Addressing Childhood Obesity for Type 2 Diabetes Prevention: Challenges and Opportunities

IN BRIEF Addressing the problem of childhood obesity is an important component of preventing type 2 diabetes. Although children and their families ultimately make decisions about diet, physical activity, and obesity management, many groups have a role in making these choices easier. They do this by providing families with tools and resources and by implementing policies and practices that support a healthy diet and physical activity in the places where children and their families spend their time. Diabetes educators are an important part of the solution.

Tracking and Variability in Childhood Levels of BMI: The Bogalusa Heart Study

OBJECTIVE

Although the tracking of BMI levels from childhood to adulthood has been examined, there is little information on the within-person variability of BMI.

METHODS

Longitudinal data from 11,591 schoolchildren, 3,096 of whom were reexamined as adults, were used to explore the tracking and variability of BMI levels. This article focuses on changes in age-adjusted levels of BMI.

RESULTS

There was strong tracking of BMI levels. The correlation of adjusted BMI levels was r = 0.88, and 78% of children with severe obesity at one examination had severe obesity at the next examination (mean interval, 2.7 years). Further, an increase in adjusted BMI from +5 kg/m² (above the median) to + 10 increased the risk for adult BMI ≥ 40 by 2.7-fold. However, BMI levels among children and adolescents were variable. Over a 9- to 15-month interval, the SD of adjusted BMI change was 0.9 kg/m² , and 0.7% of children had an absolute change ≥ 3.5. This variability was associated with the interval between examinations and with the initial BMI.

CONCLUSIONS

Despite the high degree of tracking of BMI, annual changes of 3.5 kg/m² or more are plausible. Knowledge of this variability is important when following a child over time.

Supporting Active Living Through Community Plans: The Association of Planning Documents With Design Standards and Features

PURPOSE

The purpose of this study was to examine the association between the presence of supportive community planning documents in US municipalities with design standards and requirements supportive of active living.

DESIGN

Cross-sectional study using data from the 2014 National Survey of Community-Based Policy and Environmental Supports for Healthy Eating and Active Living.

SETTING

Nationally representative sample of US municipalities.

PARTICIPANTS

Respondents are 2005 local officials.

MEASURES

Assessed: (1) The presence of design standards and feature requirements and (2) the association between planning documents and design standards and feature requirements supportive of active living in policies for development.

ANALYSIS

Using logistic regression, significant trends were identified in the presence of design standards and feature requirements by plan and number of supportive objectives present.

RESULTS

Prevalence of design standards ranged from 19% (developer dedicated right-of-way for bicycle infrastructure development) to 50% (traffic-calming features in areas with high pedestrian and bicycle volume). Features required in policies for development ranged from 14% (short/medium pedestrian-scale block sizes) to 44% (minimum sidewalk widths of 5 feet) of municipalities. As the number of objectives in municipal plans increased, there was a significant and positive trend ( P < .05) in the prevalence of each design standard and requirement.

CONCLUSIONS

Municipal planning documents containing objectives supportive of physical activity are associated with design standards and feature requirements supportive of activity-friendly communities.

Vital Signs: Trends in Incidence of Cancers Associated with Overweight and Obesity - United States, 2005-2014

Background

Overweight and obesity are associated with increased risk of at least 13 different types of cancer.

Methods

Data from the United States Cancer Statistics for 2014 were used to assess incidence rates, and data from 2005 to 2014 were used to assess trends for cancers associated with overweight and obesity (adenocarcinoma of the esophagus; cancers of the breast [in postmenopausal women], colon and rectum, endometrium, gallbladder, gastric cardia, kidney, liver, ovary, pancreas, and thyroid; meningioma; and multiple myeloma) by sex, age, race/ethnicity, state, geographic region, and cancer site. Because screening for colorectal cancer can reduce colorectal cancer incidence through detection of precancerous polyps before they become cancerous, trends with and without colorectal cancer were analyzed.

