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Guidelines for counseling obese patients are presented, based on a model developed by the National Institutes of Health. It involves assessing obesity risk, asking about readiness to lose weight, helping patients design a weight loss program, establishing an appropriate treatment, and following up on a regular basis. Obesity is a chronic condition and may require long-term treatment.

Binge drinking appears to be increasing among Americans, even those over 25 years of age. An analysis of data from the Behavioral Risk Factor Surveillance System surveys taken in 1993 and 2001 showed that the number of binge drinking episodes per person per year increased 35% between 1995 and 2001. Binge drinkers were 14 times more likely to drive while under the influence of alcohol than non-binge drinkers.

The number of Americans with morbid obesity increased from less than 1 percent in 1990 to 2% in 2000, according to data from the Behavioral Risk Factor Surveillance System survey. Morbid obesity is defined as a body mass index (BMI) of 40 or more. People with normal weights have a BMI of 25 or less. People with morbid obesity have the most severe health problems and are twice as likely to die prematurely as people who are only moderately obese.

Fewer than a third of those who should be treated for high blood cholesterol (HBC) may be receiving any treatment. Based on information from telephone interviews with 154,735 randomly-selected adults, the percentage of adults screened for HBC rose from 46.6% at the beginning of 1988 to 62.1% at the end of 1990. The percentage notified that their blood cholesterol level was high rose from 9.9% to 17.2%, and the percentage being treated for HBC rose from 7.6% to 11.7%. Based on these figures, about 28% of the estimated people who needed treatment were receiving it. Men, blacks and people between the ages of 20 and 39 were the least likely to be treated, and people with multiple risk factors for coronary heart disease were the most likely to be treated. Almost 40% of the 126,571 people who visited a physician for preventive care in the previous two years had not been tested for HBC. These missed opportunities were most common among women who visited obstetricians/gynecologists for their routine care and among young adults., Objective.--To investigate recent trends in the percentage and characteristics of patients being treated by a physician for high blood cholesterol (HBC) and to assess missed clinical opportunities to screen for HBC. Design, Setting, Participants.--Telephone interviews of 154735 adults in 37 states that participated in the Behavioral Risk Factor Surveillance System during 1988-1990 to assess trends in the percentage of patients treated for HBC by a physician. An opportunity was considered missed if a person did not report being screened for HBC despite seeing a physician for preventive care in the last 2 years. Results.--Between the first quarter of 1988 and the last quarter of 1990, the percentage of persons treated by a physician for HBC increased from 7.6% to 11.7% (P Conclusions.--Fewer than one third of persons who need treatment for HBC as estimated by data from the second National Health and Nutrition and Nutrition Examination Survey are receiving treatment. Better use of clinical opportunities to screen for HBC could substantially accelerate the progress in identifying persons, young adults in particular, who are likely to benefit from cholesterol reduction.

* Objective.--To determine if there were trends in underweight, short stature, and obesity among 1- through 5-year-old Mescalero (NM) Apache Indian children from 1968 through 1988. Design.--Cross-sectional review of hospital clinic charts for five cohorts. Setting.--General pediatric outpatient clinic at the Mescalero Indian Health Service Hospital. Participants.--Sixty-nine patients aged 1 through 5 years in 1968, 1973, 1978, 1983, or 1988 for whom weight and height were recorded during a well-child visit that occurred in the respective year. Selection Procedures.--Approximately half the charts were screened for eligibility through systematic sampling for all years except 1988; for 1988 all available charts were screened for eligibility for the study. Interventions.--None. Measurements and Results.--We found trends of decreasing prevalence of both underweight (defined as weight-for-height below the fifth percentile) and short stature (defined as height-for-age below the fifth percentile) based on the Centers for Disease Control/World Health Organization growth reference. We found no secular trends in obesity (weight-for-height above the 95th percentile), although the prevalences throughout the 21-year period were as much as two to four times higher than expected when compared with the Centers for Disease Control/World Health Organization reference. There has been an upward shift in both weight-for-height and height-for-age distributions since 1968, indicating that Mescalero children today are, on average, heavier and taller. Conclusions.--Underweight and short stature decreased among Mescalero preschool children from 1968 through 1988, suggesting nutritional improvements. However, given the current high prevalence of obesity, it is recommended that surveillance of nutritional status be continued and appropriate interventions be developed to treat and prevent obesity in this population. (AJDC. 1992;146:1194-1198)

Doctors should be aware that some of their overweight patients may take non-prescription diet pills, including phenylpropanolamine (PPA) and ephedra. In a survey of 14,679 patients, 7% said they were taking non-prescription diet pills, 2% said they were using PPA, and 1% said they were using ephedra.

