Food insecurity as a social determinant of health is associated with adverse physical health outcomes such as obesity.
Aim
This study aimed to evaluate the effects of nutrition education intervention based on the transtheoretical model (TTM) on food security, anthropometry, and body composition status.
Methods
In this randomized controlled trial, an intervention was conducted over months (five weeks) using the TTM among 160 women aged 19–64 years. Food security status, anthropometry, and body composition were determined three times: at baseline, three months, and six months after the intervention.
Results
In the intervention group, food insecurity significantly decreased before, immediately after, and six months after the intervention, these changes were significant in follow-up time and treatment effect. After six months of follow-up, the intervention group significantly decreased weight (−1.29 kg), body mass index (−0.54), and waist circumference (−3.48 cm). Although differences between the two groups were not statistically significant except in the interaction between follow-up time and intervention groups. Also, the mean of fat mass and total body water decreased in the intervention group and differences between the two groups were statistically significant in follow-up time (p < 0.001 and p = 0.01, respectively) and interaction between follow-up time and intervention group (p < 0.001 and p = 0.005, respectively).
Conclusion
In the current study, the findings of a six-month TTM-based intervention among women were positive that revealed to be a strategy that may improve anthropometric and nutritional status. Therefore, government programs that offer nutrition counseling should be prioritized to help the population to improve their eating habits.
AjaoKOOjofeitimiEOAdebayoAA (2010) Influence of family size, household food security status, and child care practices on the nutritional status of under-five children in Ile-Ife, Nigeria. African Journal of Reproductive Health14: 117–126.
2.
AnJYoonSRLeeJH, et al. (2019) Importance of adherence to personalized diet intervention in obesity related metabolic improvement in overweight and obese Korean adults. Clinical Nutrition Research8(3): 171–183.
3.
AndersonSA (1990) Core indicators of nutritional state for difficult-to-sample populations. The Journal of Nutrition120(suppl_11): 1555–1600.
4.
AuldGBakerSConwayL, et al. (2015) Outcome effectiveness of the widely adopted EFNEP curriculum eating smart being active. Journal of Nutrition Education and Behavior47: 19–27.
5.
Ballard-BarbashRSiddiqiSMBerriganDA, et al. (2013) Trends in research on energy balance supported by the National Cancer Institute. American Journal of Preventive Medicine44(4): 416–423.
6.
de MenezesMCMingotiSACardosoCS, et al. (2015) Intervention based on transtheoretical model promotes anthropometric and nutritional improvements—A randomized controlled trial. Eating Behaviors17: 37–44.
7.
DhurandharEJ (2016) The food-insecurity obesity paradox: A resource scarcity hypothesis. Physiology & Behavior162: 88–92.
8.
DrewnowskiADarmonN (2005) The economics of obesity: Dietary energy density and energy cost. The American Journal of Clinical Nutrition82(1): 265S–273S.
9.
EatonDKKannLKinchenS, et al. (2012) Youth risk behavior surveillance—United States, 2011. Surveillance summaries. Morbidity and Mortality Weekly Report61: 1–162.
10.
FriedrichMGoluch-KoniuszyZ (2015) Assessment of influence of pro-health nutrition education and resulting changes of nutrition behavior of women aged 65–85 on their body content. Przeglad Menopauzalny = Menopause Review14(4): 223–230.
11.
FurnessBWSimonPAWoldCM, et al. (2004) Prevalence and predictors of food insecurity among low-income households in Los Angeles County. Public Health Nutrition7(6): 791–794.
12.
GhassemiHHarrisonGMohammadK (2002) An accelerated nutrition transition in Iran. Public Health Nutrition5(1A): 149–155.
13.
GundersenCGGaraskySB (2012) Financial management skills are associated with food insecurity in a sample of households with children in the United States. The Journal of Nutrition142(10): 1865–1870.
14.
HaynosAFO’DonohueWT (2012) Universal childhood and adolescent obesity prevention programs: Review and critical analysis. Clinical Psychology Review32(5): 383–399.
15.
JordanKCFreeland-GravesJHKlohe-LehmanDM, et al. (2008) A nutrition and physical activity intervention promote weight loss and enhances diet attitudes in low-income mothers of young children. Nutrition Research28(1): 13–20.
16.
KarintrakulSAngkatavanichJ (2017) A randomized controlled trial of an individualized nutrition counseling program matched with a trans-theoretical model for overweight and obese females in Thailand. Nutrition Research and Practice11(4): 319–326.
17.
KendallAOlsonCMFrongillo JrEA (1996) Relationship of hunger and food insecurity to food availability and consumption. Journal of the American Dietetic Association96(10): 1019–1024.
