Trends in overweight among US adults from 1987 to 1993: a multistate telephone survey

Correction of self-reported BMI based on objective measurements: a Belgian experience

BACKGROUND

Based on successive Health Interview Surveys (HIS), it has been demonstrated that also in Belgium obesity, measured by means of a self-reported body mass index (BMI in kg/m2), is a growing public health problem that needs to be monitored as accurately as possible. Studies have shown that a self-reported BMI can be biased. Consequently, if the aim is to rely on a self-reported BMI, adjustment is recommended. Data on measured and self-reported BMI, derived from the Belgian Food Consumption Survey (FCS) 2014 offers the opportunity to do so.

METHODS

The HIS and FCS are cross-sectional surveys based on representative population samples. This study focused on adults aged 18-64 years (sample HIS = 6545 and FCS = 1213). Measured and self-reported BMI collected in FCS were used to assess possible misreporting. Using FCS data, correction factors (measured BMI/self-reported BMI) were calculated in function of a combination of background variables (region, gender, educational level and age group). Individual self-reported BMI of the HIS 2013 were then multiplied with the corresponding correction factors to produce a corrected BMI-classification.

RESULTS

When compared with the measured BMI, the self-reported BMI in the FCS was underestimated (mean 0.97 kg/m2). 28% of the obese people underestimated their BMI. After applying the correction factors, the prevalence of obesity based on HIS data significantly increased (from 13% based on the original HIS data to 17% based on the corrected HIS data) and approximated the measured one derived from the FCS data.

CONCLUSIONS

Since self-reported calculations of BMI are underestimated, it is recommended to adjust them to obtain accurate estimates which are important for decision making.

Obesity. An analysis of epidemiological and prognostic research

INTRODUCTION

Apart from its medical dimension, the current problem with obesity has acquired social urgency. This serious lifestyle disease has a negative impact on a number of life processes in the body, causing distortions and damaging different structures. It also contributes to clinical complications, lowers the quality of life and reduces life expectancy. Apart from health-related consequences, it can bring such unfavourable results as social, mental and emotional disorders.

MATERIAL AND METHODS

A systematic review of relevant epidemiological studies on obesity in Poland relative to selected countries in Europe and the world over the past 15 years was conducted. Also an attempt was made at forecasting the development of the obesity problem.

RESULTS

The analysed results demonstrated that the percentage of obese people among the adult population of Poland was on the rise in the period under investigation. Taking into account the estimated growth rate, we can assume that the percentage of obese people in Poland right now might total 23.7% for men and 23.3% for women. If no changes are introduced in this respect, in 2020 we can expect a rise to, respectively, 30.3% and 27.3%, and in 2030 to 37% for men and 31.4% for women.

CONCLUSIONS

The increase in the percentage of obese people among the adult population in Poland is most likely connected with a positive energy balance. In comparison to other European countries Poland has the highest percentage of obese men and women.

Masculinity constructs as protective buffers and risk factors for men's health

This study was designed to replicate the study of Levant, Wimer, and Williams (2011), which reported complex relationships between masculinity and health behaviors using a more diverse sample and updated measures. A sample of 589 college and community-dwelling men responded to an online survey consisting of five scales. Levant et al.'s (2011) study was partially replicated-some masculinity constructs were identified as protective buffers for some health behaviors and others as risk factors. The vast majority of the findings that were replicated were risk factors, suggesting that traditional masculinity is more of risk than a buffer, and occurred in the analyses involving Avoiding Anger and Stress and Avoiding Substance Use subscales, suggesting that these health behaviors are most closely associated with masculinity. The results are discussed in terms of limitations, suggestions for future research, and implications for health care practice.

Effect of skipping breakfast on subsequent energy intake

The objective was to examine the effect of consuming breakfast on subsequent energy intake. Participants who habitually ate breakfast and those who skipped breakfast were recruited for two studies. Using a randomized crossover design, the first study examined the effect of having participants consume either (a) no breakfast, (b) a high carbohydrate breakfast (335 kcals), or (c) a high fiber breakfast (360 kcals) on three occasions and measured ad libitum intake at lunch. The second study again used a randomized crossover design but with a larger, normal carbohydrate breakfast consumed ad libtum. Intake averaged 624 kcals and subsequent food intake was measured throughout the day. Participants ate only foods served from the Cornell Human Metabolic Research Unit where all foods were weighed before and after consumption. In the first study, neither eating breakfast nor the kind of breakfast consumed had an effect on the amount consumed at lunch despite a reduction in hunger ratings. In the second study, intake at lunch as well as hunger ratings were significantly increased after skipping breakfast (by 144 kcal), leaving a net caloric deficit of 408 kcal by the end of the day. These data are consistent with published literature demonstrating that skipping a meal does not result in accurate energy compensation at subsequent meals and suggests that skipping breakfast may be an effective means to reduce daily energy intake in some adults.

Sex, Health Behaviors and Social Support: Functional Decline among Older Diabetics

PROBLEM STATEMENT

Men and women experience pronounced differences in functional decline as they age. The mechanisms behind these differences remain unclear, particularly among chronically ill populations. Drawing on the theory of the disablement process, this research examines sex differences in functional decline, focusing on two mechanisms suggested by the literature to partially mediate these disparities: health behaviors and social support.

APPROACH

Data from diabetics aged 50 and older from the Health and Retirement Study (n = 2,493) were examined for change in functional status over a 10-year period. Multivariate longitudinal multi-level models were conducted to analyze (1) health behavior (2) social support; and (3) a full model with health behavior and social support together, followed by a separate analysis using sex interaction terms.

RESULTS

Women and men both experienced functional decline over time. In the models that examined health behaviors and social support separately, women experienced steeper rates of decline. In the full model (which included health behaviors and social support together), men experienced a steeper rate of decline relative to women. The analyses suggest that it is the combination of health and social characteristics (largely through engagement in socially supportive activities that promote health) that are protective against functional decline.

CONCLUSION/RECOMMENDATIONS

As diabetic men experienced a steeper rate of functional decline than diabetic women once health behaviors and social support were both held constant, future research must examine (a) how these protective factors operate in tandem to protect against disablement of women with diabetes; and (b) how clinical and social policy can promote multi-pronged interventions to improve health behaviors in supportive contexts. Such research will benefit from multi-disciplinary collaborations.

Associations of large artery structure and function with adiposity: effects of age, gender, and hypertension. The SardiNIA Study

In the context of obesity epidemic, no large population study has extensively investigated the relationships between total and abdominal adiposity and large artery structure and function nor have such relationships been examined by gender, by age, by hypertensive status. We investigated these potential relationships in a large cohort of community dwelling volunteers participating the SardiNIA Study.

METHODS AND RESULTS

Total and visceral adiposity and arterial properties were assessed in 6148 subjects, aged 14-102 in a cluster of 4 towns in Sardinia, Italy. Arterial stiffness was measured as aortic pulse wave velocity (PWV), arterial thickness and lumen as common carotid artery (CCA) intima-media thickness (IMT) and diameter, respectively. We reported a nonlinear relationship between total and visceral adiposity and arterial stiffness, thickness, and diameter. The association between adiposity and arterial properties was steeper in women than in men, in younger than in older subjects. Waist correlated with arterial properties better than BMI. Within each BMI quartile, increasing waist circumference was associated with further significant changes in arterial structure and function.

CONCLUSION

The relationship between total or abdominal adiposity and arterial aging (PWV and CCA IMT) is not linear as described in the current study. Therefore, BMI- and/or waist-specific reference values for arterial measurements might need to be defined.