Results

In 2014, approximately 631,000 persons in the United States received a diagnosis of a cancer associated with overweight and obesity, representing 40% of all cancers diagnosed. Overweight- and obesity-related cancer incidence rates were higher among older persons (ages ≥50 years) than younger persons; higher among females than males; and higher among non-Hispanic black and non-Hispanic white adults compared with other groups. Incidence rates for overweight- and obesity-related cancers during 2005–2014 varied by age, cancer site, and state. Excluding colorectal cancer, incidence rates increased significantly among persons aged 20–74 years; decreased among those aged ≥75 years; increased in 32 states; and were stable in 16 states and the District of Columbia.

Conclusions

The burden of overweight- and obesity-related cancer is high in the United States. Incidence rates of overweight- and obesity-related cancers except colorectal cancer have increased in some age groups and states.

Implications for Public Health Practice

The burden of overweight- and obesity-related cancers might be reduced through efforts to prevent and control overweight and obesity. Comprehensive cancer control strategies, including use of evidence-based interventions to promote healthy weight, could help decrease the incidence of these cancers in the United States.

Developmental Process and Early Phases of Implementation for the US Interagency Committee on Human Nutrition Research National Nutrition Research Roadmap 2016-2021

The Interagency Committee on Human Nutrition Research (ICHNR) is charged with improving the planning, coordination, and communication among federal agencies engaged in nutrition research and with facilitating the development and updating of plans for federal research programs to meet current and future domestic and international needs for nutrition. The ICHNR is co-chaired by the USDA Under Secretary for Research, Education, and Economics and Chief Scientist and the US Department of Health and Human Services Assistant Secretary for Health and is made up of >10 departments and agencies. Once the ICHNR was reassembled after a 10-y hiatus, the ICHNR recognized a need for a written roadmap to identify critical human nutrition research gaps and opportunities. This commentary provides an overview of the process the ICHNR undertook to develop a first-of-its-kind National Nutrition Research Roadmap, which was publicly released on 4 March 2016. The primary audience for the Roadmap is federal science agency leaders, along with relevant program and policy staff who rely on federally supported human nutrition research, in addition to the broader scientific community. The Roadmap is framed around the following 3 questions: 1) How can we better understand and define eating patterns to improve and sustain health? 2) What can be done to help people choose healthy eating patterns? 3) How can we develop and engage innovative methods and systems to accelerate discoveries in human nutrition? Within these 3 questions, 11 topical areas were identified on the basis of the following criteria: population impact, feasibility given current technological capacities, and emerging scientific opportunities. This commentary highlights initial federal and some professional research society efforts to address the Roadmap's research and resource priorities. We conclude by noting examples of early collaborations and partnerships to move human nutrition research forward in the 21st century.

Sociodemographic and Behavioral Factors Associated with Added Sugars Intake among US Adults

BACKGROUND

Reducing added sugars intake is one of the Healthy People 2020 objectives. High added sugars intake may be associated with adverse health consequences.

OBJECTIVE

This cross-sectional study identified sociodemographic and behavioral characteristics associated with added sugars intake among US adults (18 years and older) using the 2010 National Health Interview Survey data (n=24,967).

METHODS

The outcome variable was added sugars intake from foods and beverages using scoring algorithms to convert dietary screener frequency responses on nine items to estimates of individual dietary intake of added sugars in teaspoons per day. Added sugars intake was categorized into tertiles (lowest, middle, highest) stratified by sex. The explanatory variables were sociodemographic and behavioral characteristics. Multinomial logistic regression was used to estimate the adjusted odds ratios for the highest and middle tertile added sugars intake groups as compared with the lowest tertile group.

