Physical Activity-Friendly Policies and Community Design Features in the US, 2014 and 2021

INTRODUCTION

The 2014 Community-Based Survey of Supports for Healthy Eating and Active Living documented the prevalence of US municipal policy and community design supports for physical activity. The survey was repeated in 2021. Our study examined change in the prevalence of supports from 2014 to 2021, overall and by municipality characteristic.

METHODS

Municipalities were sampled independently each survey year. We calculated prevalence in 2014 and 2021 and the prevalence ratio (PR) for 15 supports covering zoning codes, park policies and budgets, design standards, Complete Streets policies, and shared use agreements. We used a Bonferroni-corrected Breslow-Day test to test for interaction by municipality characteristic.

RESULTS

In 2014 (2,009 municipalities) compared with 2021 (1,882 municipalities), prevalence increased for several zoning codes: block sizes of walkable distances (PR = 1.46), minimum sidewalk width (PR = 1.19), pedestrian amenities along streets (PR = 1.15), continuous sidewalk coverage (PR = 1.14), and building orientation to pedestrian scale (PR = 1.08). Prevalence also increased for design standards requiring dedicated bicycle infrastructure for roadway expansion projects or street retrofits (PR = 1.19). Prevalence declined for shared use agreements (PR = 0.87). The prevalence gap widened between the most and least populous municipalities for Complete Streets policies (from a gap of 33.6 percentage points [PP] in 2014 to 54.0 PP in 2021) and for zoning codes requiring block sizes that were walkable distances (from 11.8 PP to 41.4 PP).

CONCLUSION

To continue progress, more communities could consider adopting physical activity-friendly policies and design features.

Changes in Policy Supports for Healthy Food Retailers, Farmers Markets, and Breastfeeding Among US Municipalities, 2014-2021: National Survey of Community-Based Policy and Environmental Supports for Healthy Eating and Active Living (CBS-HEAL)

INTRODUCTION

Policies and practices at the local level can help reduce chronic disease risk by providing environments that facilitate healthy decision-making about diet.

METHODS

We used data from the 2014 and 2021 National Survey of Community-Based Policy and Environmental Supports for Healthy Eating and Active Living to examine prevalence among US municipalities of policies to support access to healthier food in supermarkets, convenience stores, and farmers markets, as well as policies to support breastfeeding among government employees. Chi-square tests were conducted to compare prevalence estimates from 2021 to 2014 overall and according to municipal characteristics.

RESULTS

In 2021, 29% of municipalities had at least 1 policy to encourage full-service grocery stores to open stores, which was not significantly different from 31% in 2014. Prevalence of having at least 1 policy to help corner stores sell healthier foods declined significantly from 13% in 2014 to 9% in 2021. Prevalence of policies providing all local government employees who were breastfeeding breaktime and space to pump breast milk increased significantly from 25% in 2014 to 52% in 2021. The percentage of municipalities that provided 8 or more weeks of paid maternity leave for employees increased significantly from 16% in 2014 to 19% in 2021.

CONCLUSION

Prevalence of supports for supermarkets, convenience stores, and farmers markets generally did not increase among US municipalities from 2014 to 2021, while some supports for breastfeeding among municipal employees increased during this time. Opportunities exist to improve municipal-level policies that support healthy eating and breastfeeding among community residents and employees.

Meeting the Healthy People 2030 Added Sugars Target

INTRODUCTION

Many Americans exceed the dietary recommendations for added sugars. Healthy People 2030 set a population target mean of 11.5% calories from added sugars for persons aged ≥2 years. This paper describes the reductions needed in population groups with varying added sugars intake to meet this target using 4 different public health approaches.

METHODS

Data from the 2015-2018 National Health and Nutrition Examination Survey (n=15,038) and the National Cancer Institute method were used to estimate the usual percentage calories from added sugars. Four approaches investigated lowering intake among (1) the general U.S. population, (2) people exceeding the 2020-2025 Dietary Guidelines for Americans recommendation for added sugars (≥10% calories/day), (3) high consumers of added sugars (≥15% calories/day), or (4) people exceeding the Dietary Guidelines for Americans recommendation for added sugars with 2 different reductions on the basis of added sugars intake. Added sugars intake was examined before and after reduction by sociodemographic characteristics.

