Childhood Obesity Evidence Base Project: A Rationale for Taxonomic versus Conventional Meta-Analysis.

Introduction: There is a great need for analytic techniques that allow for the synthesis of learning across seemingly idiosyncratic interventions. Objectives: The primary objective of this paper is to introduce taxonomic meta-analysis and explain how it is different from conventional meta-analysis. Results: Conventional meta-analysis has previously been used to examine the effectiveness of childhood obesity prevention interventions. However, these tend to examine narrowly defined sections of obesity prevention initiatives, and as such, do not allow the field to draw conclusions across settings, participants, or subjects. Compared with conventional meta-analysis, taxonomic meta-analysis widens the aperture of what can be examined to synthesize evidence across interventions with diverse topics, goals, research designs, and settings. A component approach is employed to examine interventions at the level of their essential features or activities to identify the concrete aspects of interventions that are used (intervention components), characteristics of the intended populations (target population or intended recipient characteristics), and facets of the environments in which they operate (contextual elements), and the relationship of these components to effect size. In addition, compared with conventional meta-analysis methods, taxonomic meta-analyses can include the results of natural experiments, policy initiatives, program implementation efforts and highly controlled experiments (as examples) regardless of the design of the report being analyzed as long as the intended outcome is the same. It also characterizes the domain of interventions that have been studied. Conclusion: Taxonomic meta-analysis can be a powerful tool for summarizing the evidence that exists and for generating hypotheses that are worthy of more rigorous testing.

Childhood Obesity Evidence Base Project: A Systematic Review and Meta-Analysis of a New Taxonomy of Intervention Components to Improve Weight Status in Children 2-5 Years of Age, 2005-2019.

Objective: To evaluate the efficacy of childhood obesity interventions and conduct a taxonomy of intervention components that are most effective in changing obesity-related health outcomes in children 2-5 years of age. Methods: Comprehensive searches located 51 studies from 18,335 unique records. Eligible studies: (1) assessed children aged 2-5, living in the United States; (2) evaluated an intervention to improve weight status; (3) identified a same-aged comparison group; (4) measured BMI; and (5) were available between January 2005 and August 2019. Coders extracted study, sample, and intervention characteristics. Effect sizes [ESs; and 95% confidence intervals (CIs)] were calculated by using random-effects models. Meta-regression was used to determine which intervention components explain variability in ESs. Results: Included were 51 studies evaluating 58 interventions (N = 29,085; mean age = 4 years; 50% girls). Relative to controls, children receiving an intervention had a lower BMI at the end of the intervention (g = 0.10, 95% CI = 0.02-0.18; k = 55) and at the last follow-up (g = 0.17, 95% CI = 0.04-0.30; k = 14; range = 18-143 weeks). Three intervention components moderated efficacy: engage caregivers in praise/encouragement for positive health-related behavior; provide education about the importance of screen time reduction to caregivers; and engage pediatricians/health care providers. Conclusions: Early childhood obesity interventions are effective in reducing BMI in preschool children. Our findings suggest that facilitating caregiver education about the importance of screen time reduction may be an important strategy in reducing early childhood obesity.

Worksite Food and Physical Activity Environments and Wellness Supports Reported by Employed Adults in the United States, 2013.

PURPOSE: To examine the workplace food and physical activity (PA) environments and wellness culture reported by employed United States adults, overall and by employer size. DESIGN: Cross-sectional study using web-based survey on wellness policies and environmental supports for healthy eating and PA. SETTING: Worksites in the United States. PARTICIPANTS: A total of 2101 adults employed outside the home. MEASURES: Survey items were based on the Centers for Disease Control and Prevention Worksite Health ScoreCard and Checklist of Health Promotion Environments and included the availability and promotion of healthy food items, nutrition education, promotion of breast-feeding, availability of PA amenities and programs, facility discounts, time for PA, stairwell signage, health promotion programs, and health risk assessments. ANALYSIS: Descriptive statistics were used to examine the prevalence of worksite environmental and facility supports by employer size (<100 or ≥100 employees). Chi-square tests were used to examine the differences by employer size. RESULTS: Among employed respondents with workplace food or drink vending machines, approximately 35% indicated the availability of healthy items. Regarding PA, 30.9% of respondents reported that their employer provided opportunities to be physically active and 17.6% reported worksite exercise facilities. Wellness programs were reported by 53.2% working for large employers, compared to 18.1% for smaller employers. CONCLUSION: Employee reports suggested that workplace supports for healthy eating, PA, and wellness were limited and were less common among smaller employers.

