study conducted in Lenoir County, located in rural southeastern NC. Sample sizes ranged from 132 to 249, depending upon the availability of the data. Intervention Participants received 4 counseling sessions that focused on healthy eating (adapted Mediterranean diet pattern) and increasing physical activity. Potential moderating factors Density of and distance to food and physical activity venues, modified food environment index, Walk Score®, crime, and perceived nutrition and physical activity neighborhood barriers. Outcome Measures Diet quality, physical activity, and weight loss. Statistical Analyses Correlation and linear regression, controlling for potential confounders (baseline values of the dependent variables, age, race, education, and sex). Results In adjusted analysis, there was an inverse association between weight change and the food environment, suggesting that participants who lived in a less healthy food environment lost more weight over the 6-month intervention period (P = 0.01). Also, there was a positive association between self-reported physical activity and distance to private gyms (P = 0.04) and an inverse association between private gym density and pedometer-measured steps (P = 0.03), indicating that those who lived further from gyms and in areas with lower density of gyms had greater increases in physical activity and steps, respectively. Conclusions Contrary to our hypotheses, results indicated that those living in less favorable food and physical activity environments had greater improvements in diet, PA and weight, compared to those living in more favorable environments. Additional research should be undertaken to address these paradoxical findings, and if confirmed, to better understand them.
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