RESULTS

Estimated median added sugars intake was 17.6 tsp/d for men and 11.7 tsp/d for women. For men and women, those who had significantly greater odds for being in the highest tertile of added sugars intake (men: ≥22.0 tsp/d; women: ≥14.6 tsp/d) were younger, less educated, had lower income, were less physically active, were current smokers, and were former or current infrequent/light drinkers, whereas non-Hispanic other/multiracial and those living in the West had significantly lower odds for being in the highest tertile of added sugars intake. Different patterns were found by sex. Non-Hispanic black men had lower odds for being in the highest tertile of added sugars intake, whereas non-Hispanic black women had greater odds for being in the highest tertile.

CONCLUSIONS

One in three men consumed ≥22.0 tsp added sugars and one in three women consumed ≥14.6 tsp added sugars daily. Higher added sugars intake was associated with various sociodemographic and behavioral characteristics; this information can inform efforts to design programs and policies specific to high-intake populations.

Cost-Effectiveness of Osteoporosis Screening and Treatment with Hormone Replacement Therapy, Raloxifene, or Alendronate

Recent information about osteoporosis treatments and their nonfracture side effects suggests the need for a new costeffectiveness analysis. The authors estimate the cost effectiveness of screening women for osteoporosis at age 65 and treating those who screen positive with hormone replacement therapy (HRT), raloxifene, or alendronate. A Markov model of osteoporosis disease progression simulates costs and outcomes of women aged 65 years. Incremental cost effectiveness ratios of screen-and-treat strategies are calculated relative to a no-screen, no-treat (NST) strategy. Disease progression parameters are derived from clinical trials; cost and quality-of-life parameters are based on review of cost databases and cost-effectiveness studies. Women are screened using dual-energy x-ray absorptiometry, and women screening positive are treated with HRT, raloxifene, or alendronate. Screening and treatment with HRT increase costs and lower quality-adjusted life years (QALYs; relative to the NST strategy). The only scenario (of several) in the sensitivity analysis in which HRT increases QALYs is when it is assumed that there are no drug-related (nonfracture) health effects. Raloxifene increases costs and QALYs; its cost-effectiveness ratio is $447,559 per QALY. When prescribed for the shortest duration modeled, raloxifene’s cost-effectiveness ratio approached $133,000 per QALY. Alendronate is the most cost-effective strategy; its cost-effectiveness ratio is $72,877 per QALY. Alendronate’s cost-effectiveness ratio approaches $55,000 per QALY when treatment effects last for 5 years or the discount rate is set to zero. The authors conclude that screening and treating with alendronate are more costeffective than screening and treating with raloxifene or HRT. Relative to an NST strategy, alendronate has a fairly good cost-effectiveness ratio

Regional Differences in Sugar-Sweetened Beverage Intake among US Adults

BACKGROUND

Higher consumption of sugar-sweetened beverages (SSBs) is associated with obesity and type 2 diabetes, and the prevalence of obesity varies by geographic region. Although information on whether SSB intake differs geographically could be valuable for designing targeted interventions, this information is limited.

OBJECTIVE

This cross-sectional study examined associations between living in specific census regions and frequency of SSB consumption among US adults using 2010 National Health Interview Survey data (n=25,431).

METHODS

SSB consumption was defined as the consumption of four types of beverages (regular sugar-sweetened carbonated beverages, fruit drinks, sports/energy drinks, and sweetened coffee/tea drinks). The exposure variable was census region of residence (Northeast, Midwest, South, and West). We used multivariable logistic regression to estimate adjusted odds ratios (aORs) and 95% CIs for drinking SSBs after controlling for sociodemographic characteristics.