Clinical-Community Partnerships to Identify Patients With Food Insecurity and Address Food Needs.

INTRODUCTION: More than 42 million people in the United States are food insecure. Although some health care entities are addressing food insecurity among patients because of associations with disease risk and management, little is known about the components of these initiatives. METHODS: The Systematic Screening and Assessment Method was used to conduct a landscape assessment of US health care entity-based programs that screen patients for food insecurity and connect them with food resources. A network of food insecurity researchers, experts, and practitioners identified 57 programs, 22 of which met the inclusion criteria of being health care entities that 1) screen patients for food insecurity, 2) link patients to food resources, and 3) target patients including adults aged 50 years or older (a focus of this assessment). Data on key features of each program were abstracted from documentation and telephone interviews. RESULTS: Most programs (n = 13) focus on patients with chronic disease, and most (n = 12) partner with food banks. Common interventions include referrals to or a list of food resources (n = 19), case managers who navigate patients to resources (n = 15), assistance with federal benefit applications (n = 14), patient education and skill building (n = 13), and distribution of fruit and vegetable vouchers redeemable at farmers markets (n = 8). Most programs (n = 14) routinely screen all patients. CONCLUSION: The programs reviewed use various strategies to screen patients, including older adults, for food insecurity and to connect them to food resources. Research is needed on program effectiveness in improving patient outcomes. Such evidence can be used to inform the investments of potential stakeholders, including health care entities, community organizations, and insurers.

Health-Related Behaviors by Urban-Rural County Classification - United States, 2013.

PROBLEM/CONDITION: Persons living in rural areas are recognized as a health disparity population because the prevalence of disease and rate of premature death are higher than for the overall population of the United States. Surveillance data about health-related behaviors are rarely reported by urban-rural status, which makes comparisons difficult among persons living in metropolitan and nonmetropolitan counties. REPORTING PERIOD: 2013. DESCRIPTION OF SYSTEM: The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based, random-digit-dialed landline- and cellular-telephone survey of noninstitutionalized adults aged ≥18 years residing in the United States. BRFSS collects data on health-risk behaviors, chronic diseases and conditions, access to health care, and use of preventive health services related to the leading causes of death and disability. BRFSS data were analyzed for 398,208 adults aged ≥18 years to estimate the prevalence of five self-reported health-related behaviors (sufficient sleep, current nonsmoking, nondrinking or moderate drinking, maintaining normal body weight, and meeting aerobic leisure time physical activity recommendations) by urban-rural status. For this report, rural is defined as the noncore counties described in the 2013 National Center for Health Statistics Urban-Rural Classification Scheme for Counties. RESULTS: Approximately one third of U.S. adults practice at least four of these five behaviors. Compared with adults living in the four types of metropolitan counties (large central metropolitan, large fringe metropolitan, medium metropolitan, and small metropolitan), adults living in the two types of nonmetropolitan counties (micropolitan and noncore) did not differ in the prevalence of sufficient sleep; had higher prevalence of nondrinking or moderate drinking; and had lower prevalence of current nonsmoking, maintaining normal body weight, and meeting aerobic leisure time physical activity recommendations. The overall age-adjusted prevalence of reporting at least four of the five health-related behaviors was 30.4%. The prevalence among the estimated 13.3 million adults living in noncore counties was lower (27.0%) than among those in micropolitan counties (28.8%), small metropolitan counties (29.5%), medium metropolitan counties (30.5%), large fringe metropolitan counties (30.2%), and large metropolitan centers (31.7%). INTERPRETATION: This is the first report of the prevalence of these five health-related behaviors for the six urban-rural categories. Nonmetropolitan counties have lower prevalence of three and clustering of at least four health-related behaviors that are associated with the leading chronic disease causes of death. Prevalence of sufficient sleep was consistently low and did not differ by urban-rural status. PUBLIC HEALTH ACTION: Chronic disease prevention efforts focus on improving the communities, schools, worksites, and health systems in which persons live, learn, work, and play. Evidence-based strategies to improve health-related behaviors in the population of the United States can be used to reach the Healthy People 2020 objectives for these five self-reported health-related behaviors (sufficient sleep, current nonsmoking, nondrinking or moderate drinking, maintaining normal body weight, and meeting aerobic leisure time physical activity recommendations). These findings suggest an ongoing need to increase public awareness and public education, particularly in rural counties where prevalence of these health-related behaviors is lowest.