RESULTS

To meet the Healthy People 2030 target using the 4 approaches, added sugars intake needs to decrease by an average of (1) 13.7 calories/day for the general population; (2) 22.0 calories/day for people exceeding the Dietary Guidelines for Americans recommendation; (3) 56.6 calories/day for high consumers; or (4) 13.9 and 32.3 calories/day for people consuming 10 to <15% and ≥15% calories from added sugars, respectively. Differences in added sugars intake were observed before and after reduction by race/ethnicity, age, and income.

CONCLUSIONS

The Healthy People 2030 added sugars target is achievable with modest reductions in added sugars intake, ranging from 14 to 57 calories/day depending on the approach.

Prospective Association of Daily Steps With Cardiovascular Disease: A Harmonized Meta-Analysis

BACKGROUND

Taking fewer than the widely promoted "10 000 steps per day" has recently been associated with lower risk of all-cause mortality. The relationship of steps and cardiovascular disease (CVD) risk remains poorly described. A meta-analysis examining the dose-response relationship between steps per day and CVD can help inform clinical and public health guidelines.

METHODS

Eight prospective studies (20 152 adults [ie, ≥18 years of age]) were included with device-measured steps and participants followed for CVD events. Studies quantified steps per day and CVD events were defined as fatal and nonfatal coronary heart disease, stroke, and heart failure. Cox proportional hazards regression analyses were completed using study-specific quartiles and hazard ratios (HR) and 95% CI were meta-analyzed with inverse-variance-weighted random effects models.

RESULTS

The mean age of participants was 63.2±12.4 years and 52% were women. The mean follow-up was 6.2 years (123 209 person-years), with a total of 1523 CVD events (12.4 per 1000 participant-years) reported. There was a significant difference in the association of steps per day and CVD between older (ie, ≥60 years of age) and younger adults (ie, <60 years of age). For older adults, the HR for quartile 2 was 0.80 (95% CI, 0.69 to 0.93), 0.62 for quartile 3 (95% CI, 0.52 to 0.74), and 0.51 for quartile 4 (95% CI, 0.41 to 0.63) compared with the lowest quartile. For younger adults, the HR for quartile 2 was 0.79 (95% CI, 0.46 to 1.35), 0.90 for quartile 3 (95% CI, 0.64 to 1.25), and 0.95 for quartile 4 (95% CI, 0.61 to 1.48) compared with the lowest quartile. Restricted cubic splines demonstrated a nonlinear association whereby more steps were associated with decreased risk of CVD among older adults.

CONCLUSIONS

For older adults, taking more daily steps was associated with a progressively decreased risk of CVD. Monitoring and promoting steps per day is a simple metric for clinician-patient communication and population health to reduce the risk of CVD.

High Added Sugars Intake among US Adults: Characteristics, Eating Occasions, and Top Sources, 2015-2018

The 2020−2025 Dietary Guidelines for Americans (DGA) recommends less than 10% of total daily calories come from added sugars. However, many adults overconsume added sugars putting them at risk for poor health outcomes. We examined characteristics of high added sugars consumers among US adults (≥20 years) and described their top 10 sources of added sugars intake using National Health and Nutrition Examination Survey 2015−2018 data (n = 9647). We defined high consumers as consuming >15% of daily calories from added sugars (1.5 times higher than the DGA). We used the National Cancer Institute method to estimate usual intake of energy and percent of calories from added sugars. Top 10 sources were identified based on their percentage contribution to total added sugars intake on a given day. T-tests were used to examine differences by age, sex, race/ethnicity, education, income, marital status, and weight status. Overall, mean usual total energy intake and added sugars intake was 2068 kcal/day and 264 kcal/day, respectively, and 30% of adults were classified as high consumers. The prevalence of high added sugars consumers was significantly higher among 20−30-year-olds (29%), 31−50-year-olds (33%), and 51−70-year-olds (29%) than those aged ≥70 years (22%); non-Hispanic Black (39%) and non-Hispanic White (31%) adults than Hispanics (26%); adults with <high school (37%), high school/GED (38%), or some college (34%) than adults with college or higher (15%); adults living in lower-income households (39% for federal poverty income ratio < 130% and 35% for 130%−<350%) than high-income households (21%). The prevalence of high consumers did not differ by sex or weight status. Top sources of added sugars were sweetened beverages (42%), tea (12%), sweet bakery products (11%), and jams/syrups/sugars (7%). Our findings can inform intervention efforts to decrease added sugars intake to support health.