It appears that many doctors are not advising their obese patients to lose weight. In a survey of 12,835 obese adults, only 42% said their doctor had advised them to lose weight. Women were more likely to receive weight loss advice, as were middle aged people, those with poor health, those who were most obese and those who had diabetes. Those who received weight loss advice from their doctor were about three times more likely to try to lose weight.

The number of Americans who are obese increased substantially between 1991 and 1998. According to data from the Behavioral Risk Factor Surveillance System, 18% of Americans were obese in 1998, up from 12% in 1991. The increase occurred across all age groups, both sexes, all races and all educational levels. People between the ages of 18 to 29 had the biggest increase, as did Hispanics and those with some college education. Georgia had the biggest increase and Delaware had the smallest.

Many Americans are trying to lose weight but most are not following the recommended method of doing so. In a survey of 107,804 American adults participating in the 1996 Behavioral Risk Factor Surveillance System, 44% of the women and 29% of the men were attempting to lose weight. But only 21% of the men and 19% of the women were eating fewer calories and participating in some kind of physical activity for at least two hours a week, which is the recommended method for losing weight.

One of the nation's health goals is to reduce the number of pregnant women who smoke, so that pregnant women are half as likely as nonpregnant women to smoke by 1990. To evaluate the progress toward this goal, the prevalence of smoking reported by 836 pregnant women was compared to that of 18025 nonpregnant women in 1985 and 1986. Pregnant women were 70 percent as likely to smoke cigarettes as nonpregnant women. Comparisons were also made with regard to race and marital status. Differences in smoking prevalence occurred because pregnant women were more likely to have stopped smoking rather than being more likely to have smoked at all. Also, unmarried pregnant white women were 40 percent more likely to smoke than single nonpregnant white women. Based on the findings, the national health goal seems unlikely to be achieved by 1990, and it is recommended that physicians spend more time counseling pregnant women who smoke to quit the habit.

Presents several medical-related letters to the editor as of June 20, 2001. Intensity of physical activity and the risk of coronary heart disease; Brassica vegetables and breast cancer risk; Histamine poisoning from seafood; Others.

Presents letters to the editor regarding medical news and developments as of October 4, 2000. Issues in establishing primary stroke centers; Safety precautions to limit exposure from plague-infected patients; The role of genotypic resistance testing in selecting therapy for HIV; Others.

Background: Beyond perinatal folic acid supplementation, the need for additional prenatal prophylaxis of iron with or without other micronutrients remains unclear. We aim to investigate the maternal and infant health effects of iron plus folic acid and multiple micronutrient supplements vs folic acid alone when provided to pregnant women with no or mild anemia., Methods: In this randomized double-blind controlled trial, 18,775 nulliparous pregnant women with mild or no anemia were enrolled from 5 counties of northern China from May 2006 through April 2009. Women were randomly assigned to daily folic acid (400 μg) (control), folic acid-iron (30 mg), or folic acid, iron, and 13 additional vitamins and minerals provided before 20 weeks gestation to delivery. Primary outcome was perinatal mortality. Secondary outcomes included neonatal and infant mortality, preterm delivery, birth weight, birth length, gestational duration, and maternal hemoglobin concentration and anemia., Results: A total of 92.7% of women consumed 80% to 100% of supplements as instructed. On average, women consumed 177 supplements. Compared with daily prenatal folic acid, supplementation with iron-folic acid with or without other micronutrients did not affect the rate of perinatal mortality (8.8, 8.7, and 8.3, respectively) per 1000 births, and relative risks (RRs) were 1.00 (95% CI, 0.68-1.46; P = .99) and 0.94 (95% CI, 0.64-1.39; P = .76), respectively. Risk of other adverse maternal and infant outcomes also did not differ, except that RRs for third-trimester maternal anemia were 0.72 (95% CI, 0.63-0.83; P < .001) and 0.71 (95% CI, 0.62-0.82; P < .001), respectively., Conclusion: Prenatal iron-folic acid and other micronutrient supplements provided to Chinese women with no or mild anemia prevented later pregnancy anemia beyond any benefit conferred by folic acid alone but did not affect perinatal mortality or other infant outcomes., Trial Registration: clinicaltrials.gov Identifier: NCT00133744.