Patient provider communication about the health effects of obesity

OBJECTIVE

We assessed the influence of race/ethnicity and provider communication on overweight and obese patients' perceptions of the damage weight causes to their health.

METHODS

The study included 1071 overweight and obese patients who completed the 2002 Community Health Center (CHC) User survey. We used logistic regression analyses to examine determinants of patients' perceptions of the impact of their weight on their health. Models were adjusted for covariates and weighting was used to account for the sampling design.

RESULTS

Forty-one percent of respondents were overweight and 59% were obese. Non-Hispanic Blacks and Hispanics were half as likely as non-Hispanic Whites to believe weight was damaging to their health while controlling for covariates. Overweight/obese CHC patients who were told they were overweight by healthcare providers were almost nine times more likely to perceive that weight was damaging to their health compared to those not told.

CONCLUSIONS

We observed large racial/ethnic disparities in the perception that overweight is unhealthy but provider communication may be a powerful tool for helping patients understand that overweight is damaging to health.

PRACTICE IMPLICATIONS

Given obesity is a national epidemic, further attention to the role of patient provider communication in illness is essential with important implications for both health professional training and health care provision.

Gender-ethnic disparity in BMI and waist circumference distribution shifts in US adults

While obesity has been increasing in the United States, little is known about the variation in recent BMI and waist circumference (WC) distribution shifts across socio-demographic groups. We assessed shifts in BMI and WC distributions and compared between-group differences over the past decade, and projected future BMI and WC distributions and prevalence of obesity and central obesity using National Health and Nutrition Examination Survey (NHANES) 1988-1994 and 1999-2004 data. BMI/WC distributional shifts overall and in percentiles were compared across groups. Average yearly shift was calculated and used for projecting future distributions and prevalence. Both BMI and WC increased more in their uppermost percentile distribution, though BMI shift declined toward the uppermost percentiles among women. Heavier Americans gained more adiposity over the past decade. Ethnic (non-Hispanic (NH) white vs. black) disparities in mean BMI and WC became wider. Over the survey period, mean BMI increased by 1.3 units vs. 1.8 units among men and women, whereas WC, by 4.2 cm vs. 4.8 cm. Young adults had the largest increase. Shift in women's WC was stable between the 25th and 75th percentiles, but gained pace at higher WC, while women's BMI and men's BMI and WC shifts increased linearly. NH black women had the largest shifts and would have central obesity and obesity prevalence of 90.8 and 70.7% by 2020. Shifts in BMI and WC distribution varied across age-, gender-, and ethnic groups. Future rise in the obesity and central obesity prevalence rates are expected, but would vary by demographic groups.

A tale of two countries--the United States and Japan: are differences in health due to differences in overweight?

Background

Despite similar standards of living and health care systems for older persons, there are marked differences in the relative health of the elderly populations in the United States (US) and Japan. We explore the association of overweight and obesity with these health disparities.

Methods

Data on older adults from the US National Health Interview Survey (1994) and the Longitudinal Study of Aging II (1994) were compared to similar data from the 1999-2001 Nihon University Japanese Longitudinal Study of Aging. Regression analyses for the 2 countries were conducted to examine the correlates of being overweight and obese, and the relationships of overweight and obesity with activities of daily living functioning, heart disease, arthritis, and diabetes.

Results

The prevalence of overweight and obesity is higher in the US than in Japan, as is the prevalence of heart disease, diabetes, arthritis, and functioning problems. Education level and marital status are predictors of overweight for older Americans but not for older Japanese people. Health behaviors affect weight in all groups. The prevalence of functioning problems and disease are more likely to be associated with being overweight in US men and women than in Japanese women, and are not associated with being overweight in Japanese men.

Conclusion

Despite similar standards of living and health care systems for older persons, the conditions associated with poor health differ in the US and Japan. Being overweight or obese appears to be related to more functioning problems and arthritis in the US than in Japan.

Use of spline regression in an analysis of maternal prepregnancy body mass index and adverse birth outcomes: does it tell us more than we already know?

PURPOSE

Categorical analyses of prepregnancy body mass index (BMI) have shown that maternal overweight and obesity are associated with adverse pregnancy outcomes. It is unclear whether further insight into these associations can be gained from spline regression.

METHODS

We used spline regression to examine the relations between prepregnancy BMI and five adverse pregnancy outcomes in the Baltimore-Washington Infant Study, a case-control study of congenital cardiac defects. Analyses included 3,226 singleton live-born control infants delivered 1981 through 1989. We modeled BMI using (a) traditional categories of underweight, average weight, overweight, and obese and (b) restricted quadratic splines.

RESULTS

We confirmed that overweight status and obesity were associated with increased risk of macrosomia and large for gestational age. For these outcomes, splines provided detail about the associations at the ends of the BMI distribution and within the average BMI category. Spline analyses also showed that underweight status was associated with increased risk of preterm delivery.

CONCLUSIONS

Analyses of traditional categories of BMI provide good understanding of the associations with several adverse birth outcomes. For three outcomes, modeling with splines provided additional insight regarding dose-response relations within categories. Results suggest the need for further analyses of average BMI and adverse pregnancy outcomes.

Personal and lifestyle characteristics predictive of the consumption of fast foods in Australia

Objective

To identify key predictors of fast-food consumption from a range of demographic, attitudinal, personality and lifestyle variables.

Methods

We analysed data from a nationwide survey (n= 20 527) conducted in Australia by Nielsen Media Research. Items assessing frequency of fast-food consumption at (1) eat in and (2) take away were regressed onto 12 demographic, seven media consumption, and 23 psychological and lifestyle variables, the latter derived from factor analysis of responses to 107 attitudinal and behavioural items.

Results

Stepwise multiple regression analyses explained 29.6% of the variance for frequency of take-away and 9.6% of the variance for frequency of eat-in consumption of fast foods. Predictors of more frequent consumption of fast food at take away (and, to a lesser extent, eat in) included lower age – especially under 45 years, relative indifference to health consequences of behaviour, greater household income, more exposure to advertising, greater receptiveness to advertising, lesser allocation of time for eating, and greater allocation of time to home entertainment. There were no effects for occupational status or education level.

Conclusions

The effects for age suggest that fast-food take-away consumption is associated with a general cultural shift in eating practices; individual differences in attitudinal and lifestyle characteristics constitute additional, cumulative, predictive factors. The role of advertising and the reasons for the lesser explanatory value of the eat-in models are important targets for further research.

Nine-year incidence of obesity and overweight in an African-origin population

OBJECTIVE

To provide 9-year incidence estimates for obesity and overweight and describe weight changes over time in an African-origin population.

DESIGN

A population-based cohort in which participants were examined at baseline and reexamined after 9 years.

MEASUREMENTS

Obesity and overweight were defined as having body mass indices (BMIs)> or =30 and 25 kg m(-2), respectively. Incidence rates were based on persons without such conditions at baseline and are presented along with 95% confidence intervals.

RESULTS

Of the 869 men and 921 women at risk at baseline, the 9-year gender-specific incidence rates for obesity were 6.9% (95% confidence interval (5.3, 8.8)) and 13.1% (11.0, 15.5), respectively. The incidence of obesity steadily declined with age, decreasing from 14.4% for those between 40 and 49 years of age to 1.5% for those who were 70 years and older. Overall, the incidence of obesity over 9 years was approximately 10%. The 9-year incidence rate for overweight was 23.3% (20.5, 26.3). Changes in weight over the 9-year period varied by age group. Persons 40-49 years of age at baseline gained, on average, almost 3% of their baseline body weight, whereas persons > or =70 years lost 5% of their body weight in 9 years.