Daily steps and all-cause mortality: a meta-analysis of 15 international cohorts

Background

Although 10 000 steps per day is widely promoted to have health benefits, there is little evidence to support this recommendation. We aimed to determine the association between number of steps per day and stepping rate with all-cause mortality.

Methods

In this meta-analysis, we identified studies investigating the effect of daily step count on all-cause mortality in adults (aged ≥18 years), via a previously published systematic review and expert knowledge of the field. We asked participating study investigators to process their participant-level data following a standardised protocol. The primary outcome was all-cause mortality collected from death certificates and country registries. We analysed the dose–response association of steps per day and stepping rate with all-cause mortality. We did Cox proportional hazards regression analyses using study-specific quartiles of steps per day and calculated hazard ratios (HRs) with inverse-variance weighted random effects models.

Findings

We identified 15 studies, of which seven were published and eight were unpublished, with study start dates between 1999 and 2018. The total sample included 47 471 adults, among whom there were 3013 deaths (10.1 per 1000 participant-years) over a median follow-up of 7.1 years ([IQR 4.3–9.9]; total sum of follow-up across studies was 297 837 person-years). Quartile median steps per day were 3553 for quartile 1, 5801 for quartile 2, 7842 for quartile 3, and 10 901 for quartile 4. Compared with the lowest quartile, the adjusted HR for all-cause mortality was 0.60 (95% CI 0.51–0.71) for quartile 2, 0.55 (0.49–0.62) for quartile 3, and 0.47 (0.39–0.57) for quartile 4. Restricted cubic splines showed progressively decreasing risk of mortality among adults aged 60 years and older with increasing number of steps per day until 6000–8000 steps per day and among adults younger than 60 years until 8000–10 000 steps per day. Adjusting for number of steps per day, comparing quartile 1 with quartile 4, the association between higher stepping rates and mortality was attenuated but remained significant for a peak of 30 min (HR 0.67 [95% CI 0.56–0.83]) and a peak of 60 min (0.67 [0.50–0.90]), but not significant for time (min per day) spent walking at 40 steps per min or faster (1.12 [0.96–1.32]) and 100 steps per min or faster (0.86 [0.58–1.28]).

Interpretation

Taking more steps per day was associated with a progressively lower risk of all-cause mortality, up to a level that varied by age. The findings from this meta-analysis can be used to inform step guidelines for public health promotion of physical activity.

Estimated Number of Deaths Prevented Through Increased Physical Activity Among US Adults

This cohort study uses National Health and Nutrition Examination Survey data to estimate the number of deaths that could be prevented through increased physical activity among US adults.

Public Health Representation on Active Transportation Bodies Across US Municipalities

CONTEXT

Municipal bodies such as planning or zoning commissions and active transportation advisory committees can influence decisions made by local governments that support physical activity through active transportation. Public health professionals are encouraged to participate in and inform these processes. However, the extent of such collaboration among US municipalities is currently unknown.

OBJECTIVE

To estimate the prevalence of active transportation bodies among US municipalities and the proportion with a designated public health representative.

DESIGN

A cross-sectional survey administered from May through September 2014.

SETTING

Nationally representative sample of US municipalities with populations of 1000 or more people.

PARTICIPANTS

Respondents were the city or town manager, planner, or person with similar responsibilities (N = 2018).

MAIN OUTCOME MEASURES

The prevalence of planning or zoning commissions and active transportation advisory committees among municipalities and whether there was a designated public health representative on them.

