Faculty Bibliography

BACKGROUND/UNASSIGNED:Weight bias is pervasive, occurs in a variety of contexts, and is associated with a range of suboptimal outcomes, including delays or avoidance in seeking health care, misdiagnosis, and denial of services. The aim of this study was to quantitatively describe the relationship between experiences of weight bias and eating behaviors of patients in a lifestyle medicine program and qualitatively describe healthcare providers' insights about weight bias. METHODS/UNASSIGNED:This study utilized an explanatory sequential design that drew on one-time survey data collected from 109 patients of a Plant-Based Lifestyle Medicine (PBLM) Program in New York City in 2019. Ordinary Least Squares and logistic regression models examined the association between weight bias and healthful plant-based eating and emotional eating after adjusting for sociodemographic characteristics. Qualitative data come from asynchronous interviews with five healthcare providers from the PBLM program completed in 2024 which were analyzed using rapid coding. RESULTS/UNASSIGNED:Survey participants were on average 53 years old, 67.0% female, 68.6% Black, Indigenous, and other people of color (BIPOC), and 56.2% reported experiencing weight bias. Weight bias was associated with 4.07 fewer points on the healthful plant-based eating measure (95%CI: 6.86, -1.27), and participants had 5.06 times the odds (95%CI: 1.76, 14.59) of emotional eating compared to those not reporting weight bias. Interview themes were: (1) Weight bias negatively influences patient lives, (2) Weight bias is negatively associated with patients' mental health, (3) Promising weight-inclusive approaches, and (4) Recommendations for providers to address weight bias. CONCLUSION/UNASSIGNED:Experiences of weight bias were associated with suboptimal eating behaviors and poor mental health. Providers observed their patients experience harm in connection with weight bias, suggested weight-inclusive approaches, and identified recommendations that would mitigate weight bias in healthcare environments including routinely screening for weight bias, training providers on weight inclusive care, incorporating mental health services into care teams, and creating size inclusive spaces. This study demonstrates that weight bias is linked to deleterious outcomes and the importance of weight-inclusive care delivery and environments.

INTRODUCTION/UNASSIGNED:This study leverages advertising industry data to quantify social media advertising expenditures and advertising impressions of the food and beverage industry on Facebook, Twitter/X, and Instagram from January 2019 to August 2021. METHODS/UNASSIGNED:=18 months). Primary outcomes were monthly trends expenditures of food/beverage advertising and the number of views and expenditures of food/beverage advertising by platform (e.g., TV, online, mobile, print). Primary outcomes was measured by monthly expenditures by (1) social media company, (2) brand, and (3) before COVID-19 versus the first year of the pandemic. RESULTS/UNASSIGNED:for interaction<0.001). CONCLUSIONS/UNASSIGNED:These data reveal that the food/beverage industry spends at least $2.8 billion on social media advertising, which generate billions of views for their products online. Determining adults' exposure to social media food advertising is critical for understanding the upstream factors that shape the risk for diet-related diseases.

BACKGROUND:Best practices for engaging patients and the community in biomedical research evolved significantly in recent years. However, few focus on patient engagement in the design and implementation of a national study. OBJECTIVES/OBJECTIVE:To describe the initial engagement development and implementation; present findings from data collected during the first year; and discuss lessons learned. METHODS:Data were collected as part of continuous quality improvement efforts to assess and refine the engagement strategy. Fifty-two patient, caregiver, and community representatives were invited to complete a brief online survey about their experience participating in a national initiative. RESULTS:A framework for engagement was created and 35 representatives completed the survey (67% response rate). Representatives demonstrated awareness related to their roles and responsibilities. Seventy-six percent indicated that they felt comfortable expressing opinions and the decision-making process. CONCLUSIONS:The RECOVER initiative's approach promoted greater transparency and trust between researchers and the community, leading to more impactful engagement.