CONCLUSIONS

This study highlights the high incidence of obesity/overweight in this cohort and suggests that the future public health burden of excess weight and its associated comorbidities may be elevated in this population of African origin. The development of strategies and interventions for the prevention and treatment of obesity/overweight are therefore of primary and immediate importance.

Apparent low frequency of undernutrition in Dublin hospital in-patients: should we review the anthropometric thresholds for clinical practice?

Protein–energy undernutrition, or the possibility of its development, has been documented to occur frequently in patients on admission to hospital. Deterioration in nutritional status is known to occur in hospital. In a prospective study of 594 sequential hospital admissions, we aimed to assess the prevalence of undernutrition among patients on admission to two acute teaching hospitals in Dublin, Republic of Ireland using the widely-accepted anthropometric criteria applied in a large study from Dundee, Scotland, UK () and to determine changes in nutritional status in hospital. The mean prevalence of undernutrition (11 %) was considerably lower than was reported from Dundee (40 %). Unintentional weight loss before admission and functional impairment on admission occurred to a similar extent in both centres. Weight loss in hospital occurred in the same proportion of patients, but less frequently among those undernourished on admission to hospital, in Dublin compared with Dundee. The patients found to be undernourished on admission in this study had a mortality rate in hospital (6·5 %) over three times that of the adequately nourished group (2 %). The magnitude of the difference in prevalence of undernutrition between the two centres cannot be explained by ethnicity, case-mix or age distribution. With the secular increase in BMI in the population, the thresholds for classifying patients as undernourished or at risk of nutritional deterioration may need to be reviewed. For clinical use, recent weight loss and functional status may be more appropriate variables to use in the evaluation of nutritional status on admission to hospital.

Relationship between urban sprawl and weight of United States youth

BACKGROUND

Among United States youth there is an obesity epidemic with potential life-long health implications. To date, relationships between the built environment and body mass index (BMI) have not been evaluated for youth, and have not been evaluated longitudinally.

OBJECTIVES

To determine if urban sprawl is associated with BMI for U.S. youth.

METHODS

Using data from the 1997 National Longitudinal Survey of Youth (NLSY97), both cross-sectional and longitudinal analyses were conducted. Hierarchical modeling was used to relate characteristics of individuals, households, and places to BMI. Individual and household data were extracted from the NLSY97. The independent variable of interest was the county sprawl index, which was derived with principal components analyses from census and other data.

RESULTS

In a cross-sectional analysis, the likelihood of U.S. adolescents (aged 12-17 years) being overweight or at risk of overweight (> or =85th percentile relative to the Centers for Disease Control growth charts) was associated with county sprawl (p=0.022). In another cross-sectional analysis, after controlling for sociodemographic and behavioral covariates, the likelihood of young adults (aged 18-23 years) being obese was also associated with county sprawl (p=0.048). By contrast, in longitudinal analyses, BMI growth curves for individual youth over the 7 years of NLSY97, and BMI changes for individual youth who moved between counties, were not related to county sprawl (although coefficient signs were as expected).

CONCLUSIONS

Cross-sectional analyses suggest that urban form is associated with being overweight among U.S. youth. The strength of these relationships proved comparable to those previously reported for adults. Longitudinal analyses show no such relationship. It is unclear why these approaches give different results, but sample sizes, latent effects, and confounders may contribute.

The burden of obesity among a national probability sample of veterans

BACKGROUND

Few national data exist about the prevalence of obesity and the resulting health burden among veterans.

METHODS

We analyzed data from the 2003 Behavioral Risk Factor Surveillance System (n = 242,362) to compare rates of obesity among veterans who do and do not utilize the VA, compared with nonveterans. We used bivariate analyses to describe the association of obesity with lifestyle factors, disability, and comorbid disease, and multivariate analysis to assess the independent association of obesity with VA care.

RESULTS

Veterans who use the VA for health care have the highest rates of obesity compared with veterans who do not use the VA and nonveterans (27.7% vs 23.9% vs 22.8%, P < .001). Only 27.8% of veterans who receive health care at the VA are of normal weight (vs 42.6% of the general population, P < .001), 44.5% are overweight, 19.9% have class I obesity, 6% have class II obesity, and 1.8% are morbidly obese (an estimated 82,950 individuals). Obese veterans who utilize the VA for services have higher rates of hypertension (65.8%) and diabetes (31.3%), are less likely to follow diet and exercise guidelines, and more likely to report poor health and disability than their normal-weight counterparts.

CONCLUSIONS

Veterans who receive care at the VA have higher rates of overweight and obesity than the general population. At present, less than half of VA medical centers have weight management programs. As the largest integrated U.S. health system, the VA has a unique opportunity to respond to the epidemic of obesity.

The burden of obesity among a national probability sample of veterans

BACKGROUND

Few national data exist about the prevalence of obesity and the resulting health burden among veterans.

METHODS

We analyzed data from the 2003 Behavioral Risk Factor Surveillance System (n = 242,362) to compare rates of obesity among veterans who do and do not utilize the VA, compared with nonveterans. We used bivariate analyses to describe the association of obesity with lifestyle factors, disability, and comorbid disease, and multivariate analysis to assess the independent association of obesity with VA care.

RESULTS

Veterans who use the VA for health care have the highest rates of obesity compared with veterans who do not use the VA and nonveterans (27.7% vs 23.9% vs 22.8%, P < .001). Only 27.8% of veterans who receive health care at the VA are of normal weight (vs 42.6% of the general population, P < .001), 44.5% are overweight, 19.9% have class I obesity, 6% have class II obesity, and 1.8% are morbidly obese (an estimated 82,950 individuals). Obese veterans who utilize the VA for services have higher rates of hypertension (65.8%) and diabetes (31.3%), are less likely to follow diet and exercise guidelines, and more likely to report poor health and disability than their normal-weight counterparts.

CONCLUSIONS

Veterans who receive care at the VA have higher rates of overweight and obesity than the general population. At present, less than half of VA medical centers have weight management programs. As the largest integrated U.S. health system, the VA has a unique opportunity to respond to the epidemic of obesity.

Avaliação antropométrica de pré-escolares do município de Mogi-Guaçú, São Paulo: subsídio para políticas públicas de saúde

OBJETIVOS: analisar o estado nutricional, através de avaliação antropométrica, dos pré-escolares que freqüentam Escolas Municipais de Educação Infantil (EMEIs) de Mogi-Guaçú, São Paulo, Brasil. MÉTODOS: a partir de uma amostra por conglomerado, estimada pela equiprobabilidade, com participação de 347 crianças de três a sete anos de idade, matriculadas em nove EMEIs, das 38 existentes na pesquisa, foram tomadas medidas individuais de peso e estatura, complementadas por questionário com informações socioeconômicas familiares. As medidas foram controladas com o uso de escores z e comparadas com o referencial do Centro Nacional de Estatísticas da Saúde dos Estados Unidos da América, e o índice de massa corporal. RESULTADOS: verificou-se um provável deslocamento da média dos índices antropométricos para a direita da curva normal no tocante ao escore z dos indicadores peso/idade (+0,54; dp 1,48), altura/idade (+0,20; dp 1,02), IMC (+0,30; dp 1,13). CONCLUSÕES: a caracterização da situação nutricional das crianças matriculadas nas EMEIs não aponta para risco de desnutrição protéico-energética (DPE). Em contrapartida, observou-se, como problema, a presença de sobrepeso e obesidade.

