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Objective: Understanding body size perceptions and discrepancies among African American women may have implications for effective weight-loss interventions. The purpose of this study is to examine body size perceptions of economically disadvantaged, overweight and obese African American women., Design: Cross-sectional using baseline data from a randomized controlled trial., Setting: 18 census tracts in a central South Carolina city where ≥ 25% of residents were below poverty income., Participants: 147 economically disadvantaged, overweight and obese African American women., Main Outcome Measures: Using Pulvers' figure rating scale, participants chose the figure: 1) closest to their current figure; 2) they would be satisfied with; and 3) with a body weight that would be a health problem for the average person. Mean body mass indices corresponding to each figure were compared with those in a large sample of White women., Results: Most participants wanted to be smaller (mean=2.6 figures smaller) than their current size. A majority (67%) chose the largest figure as representing a body size that could lead to a health problem, and most (60%) chose a current figure smaller than the figure they believed would be associated with health problems. The mean body mass index for women selecting any given figure as their current size was significantly larger (5.2-10.8 kg/m(2) larger, P<.0001) than those established in the sample of White women., Conclusions: Although women desired a smaller body size, there nonetheless were misperceptions of body size and the associated health consequences. Body size misperceptions and/or satisfaction may pose barriers for effective weight-loss.

Evidence suggests that depressive symptoms are associated with poorer dietary intake and inadequate physical activity; however, this association has not been examined in lower-income overweight and obese African American women. The objective of this cross-sectional study was to examine the associations between depressive symptoms and diet and physical activity in 196 women (87% African American; age, 25-51 years). Higher depressive symptoms were hypothesized to predict poorer diet quality, greater emotional eating, lower physical activity levels, and greater sedentary time. Depressive symptoms were measured using the validated short form of the Center for Epidemiological Studies Depression Scale. Dietary intake and quality were assessed using three 24-hour dietary recalls. Emotional eating was evaluated using 4 items from the emotional eating subscale of the Eating Behavior Patterns Questionnaire. Physical activity and sedentary time were objectively measured using the ActiGraph accelerometer. Linear regression models tested the associations between depressive symptoms and each dietary and physical activity outcome variable. Symptoms of depression were positively associated with total daily caloric intake from saturated fat and total sugars, as well as emotional eating scores (P < .05). Although not statistically significant, depressive symptoms were positively associated with sweetened beverage consumption (P = .06) and added sugars (P = .07). Depressive symptoms were not associated with total fat, sodium, fruit and vegetables, fast food consumption, the Alternate Healthy Eating Index score, moderate-to-vigorous physical activity, or sedentary time. Future studies should explore the mechanisms linking the identified associations between depressive symptoms and dietary intake, such as the role of emotional eating., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Fast-food restaurants are more prevalent in lower-income and predominately African American neighborhoods, where consumption of fast food is also higher. In general populations, fast-food consumption is related to less healthy dietary intake. This cross-sectional study examined the hypotheses that greater fast-food consumption is associated with less healthy dietary intake and poorer diet quality in overweight and obese women (n = 196, 25-51 years, 87% African American) recruited from financially disadvantaged Census tracts. Dietary intake and diet quality (Alternate Healthy Eating Index) were assessed via three 24-hour dietary recalls. Linear regression models tested the association between fast-food consumption and each outcome (model 1). Model 2 added sociodemographics and physical activity. Model 3 added total caloric intake. Fast-food consumption was significantly associated with total caloric intake; total intake of meat, grains, sweetened beverages, dairy, fiber, cholesterol, sodium, and added sugar; and percent of calories from total fat, saturated fat, and trans-fatty acids. Statistically significant associations remained in model 2, but most were not significant in model 3. Fast-food consumption was not associated with diet quality (Alternate Healthy Eating Index) in any model. In this at-risk sample, fast-food consumption was associated with more negative dietary practices. Significant associations generally disappeared when controlling for total caloric intake, suggesting that women who eat more fast food have higher total caloric intakes as a result of increased consumption of unhealthy rather than healthy foods., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objectives: Few studies have objectively quantified sedentary behavior, particularly in special population subgroups. This study quantified the volume of and breaks from sedentary behavior in a sample of overweight and obese, primarily African American, women., Design: Cross-sectional., Setting: 18 census tracts in Columbia, South Carolina with higher than state and national poverty levels., Participants: 197 overweight/obese women (87% African American). Mean age 38.3 +/- 7.6 years, mean body mass index 40.6 +/- 8.8 kg/m2., Main Outcomes Measures: Using a cut point of < 100 counts/minute, estimated daily averages of: 1) total volume, 2) > or = 10, 30, and 60-minute bouts, and 3) patterns of sedentary behavior according to time of day and day of the week were computed. Total breaks, or interruptions, in sedentary time were also calculated., Results: Participants were sedentary 64.1% of the day, engaging in 10.5 +/- 2.8 daily bouts of sedentary behavior per hour of sedentary time; each bout lasted approximately 6.4 +/- 1.7 minutes. All participants engaged in > or = 1 daily bout of sedentary behavior > or = 10 and > or = 30 minutes, and most (83%) engaged in > or = 1 bout > or = 60 minutes. Participants were slightly more sedentary during the evening (6 pm-midnight) and on weekdays. On average, participants took 90.9 +/- 16.0 breaks from sedentary behavior; each break lasted 3.3 +/- .8 minutes., Conclusions: Women engaged in more sedentary behavior than that reported in national data sets. In an effort to improve public health, efforts should not only focus on increasing physical activity, but also on decreasing time spent sedentary.