BACKGROUND:Glucagon-like peptide-1 (GLP-1) medications, recently introduced in the United States for treating type 2 diabetes and obesity, have sparked interest and discussion on social media. Social media has emerged as a prominent platform for the distribution of health information; its vast user base and accessibility make it a popular resource for individuals seeking medical advice. This study characterized GLP-1 medication-related content on Instagram about 3 critical areas of public health: women's health, access from nontraditional settings, and barriers to access. OBJECTIVE:This study aimed to perform passive content analysis in which information patterns would be observed from Instagram posts. METHODS:We examined 40 GLP-1 medication-related Instagram posts to develop a list of the most frequently used hashtags. In total, 10 "top posts" were collected for 7 days (July 11-17, 2023) for 11 study hashtags (eg, #Ozempic). Duplicates, deleted posts or accounts, non-English content, and unrelated posts were removed. Each post was reviewed by at least 2 coders. Coding discrepancies were resolved through discussion. RESULTS:The final sample included 239 posts. More than half of the posts (130/239, 54%) were from GLP-1 medication users. Raters perceived most users to be female (90/97, 92.8%); inferred that most used medications for weight loss (69/130, 53.1%); determined the most frequently noted health condition was polycystic ovarian syndrome (25/130, 19.2%); and judged posts to have positive sentiments about well-being (64/130, 49.2%) and toward the medications (100/130, 76.9%). About a quarter of the posts (55/239, 23%) offered services for obtaining GLP-1 medications; GLP-1 medications were perceived to be accessible via nontraditional health care settings (eg, medical spas) versus traditional settings (39/239,16.3% vs 12/239, 5%). Most users (78/97, 80.4%) were perceived to be White; barriers to access (ie, shortages, insurance, and cost) were infrequently mentioned (6/239, 2.5%; 3/239, 1.3%; and 1/239, 0.4%, respectively). CONCLUSIONS:Our findings highlight the perceived benefits of GLP-1 medications for women's health, the need to increase health literacy about where to safely access medications, and how additional attention is needed for equitable access to GLP-1 medications. The onus is on social media companies to promote content that is safe and for the health care system and its payers to address health care inequities for historically marginalized communities.

INTRODUCTION/BACKGROUND:Social media is the most prominent source of online food and beverage advertisements (ads) seen by adolescents. Companies target adolescent social media users with ads that feature calorie-dense, nutrient-poor products, and exposure to ads drives poor diet and risk for future diet-related diseases. Black, Hispanic and lower socio-economic status youth are exposed to significantly more ads than White peers. Several state-level policies in the USA have passed restricting youth from accessing social media without parental approval, and some policies have banned advertising to youth. This protocol paper describes a current study that aims to understand the impact of such policies in two states, Louisiana and Texas, as they were among the first to be implemented with racially/ethnically diverse populations. METHODS AND ANALYSIS/METHODS:This study employs a repeated cross-sectional difference-in-difference design in which 700 youth ages 13-17 years are being recruited each year for 5 years (Louisiana n=175, Texas n=175, matched comparisons from other states n=350). Youth screen record their mobile devices for 60 minutes while they browse social media platforms (eg, TikTok, Instagram) or use the internet. They also complete a brief survey about a variety of topics (eg, health behaviours, mental health). Adolescents are compensated for screen recording ($75) and the survey ($25). Study team members are coding recordings for several characteristics, including media platforms used, appearances of food or beverages, and food or beverage type. We will estimate the impact of policies on food and beverage ads seen per hour using Ordinary Least Squares regression models and heterogeneity-robust standard errors clustered at the state level (by year and cumulatively). We will run additional models with interaction terms with income and race/ethnicity, separately, to test the role of the policies on health disparities. ETHICS AND DISSEMINATION/BACKGROUND:Study procedures have been approved by the Institutional Review Board of the NYU Grossman School of Medicine. We will distribute findings in peer-reviewed journals and at local and national conferences. To complement traditional dissemination pathways, we will create infographics to share with relevant community stakeholders. We will also share findings with policymakers in states that have passed or considered similar policies.

Despite progress to define primary care practice transformation models, there remain gaps in translating evidence-based guidelines into routine clinical care. Primary care providers (MD, DO, NP, PA) and researchers need tools to assess modifiable factors that improve practice performance to inform practice transformation efforts. We aimed to develop a pragmatic tool for assessing practice-level primary care structures and processes that are associated with better care quality and clinical outcomes. We generated 314 candidate items for the Tool for Advancing Practice Performance (TAPP) using data from a comprehensive literature review, Delphi study, and qualitative interviews with high-performing practices. We used empirical criteria and expert review to eliminate redundancy and improve clarity via removing and retaining items. The retained items were formatted into a survey tool, and we further revised the tool based on feedback elicited from cognitive interviews and pilot testing with primary care providers and staff. The final candidate pool comprised 126 items after refinement and expert review. For the survey tool, we adapted and developed survey questions for each of the 126 items. Eight cognitive interview participants reviewed the tool and provided feedback on its content and language. Based on this feedback, we eliminated 13 items because they were poorly or incorrectly understood by participants, resulting in a 113-item tool. Fifteen participants pilot tested the tool and no additional items were eliminated. The TAPP is a novel, low-burden tool that researchers and primary care providers can use to identify areas for improvement at the practice-level. Practices and health systems could use the TAPP to assess their own performance and identify gaps in their structures and processes, and practice networks and health systems can use the tool to assess structures and processes at individual clinics, track this information over time, and evaluate its relationship to care quality and clinical outcomes.