Gender disparities in adult health: an examination of three measures of morbidity

Recent examinations of gender differences in physical health suggest that women's disadvantage may be smaller than previously assumed, varying by health status measure and age. Using data from the 1997-2001 National Health Interview Surveys, we examine gender-by-age differences in life-threatening medical conditions, functional limitations, and self-rated health and consider whether potential mediating mechanisms (e.g., socioeconomic status, behavioral factors) operate uniformly across health measures. The results show that the gender gap is smallest for life-threatening medical conditions and that men do increasingly worse with age. For self-rated health, men are more likely to report excellent health at younger ages, but with increasing age this gap closes. Only for functional limitations do we find a consistent pattern of female disadvantage: Women report more functional limitations than men, and the gap increases with age. The ability of explanatory mechanisms to account for these patterns varies by the health measure examined.

Getting to the heart of social support: a qualitative analysis of the types of instrumental support that are most helpful in motivating cardiac risk factor modification

PURPOSE

This study evaluates the types of instrumental social support that are perceived by patients with coronary artery disease as being most helpful to health behavior modification.

METHODS

A purposive sample of 63 patients with coronary artery disease were enrolled in this qualitative study. Patients described lifestyle changes that they made in an effort to stay healthy and the types of instrumental supports provided by their social networks that helped them make these changes.

RESULTS

The most frequently cited lifestyle changes reported were making dietary changes, reducing responsibilities, keeping doctors' appointments, taking medications, and exercising more. The types of instrumental support that were perceived as being most helpful in making these changes were those that (1) made it easier and practical to engage in healthy behaviors, (2) alleviated stressful situations, and (3) facilitated the process of receiving medical care.

CONCLUSIONS

These findings identify practical ways in which social networks can promote risk factor modification and ultimately contribute to improving coronary artery disease outcomes.

Prevalence of obesity in the United States

Obesity is a major public health problem in the United States. Data on measured heights and weights indicates that the prevalence of obesity has significantly increased among the US population over the past 30 years. Data collected from 1999 to 2002 estimates that nearly 1/3 of adults are obese (27.6% of men and 33.2% of women) and one in six children and adolescents is overweight. Increased prevalence of excessive weight is noted among all age, gender and racial/ethnic groups; however, disparities exist. There is a need for further research to better understand why these increases have occurred, why the observed disparities exist and how to reverse these trends.

The more food young adults are served, the more they overeat

Young and Nestle suggested that the increase in the portion size of food products evident in the United States during the past 20 years may be responsible for the epidemic of overweight and obesity. They based their conclusion on statistical correlations. The purpose of the present study was to provide experimental evidence to support their proposal. Cornell undergraduate students were given access to a buffet lunch on Monday, Wednesday, and Friday and were told this was a test of flavor enhancers. They were instructed to eat as much or as little as they wanted. On the same days of the following week, the subjects were divided into 3 groups. Each group was served either 100%, 125%, or 150% of the amount of food they had consumed the previous week. When larger amounts were served, significantly greater amounts of food were consumed. Each of the 4 foods that comprised the meal (soup, pasta, breadsticks, ice cream) increased significantly in proportion to the portion size. The data clearly support the hypothesis proposed by Young and Nestle and support the powerful role that environment plays in determining energy intake and potential increases in body weight.

[The obesity epidemic and related factors: the case of Spain]

The obesity epidemic is a global phenomenon that does not respect geographic or socio-demographic boundaries. Thus, research on factors related to the obesity epidemic has focused on social and economic characteristics of modern societies. This article discusses obesity in Spain and trends in several associated factors. Together with the increase in the prevalence of obesity, important changes in the population's dietary pattern have been observed, although total energy and fat intake appear to be stable. According to several indirect indicators, sedentary behavior predominates, although the percentage of the population reporting some leisure exercise is increasing. An increase in the amount of leisure time in modern societies is suggested as an explanation for this paradox. Factors related to energy expenditure could be as important as dietary factors in the genesis of the obesity epidemic.

Prevalence and determinants of obesity in an urban sample of Portuguese adults

OBJECTIVE

To evaluate the prevalence and the determinants of obesity, and the associated cardiovascular risk factors in a random sample of non-institutionalised adults.

DESIGN

Cross-sectional study.

SUBJECTS

A random sample of 1436 habitants of Porto (873 women and 563 men) aged 18-90 years.

MEASUREMENTS

All participants answered a structured questionnaire comprising information on social, demographic, behavioural and clinical aspects. Anthropometric measures, blood pressure and fasting blood samples were obtained. Diet was assessed using a semi-quantitative food-frequency questionnaire, and physical activity was evaluated using a questionnaire exploring all professional, domestic and leisure-time activities. When the body mass index was > or =30 kg/m2, the subject was considered as 'obese'. Proportions were age adjusted for the European population. Odds ratios and 95% confidence intervals were computed using unconditional logistic regression.

RESULTS

The prevalence of obesity was significantly higher in women (26.1%) than men (13.9%). Regardless of gender, obesity increased with age, decreased with education, and was more frequent in married blue-collar workers and unemployed subjects. Smoking was more prevalent in subjects of normal weight, and a higher proportion of those reporting no regular exercise were obese. In men, obesity prevalence increased with increasing quartiles of energy intake, but no such changes were found in women. Compared with subjects of normal weight, obese men showed a significantly higher prevalence of hypertension (53.3 vs 26.1%) and hypertriglyceridaemia (23.4 vs 9.0%). Also, hypertension (43.7 vs 30.7%), diabetes (7.6 vs 2.7%), hypertriglyceridaemia (27.1 vs 5.0%), and abnormal low-density lipoprotein (30.4 vs 21.4%) and high-density lipoprotein cholesterol concentration (15.0 vs 5.3%) were more frequent in obese women.

CONCLUSION

Obesity is a major public health issue in urban Portuguese populations, and obese individuals have many features of metabolic syndrome. Education and relative deprivation are modifiable factors that are significantly associated with obesity. However, no clear-cut relationship was found between physical activity and energy intake.

A comparison of national estimates from the National Health Interview Survey and the Behavioral Risk Factor Surveillance System

OBJECTIVES

The purpose of this study was to compare national estimates from the National Health Interview Survey (NHIS) and the Behavioral Risk Factor Surveillance System (BRFSS).

METHODS

The authors compared data from the 2 surveys on smoking, height, weight, body mass index, diabetes, hypertension, immunization, lack of insurance coverage, cost as a barrier to medical care, and health status.

RESULTS

Overall national estimates were similar for 13 of the 14 measures examined. Small differences according to demographic characteristics were found for height and body mass index, with larger differences for health status.

CONCLUSIONS

Although estimates differed within subgroups, the BRFSS provided national estimates comparable to those of the NHIS. BRFSS national data could provide rapidly available information to guide national policy and program decisions.

A population perspective on diabetes prevention: whom should we target for preventing weight gain?

OBJECTIVE

To examine the influence of obesity and prevention of weight gain on the incidence of type 2 diabetes.

RESEARCH DESIGN AND METHODS

We examined participants in the San Antonio Heart Study, a prospective population-based study of Mexican Americans and non-Hispanic whites residing in San Antonio, Texas. BMI was stratified into four categories: normal (<25 kg/m(2)), overweight (> or =25 kg/m(2) and <30 kg/m(2)), obese (> or =30 kg/m(2) and <35 kg/m(2)), and very obese (> or =35 kg/m(2)). The number and proportion of incident cases prevented by targeting each BMI category were estimated. In addition, we calculated the decrease in risk of developing type 2 diabetes associated with weight gain prevention across both the BMI and age spectra.