RESULTS

Approximately 64% of adults consumed SSBs ≥1 time/day. The odds of drinking SSBs ≥1 time/day were significantly higher among adults living in the Northeast (aOR=1.13; 95% CI=1.01, 1.26) but lower among adults living in the Midwest (aOR=0.70; 95% CI=0.64, 0.78) or West (aOR=0.78; 95% CI=0.71, 0.87) compared with those living in the South. By type of SSB, the odds of drinking regular soda ≥1 time/day was significantly lower among adults living in the Northeast (aOR=0.51; 95% CI=0.45, 0.57), Midwest (aOR=0.86; 95% CI=0.78, 0.96), or West (aOR=0.56; 95% CI=0.51, 0.62) than those living in the South. The odds of drinking sports/energy drinks ≥1 time/day were significantly lower among adults living in the West (aOR=0.77; 95% CI=0.64, 0.93) than those living in the South. The odds of drinking a sweetened coffee/tea drink ≥1 time/day were significantly higher among adults living in the Northeast (aOR=1.60; 95% CI=1.43, 1.78) but lower among adults living in the Midwest (aOR=0.70; 95% CI=0.62, 0.78) than those living in the South.

CONCLUSIONS

Total frequency of SSB consumption and types of SSB consumption differed by geographic region. Interventions to reduce SSB intake could consider regional variations in SSB intake, particularly when more local data are not available.

Associations of Physical Activity and Sedentary Behaviors with Dietary Behaviors among US High School Students

BACKGROUND

Physical activity (PA), sedentary behaviors, and dietary behaviors are each associated with overweight and obesity among youth. However, the associations of PA and sedentary behaviors with dietary behaviors are complex and not well understood.

PURPOSE

To describe the associations of PA and sedentary behaviors with dietary behaviors among a representative sample of US high school students.

METHODS

We analyzed data from the 2010 National Youth Physical Activity and Nutrition Study (NYPANS). Using logistic regression models which controlled for sex, race/ethnicity, grade, body weight status, and weight management goals, we compared dietary behaviors among students who did and did not meet national recommendations for PA and sedentary behaviors.

RESULTS

Students who participated in recommended levels of daily PA (DPA) and muscle strengthening PA (MSPA) were more likely than those who did not to eat fruits and vegetables. Students who exceeded recommended limits for television (TV) and computer/video game (C/VG) screen time were less likely than those who did not to consume fruits and vegetables and were more likely to consume fast food and sugar-sweetened beverages.

CONCLUSIONS

Researchers may want to address PA, sedentary behaviors, and dietary behaviors jointly when developing health promotion and obesity prevention programs for youth.

Vital signs: sodium intake among U.S. school-aged children - 2009-2010

BACKGROUND

A national health objective is to reduce average U.S. sodium intake to 2,300 mg daily to help prevent high blood pressure, a major cause of heart disease and stroke. Identifying common contributors to sodium intake among children can help reduction efforts.

METHODS

Average sodium intake, sodium consumed per calorie, and proportions of sodium from food categories, place obtained, and eating occasion were estimated among 2,266 school-aged (6–18 years) participants in What We Eat in America, the dietary intake component of the National Health and Nutrition Examination Survey, 2009–2010.

RESULTS

U.S. school-aged children consumed an estimated 3,279 mg of sodium daily with the highest total intake (3,672 mg/d) and intake per 1,000 kcal (1,681 mg) among high school–aged children. Forty-three percent of sodium came from 10 food categories: pizza, bread and rolls, cold cuts/cured meats, savory snacks, sandwiches, cheese, chicken patties/nuggets/tenders, pasta mixed dishes, Mexican mixed dishes, and soups. Sixty-five percent of sodium intake came from store foods, 13% from fast food/pizza restaurants, 5% from other restaurants, and 9% from school cafeteria foods. Among children aged 14–18 years, 16% of total sodium intake came from fast food/pizza restaurants versus 11% among those aged 6–10 years or 11–13 years (p<0.05). Among children who consumed a school meal on the day assessed, 26% of sodium intake came from school cafeteria foods. Thirty-nine percent of sodium was consumed at dinner, followed by lunch (29%), snacks (16%), and breakfast (15%).