Nutrition-related policy and environmental strategies to prevent obesity in rural communities: a systematic review of the literature, 2002-2013.

INTRODUCTION: Residents of rural communities in the United States are at higher risk for obesity than their urban and suburban counterparts. Policy and environmental-change strategies supporting healthier dietary intake can prevent obesity and promote health equity. Evidence in support of these strategies is based largely on urban and suburban studies; little is known about use of these strategies in rural communities. The purpose of this review was to synthesize available evidence on the adaptation, implementation, and effectiveness of policy and environmental obesity-prevention strategies in rural settings. METHODS: The review was guided by a list of Centers for Disease Control and Prevention Recommended Community Strategies and Measurements to Prevent Obesity in the United States, commonly known as the "COCOMO" strategies. We searched PubMed, Cumulative Index of Nursing and Allied Health Literature, Public Affairs Information Service, and Cochrane databases for articles published from 2002 through 2013 that reported findings from research on nutrition-related policy and environmental strategies in rural communities in the United States and Canada. Two researchers independently abstracted data from each article, and resolved discrepancies by consensus. RESULTS: Of the 663 articles retrieved, 33 met inclusion criteria. The interventions most commonly focused on increasing access to more nutritious foods and beverages or decreasing access to less nutritious options. Rural adaptations included accommodating distance to food sources, tailoring to local food cultures, and building community partnerships. CONCLUSIONS: Findings from this literature review provide guidance on adapting and implementing policy and environmental strategies in rural communities.

Relationship between child care centers' compliance with physical activity regulations and children's physical activity, New York City, 2010.

INTRODUCTION: Physical activity may protect against overweight and obesity among preschoolers, and the policies and characteristics of group child care centers influence the physical activity levels of children who attend them. We examined whether children in New York City group child care centers that are compliant with the city's regulations on child physical activity engage in more activity than children in centers who do not comply. METHODS: A sample of 1,352 children (mean age, 3.39 years) served by 110 group child care centers in low-income neighborhoods participated. Children's anthropometric data were collected and accelerometers were used to measure duration and intensity of physical activity. Multilevel generalized linear regression modeling techniques were used to assess the effect of center- and child-level factors on child-level physical activity. RESULTS: Centers' compliance with the regulation of obtaining at least 60 minutes of total physical activity per day was positively associated with children's levels of moderate to vigorous physical activity (MVPA); compliance with the regulation of obtaining at least 30 minutes of structured activity was not associated with increased levels of MVPA. Children in centers with a dedicated outdoor play space available also spent more time in MVPA. Boys spent more time in MVPA than girls, and non-Hispanic black children spent more time in MVPA than Hispanic children. CONCLUSION: To increase children's level of MVPA in child care, both time and type of activity should be considered. Further examination of the role of play space availability and its effect on opportunities for engaging in physical activity is needed.

Evaluability assessment to improve public health policies, programs, and practices.

Evaluability assessment, also commonly known as exploratory evaluation, has assisted the field of public health to improve programs and to develop a pragmatic, practice-based research agenda. Evaluability assessment was originally developed as a low-cost pre-evaluation activity to prepare better for conventional evaluations of programs, practices, and some policies. For public health programs, however, it serves several other important purposes: (a) giving program staff rapid, constructive feedback about program operations; (b) assisting the core public health planning and assurance functions by helping to develop realistic objectives and providing low-cost, rapid feedback on implementation; (c) navigating federal performance measurement requirements; (d) translating research into practice by examining the feasibility, acceptability, and adaptation of evidence-based practices in new settings and populations; and (e) translating practice into research by identifying promising new approaches to achieve public health goals.

Recommended community strategies and measurements to prevent obesity in the United States.