RESULTS

Approximately 90.9% of US municipalities have a planning or zoning commission, whereas only 6.5% of these commissions have a designated public health representative. In contrast, while 16.5% of US municipalities have an active transportation advisory committee, 22.4% of them have a designated public health representative. These active transportation bodies are less common among municipalities that are smaller, rural, located in the South, and where population educational attainment is lower. Overall, few US municipalities have a planning or zoning commission (5.9%) or an active transportation advisory committee (3.7%) that also has a designated public health representative.

CONCLUSIONS

Approximately 9 in 10 US municipalities have a planning or zoning commission, whereas only 1 in 6 has an active transportation advisory committee. Public health representation on active transportation bodies across US municipalities is low. Increasing the adoption of active transportation advisory committees and ensuring a designated public health representative on active transportation bodies may help promote the development of activity-friendly communities across the United States.

Changes in High Weight-for-Length among Infants Enrolled in Special Supplemental Nutrition Program for Women, Infants, and Children during 2010-2018

Background: Infants and young children with high weight-for-length are at increased risk for obesity in later life. This study describes prevalence of high weight-for-length and examines changes during 2010-2018 among 11,366,755 infants and young children 3-23 months of age in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Methods: Children's weights and lengths were measured. High weight-for-length was defined as ≥2 standard deviations above sex and age-specific median on World Health Organization growth charts. Adjusted prevalence differences (APDs) between years were calculated as 100 times marginal effects from logistic regression models. APD was statistically significant if 95% confidence interval did not include 0. Results: Adjusted prevalence of high weight-for-length decreased from 2010 to 2014, and leveled off through 2018 overall, in boys and girls, those 6-11 and 18-23 months of age, and non-Hispanic whites, non-Hispanic blacks, Hispanics, and Asians/Pacific Islanders. For 12-17 months old and American Indian/Alaska Native infants and young children, adjusted prevalence decreased from 2010 to 2014, and then increased slightly through 2018. Among 56 WIC state or territorial agencies, 33 had significant decreases between 2010 and 2018, whereas 8 had significant increases. Between 2014 and 2018, prevalence decreased significantly in 12 agencies and increased significantly in 23. Conclusions: The results indicate overall declines in prevalence of high weight-for-length from 2010 to 2018, with a prevalence stabilization since 2014. Continued surveillance is needed. Obesity prevention strategies in WIC and multiple settings are important for ensuring healthy child growth.

Trends in Self-Reported Sitting Time by Physical Activity Levels Among US Adults, NHANES 2007/2008-2017/2018

BACKGROUND

High levels of sedentary behavior and physical inactivity increase the risk of premature mortality and several chronic diseases. Monitoring national trends and correlates of sedentary behavior and physical inactivity can help identify patterns of risk in the population over time.

METHODS

The authors used self-reported data from the National Health and Nutrition Examination Surveys (2007/2008-2017/2018) to estimate trends in US adults' mean daily sitting time, overall, and stratified by levels of leisure-time and multidomain physical activity, and in the joint prevalence of high sitting time (>8 h/d) and physical inactivity. Trends were tested using orthogonal polynomial contrasts.

RESULTS

Overall, mean daily sitting time increased by 19 minutes from 2007/2008 (332 min/d) to 2017/2018 (351 min/d) (Plinear < .05; Pquadratic < .05). The highest point estimate occurred in 2013/2014 (426 min/d), with a decreasing trend observed after this point (Plinear < .05). Similar trends were observed across physical activity levels and domains, with one exception: an overall linear increase was not observed among sufficiently active adults. The mean daily sitting time was lowest among highly active adults compared with less active adults when using the multidomain physical activity measure.

CONCLUSIONS

Sitting time among adults increased over the study period but decreased in recent years.

Association of Usual Sodium Intake with Obesity Among US Children and Adolescents, NHANES 2009-2016

OBJECTIVE

The purpose of this study was to investigate the association of sodium intake with obesity in US children and adolescents.

METHODS

Cross-sectional data were analyzed for 9,026 children and adolescents in the National Health and Nutrition Examination Survey (NHANES) 2009-2016. Usual sodium intake was estimated from 24-hour dietary recalls using a measurement error model. Logistic regression was used to assess the association of sodium intake with overweight/obesity, obesity, and central obesity (waist to height ratio [WtHR] ≥ 0.5; waist circumferences (WC) ≥ age- and sex-specific 90th percentile).