IMPLICATIONS FOR PUBLIC HEALTH PRACTICE

Sodium intake among school-aged children is much higher than recommended. Multiple food categories, venues, meals, and snacks contribute to sodium intake among school-aged children supporting the importance of populationwide strategies to reduce sodium intake. New national nutrition standards are projected to reduce the sodium content of school meals by approximately 25%–50% by 2022. Based on this analysis, if there is no replacement from other sources, sodium intake among U.S. school-aged children will be reduced by an average of about 75–150 mg per day and about 220–440 mg on days children consume school meals.

Breastfeeding duration is associated with child diet at 6 years

BACKGROUND AND OBJECTIVE

Breastfeeding has been associated with early infant food preferences, but less is known about how breastfeeding is associated with later child diet. The objective of this study was to assess whether any and exclusive breastfeeding duration are associated with child diet at 6 years.

METHODS

We linked data from the Infant Feeding Practices Study II and Year 6 Follow-Up. We used approximately monthly questionnaires throughout infancy to calculate any and exclusive breastfeeding duration (n = 1355). We calculated median daily frequency of intake of water, milk, 100% juice, fruits, vegetables, sugar-sweetened beverages, sweets, and savory snacks at 6 years from a dietary screener and examined frequency of consumption of each food or beverage group by any and exclusive breastfeeding duration. We used separate multivariable logistic regression models to calculate odds of consuming more than the median daily frequency of intake of food or beverage items, adjusting for confounders.

RESULTS

Intake of milk, sweets, and savory snacks at 6 years was not associated with any or exclusive breastfeeding duration in unadjusted analyses. Frequency of consumption of water, fruits, and vegetables was positively associated, and intake of sugar-sweetened beverages was inversely associated with any and exclusive breastfeeding duration in adjusted models; 100% juice consumption was inversely associated with exclusive breastfeeding duration only.

CONCLUSIONS

Among many other health benefits, breastfeeding is associated with a number of healthier dietary behaviors at age 6. The association between breastfeeding and child diet may be an important factor to consider when examining associations between breastfeeding and child obesity and chronic diseases.

A longitudinal analysis of sugar-sweetened beverage intake in infancy and obesity at 6 years

OBJECTIVE

To examine whether sugar-sweetened beverage (SSB) intake during infancy predicts obesity at age 6 years.

METHODS

We included 1189 children who participated in the Infant Feeding Practices Study II in 2005-2007 and were followed up at 6 years in 2012. Children's weight and height were measured by mothers. Obesity was defined as gender-specific BMI-for-age ≥95th percentile. We used logistic regression to estimate the associations of any SSB intake and age at SSB introduction before 12 months and mean SSB intake during ages 10 to 12 months with obesity at 6 years controlling for baseline characteristics.

RESULTS

The obesity prevalence at 6 years among children who consumed SSBs during infancy was twice as high as that among non-SSB consumers (17.0% vs 8.6%). The adjusted odds of obesity at 6 years was 71% higher for any SSB intake and 92% higher for SSB introduction before 6 months compared with no SSB intake during infancy. Children who consumed SSBs ≥3 times per week during ages 10 to 12 months had twice the odds of obesity compared with those who consumed no SSBs in this period. However, among children who consumed SSBs, the odds of obesity at 6 years did not differ by age at SSB introduction during infancy or by mean weekly SSB intake during ages 10 to 12 months.

CONCLUSIONS

Children who consumed SSBs during infancy had higher odds of obesity at 6 years than non-SSB consumers. SSB consumption during infancy may be a risk factor for obesity in early childhood. Whether unmeasured behaviors contributed to the association is unclear.