RESULTS

Preventing normal individuals from becoming overweight would result in the greatest reduction in incidence of type 2 diabetes. This would result in a 62 and 74% reduction in the incidence of type 2 diabetes in Mexican Americans and non-Hispanic whites, respectively. Preventing the entire population from gaining, on average, 1 BMI unit would result in a reduction in incidence of type 2 diabetes of 12.4 and 13.0% in Mexican Americans and non-Hispanic whites, respectively.

CONCLUSIONS

The majority of cases of type 2 diabetes were in individuals who were overweight or mildly obese with a family history of type 2 diabetes. Public health resources should be directed toward the prevention of weight gain among normal and overweight individuals in order to prevent the maximum number of cases of type 2 diabetes.

Medium-chain triglycerides increase energy expenditure and decrease adiposity in overweight men

OBJECTIVE

The objectives of this study were to compare the effects of diets rich in medium-chain triglycerides (MCTs) or long-chain triglycerides (LCTs) on body composition, energy expenditure, substrate oxidation, subjective appetite, and ad libitum energy intake in overweight men.

RESEARCH METHODS AND PROCEDURES

Twenty-four healthy, overweight men with body mass indexes between 25 and 31 kg/m(2) consumed diets rich in MCT or LCT for 28 days each in a crossover randomized controlled trial. At baseline and after 4 weeks of each dietary intervention, energy expenditure was measured using indirect calorimetry, and body composition was analyzed using magnetic resonance imaging.

RESULTS

Upper body adipose tissue (AT) decreased to a greater extent (p < 0.05) with functional oil (FctO) compared with olive oil (OL) consumption (-0.67 +/- 0.26 kg and -0.02 +/- 0.19 kg, respectively). There was a trend toward greater loss of whole-body subcutaneous AT volume (p = 0.087) with FctO compared with OL consumption. Average energy expenditure was 0.04 +/- 0.02 kcal/min greater (p < 0.05) on day 2 and 0.03 +/- 0.02 kcal/min (not significant) on day 28 with FctO compared with OL consumption. Similarly, average fat oxidation was greater (p = 0.052) with FctO compared with OL intake on day 2 but not day 28.

DISCUSSION

Consumption of a diet rich in MCTs results in greater loss of AT compared with LCTs, perhaps due to increased energy expenditure and fat oxidation observed with MCT intake. Thus, MCTs may be considered as agents that aid in the prevention of obesity or potentially stimulate weight loss.

Relation of parental history of coronary heart disease to obesity in young adults

OBJECTIVE

To assess the association between obesity and parental coronary heart disease (CHD) history.

DESIGN

Analysis of data from an ongoing, large-scale survey on medical status, health behaviour and attitudes.

SUBJECTS

Representative samples of Israeli military personnel upon discharge from compulsory service at age 20-22 y. Overall 14297 men and 11638 women were interviewed and examined upon release from military service between 1989 and 1999.

MEASUREMENTS

Data on demographic characteristics, family history of CHD, lifestyle, weight and height were collected. Analysis of variance and logistic regression were used.

RESULTS

Higher mean body mass index (BMI) and obesity (BMI>30 kg/m(2)) were associated with paternal CHD history in both sexes, and with maternal CHD history among men. Offspring of a parent with a positive CHD history had a higher mean BMI (23.22 vs 22.86 kg/m(2), P<0.001) and were more likely to be obese (5.4 vs 3.7%, P<0.001) than offspring of parents with no history of CHD. Multivariate adjustment for demographic and behavioural variables associated with obesity attenuated the association (adjusted odds ratio for obesity 1.37, 95% confidence interval: 1.15, 1.64). When stratified by sex, this association remained statistically significant only among males.

CONCLUSION

Young adults with a parental history of CHD are more likely to be overweight. This high-risk group should be targeted for early preventive activities.

Environmental and policy factors associated with overweight among adults in Missouri

PURPOSE

To measure the association between environmental and policy factors (i.e., community perceptions, community infrastructure, and worksite infrastructure) and being overweight.

DESIGN

Cross-sectional data from the Missouri Cardiovascular Disease Survey, a one-time random-digit-dialed telephone interview of noninstitutionalized adults.

SETTING

Missouri, 1999 to 2000.

SUBJECTS

The response rate was 69.6%. A total of 2821 adults completed the interview. The sample was weighted to represent the population of Missouri: 52% female, 71% white, and 59% overweight.

MEASURES

The survey comprised 92 closed-ended multiple-choice items. Overweight was defined as a body mass index greater than or equal to 25 kg/m2 on the basis of self-reported height and weight.

RESULTS

After adjustment for demographic and behavioral factors, environmental variables associated with being overweight included negative (i.e., unsafe and unpleasant) community perceptions (adjusted odds ratio [OR] = 1.6; 95% confidence interval [CI] = 1.1, 2.3) and the absence of outdoor exercise facilities (OR = 1.2; CI = 1.0, 1.5). Worksite policy variables were not related to the outcome; however, negative community perceptions (OR = 2.8; CI = 1.5, 5.2) and the absence of sidewalks and shoulders (OR = 1.7; CI = 1.3, 2.4) were associated with overweight among employed persons.

CONCLUSIONS

An ecological perspective, focusing on the physical and social environment, was adopted to address the subject of overweight and obesity. Results of this study show that negative perceptions of the physical environment and the absence of enabling infrastructure are modestly associated with overweight, in comparison with other known risk factors. Environmental and policy interventions that promote healthier lifestyles by encouraging physical activity and healthy eating may have an effect on reducing the prevalence of overweight and obesity.

Epidemiological research on cancer with a focus on Europe

Cancer has been a growing public health problem throughout the last century. Cancer mortality rates in both sexes combined in the European Union (EU) reached a peak in 1988. Thereafter, they declined by 9.4% in 1998. Likewise, lung cancer rates in the EU for both sexes combined increased by 58% between 1960 and 1988, but declined by 14% in 1998. Over a third of the decline was accounted for by lung cancer alone and approximately half by the combination of tobacco-related neoplasms. About half of the decline in total cancer mortality not attributable to tobacco derived from the steady fall in mortality from gastric cancer. The remaining half, including favourable trends in colorectal, breast, testis and lymphoid neoplasms, can be at least in part attributed to advancements in cancer diagnosis and treatment. The major causes of cancer and hence the most important priorities for research will be reviewed, with a specific focus on European priorities for research.

The reproductive health of daughters of pregestational diabetic women: Medical Birth Registry of Norway

Maternal diabetes may have an impact upon a daughter's reproductive health through genetic influences, an altered fetal metabolic environment or both. We examined the reproductive health of daughters of diabetic women using linked generation data from the Medical Birth Registry of Norway. Among all female births between 1967 and 1982 (n = 459182), 739 had a mother with registered pregestational diabetes, a rate of 1.6 per 1000 deliveries. A total of 142904 daughters delivered at least one child by 1998. After taking into account differences in survival, we observed no differences in the percentage of childbearing and in the average number of children born by 1998 between daughters with and without a diabetic mother in age-stratified analyses. In analyses limited to singleton deliveries and stratified by mothers' and daughters' diabetic status, we found a threefold excess stillbirth delivery rate among women who had either a mother with pregestational diabetes (2.6%) or pregestational diabetes themselves (2.6%) compared with the stillbirth delivery rate observed in non-diabetic women with no maternal history of diabetes (0.8%). These findings were unaltered in multivariable analyses adjusting for daughters' maternal age and registered obstetric risk factors. Our results indicate that pregestational diabetes remains a health care challenge in Norway and that further evaluation of the reproductive health of daughters of diabetic pregnancies is warranted.