Approximately two thirds of U.S. adults and one fifth of U.S. children are obese or overweight. During 1980--2004, obesity prevalence among U.S. adults doubled, and recent data indicate an estimated 33% of U.S. adults are overweight (body mass index [BMI] 25.0-29.9), 34% are obese (BMI >or=30.0), including nearly 6% who are extremely obese (BMI >or=40.0). The prevalence of being overweight among children and adolescents increased substantially during 1999-2004, and approximately 17% of U.S. children and adolescents are overweight (defined as at or above the 95% percentile of the sex-specific BMI for age growth charts). Being either obese or overweight increases the risk for many chronic diseases (e.g., heart disease, type 2 diabetes, certain cancers, and stroke). Reversing the U.S. obesity epidemic requires a comprehensive and coordinated approach that uses policy and environmental change to transform communities into places that support and promote healthy lifestyle choices for all U.S. residents. Environmental factors (including lack of access to full-service grocery stores, increasing costs of healthy foods and the lower cost of unhealthy foods, and lack of access to safe places to play and exercise) all contribute to the increase in obesity rates by inhibiting or preventing healthy eating and active living behaviors. Recommended strategies and appropriate measurements are needed to assess the effectiveness of community initiatives to create environments that promote good nutrition and physical activity. To help communities in this effort, CDC initiated the Common Community Measures for Obesity Prevention Project (the Measures Project). The objective of the Measures Project was to identify and recommend a set of strategies and associated measurements that communities and local governments can use to plan and monitor environmental and policy-level changes for obesity prevention. This report describes the expert panel process that was used to identify 24 recommended strategies for obesity prevention and a suggested measurement for each strategy that communities can use to assess performance and track progress over time. The 24 strategies are divided into six categories: 1) strategies to promote the availability of affordable healthy food and beverages), 2) strategies to support healthy food and beverage choices, 3) a strategy to encourage breastfeeding, 4) strategies to encourage physical activity or limit sedentary activity among children and youth, 5) strategies to create safe communities that support physical activity, and 6) a strategy to encourage communities to organize for change.

Activity/participation limitation and weight loss among overweight and obese US adults: 1999 to 2002 NHANES.

OBJECTIVE: To examine the prevalence and association of activity/participation limitation with trying to lose weight and weight loss practices (eating fewer calories, physical activity, or both) among overweight and obese adults in the United States. RESEARCH METHODS AND PROCEDURES: Eligible adults were 20 years of age or older with a body mass index (BMI) >or= 25 kg/m(2) (n = 5608) who responded to standard physical functioning questions included in the 1999-2002 National Health and Nutrition Examination Survey, a continuous survey of the civilian non-institutionalized US population. RESULTS: Obese (BMI >or= 30) men with vs. without activity/participation limitations were more likely to try to lose weight (OR = 1.59, 95% CI 1.05-2.41). This was not the case for overweight women and men (BMI 25-29.9), or obese women. Among adults trying to lose weight, reducing calorie consumption was common (63%-73%, men, 67%-76%, women). Overweight women with vs without activity/participation limitations had significantly reduced likelihood of attaining recommended physical activity (OR = 0.56, 95% CI 0.36-0.89). Obese adults were more likely to try to lose weight if they attributed their limitation to body weight (OR = 1.78, 95% CI 1.11-2.88) or diabetes (OR = 1.86, 95% CI 1.01-3.43) compared to other causes. Overweight and obese adults who attributed activity/participation limitations to mental health, musculoskeletal, or cardiovascular problems were equally likely to attempt weight loss when respondents with each condition were compared to respondents without the condition. DISCUSSION: These results verify the importance of adequate subjective health assessment when developing individual weight loss plans, and may help guide weight management professionals in the development and delivery of more personalized care.

Childhood overweight and family income.

