Church-based health promotion (CBHP) interventions can reach broad populations and have great potential for reducing health disparities. From a socioecological perspective, churches and other religious organizations can influence members' behaviors at multiple levels of change. Formative research is essential to determine appropriate strategies and messages for diverse groups and denominations. A collaborative partnership approach utilizing principles of community-based participatory research, and involving churches in program design and delivery, is essential for recruitment, participation, and sustainability. For African Americans, health interventions that incorporate spiritual and cultural contextualization have been effective. Evidence indicates that CBHP programs have produced significant impacts on a variety of health behaviors. Key elements of CBHP are described with illustrations from the authors' research projects.

Eating patterns are increasingly varied. Typical breakfast, lunch, and dinner meals are difficult to distinguish because skipping meals and snacking have become more prevalent. Such eating styles can have various effects on cardiometabolic health markers, namely obesity, lipid profile, insulin resistance, and blood pressure. In this statement, we review the cardiometabolic health effects of specific eating patterns: skipping breakfast, intermittent fasting, meal frequency (number of daily eating occasions), and timing of eating occasions. Furthermore, we propose definitions for meals, snacks, and eating occasions for use in research. Finally, data suggest that irregular eating patterns appear less favorable for achieving a healthy cardiometabolic profile. Intentional eating with mindful attention to the timing and frequency of eating occasions could lead to healthier lifestyle and cardiometabolic risk factor management.T he patterns of meal and snack eating behavior in American adults have changed over the past 40 years. Based on NHANES (National Health and Nutrition Examination Survey) data from 1971 to 1974 to 2009 to 2010 (n=62 298), women 20 to 74 years of age reported a decrease in 24-hour meal-derived total energy intake (TEI) from 82% in the 1970s to 77% in 2009 to 2010 and an increase in the proportion of TEI consumed from snacks from 18% to 23%.1 Similar trends were reported among men. The proportion of men and women who reported consuming all 3 standard meals declined over this period (from 73% to 59% in men; from 75% to 63% in women), 1 reflecting changes in eating patterns rather than changes in eating frequency. Indeed, the traditional breakfast-lunch-dinner pattern was not observed in a population of healthy, non-shift-working adults. 2 In that study, the number of eating occasions, defined as consumption of any food or beverage providing at least 5 kcal, was ≈4.2 times a day in the lowest decile and 10.5 times a day for the top decile. There were only 5 hours during the 24-hour day when <1% of all eating occasions occurred: between 1 and 6 am. This study clearly demonstrated that adults in the United States eat around the clock. Because feeding and fasting entrain clock genes, which regulate all aspects of metabolism, meal timing can have serious implications for the development of cardiovascular disease (CVD), type 2 diabetes mellitus, and obesity. 3,4 The circadian rhythms of the body are controlled by the central clock located in the suprachiasmatic nucleus of the hypothalamus but also by clocks of peripheral organs. Although the master clock is strongly entrained by light, clocks of peripheral organs are additionally responsive to food supply, and temporal restriction of food can reset clock gene rhythms. In mice, food given in the normal sleeping period can uncouple peripheral clocks from the master clock. 5 In fact, time-restricted feeding CLINICAL STATEMENTS AND GUIDELINESin mice alters the robustness and coherence of rhythmic gene transcripts, 6 which may be relevant for cardiom...

The obesity epidemic is a global issue and shows no signs of abating, while the cause of this epidemic remains unclear. Marketing practices of energy-dense foods and institutionally-driven declines in physical activity are the alleged perpetrators for the epidemic, despite a lack of solid evidence to demonstrate their causal role. While both may contribute to obesity, we call attention to their unquestioned dominance in program funding and public efforts to reduce obesity, and propose several alternative putative contributors that would benefit from equal consideration and attention. Evidence for microorganisms, epigenetics, increasing maternal age, greater fecundity among people with higher adiposity, assortative mating, sleep debt, endocrine disruptors, pharmaceutical iatrogenesis, reduction in variability of ambient temperatures, and intrauterine and intergenerational effects, as contributing factors to the obesity epidemic are reviewed herein. While the evidence is strong for some contributors such as pharmaceutical-induced weight gain, it is still emerging for other reviewed

Objective: To investigate plausible contributors to the obesity epidemic beyond the two most commonly suggested factors, reduced physical activity and food marketing practices. Design: A narrative review of data and published materials that provide evidence of the role of additional putative factors in contributing to the increasing prevalence of obesity. Data: Information was drawn from ecological and epidemiological studies of humans, animal studies and studies addressing physiological mechanisms, when available. Results: For at least 10 putative additional explanations for the increased prevalence of obesity over the recent decades, we found supportive (although not conclusive) evidence that in many cases is as compelling as the evidence for more commonly discussed putative explanations. Conclusion: Undue attention has been devoted to reduced physical activity and food marketing practices as postulated causes for increases in the prevalence of obesity, leading to neglect of other plausible mechanisms and well-intentioned, but potentially ill-founded proposals for reducing obesity rates.

Purpose-The primary aim of this study was to examine whether parent affect and child temperament characteristics differ across feeding styles in low-income families, given suggestive evidence. The secondary aim was to examine whether feeding styles were still related to children's body mass index independent of parent affect, child temperament, and known correlates.Methods-Participants in this study were 718 parents of childrens attending Head Start programs across two sites (Texas and Alabama). Parents were categorized into feeding styles of authoritative (n = 118), authoritarian (n = 219), indulgent (n = 240) and uninvolved (n = 141) using a parent-report questionnaire characterizing feeding in a general parenting paradigm. Parents completed questionnaires and measured height and weight was obtained from parents and children.Results-Differences were found across feeding styles on parent affect and child temperament characteristics. Indulgent parents reported lower Negative Affect for themselves and lower Negative Affectivity for their children. The indulgent feeding style was significantly associated with higher child body mass index after controlling for parent affect, child temperament, and correlates (ethnicity, child age, parent body mass index). Conclusions-The results of this study not only show a robust association between the indulgent feeding style and weight status of low-income preschool childrens, but also suggest how congruence between parent emotional affect and child temperament characteristics may contribute to excess consumption among children of indulgent parents. Index termslow-income minorities; feeding styles; temperament; preschoolers; weight status It is well recognized that parenting plays a fundamental role in shaping the trajectory of the behavior and development of children. 1 Parenting style is considered a constellation of parenting behaviors that reflect a certain attitude toward the child and is stable over time. 2 A broad set of literature relates parenting styles to children's behavior and outcomes in cognitive, socio-emotional, and health related areas. 3 Little research has related parenting styles to the weight status of children until recently. A recent study showed an association between parenting style and childhood overweight in a predominantly White, middle-class sample. 4 However, it would be premature to apply this finding to other ethnic groups and feeding practices without further investigation. Given the notable ethnic differences in the prevalence of childhood overweight 5 and the emerging appreciation for the association between socioeconomic status and childhood overweight, 6 there is a pressing need to investigate styles of food parenting using culturally relevant measures designed for low-income ethnically diverse populations most at-risk for overweight in childhood.Little is known about styles of food parenting. Parenting may be domain specific suggesting that parents vary their style due to concerns about specific health issues or food. 7 For example...