Self-perception of being overweight in Spanish adults

OBJECTIVE

To describe the frequency, distribution and trend in misperceived overweight and obesity.

DESIGN

Three independent cross-sectional studies carried out in 1987, 1995 and 1997 over representative samples of Spanish adult population.

SETTING

Spanish adult population aged 20 y and over.

SUBJECTS AND INTERVENTIONS

A total of 11 496 men and women aged 20 y and over with a body mass index (BMI) >or=25 kg/m(2).

MAIN OUTCOME MEASURES

Prevalence and time trend of misperceived overweight and obesity based on self-perceived weight and height.

RESULTS

Some 28.4% of the population did not perceive themselves to be overweight or obese in 1987 (26.9% in 1995/97). Overweight was more frequently misperceived among men, persons over 64 y of age, those residing in rural areas and those with an elementary educational level. The largest percentages of misperceived overweight were in the more moderate levels of BMI: 50% of men and 30% of women with a BMI of 25-26.9 kg/m(2) in 1995/1997 did not perceive themselves to be overweight.

CONCLUSIONS

Misperceived overweight and obesity is frequent in the adult population in Spain. Some social and cultural factors may explain its higher frequency in men, older individuals and those with elementary level of education. The fact that most of those who do not perceive themselves to be overweight are in the moderate levels of overweight should be taken into account when designing strategies for the prevention and control of overweight and obesity in the general population.

Work-related physical activity is not associated with body mass index and obesity

OBJECTIVE

To analyze the association of work-related physical activity (WRPA) and leisure-time physical activity (LTPA) with body mass index (BMI) and obesity in the Spanish adult population aged 20 to 60 years.

RESEARCH METHODS AND PROCEDURES

The data were taken from the 1993 Spanish National Health Survey. We analyzed a sample of 12,044 men and women representative of the Spanish population aged 20 to 60 years. BMI and frequency of obesity (BMI > or = 30 kg/m(2)) were obtained from self-reported weight and height. Multiple linear regression and logistic regression models were constructed, adjusting for the main confounding factors. WRPA and LTPA were measured by two questions to classify subjects into four categories of physical activity.

RESULTS

Neither mean BMI nor percentage of obesity varied significantly (p > 0.05) by WRPA. Mean BMI was significantly higher (p < 0.01) in those who were inactive in their leisure time (25.90 kg/m(2) in men and 24.43 kg/m(2) in women) than in those who reported vigorous activity (24.42 kg/m(2) and 22.97 kg/m(2) in men and women, respectively). The odds ration (OR) for obesity decreased with increasing level of LTPA in both men (OR of 0.64 for vigorous activity) and women (OR = 0.68), showing a statistically significant dose-response relation in both men (for linear trend, p = 0.0021) and women (p = 0.0245).

DISCUSSION

These results raise questions about the association between WRPA and obesity and suggest the need to reexamine models of the obesity epidemic that point to automation of the workplace as one of the major explanatory factors.

Time trends of obesity in pre-school children in China from 1989 to 1997

OBJECTIVE

To examine predictors and time trends of obesity in pre-school children in China.

DESIGN

This study was based on data from China Health and Nutrition Survey, a longitudinal survey from 1989 to 1997.

SUBJECTS

For cross-sectional analysis, we included 944, 1058, 903 and 483 children aged 2-6 y in 1989, 1991, 1993 and 1997, respectively. For longitudinal analysis, we included 944 children and 3146 measurements during four time periods.

MEASURES

Overweight and obesity according to age- and sex-specific BMI cut-off points proposed by International Obesity Task Force.

RESULTS

The overall prevalence of obesity increased from 4.2% in 1989 to 6.4% in 1997 among children aged 2-6 y. The increase largely occurred in urban areas, where the prevalence of obesity increased from 1.5% in 1989 to 12.6% in 1997 and prevalence of overweight increased from 14.6 to 28.9% at the same period. Longitudinal analysis shows BMI increased by 0.2 kg/m2 per year in urban areas and 0.1 kg/m2 per year in rural areas. In multivariate analysis, overweight in early childhood (2-6 y), parental overweight, high income and urban areas independently predicted overweight at age 10-14 y.

CONCLUSION

A substantial increase in overweight and obesity among children aged 2-6 y was observed in urban areas in China from 1989 to 1997. Overweight in early childhood significantly predicted overweight during adolescence. Urgent public health strategies are needed to prevent childhood obesity in China.

Changes in cardiovascular disease risk factors among American Indians. The Strong Heart Study

PURPOSE

This study describes changes in cardiovascular disease (CVD) risk factors in older American Indians over a 4-year period.

METHODS

The Strong Heart Study, a longitudinal population-based study of CVD and CVD risk factors among American Indians aged 45-74 years, measured CVD risk factors among 3638 members of 13 tribes in three geographic areas during examinations in 1989 to 1991 and 1993 to 1995.

RESULTS

Changes in mean low-density lipoprotein (LDL) cholesterol and the prevalence of elevated LDL cholesterol were inconsistent. Mean high- density lipoprotein (HDL) cholesterol decreased, and the prevalence of low HDL cholesterol increased throughout. Mean systolic blood pressure and hypertension rates increased in nearly all center-sex groups, and hypertension awareness and treatment improved. Smoking rates decreased but remained higher than national rates except among Arizona women. Mean weight and percentage body fat decreased in nearly all center-sex groups but the prevalence of obesity did not change significantly in any group. Diabetes and albuminuria prevalence rates increased throughout the study population. The prevalence of alcohol use decreased, but binge drinking remained common in those who continued to drink.

CONCLUSIONS

Improvements in management and prevention of hypertension, diabetes, renal disease, and obesity, and programs to further reduce smoking and alcohol abuse, are urgently needed.

Obesity and body mass index in Spain: the 'single population' theory revisited

OBJECTIVE

The 'single population' theory suggests that the distribution of body mass index (BMI) moves up and down as a whole. We test directly whether this theory is valid among the adult population within one country over time, by examining the association between median BMI and the prevalence of obesity in the adult population of Spain's 17 regions between 1987 and 1993.

DESIGN AND SETTING

Ecological study using data from two national health surveys.

SUBJECTS AND INTERVENTIONS

Self-reported weight and height for persons aged 20-64 y were drawn from representative Spanish-population samples from two similar National Health Surveys carried out in 1987 (n = 20 705) and 1993 (n = 15 490).

MAIN OUTCOME MEASURES

Correlation and linear regression between the difference in median BMI and the difference in the prevalence of obesity (BMI > or = 30 kg/m(2)) between 1987 and 1993.

RESULTS

Between 1987 and 1993 the change in median BMI was in general strongly correlated with the change in the prevalence of obesity (r = 0.85; P < 0.001). The correlation is greater in women, persons over 45 y, and those with lower educational levels. Between 1987 and 1993 each unit of increase in median BMI is associated with an absolute increase of 5.1% (95% CI 3.3-6.8%) in the prevalence of obesity.

CONCLUSIONS

The single population hypothesis holds true among the adult population within a whole country over time. This could be useful for monitoring and understanding the prevalence of obesity within a population.

Temporal trends in BMI among adults with diabetes

OBJECTIVE

Increasing obesity within the general population has been accompanied by rising rates of diabetes. The extent to which obesity has increased among people with diabetes is unknown, as are the potential consequences for diabetes outcomes.

