Neighborhood and weight-related health behaviors in the Look AHEAD (Action for Health in Diabetes) study.

BACKGROUND: Previous studies have shown that neighborhood factors are associated with obesity, but few studies have evaluated the association with weight control behaviors. This study aims to conduct a multi-level analysis to examine the relationship between neighborhood SES and weight-related health behaviors. METHODS: In this ancillary study to Look AHEAD (Action for Health in Diabetes) a trial of long-term weight loss among individuals with type 2 diabetes, individual-level data on 1219 participants from 4 clinic sites at baseline were linked to neighborhood-level data at the tract level from the 2000 US Census and other databases. Neighborhood variables included SES (% living below the federal poverty level) and the availability of food stores, convenience stores, and restaurants. Dependent variables included BMI, eating patterns, weight control behaviors and resource use related to food and physical activity. Multi-level models were used to account for individual-level SES and potential confounders. RESULTS: The availability of restaurants was related to several eating and weight control behaviors. Compared to their counterparts in neighborhoods with fewer restaurants, participants in neighborhoods with more restaurants were more likely to eat breakfast (prevalence Ratio [PR] 1.29 95% CI: 1.01-1.62) and lunch (PR = 1.19, 1.04-1.36) at non-fast food restaurants. They were less likely to be attempting weight loss (OR = 0.93, 0.89-0.97) but more likely to engage in weight control behaviors for food and physical activity, respectively, than those who lived in neighborhoods with fewer restaurants. In contrast, neighborhood SES had little association with weight control behaviors. CONCLUSION: In this selected group of weight loss trial participants, restaurant availability was associated with some weight control practices, but neighborhood SES was not. Future studies should give attention to other populations and to evaluating various aspects of the physical and social environment with weight control practices.

Psychosocial and behavioral status of patients undergoing bariatric surgery: what to expect before and after surgery.

Extreme obesity, characterized by a body mass index (BMI) of 40 kg/m(2) or greater, is associated with significantly increased mortality, principally from cardiovascular disease, type 2 diabetes, and several cancers. It also is associated with an increased risk of psychosocial complications, including depression, eating disorders, and impaired quality of life. This article briefly examines the psychosocial status of extremely obese individuals who seek bariatric surgery and describes changes in functioning that can be expected with surgically induced weight loss. The article combines a review of the literature with clinical impressions gained from the more than 2500 candidates for bariatric surgery whom the authors have evaluated at the Hospital of the University of Pennsylvania.

Gender and ethnic differences in body image and opposite sex figure preferences of rural adolescents.

This study examined whether rural adolescents would report gender and ethnic differences in body image similar to those that have been observed in urban samples. Data were analyzed for 384 rural adolescents (57% African American, 43% Caucasian, mean age 13 years) to determine gender and ethnic differences in body dissatisfaction, body size discrepancy, and current and ideal figure ratings. Females wanted to be smaller and reported more body dissatisfaction than did males. Caucasian females reported the most body dissatisfaction. African Americans reported larger current and ideal figure ratings than did Caucasians. African Americans preferred larger opposite sex figures than did Caucasians. Both African American and Caucasian males selected a larger female figure as ideal than was selected by females. Results demonstrated that gender and ethnic differences exist in body image for rural adolescents. This frequently overlooked population may benefit from further study. Implications of findings and limitations of the study are also discussed.

Measuring adolescent smoking cessation strategies: instrument development and initial validation.

A majority of adolescent smokers attempt cessation and report intentions to quit, yet little is known regarding the teen cessation process. To advance inquiry into the adolescent smoking cessation process the present report describes the development and initial evaluation of the Ways of Quitting questionnaire (WOQ), a measure designed to assess adolescent smoking cessation strategies. All participants were recruited from four public high schools in metropolitan San Diego, California. Items and questionnaire wording and format were developed based on responses from 36 adolescent participants in six focus groups. The resulting questionnaire included 28 cessation strategies. Descriptive and psychometric analyses were conducted for 88 adolescents who had previously attempted smoking cessation. For each WOQ item, respondents indicated whether they had used a given strategy and, if used, how helpful it was. The most frequently reported cessation methods included avoidance, reduction, and distraction strategies. These, along with social support strategies, received the highest helpfulness ratings. Formal intervention approaches were the least frequently used strategies. Formal methods also were rated as least helpful. Initial validation analyses on a subsample of participants revealed that use of more social support and smoking reduction strategies was significantly associated with length of abstinence following a cessation attempt. The present findings thus provide initial support for the utility and criterion validity of this newly developed measure.

State of the science: behavioural treatment of obesity.

Obesity is a global and preventable epidemic with serious health consequences for individuals worldwide, particularly for those in developed countries. The World Health Organization estimates that at least 1 billion people worldwide are overweight, and 300 million are obese. Research has demonstrated that weight losses as small as 7-10% of initial weight produce significant health benefits. These include reducing the risk of heart disease, stroke, and some cancers. This paper describes behavioural methods to modify maladaptive eating and activity habits to achieve a healthy weight. It also examines the short- and long-term results of behavioural treatment for obesity and methods to improve long-term weight control.