Background: Lower socioeconomic status at both the individual and neighborhood level is associated with increased health risks. Weight loss can reduce this risk, but few high quality weight-loss studies target this population., Objectives: STARS tests a culturally appropriate, group-based behavioral and social support intervention on body weight and waist circumference in women from financially disadvantaged neighborhoods., Design: A stratified (by BMI) randomized trial. Randomization to group was generated by a random numbers table with allocation concealment by opaque envelopes., Methods: Participants 25-50 years who had a BMI ≥ 25 kg/m(2) and a waist circumference ≥ 88 cm were recruited from 18 census tracts in Columbia, SC with high rates of poverty between November 2008 and November 2010. All participants received a dietary and exercise counseling session. Intervention participants then receive 16 theoretically-based and tailored weekly group sessions followed by 8 weeks of telephone maintenance counseling. Control participants receive 16 weekly health education mailings. Measurements correspond to baseline, post-group intervention, and post-telephone counseling, and for intervention participants, after a 12-week no-contact period. Measurement staff was blinded to group assignment., Results: Participants (N=155; n=80 intervention, n=75 minimal intervention control) were primarily African American (86.5%) and averaged 38.9 years with a mean BMI of 40.1 kg/m(2) and waist circumference of 115.4 cm. Food insecurity was reported by 43% of participants., Summary: STARS targets an underserved population with an innovative, tailored, and theoretically-grounded, group-based intervention followed by telephone maintenance. If effective, the approach has the potential to be feasible and cost-effective for community delivery., (Copyright © 2011 Elsevier Inc. All rights reserved.)

A physical activity intervention applied principles of community-based participatory research, the community-based prevention marketing framework, and social cognitive theory. A nonrandomized design included women ages 35 to 54 in the southeastern United States. Women (n = 430 preprogram, n = 217 postprogram) enrolled in a 24-week behavioral intervention and were exposed to a media campaign. They were compared to cross-sectional survey samples at pre- (n = 245) and postprogram (n = 820) from the media exposed county and a no-intervention county (n = 234 pre, n = 822 post). Women in the behavioral intervention had statistically significant positive changes on physical activity minutes, walking, park and trail use, knowledge of mapped routes and exercise partner, and negative change on exercise self-efficacy. Media exposed women had statistically significant pre- to postprogram differences on knowledge of mapped routes. No-intervention women had significant pre- to postprogram differences on physical activity minutes, walking, and knowledge of mapped routes.

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.

Objectives: The purpose was to assess the prevalence and correlates of complementary and alternative medicine use for weight control., Design: A list-assisted random-digit-dialed telephone survey of adults was conducted in the fall of 2002 (n = 11,211). The focus of the study was complementary and alternative medicine (CAM) use, other than dietary supplements, in the previous 12 months., Settings/location: The sample of respondents was drawn from the total noninstitutionalized U.S. adult population residing in telephone-equipped locations., Subjects: The sampling procedures were designed to obtain adequate representation of Hispanic and non-Hispanic black respondents. Data from the total sample of 11,211 were weighted to achieve an estimate of the U.S. population. Analyses focused on 372 people who had used CAM within the previous 12 months., Results: Of the total, 3.3% (n = 372) had used a CAM therapy in the previous 12 months. Higher adjusted odds ratios for CAM use were found among respondents who were exercising for weight control; using a lower carbohydrate, higher protein diet; using a nonprescription weight-loss product(s); overweight; physically active; and not satisfied with one's body (adjusted for age, race, gender, education, and city size). The most often used therapies were yoga (57.4%), meditation (8.2%), acupuncture (7.7%), massage (7.5%), and Eastern martial arts (5.9%). CAM users used CAM therapies on their own (62.6%), in a group setting (26.8%) or with a CAM practitioner (10.6%)., Conclusions: The use of CAM therapies other than dietary supplements for weight loss was relatively low. The most popular therapy was yoga, and the majority of CAM users used CAM therapies on their own. Persons who had used other weight loss methods had greater odds for using CAM in the previous 12 months, suggesting that CAM use is often added to other weight-loss strategies.

The sale of nonprescription weight-loss products accounts for millions of dollars spent by Americans trying to lose weight, yet there is little evidence for effectiveness and there are multiple safety concerns. The purpose of this study was to determine what products, and ingredients within products, were available at retail outlets in a metropolitan area. A purposive sampling strategy identified 73 retail outlets. An audit form was used to collect information from product labels. The audit identified 402 products containing 4,053 separate ingredients. The mean number of ingredients per product was 9.9+/-8.96 (range = 1 to 96). A database search was conducted regarding evidence for effectiveness, safety precautions, and side effects for the 10 ingredients that appeared most often across products. Modest evidence of effectiveness exists for green tea (Camellia sinensis), chromium picolinate, and ma huang (Ephedra major). For the remaining seven (ginger root [Zingiber officinale], guarana [Paullinia cupana], hydroxycitric acid [Garcinia cambogia], white willow [Salix alba], Siberian ginseng [Eleutherococcus senticosus], cayenne [Capsicum annuum], and bitter orange/zhi shi [Citrus aurantium]), inadequate or negative evidence exists. Although precautions and contraindications were found for all 10 ingredients, the strongest concerns in the literature appear for ma huang, bitter orange, and guarana. Our audit revealed numerous weight-loss products available to consumers, yet there is little evidence to support the effectiveness of the top 10 ingredients identified and many potential adverse reactions; therefore, food and nutrition professionals should discuss dietary supplement use with their clients.