Associations of body mass index with sexual risk-taking and injection drug use among US high school students

The purpose of this study was to determine if body mass index (BMI) is associated with behaviors that may increase risk for HIV and other sexually transmitted diseases (STDs) among US high school students. We analyzed nationally representative data from the 2005-2011 national Youth Risk Behavior Surveys (YRBS) to examine associations of BMI categories with sexual risk behaviors and injection drug use among sexually active high school students, using sex-stratified logistic regression models. Controlling for race/ethnicity and grade, among female and male students, both underweight (BMI < 5th percentile) and obesity (BMI ≥ 95th percentile) were associated with decreased odds of being currently sexually active (i.e., having had sexual intercourse during the past 3 months). However, among sexually active female students, obese females were more likely than normal weight females to have had 4 or more sex partners (odds ratio, OR = 1.59), not used a condom at last sexual intercourse (OR = 1.30), and injected illegal drugs (OR = 1.98). Among sexually active male students, overweight (85th percentile ≤ BMI < 95th percentile) was associated with not using a condom at last sexual intercourse (OR = 1.19) and obesity was associated with injection drug use (OR = 1.42). Among sexually active students, overweight and obesity may be indicators of increased risk for HIV and other STDs.

Weight Counseling Patterns of U.S. Pediatricians

OBJECTIVE

To estimate the proportion and characteristics of U.S. pediatricians who reportedly counsel their patients about maintaining a healthy weight.

RESEARCH METHODS AND PROCEDURES

Beginning in October 1998, information was collected from 813 primary care pediatricians randomly selected from a nationally representative sample. Pediatricians were asked how frequently they counseled about maintaining a healthy weight during the well-care visits of patients in three age groups. Multivariable logistic regression determined which physician characteristics were associated with counseling.

RESULTS

Approximately fifty percent of pediatricians reportedly always counseled about maintaining a healthy weight. Those who always counseled were more likely to be women, to spend more time with patients during well-care visits, and to conduct more well-care visits per week from patients in one particular age group. Most pediatricians who responded that they always counseled about healthy weight reported that they counseled about physical activity and nutrition, but not about balancing caloric intake with expenditure.

DISCUSSION

Although many pediatricians report counseling about healthy weight, the frequency of counseling might be further increased by increasing the amount of time the patient spends during office visits with the pediatrician or with other professional staff, such as nurses or dietitians.

Knowledge of energy balance guidelines and associated clinical care practices: the U.S. National Survey of Energy Balance Related Care among Primary Care Physicians

OBJECTIVE

To assess primary care physicians' (PCPs) knowledge of energy balance related guidelines and the association with sociodemographic characteristics and clinical care practices.

METHOD

As part of the 2008 U.S. nationally representative National Survey of Energy Balance Related Care among Primary Care Physicians (EB-PCP), 1776 PCPs from four specialties who treated adults (n=1060) or children and adolescents (n=716) completed surveys on sociodemographic information, knowledge of energy balance guidelines, and clinical care practices.

RESULTS

EB-PCP response rate was 64.5%. For PCPs treating children, knowledge of guidelines for healthy BMI percentile, physical activity, and fruit and vegetables intake was 36.5%, 27.0%, and 62.9%, respectively. For PCPs treating adults, knowledge of guidelines for overweight, obesity, physical activity, and fruit and vegetables intake was 81.4%, 81.3%, 70.9%, and 63.5%, respectively. Generally, younger, female physicians were more likely to exhibit correct knowledge. Knowledge of weight-related guidelines was associated with assessment of body mass index (BMI) and use of BMI-for-age growth charts.

CONCLUSION

Knowledge of energy balance guidelines among PCPs treating children is low, among PCPs treating adults it appeared high for overweight and obesity-related clinical guidelines and moderate for physical activity and diet, and was mostly unrelated to clinical practices among all PCPs.