OBJECTIVE: To examine the relation of family income, expressed relative to the poverty threshold, to the prevalence of childhood overweight, and to determine whether the association differs by race/ethnicity and time period. SUBJECTS AND METHODS: Most analyses were based on 2- to 19-year-old participants (n=10,409) in the US National Health and Nutrition Examination Survey (NHANES) from 1999 to 2004. Additional analyses were performed using NHANES data collected from 1971 to 1994 to determine whether family income showed similar associations with childhood overweight (body mass index [BMI] for age > or = CDC 95th percentile) over this time period. RESULTS: The relation of family income to childhood overweight differed (P < .001) by race/ethnicity in 1999-2004. As compared with children below the poverty level (annual family income of about $19,200), the odds of overweight among children from families with incomes of 4 or more times the poverty threshold were 0.63 (white children) and 0.51 (Mexican-American children). Among black children, however, overweight was positively associated (odds ratio of 1.12) with family income. Although family income was not associated with childhood overweight in 1971-1974, the observed associations also differed by race/ethnicity in the 1976-1980 and 1988-1994 surveys. Furthermore, the association changed during the past few decades among Mexican-American children (P = .03 for secular trend), but not among white or black children. DISCUSSION: Although family income is related to childhood overweight, the association varies by race/ethnicity. Additional information on the reasons for these racial/ethnic differences may help in the development of appropriate interventions.

Health-related quality of life and weight loss practices among overweight and obese US adults, 2003 behavioral risk factor surveillance system.

BACKGROUND: Trying to lose weight is a concern for many Americans, but motivation for weight loss is not fully understood. Clinical assessment for obesity treatment is primarily based on measures of body size and physical comorbidities; however, these factors may not be enough to motivate individuals to lose weight. Health-related quality of life (HRQOL) may have a role in an individual's decision to try to lose weight. The objective of this study was to examine the prevalence and association of HRQOL measures as independent moderators of weight loss practices among overweight and obese men and women. RESEARCH METHODS AND PROCEDURES: Data were from the 2003 Behavioral Risk Factor Surveillance System, an annual state-based telephone survey of the civilian noninstitutionalized population of adults 20 years of age or older with BMI > or = 25.0 kg/m2 (n = 111,456) who responded to 4 standard HRQOL measures that assessed general health status, physical health, mental health, and activity limitation in the past 30 days. RESULTS: Among men with BMI 25-34.9 kg/m2, the odds of trying to lose weight increased for the moderate vs best category of HRQOL but not for the poorest vs best category, and no associations were noted for men with BMI > or = 35 kg/m2. Women with BMI 25-34.9 kg/m2 had reduced odds and decreasing associated trends in the prevalence of trying to lose weight with poorer general health, increased physically unhealthy days, and increased activity limitation days. Conversely, women with 1-13 vs 0 mentally unhealthy days had greater odds of trying to lose weight. Among those trying to lose weight, reducing calories was common (52%-69%, men; 56%-69%, women). Among men, with the exception of recent mental health, poorer levels of HRQOL measures were associated with diminished attainment of recommended physical activity levels. Among women, poorer general health status was associated with diminished attainment of recommended physical activity levels. DISCUSSION: With the exception of recent mental health, HRQOL was differentially associated with trying to lose weight among men and women. Specifically, moderately poor HRQOL among men and better HRQOL among women were associated with trying to lose weight. Consideration of these influences on weight loss may be useful in the treatment and support of obese patients.

Sedentary behavior, recreational physical activity, and 7-year weight gain among postmenopausal U.S. women.

OBJECTIVE: To assess the relationship among recreational physical activity (PA), non-occupational sedentary behavior, and 7-year weight gain among postmenopausal U.S. women 40 to 69 years old. RESEARCH METHODS AND PROCEDURES: In 1992 and 1999, 18,583 healthy female participants from the Cancer Prevention Study II Nutrition Cohort completed questionnaires on anthropometric characteristics and lifestyle factors. The associations between recreational PA [in metabolic equivalent (MET) hours per week] and non-occupational sedentary behavior (in hours per day) at baseline and risk for 7-year weight gain (5 to 9 or >or =10 vs. +/-4 pounds) were assessed using multivariate logistic regression analysis. RESULTS: Neither PA nor sedentary behavior was associated with a 5- to 9-pound weight gain. Among women who were not overweight at baseline (BMI <25.0), the odds of > or =10-pound weight gain were 12% lower (odds ratio, 0.88; 95% confidence interval, 0.77 to 0.99) for those in the highest category of recreational PA (> or =18 MET h/wk) compared with >0 to <4 MET h/wk; odds were 47% higher (odds ratio, 1.47; 95% confidence interval, 1.21 to 1.79) for non-overweight women who reported > or =6 h/d of non-occupational sedentary behavior compared with <3 h/d. Neither PA nor sedentary behavior were associated with risk of > or =10-pound weight gain weight among women who were overweight at baseline (BMI > or =25.0). DISCUSSION: Both recreational PA and non-occupational sedentary behavior independently predicted risk of > or =10-pound weight gain among postmenopausal women who were not overweight at baseline. Public health messages to prevent weight gain among normal-weight postmenopausal women may need to focus on decreasing time spent in sedentary behaviors and increasing the amount of time spent on PA.