RESEARCH DESIGN AND METHODS

Community medical records (hospital and ambulatory) of all Rochester, Minnesota, residents aged > or =30 years who first met standardized research criteria for diabetes from 1970 to 1989 (n = 1,306) were reviewed to obtain data on BMI and related characteristics as of the diabetes identification date (+/-3 months). Vital status as of 31 December 1999 and date of death for those who died were obtained from medical records, State of Minnesota death tapes, and active follow-up.

RESULTS

As of the identification date, data on BMI were available for 1,290 cases. Of the 272 who first met diabetes criteria in 1970-1974, 33% were obese (BMI > or =30), including 5% who were extremely obese (BMI > or =40). These proportions increased to 49% (P < 0.001) and 9% (P = 0.012), respectively, for the 426 residents who first met diabetes criteria in 1985-1989. BMI increased significantly with increasing calendar year of diabetes identification in multivariable regression analysis. Analysis of survival revealed an increased hazard of mortality for BMI > or =41, relative to BMI of 23-25 (hazard ratio 1.60, 95% CI 1.09-2.34, P = 0.016).

CONCLUSIONS

The prevalence of obesity and extreme obesity among individuals at the time they first met criteria for diabetes has increased over time. This is disturbing in light of the finding that diabetic individuals who are extremely obese are at increased risk of mortality compared with their nonobese diabetic counterparts.

Prevalence and clinical implications of American Diabetes Association-defined diabetes and other categories of glucose dysregulation in older adults: the health, aging and body composition study

Using data on history of diabetes, fasting glucose (FG) and the oral glucose tolerance test (OGTT), the authors contrasted cardiovascular disease (CVD) risk factors (body mass index, blood pressure, lipids and glycated hemoglobin) in 3052 African-American and White adults aged 70-79 in mutually exclusive categories of diagnosed diabetes, undiagnosed diabetes defined by the American Diabetes Association (ADA), isolated post-challenge hyperglycemia (IPH; FG < 126 mg/dL and 2 h post-OGTT > or = 200 mg/dL), impaired fasting glucose (IFG; FG > or = 110 but < 126 mg/dL), and individuals who were non-diabetic by both ADA and World Health Organization (WHO) criteria (FG < 126 mg/dL and 2 h post-challenge glucose < 200 mg/dL). The prevalence of diagnosed diabetes, undiagnosed ADA diabetes and IPH were 15.2, 3.8 and 4.7%, respectively, with more diagnosed and undiagnosed ADA diabetes in African-Americans than Whites. Compared to mean glycated hemoglobin (HbA(1c)) among ADA/WHO non-diabetic individuals (6.0%), HbA(1c) was substantially higher in the diagnosed diabetes and undiagnosed ADA diabetes groups (8.0% and 7.7%), but not in the IPH group (6.3%). The diagnosed and undiagnosed ADA diabetic groups had worse CVD risk factor profiles than the ADA/WHO non-diabetic group. IPH subjects had elevated levels of some CVD risk factors, but differences were more modest than those for the diabetic groups. Among people with IPH, those who also had IFG had worse CVD profiles than those with IPH alone. Although the OGTT may identify additional adults with more CVD risk factors than normals, these differences appear to be clustered among those who also have IFG.

Fruit and vegetable consumption and diabetes mellitus incidence among U.S. adults

BACKGROUND

Adequate fruit and vegetable intake may lower the risk of several chronic diseases, but little is known about how it affects the risk of diabetes mellitus.

METHODS

We examined whether fruit and vegetable consumption was associated with diabetes incidence in a cohort of U. S. adults aged 25-74 years who were followed for about 20 years.

RESULTS

In the analytic sample of 9,665 participants, 1,018 developed diabetes mellitus. The mean daily intake of fruits and vegetables as well as the percentage of participants consuming five or more fruits and vegetables per day was lower among persons who developed diabetes than among persons who remained free of this disease (P < 0.001). After adjustments for age, race or ethnicity, cigarette smoking, systolic blood pressure, use of antihypertensive medication, serum cholesterol concentration, body mass index, recreational exercise, nonrecreational exercise, and alcohol consumption, the hazard ratio for participants consuming five or more servings of fruits and vegetables per day compared with those consuming none was 0.73 (95% confidence interval (CI), 0.54-0.98) for all participants, 0.54 (95% CI, 0.36-0.81) for women, and 1.09 (95% CI, 0.63-1.87) for men. Adding education to the model changed the hazard ratios to 0.79 (95% CI, 0.59-1.06) for all participants, 0.61 (95% CI, 0.42-0.88) for women, and 1.14 (95% CI, 0.67-1.93) for men.

CONCLUSIONS

Fruit and vegetable intake may be inversely associated with diabetes incidence particularly among women. Education may explain partly this association.

Increasing prevalence of overweight and obesity among Spanish adults, 1987-1997

OBJECTIVE

To study the trend in the prevalence of obesity and overweight in Spanish men and women 25-64 y of age between 1987 and 1997.

DESIGN

Cross-sectional surveys of representative samples of the non-institutionalized population in Spain in 1987, 1995 and 1997.

SUBJECTS

14,676 and 7004 adults aged 25-64 who were representative of the Spanish population in 1987 and 1995/1997.

MEASURES

Body mass index (BMI) calculated from self-reported weight and height. Overweight is defined as BMI = 27-29.9 kg/m2 and obesity as BMI > or = 30 kg/m2.

RESULTS

Between 1987 and 1995/97, the prevalence of overweight in the Spanish population aged 25-64 increased by 2.2% (P < 0.01); the increase was greater in men (3.8%; P < 0.01) than in women (0.6%; P > 0.05). The largest increases in the prevalence of overweight were seen in men (5.2%; P < 0.01) and women (2.3%; P < 0.05) aged 25-34. During the same period, the prevalence of obesity increased by 3.9% (P < 0.01), 4.6% in men (P < 0.01) and 3.2% in women (P < 0.01). The largest increases were seen in men aged 45-54 (6.5%, P < 0.01) and in women aged 25-34 (2.2%, P < 0.05). By educational level, the prevalence of overweight increased significantly in men with fewer than 12 y of education (4.7%, P < 0.01). Obesity increased by 4.6% (P < 0.01) and by 4.9% (P < 0.01) in men and women with fewer than 12 y of education, respectively.

CONCLUSIONS

The prevalence of overweight and obesity is increasing in Spain, the same as it is in other developed countries. The increase, which is found in most age and sex groups in the population, especially affects middle-aged men, young women and persons with lower educational level. The causes of the increase in the prevalence of overweight and obesity are likely to be multifactorial.

Rising trend in obesity in Mexican Americans and non-Hispanic whites: is it due to cigarette smoking cessation?

OBJECTIVE

Several studies have examined the influence of smoking cessation on weight gain. However, to date no study has examined this association in Mexican Americans (MA).

DESIGN

Using data collected from the San Antonio Heart Study, a population-based study of diabetes and cardiovascular disease, we examined the association between smoking cessation and weight gain in 1930 Mexican Americans and 1126 non-Hispanic whites (NHW). Smoking cessation was defined as self-reported smoking at baseline but not at follow-up.

RESULTS

Although there was no significant ethnic difference in the prevalence of smoking at baseline (27.2% in MA and 25.4% in NHW, P = 0.309), a greater proportion of MA smoked at follow-up compared to NHW (19.7% vs 16.5%, P = 0.037). However, there was no significant ethnic difference in the percentage of individuals who stopped smoking during the follow-up period. A two-fold greater percentage of MA quitters than NHW quitters became overweight or obese, defined as a body mass index greater than or equal to 25 kg/m2 (7.4% vs 3.1%). However, this difference did not quite reach statistical significance (P = 0.072). Using linear regression to predict change in weight or body mass index from baseline to follow-up, smoking cessation was predictive of either weight gain or BMI gain in both ethnic groups. However, smoking status accounted for only 1.0% of the variance in these outcomes, and the estimated risk of becoming overweight or obese attributable to smoking cessation was only 7.4% in MA and 3.1% in NHW.