Association of Sleep Duration with Obesity among US High School Students

Increasing attention is being focused on sleep duration as a potential modifiable risk factor associated with obesity in children and adolescents. We analyzed data from the national Youth Risk Behavior Survey to describe the association of obesity (self-report BMI ≥95th percentile) with self-reported sleep duration on an average school night, among a representative sample of US high school students. Using logistic regression to control for demographic and behavioral confounders, among female students, compared to 7 hours of sleep, both shortened (≤4 hours of sleep; adjusted odds ratio (95% confidence interval), AOR = 1.50 (1.05-2.15)) and prolonged (≥9 hours of sleep; AOR = 1.54 (1.13-2.10)) sleep durations were associated with increased likelihood of obesity. Among male students, there was no significant association between obesity and sleep duration. Better understanding of factors underlying the association between sleep duration and obesity is needed before recommending alteration of sleep time as a means of addressing the obesity epidemic among adolescents.

U.S. primary care physicians' diet-, physical activity-, and weight-related care of adult patients

BACKGROUND

Overweight and obesity are substantial problems in the U.S., but few national studies exist on primary care physicians' (PCPs') clinical practices regarding overweight and obesity.

PURPOSE

To profile diet, physical activity, and weight control practice patterns of PCPs who treat adults.

METHODS

A nationally representative survey of 1211 PCPs sampled from the American Medical Association's Masterfile was conducted in 2008 and analyzed in 2010. Outcomes included PCPs' assessment, counseling, referral, and follow-up of diet, physical activity, and weight control in adult patients with and without chronic disease and PCPs' use of pharmacologic treatments and surgical referrals for overweight and obesity.

RESULTS

The survey response rate was 64.5%. Half of PCPs (49%) reported recording BMI regularly. Fewer than 50% reported always providing specific guidance on diet, physical activity, or weight control. Regardless of patients' chronic disease status, <10% of PCPs always referred patients for further evaluation/management and <22% reported always systematically tracking patients over time concerning weight or weight-related behaviors. Overall, PCPs were more likely to counsel on physical activity than on diet or weight control (p's<0.05). More than 70% of PCPs reported ever using pharmacologic treatments to treat overweight and 86% had referred for obesity-related surgery.

CONCLUSIONS

PCPs' assessment and behavioral management of overweight and obesity in adults is at a low level relative to the magnitude of the problem in the U.S. Further research is needed to understand barriers to providing care and to improve physician engagement in tracking and managing healthy lifestyles in U.S. adults.

Pediatricians' and family physicians' weight-related care of children in the U.S

BACKGROUND

Few national data exist to assess primary care physicians' (PCPs') clinical practices with regard to childhood obesity.

PURPOSE

To survey pediatricians and family practice physicians regarding their assessment, counseling, and management of diet, physical activity, and weight status among pediatric patients in the primary care setting.

METHODS

A nationally representative cross-sectional survey of pediatricians and family practice physicians sampled from the American Medical Association (AMA) Masterfile was conducted in 2008 and analyzed in 2010. Outcomes included physicians' self-reported practice behaviors regarding assessments of pediatric patients' weight status, counseling of diet and physical activity, and referrals and follow-ups.

RESULTS

Response rate excluding physicians listed as "no-contact" by the AMA was 73.7% among pediatricians and 66.9% among family physicians. Less than 50% of all PCPs assessed BMI percentiles regularly in children. Eighteen percent of all PCPs reported referring children for further evaluation or management. Fifty-eight percent of all PCPs reported never, rarely, or only sometimes tracking patients over time concerning weight or weight-related behaviors. Pediatricians were more likely than family physicians to assess weight status and provide behavioral counseling (p's<0.001).

CONCLUSIONS

Active PCP participation in assessing or managing childhood obesity in the primary care setting appears low relative to the frequency of the problem in the U.S. Interventions to reduce the barriers to physician engagement in the assessment and management of healthy lifestyles are needed to prevent and control childhood obesity.

Weight loss advice U.S. obese adults receive from health care professionals

OBJECTIVES

To estimate the prevalence of obese patients advised by health professionals about weight loss and weight loss strategies.

METHODS

A national sample of 1873 obese adults (body mass index > or = 30 kg/m(2), > or = 18 years) was surveyed. Multivariable linear regression was used to determine characteristics associated with receiving weight loss advice, and advice on diet and physical activity. Linear regression was used to evaluate characteristics associated with how much weight loss was advised.