OBJECTIVE:To identify primary care structures and processes that have the highest and lowest impact on chronic disease management and screening and prevention outcomes as well as to assess the feasibility of implementing these structures and processes into practice. DESIGN/METHODS:A two-round Delphi study was conducted to establish consensus on the impact and feasibility of 258 primary care structures and processes. PARTICIPANTS/METHODS:29 primary care providers, health system leaders and health services researchers in the USA. OUTCOMES/RESULTS:Primary outcomes were (1) consensus on the impact of each structure and process on chronic disease management and screening and prevention outcomes, separately and (2) consensus on feasibility of implementation by primary care practices. RESULTS:Consensus on high impact and feasibility of implementation was reached on four items for chronic disease management: 'Providers use motivational interviewing to help patients set goals', 'Practice has designated staff to manage patient panel', 'Practice has onsite providers or staff that speak the most dominant, non-English language spoken by patients' and 'Practice includes mental health providers and/or behavioural health specialists in care team' and seven items for screening and prevention: 'Practice utilizes standing protocols and orders', 'Practice generates reports to alert clinicians to missed targets and to identify gaps in care, such as overdue visits, needed vaccinations, screenings or other preventive services', 'Practice has designated staff to manage patient panel', 'Practice sets performance goals and uses benchmarking to track quality of care', 'Practice uses performance feedback to identify practice-specific areas of improvement', 'Practice builds quality improvement activities into practice operations' and 'Pre-visit planning data are reviewed during daily huddles'. Only 'Practice has designated staff to manage patient panel' appeared on both lists. CONCLUSION/CONCLUSIONS:Findings suggest that practices need to focus on implementing mostly distinct, rather than common, structures and processes to optimise chronic disease and preventive care.

BACKGROUND:Weight stigma is a fundamental cause of health inequality. Body positivity may be a counterbalance to weight stigma. Social media is replete with weight-stigmatizing content and is a driver of poor mental health outcomes; however, there remains a gap in understanding its potential to mitigate the prevalence and impact of harmful messaging and to promote positive effects on a large scale. OBJECTIVE:We selected musical artist Lizzo, whose brand emphasizes body positivity and empowerment, for an instrumental case study on the discourse on social media and specifically Instagram. We focused on 3 domains, including body positivity, physical health, and emotional well-being. These domains challenge social norms around weight and body size and have the potential to positively affect the physical and psychological health of people with diverse body sizes. METHODS:We evaluated posts by Lizzo, comments from Instagram users, and replies to comments over a 2-month period (October 11 to December 12, 2019). Two coders rated Lizzo's posts and Instagram users' comments for their sentiments on the 3 domains. Replies to Instagram users' comments were assessed for their reactions to comments (ie, did they oppose or argue against the comment or did they support or bolster the comment). Engagement metrics, including the number of "likes," were also collected. RESULTS:The final sample included 50 original posts by Lizzo, 250 comments from Instagram users, and 1099 replies to comments. A proportion of Lizzo's content included body positive sentiments (34%) and emotional well-being (18%); no posts dealt explicitly with physical health. A substantial amount Instagram users' comments and replies contained stigmatizing content including the use of nauseated and vomiting emojis, implications that Lizzo's body was shameful and should be hidden away, accusations that she was promoting obesity, and impeachments of Lizzo's health. In spite of the stigmatizing content, we also discovered content highlighting the beneficial nature of having positive representation of a Black woman living in a larger body who is thriving. Moreover, analysis of the discourse between users illustrated that stigmatizing expressions are being combated online, at least to some degree. CONCLUSIONS:This study demonstrates that Lizzo has exposed millions of social media users to messages about body positivity and provided more visibility for conversations about weight and shape. Future research should examine the extent to which body positive messages can lead to greater acceptance of individuals living in larger bodies. Instagram and other social media platforms should consider ways to reduce body-shaming content while finding ways to promote content that features diverse bodies. Shifting the landscape of social media could decrease stereotypes about weight and shape while increasing dialog about the need for greater acceptance and inclusion of people with diverse bodies.

The influence of the social environment on health behaviors is well documented. In recent years, there is mounting evidence of the health benefits of a plant-based eating pattern, yet little is known about how the social environment impacts the adoption of a plant-based eating pattern, specifically. In this convergent parallel mixed-methods study, we analyzed quantitative survey data and qualitative focus group data to assess how social support impacted participants of a lifestyle medicine intervention focused on the adoption of a plant-predominant eating pattern. Regression analysis of survey data showed a positive association between positive social support and healthy plant-based eating, while no association was found between negative social support and healthy plant-based eating. Focus groups yielded further insights into how positive aspects of social relationships with family and friends facilitated the adoption of plant-predominant eating among participants. Qualitative findings also showed the ways in which negative social support hindered progress to adopt a plant-predominant eating pattern including not eating the same foods as participants, being judgmental about new dietary behaviors, and encouraging participants to eat non-plant-based foods. Taken together, social support appears to be an important factor for individuals adopting a plant-predominant eating pattern. Future research is needed to explore mechanisms to enhance positive social support while mitigating negative aspects of social relationships for individuals participating in similar lifestyle medicine interventions that emphasize on plant-predominant eating.