Use of nonprescription dietary supplements for weight loss is common among Americans.

OBJECTIVE: Dietary supplements are not recommended as part of a weight-loss program due to concerns about efficacy and safety. This study sought to assess prevalence and duration of nonprescription weight-loss supplement use, associated weight-control behaviors, discussion of use with a health care professional, and specific ingredient use. PARTICIPANTS AND DESIGN: Adults aged > or =18 years (n=9,403) completed a cross-sectional population-based telephone survey of health behaviors from September 2002 through December 2002. STATISTICAL ANALYSES PERFORMED: Both chi2 and t tests were conducted for categorical and mean comparisons and multiple variable logistic regression was used to determine significant predictors. RESULTS: An estimated 15.2% of adults (women 20.6%, men 9.7%) had ever used a weight-loss supplement and 8.7% had past year use (women 11.3%, men 6.0%); highest use was among women aged 18 to 34 years (16.7%). In regression models, use was equally prevalent among race/ethnic groups and education levels. One in 10 (10.2%) of users reported > or =12 month use, with less frequent long-term use in women (7.7%) than men (15.0%), P=0.01. Almost one third (30.2%) of users discussed use during the past year; 73.8% used a supplement containing a stimulant including ephedra, caffeine, and/or bitter orange. CONCLUSIONS: Use of supplements for losing weight seems to be common among many segments of the US adult population. Many adults are long-term users and most do not discuss this practice with their physician. Most of the weight-loss supplements taken contain stimulants. Qualified professionals should inquire about use of supplements for weight loss to facilitate discussion about the lack of efficacy data, possible adverse effects, as well as to dispel misinformation that may interfere with sound weight-management practices.

Use of low-carbohydrate, high-protein diets among americans: correlates, duration, and weight loss.

CONTEXT: Although low-carbohydrate, high-protein (LCHP) diets reemerged as popular diets, there are scant data on patterns of use in the general US population. OBJECTIVE: We examined the prevalence of reported LCHP diet use (eg, Sugar Busters, The Zone, The Carbohydrate Addict's Diet, The Atkins Diet), associated weight control behaviors, diet duration, and amount of weight loss while on the diet. DESIGN: Population-based cross-sectional survey. SETTING: Telephone survey of US adults conducted from September 2002 to December 2002 (N = 9300). MAIN OUTCOME MEASURES: We used multivariable logistic regression models to determine predictors of current LCHP diet use. RESULTS: At the time of the survey, 12.5% of Americans reported ever using a LCHP diet, and 3.4% reported current use. Prevalence of current use was similar across sex, race/ethnicity, and education levels. Among those trying to lose weight (n = 3790), 5.9% reported currently using an LCHP diet. Among current users, mean weight loss was 18.3 (median, 11.7) lb, with 18.2% reporting > or = 30 lb weight loss, 34.0% > or = 20 lb weight loss, and 8.8% no weight loss. More men than women reported a duration of use of more than 12 months (42.2% vs 29.6%, P = .04) and median duration was greater in men than women (5.7 vs 2.8 months, P = .08). Among those trying to control weight, a significantly higher proportion of current LCHP diet users reported eating fewer calories and meeting physical activity recommendations (38.0%) compared with nonusers (29.8%). CONCLUSIONS: LCHP diets were equally prevalent across sociodemographic subgroups and many users reported significant weight loss. Approximately 40% of male users and 30% of female users reported long-term use of the diet, suggesting that for some, this dietary approach may be well tolerated.

Low-energy-density diets are associated with high diet quality in adults in the United States.