RESULTS

Mean (SE) sodium intake was 3,010  (9) and 3,404  (20) mg/d for children and adolescents, respectively. The adjusted odds ratio (AOR) comparing Q4 versus Q1 (87.5th vs. 12.5th percentile of sodium intake) among children was 1.98 (95% CI: 1.19-3.28) for overweight/obesity, 2.20 (1.30-3.73) for obesity, 2.10 (1.12-3.95) for WC ≥ 90th percentile, and 1.68 (0.95-2.97) for WtHR ≥ 0.5, adjusting for demographics, energy, and sugar-sweetened beverage intake. Among adolescents, AOR was 1.81 (0.98-3.37) for overweight/obesity, 1.71 (0.82-3.56) for obesity, 1.62 (0.71-3.66) for WC ≥ 90th percentile, and 1.73 (0.85-3.50) for WtHR ≥ 0.5.

CONCLUSIONS

Sodium intake was positively associated with overweight/obesity, obesity, and central obesity among US children independent of energy and SSB intake, but the association did not reach significance among adolescents.

Early Formula Supplementation Trends by Race/Ethnicity Among US Children Born From 2009 to 2015

This survey study uses data from the National Immunization Survey–Child to examine trends in early formula supplementation by race/ethnicity among US children born during the period from 2009 to 2015.

The mPINC survey: Impacting US maternity care practices

The Centers for Disease Control and Prevention administered the original Maternity Practices in Infant Nutrition and Care (mPINC) survey, a census of all US birth facilities, from 2007 to 2015 to monitor infant feeding-related maternity care practices and policies. The purpose of this paper is to describe the many uses of mPINC data. Hospitals, organizations and governments (federal, state and local) have used the mPINC survey as a tool for improving care among the populations they serve. Nationally, the mPINC survey has been used to document marked improvements in infant feeding-related maternity care. Researchers have used the mPINC data to examine a variety of questions related to maternity care practices and policies. The newly revised mPINC survey (2018) has been designed to capture changes that have occurred over the past decade in infant feeding-related US maternity care. Hospitals, organizations, governments and researchers will be able to continue using this important tool in their efforts to ensure US maternity care practices and policies are fully supportive of breastfeeding.

Systematic review of the prospective association of daily step counts with risk of mortality, cardiovascular disease, and dysglycemia

BACKGROUND

Daily step counts is an intuitive metric that has demonstrated success in motivating physical activity in adults and may hold potential for future public health physical activity recommendations. This review seeks to clarify the pattern of the associations between daily steps and subsequent all-cause mortality, cardiovascular disease (CVD) morbidity and mortality, and dysglycemia, as well as the number of daily steps needed for health outcomes.

METHODS

A systematic review was conducted to identify prospective studies assessing daily step count measured by pedometer or accelerometer and their associations with all-cause mortality, CVD morbidity or mortality, and dysglycemia (dysglycemia or diabetes incidence, insulin sensitivity, fasting glucose, HbA1c). The search was performed across the Medline, Embase, CINAHL, and the Cochrane Library databases from inception to August 1, 2019. Eligibility criteria included longitudinal design with health outcomes assessed at baseline and subsequent timepoints; defining steps per day as the exposure; reporting all-cause mortality, CVD morbidity or mortality, and/or dysglycemia outcomes; adults ≥18 years old; and non-patient populations.

RESULTS

Seventeen prospective studies involving over 30,000 adults were identified. Five studies reported on all-cause mortality (follow-up time 4-10 years), four on cardiovascular risk or events (6 months to 6 years), and eight on dysglycemia outcomes (3 months to 5 years). For each 1000 daily step count increase at baseline, risk reductions in all-cause mortality (6-36%) and CVD (5-21%) at follow-up were estimated across a subsample of included studies. There was no evidence of significant interaction by age, sex, health conditions or behaviors (e.g., alcohol use, smoking status, diet) among studies that tested for interactions. Studies examining dysglycemia outcomes report inconsistent findings, partially due to heterogeneity across studies of glycemia-related biomarker outcomes, analytic approaches, and sample characteristics.