RESULTS

Among obese adults visiting a physician (past 12 months), 39.0% reported being advised to lose weight. Men had lower odds of being advised to lose weight. Adults 40-49 years of age, reporting fair/poor health, and chronic diseases had greater odds of being advised to lose weight compared to referent groups. Among adults receiving advice on amount of weight to lose, a mean 20.9% total body weight reduction was recommended. Of those advised to lose weight, 64.2% were told to change their diet, 85.7% to increase physical activity, and 58.5% to use both strategies.

CONCLUSIONS

Obese adults should be advised by health professionals more frequently about weight loss and the use of caloric reduction and increased physical activity as the recommended weight loss strategy.

Weight management and fruit and vegetable intake among US high school students

BACKGROUND

Consumption of fruits and vegetables is often recommended to promote healthy weight. The purpose of this study was to examine associations between fruit and vegetable intake and common weight management behaviors among US high school students who were trying to lose or stay the same weight.

METHODS

Data from the 1999, 2001, and 2003 national high school Youth Risk Behavior Surveys were combined and the analyses stratified by gender (females, N = 16,709; males, N = 10,521). We considered 3 common weight management strategies--being physically active (ie, moderate activity for 30 minutes on 5 or more days per week or vigorous activity for 20 minutes on 3 or more days per week), eating a reduced calorie or fat diet, and limiting TV viewing. Sufficient fruit and vegetable intake was defined as eating 5 or more servings per day. Odds ratios (ORs) were calculated using logistic regression.

RESULTS

Only 21.3% of females and 24.7% of males ate sufficient fruits and vegetables. Being physically active was associated with sufficient fruit and vegetable intake. Eating a reduced calorie or fat diet and limiting TV viewing (among males) were associated with sufficient fruit and vegetable intake only among physically active students. The odds of sufficient fruit and vegetable intake were greatest among female (OR = 3.01) and male (OR = 2.91) students who combined all 3 strategies (31.5% of females, 21.6% of males).

CONCLUSIONS

Interventions that promote fruit and vegetable intake within the context of healthy weight management may be more effective if they combine nutrition and physical activity strategies. Further research is needed to test this approach.

Relationships between body size satisfaction and weight control practices among US adults

CONTEXT

Few studies of US adults have specifically examined body size satisfaction

OBJECTIVES

Describe correlates of body size satisfaction and examine whether satisfaction was associated with trying to lose weight or specific weight control practices among US adults using a national sample of women and men.

DESIGN, SETTING & PARTICIPANTS

The National Physical Activity and Weight Loss Survey (NPAWLS) was a population-based, cross-sectional telephone survey of US adults (n = 9740).

MAIN OUTCOME MEASURES

Participants reported their weight, height, body size satisfaction, and weight loss practices. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for each dependent variable.

RESULTS

Among women and men, higher body mass index (BMI) was significantly associated with body size dissatisfaction. Dissatisfaction, compared with being very satisfied, was positively associated with trying to lose weight among women and men. This association was modified by BMI for women (OR normal weight = 19.69, overweight = 8.79, obese = 4.05; P < .01 for interaction) but not men (OR normal weight = 8.72, overweight = 10.50, obese = 7.86; P = 0.93 for interaction). Compared with women who were very satisfied, dissatisfied women used diet more (OR = 2.03), but not physical activity/exercise (OR = 0.55) or both strategies (OR = 0.63), to try to lose weight. Men who were somewhat satisfied, compared with those who were very satisfied, were more likely to use physical activity/exercise (OR = 1.64) and both diet and physical activity/exercise (OR = 1.54) to try to lose weight.

CONCLUSION

These findings highlight the sex differences in body size satisfaction, actions taken to try to lose weight, and the importance of considering body size satisfaction when designing weight-management programs.