OBJECTIVE: This study investigated food choices made by individuals consuming diets differing in energy density and explores relationships between energy density and diet quality. DESIGN: Cross-sectional, nationally representative survey. SUBJECTS: 7,500 adults (older than 19 years) in the 1994-1996 Continuing Survey of Food Intakes by Individuals. STATISTICAL ANALYSIS: Energy density values were calculated from reported food intake. Subjects were classified as consuming a low-energy-density diet, medium-energy-density diet, or high-energy-density diet using tertile cutoffs. For each group, the percentage consuming various foods/beverages and the mean amount of foods/beverages they consumed was determined along with mean nutrient intakes. RESULTS: Compared with participants consuming a high-energy-density diet, those with a low-energy-density diet had a lower energy intake but consumed more food, by weight, from most food groups. A low-energy-density diet included a relatively high proportion of foods high in micronutrients and water and low in fat, such as fruits and vegetables. Subjects with a low-energy-density diet consumed fewer (nonwater) beverages such as caloric carbonated beverages. They also consumed less fat and had higher intakes of several important micronutrients, including vitamins A, C, and B-6, folate, iron, calcium, and potassium. CONCLUSIONS: These analyses further demonstrate the beneficial effects of a low-energy-density diet, which was associated with lower energy intakes, higher food intakes, and higher diet quality than a high-energy-density diet. To achieve a low-energy-density diet, individuals should be encouraged to eat a variety of fruits and vegetables as well as low-fat/reduced-fat, nutrient-dense, and/or water-rich grains, dairy products, and meats/meat alternatives.

Weight-control practices among U.S. adults, 2001-2002.

BACKGROUND: Approximately $50 billion a year is spent by Americans on weight-loss products and services. Despite the high cost, few national studies have described specific weight-loss and weight-maintenance practices among U.S. adults. This analysis describes the use of specific practices by U.S. adults who tried to lose weight or tried only not to gain weight during the previous 12 months. METHODS: Data were analyzed from the 2001-2002 National Health and Nutrition Examination Survey (NHANES) conducted on a nationally representative sample of the U.S. population. This study focused on adults aged 20 years or older who were both interviewed and examined (n =5027). RESULTS: Fifty-one percent of U.S. adults tried to control their weight in the previous 12 months, including those who tried to lose weight (34% of men, 48% of women) and those who tried only not to gain weight (11% vs 10%, respectively). Among 2051 adults who tried to control their weight, the top four practices were the same: ate less food (65% among those who tried to lose weight, 52% among those who tried only not to gain weight); exercised (61% vs 46%, respectively); ate less fat (46% vs 42%); and switched to foods with lower calories (37% vs 36%). Less than one fourth combined caloric restriction with the higher levels of physical activity (300 or more minutes per week) recommended in the 2005 dietary guidelines by the U.S. Department of Health and Human Services and U.S. Department of Agriculture. CONCLUSIONS: Although weight control is a common concern, most people who try do not use recommended combinations of caloric restriction and adequate levels of physical activity.

Racial and ethnic differences in secular trends for childhood BMI, weight, and height.

OBJECTIVES: The prevalence of childhood overweight in the United States has markedly increased over the last 30 years. We examined differences in the secular trends for BMI, weight, and height among white, black, and Mexican-American children. RESEARCH METHODS AND PROCEDURES: Analyses were based on nationally representative data collected from 2 to 17 year olds in four examinations (1971-1974 through 1999-2002). RESULTS: Overall, black children experienced much larger secular increases in BMI, weight, and height than did white children. For example, over the 30-year period, the prevalence of overweight increased approximately 3-fold (4% to 13%) among 6- to 11-year-old white children but 5-fold (4% to 20%) among black children. In most sex-age groups, Mexican-American children experienced increases in BMI and overweight that were between those experienced by blacks and whites. Race/ethnicity differences were less marked among 2 to 5 year olds, and in this age group, white children experienced the largest increase in overweight (from 4% to 9%). In 1999-2002, the prevalence of extreme BMI levels (> or =99th percentile) reached 6% to 7% among black girls and Mexican-American boys. DISCUSSION: Because of the strong tracking of childhood BMI levels into adulthood, it is likely that the secular increases in childhood overweight will greatly increase the burden of adult disease. The further development of obesity interventions in different racial/ethnic groups should be emphasized.