CONCLUSIONS

Evidence from longitudinal data consistently demonstrated that walking an additional 1000 steps per day can help lower the risk of all-cause mortality, and CVD morbidity and mortality in adults, and that health benefits are present below 10,000 steps per day. However, the shape of the dose-response relation is not yet clear. Data are currently lacking to identify a specific minimum threshold of daily step counts needed to obtain overall health benefit.

Data for Decision-Making: Exploring the Division of Nutrition, Physical Activity, and Obesity's Data, Trends, and Maps

Public health practitioners need quick and easy access to reliable surveillance data to monitor states' progress over time, compare benchmarks nationally or among states, and make strategic decisions about priorities and resources. Data, Trends, and Maps (DTM) at https://www.cdc.gov/nccdphp/dnpao/data-trends-maps/index.html is a free, online interactive database that houses and displays data on nutrition, physical activity, breastfeeding, and obesity that practitioners can use for public health action. Created in 2015 by the Centers for Disease Control and Prevention's (CDC) Division of Nutrition, Physical Activity, and Obesity, DTM was updated and relaunched in April 2017 with the capability to customize and download data sets directly; DTM also has other user-friendly features, such as visualization options. Since its relaunch, DTM has received more than 386,000 page views from approximately 110,000 unique visitors. However, the potential exists for more widespread use of DTM if more public health practitioners understood what the site offered and how others have used it in the field. Here, we explain how public health practitioners can explore the most recent state-level data on nutrition, physical activity, breastfeeding, and obesity and use this data to inform programmatic and policy efforts to prevent and control chronic diseases. We demonstrate 3 different ways practitioners can visualize data (ie, Explore by Location, Explore by Topic, and the Open Data Portal) and present 3 real-world examples to highlight DTM's utility as a public health tool.

The Physical Activity Guidelines for Americans

IMPORTANCE

Approximately 80% of US adults and adolescents are insufficiently active. Physical activity fosters normal growth and development and can make people feel, function, and sleep better and reduce risk of many chronic diseases.

OBJECTIVE

To summarize key guidelines in the Physical Activity Guidelines for Americans, 2nd edition (PAG).

PROCESS AND EVIDENCE SYNTHESIS

The 2018 Physical Activity Guidelines Advisory Committee conducted a systematic review of the science supporting physical activity and health. The committee addressed 38 questions and 104 subquestions and graded the evidence based on consistency and quality of the research. Evidence graded as strong or moderate was the basis of the key guidelines. The Department of Health and Human Services (HHS) based the PAG on the 2018 Physical Activity Guidelines Advisory Committee Scientific Report.

RECOMMENDATIONS

The PAG provides information and guidance on the types and amounts of physical activity to improve a variety of health outcomes for multiple population groups. Preschool-aged children (3 through 5 years) should be physically active throughout the day to enhance growth and development. Children and adolescents aged 6 through 17 years should do 60 minutes or more of moderate-to-vigorous physical activity daily. Adults should do at least 150 minutes to 300 minutes a week of moderate-intensity, or 75 minutes to 150 minutes a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity. They should also do muscle-strengthening activities on 2 or more days a week. Older adults should do multicomponent physical activity that includes balance training as well as aerobic and muscle-strengthening activities. Pregnant and postpartum women should do at least 150 minutes of moderate-intensity aerobic activity a week. Adults with chronic conditions or disabilities, who are able, should follow the key guidelines for adults and do both aerobic and muscle-strengthening activities. Recommendations emphasize that moving more and sitting less will benefit nearly everyone. Individuals performing the least physical activity benefit most by even modest increases in moderate-to-vigorous physical activity. Additional benefits occur with more physical activity. Both aerobic and muscle-strengthening physical activity are beneficial.

CONCLUSIONS AND RELEVANCE

The Physical Activity Guidelines for Americans, 2nd edition, provides information and guidance on the types and amounts of physical activity that provide substantial health benefits. Health professionals and policy makers should facilitate awareness of the guidelines and promote the health benefits of physical activity and support efforts to implement programs, practices, and policies to facilitate increased physical activity and to improve the health of the US population.

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.

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

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.

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.