18.
KjøllesdalMRHjellsetVTBjørgeB, et al. (2011) Intention to change dietary habits, and weight loss among Norwegian-Pakistani women participating in a culturally adapted intervention. Journal of Immigrant and Minority Health13(6): 1150–1158.
19.
KohansalZMotamedNNajafpour BoushehriS, et al. (2019) The relationship between the awareness and performance of parents regarding food security with anthropometric indices among school-age children in Bushehr, Iran, during 2017. Evidence Based Care8(4): 75–80.
20.
MastellosNGunnLHFelixLM, et al. (2014) Transtheoretical model stages of change for dietary and physical exercise modification in weight loss management for overweight and obese adults. Cochrane Database of Systematic Reviews2: 1–79.
21.
MenezesMCBedeschiLBSantosLC, et al. (2016) Interventions directed at eating habits and physical activity using the transtheoretical model: A systematic review. Nutricion Hospitalaria33: 1194–1204.
22.
MialichMSSicchieriJMFJordaoAAJr. (2014) Analysis of body composition: A critical review of the use of bioelectrical impedance analysis. International Journal Clinical Nutrition2: 1–10.
23.
MohammadiFOmidvarNHoushiar RadA, et al. (2008) Association of food security and body weight status of adult members of Iranian households. Iranian Journal Nutrition Science and Food Technology3(2): 41–53. http://nsft.sbmu.ac.ir/article-1-80-en.html.
24.
MoradiSMirzababaeiADadfarmaA, et al. (2019) Food insecurity and adult weight abnormality risk: A systematic review and meta-analysis. European Journal of Nutrition58(1): 45–61.
25.
National Heart, Lung, and Blood Institute (2013) Managing Overweight and Obesity in Adults: Systematic Evidence Reviews from the Obesity Expert Panel. US Department of Health and Human Services, USA: National Institutes of Health.
26.
ProchaskaJO (2013) Transtheoretical model of behavior change. In: Encyclopedia of Behavioral Medicine. New York: Springer, pp.1997–2000.
27.
ProchaskaJONorcrossJCDi ClementeCC (2013) Applying the stages of change. Psychotherapy in Australia19(2): 10–15. (PMID: 9155212).
28.
RabbittMPSmithMDColeman-JensenA (2016) Food Security Among Hispanic Adults in the United States, 2011-2014. Washington, DC, USA: Economic Research Service, U.S. Department of Agriculture.
29.
RabiollahF (2009) The Effect of Intervention Based on Trans Theortical Model Using Self-Determination Theory to Promote and Maintenance Exercise Behavior in College Students, in Health Education. Tehran/Iran: Tarbiat Modares University.
30.
RafieiMNordMSadeghizadehA, et al. (2009) Assessing the internal validity of a household survey-based food security measure adapted for use in Iran. Nutrition Journal8(1): 28.
31.
RandhawaHGhaediYKhanS, et al. (2020) The prevalence of overweight and obesity among health care providers in the Emirate of Ajman, UAE. Journal of Complementary Medicine Research11(3): 40.
32.
RaymondJLMorrowK (2020) Krause and Mahan’s Food and the Nutrition Care Process E-Book. USA: Elsevier Health Sciences.
33.
RosasLGThiyagarajanSGoldsteinBA, et al. (2015) The effectiveness of two community-based weight loss strategies among obese, low-income US Latinos. Journal of the Academy of Nutrition and Dietetics115(4): 537–50.e2.
34.
SanaeinasabHSaffariMSajediSH, et al. (2019) The effect of a psycho-educational intervention on weight management in obese military personnel. Military Psychology31(1): 1–0.
35.
SharmaM (2011) Dietary education in school-based childhood obesity prevention programs. Advances in Nutrition (Bethesda, Md.)2: 207S–216S.
36.
TuahNAmielCQureshiS, et al. (2011) Transtheoretical model for dietary and physical exercise modification in weight loss management for overweight and obese adults. Cochrane Database of Systematic Reviews10: CD008066. (pub2. PMID 21975777).
World Health Organization. Regional strategy on nutrition 2010–2019. 2010.
39.
World Health Organization. (2021) The State of Food Security and Nutrition in the World 2021: Transforming Food Systems for Food Security, Improved Nutrition and Affordable Healthy Diets for All. Food & Agriculture Organisation, 9–47.
40.
ZanettiMLArreliasCCAFrancoRC, et al. (2015) Adherence to nutritional recommendations and sociodemographic variables in patients with diabetes mellitus. Revista da Escola de Enfermagem da USP49(4): 0619–0625.