CONCLUSION

We conclude that there is an ethnic difference in the influence of smoking cessation on weight gain in MA and NHW. However, in both ethnic groups this effect is quite small and makes only a slight contribution to the overall increase in prevalence of obesity in this population.

Contribution of chronic conditions to aggregate changes in old-age functioning

OBJECTIVES

This study explored the role of various chronic conditions in explaining recent improvements in functioning among older Americans.

METHODS

We used the Supplements on Aging to the 1984 and 1994 National Health Interview Surveys to examine changes among Americans 70 years and older in reports of chronic conditions and functional limitations. We decomposed functioning changes into condition-related components, controlling for demographic shifts.

RESULTS

The percentage of older Americans with upper- and lower-body limitations declined from 5.1% and 34.2%, respectively, in 1984 to 4.3% and 28.5% in 1995, and the average number of lower body limitations decreased. During the same period, reports of 8 of 9 chronic conditions increased, but many of these conditions had less debilitating effects on functioning. Reductions in the debilitating effects of various chronic conditions--particularly arthritis--are important in explaining declines in limitations experienced by older Americans.

CONCLUSIONS

Earlier diagnosis and improved treatment and management of chronic conditions, rather than prevention, may be important contributing factors to improvements in upper- and lower-body functioning among older Americans.

A profile of early versus late onset of obesity in postmenopausal women

Obesity is a serious health problem among women across the life span. Although people can become obese at any age, there is a large proportion of older women who have been obese since childhood. The purpose of this study was to determine whether postmenopausal women with an early versus late onset of obesity manifested differences in body habitus, eating behaviors, and mood. One hundred thirty-five postmenopausal women with obesity responded to self-report questionnaires on weight history, weight loss and maintenance expectancy, eating behaviors, and mood. Women with an early onset of obesity had a significantly higher body mass index (BMI), waist circumference, and highest attained adult body weight than women with a late onset of obesity. They had attempted a significantly larger number of diets and had lost more weight on any single diet. The groups also differed significantly on binge eating and overeating in response to negative affect. There was a tendency for women with an early onset to have more depressive and anxious symptoms. Postmenopausal women with an early onset of obesity differed physiologically and psychologically from those with a late onset. Tailoring dietary and behavioral interventions to profiles of postmenopausal women based on onset of obesity may improve the overall efficacy of weight loss programs.

Effects of obesity on pharmacokinetics implications for drug therapy

Obesity is a worldwide problem, with major health, social and economic implications. The adaptation of drug dosages to obese patients is a subject of concern, particularly for drugs with a narrow therapeutic index. The main factors that affect the tissue distribution of drugs are body composition, regional blood flow and the affinity of the drug for plasma proteins and/or tissue components. Obese people have larger absolute lean body masses as well as fat masses than non-obese individuals of the same age, gender and height. However, the percentage of fat per kg of total bodyweight (TBW) is markedly increased, whereas that chrome P450 isoforms are altered, but no clear overview of drug hepatic metabolism in obesity is currently available. Pharmacokinetic studies provide differing data on renal function in obese patients. This review analyses recent publications on several classes of drugs: antibacterials, anticancer drugs, psychotropic drugs, anticonvulsants, general anaesthetics, opioid analgesics, neuromuscular blockers, beta-blockers and drugs commonly used in the management of obesity. Pharmacokinetic studies in obesity show that the behaviour of molecules with weak or moderate lipophilicity (e.g. lithium and vecuronium) is generally rather predictable, as these drugs are distributed mainly in lean tissues. The dosage of these drugs should be based on the ideal bodyweight (IBW). However, some of these drugs (e.g. antibacterials and some anticancer drugs) are partly distributed in adipose tissues, and their dosage is based on IBW plus a percentage of the patient's excess bodyweight. There is no systematic relationship between the degree of lipophilicity of markedly lipophilic drugs (e.g. remifentanil and some beta-blockers) and their distribution in obese individuals. The distribution of a drug between fat and lean tissues may influence its pharmacokinetics in obese patients. Thus, the loading dose should be adjusted to the TBW or IBW, according to data from studies carried out in obese individuals. Adjustment of the maintenance dosage depends on the observed modifications in clearance. Our present knowledge of the influence of obesity on drug pharmacokinetics is limited. Drugs with a small therapeutic index should be used prudently and the dosage adjusted with the help of drug plasma concentrations.

The relation between dietary change and rising US obesity

OBJECTIVE

To determine if the source from which food is obtained has contributed to the increased obesity of the US population, while controlling for demographic, lifestyle and regional factors.

METHODS

Multiple regression was used to estimate the effect of food source on body mass index (BMI) while accounting for other factors which have been shown to affect obesity in a nationally representative sample of the US population.

SAMPLE

This study used secondary data from the 1994-1996 Continuing Survey of Food Intake by Individuals (CSFII). The CSFII is a nationally representative sample of 16,103 individuals, obtaining for each respondent 24 h recalls of all food intake on two nonconsecutive days as well as demographics and information on lifestyle choices.

RESULTS

For a large number of demographic and lifestyle factors, our results support those which have previously been found to contribute to increased overweight. Our contribution is to examine whether the source from which food is obtained also contributes to increased overweight. Our evidence suggests that this is the case. The average height for males in our sample was 1.77 m. For two such males, one who ate food away from home (FAFH) during the previous 24 h period and the other who did not, results suggest that the first will be about 1 kg heavier, all other factors being equal. For two females of average height (1.63 m) the same is true for those who ate fast food, but not at restaurants. In all cases, except females who ate at restaurants, the effects are significant in the regression (P<0.05).

CONCLUSION

The trends in both increased US obesity and in increased consumption of FAFH are unlikely to be coincidental. FAFH, and particularly fast food consumption, are likely to be contributing factors to increased obesity.

Relation of weight gain and weight loss on subsequent diabetes risk in overweight adults

STUDY OBJECTIVE

To determine whether long term weight gain and weight loss are associated with subsequent risk of type 2 diabetes in overweight, non-diabetic adults.

DESIGN

Prospective cohort. Baseline overweight was defined as BMI>/=27.3 for women and BMI>/=27. 8 for men. Annual weight change (kg/year) over 10 years was calculated using measured weight at subjects' baseline and first follow up examinations. In the 10 years after measurement of weight change, incident cases of diabetes were ascertained by self report, hospital discharge records, and death certificates.

SETTING

Community.

PARTICIPANTS

1929 overweight, non-diabetic adults.

MAIN RESULTS

Incident diabetes was ascertained in 251 subjects. Age adjusted cumulative incidence increased from 9.6% for BMI<29 to 26. 2% for BMI>/=37. Annual weight change over 10 years was higher in subjects who become diabetic compared with those who did not for all BMI<35. Relative to overweight people with stable weight, each kg of weight gained annually over 10 years was associated with a 49% increase in risk of developing diabetes in the subsequent 10 years. Each kg of weight lost annually over 10 years was associated with a 33% lower risk of diabetes in the subsequent 10 years.

CONCLUSIONS

Weight gain was associated with substantially increased risk of diabetes among overweight adults, and even modest weight loss was associated with significantly reduced diabetes risk. Minor weight reductions may have major beneficial effects on subsequent diabetes risk in overweight adults at high risk of developing diabetes.