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Background: Relatively few studies have focused on who is at risk for weight regain after weight loss and how to prevent it. The objectives of this study were to determine the prevalence and predictors of weight regain in U.S. adults who had experienced substantial weight loss. Methods: Data were analyzed from the 1999–2002 National Health and Nutrition Examination Survey (NHANES). This study examined U.S. adults aged 20–84 years who were overweight or obese at their maximum weight (body mass index ≥25) and had experienced substantial weight loss (weighed 10% less than their maximum weight 1 year before they were surveyed) (n=1310). Results: Compared to their weight 1 year ago, 7.6% had continued to lose weight (>5%), 58.9% had maintained their weight (within 5%), and 33.5% had regained weight (>5%). Factors associated with weight regain (vs weight maintenance or loss) included Mexican American ethnicity (versus non-Hispanic white) (odds ratio [OR]=2.0; 95% confidence interval [CI]=1.3–3.1), losing a greater percentage of maximum weight (≥20% vs 10% to <15%) (OR=2.8; 95% CI=2.0–4.1), having fewer years since reaching maximum weight (2–5 years vs >10 years) (OR=2.1; 95% CI=1.2–3.7), reporting greater daily screen time (≥4 hours vs 0–1 hour) (OR=2.0; 95% CI=1.3–3.2), and attempting to control weight (OR=1.8; 95% CI=1.1–3.0). Finally, weight regain was higher in those who were sedentary (OR=1.8; 95% CI=1.0–3.0) or not meeting public health recommendations for physical activity (OR=2.0; 95% CI=1.2–3.5). Conclusions: How to achieve the skills necessary for long-term maintenance of weight loss in the context of an obesogenic environment remains a challenge. [Copyright &y& Elsevier]

Background: Studies suggest that moderate drinkers have lower cardiovascular disease (CVD) mortality than nondrinkers and heavy drinkers, but there have been no randomized trials on this topic. Although most observational studies control for major cardiac risk factors, CVD is independently associated with other factors that could explain the CVD benefits ascribed to moderate drinking. Methods: Data from the 2003 Behavioral Risk Factor Surveillance System, a population-based telephone survey of U.S. adults, was used to assess the prevalence of CVD risk factors and potential confounders among moderate drinkers and nondrinkers. Moderate drinkers were defined as men who drank an average of two drinks per day or fewer, or women who drank one drink or fewer per day. Results: After adjusting for age and gender, nondrinkers were more likely to have characteristics associated with increased CVD mortality in terms of demographic factors, social factors, behavioral factors, access to health care, and health-related conditions. Of the 30 CVD-associated factors or groups of factors that we assessed, 27 (90%) were significantly more prevalent among nondrinkers. Among factors with multiple categories (e.g., body weight), those in higher-risk groups were progressively more likely to be nondrinkers. Removing those with poor health status or a history of CVD did not affect the results. Conclusions: These findings suggest that some or all of the apparent protective effect of moderate alcohol consumption on CVD may be due to residual or unmeasured confounding. Given their limitations, nonrandomized studies about the health effects of moderate drinking should be interpreted with caution, particularly since excessive alcohol consumption is a leading health hazard in the United States. [Copyright &y& Elsevier]

Objective: To determine associations between changes in obesity and vigorous physical activity (PA) status and depressive symptoms in a cohort aged 51 to 61 years at baseline., Method: Two waves (1992, 1998) of Health and Retirement Study data were used to divide participants into four obesity and four vigorous PA status categories based on change in or maintenance of their 1992 status in 1998. Depressive symptoms were defined as the upper quintile score (women >/= 4, men >/= 3) on the eight-item Center for Epidemiologic Studies-Depression Scale. Logistic regression determined adjusted odds ratios for depressive symptoms associated with obesity and vigorous PA status., Results: Among men, no significant associations were found. Among women, decreasing from high vigorous PA status and maintenance of obese status were independently associated with increased odds for depressive symptoms in 1998., Discussion: The findings illustrate the importance of examining gender differences in studies of risk factors for depression.

Objectives: To describe the relationship between BMI and perceived weight status and to determine how underassessment of weight status is associated with demographic characteristics, self-reported general health, and perceived health risk in relation to one's body weight., Methods and Procedures: In the 2004 Styles surveys, 3,888 US adult participants described their current weight status (underweight, about right, slightly overweight, very overweight), which we compared with self-reported BMI in order to determine concordance. We used multivariable logistic regression to evaluate associations between underassessment of body weight and characteristics of interest., Results: Among persons with a BMI>or=25, women were more likely than men to recognize their overweight status (slightly or very overweight; 93.0% of women vs. 73.5% of men) and the extent to which they were overweight: 70.4% of obese women vs. 49.5% of obese men described themselves as very overweight. Among the overweight and obese of both sexes, disagreement with regard to current weight as a health risk was associated with underassessment of weight. Additional factors associated with underassessment were education and race/ethnicity among overweight women; race/ethnicity among overweight men; household income and self-rated health among obese women; and self-rated health among obese men (P<0.05)., Discussion: While most of the obese participants recognized that they were overweight, many of them, particularly among the men, did not realize the extent to which they were overweight. Public health messages may be more effective if they are specifically tailored to target audiences, besides emphasizing the health risks associated with excess body weight.

Introduction: Eating a diet high in fruits and vegetables as part of an overall healthful diet can help lower chronic disease risk and aid in weight management. Increasing the percentage of Americans who consume enough fruits and vegetables every day is part of the Healthy People 2010 objectives for the nation. Assessing trends in consumption of these foods is important for tracking public health initiatives to meet this goal and for planning future objectives., Methods: We assessed total and sex-specific changes in daily consumption of fruits and vegetables among 1,227,969 adults in the 50 U.S. states and the District of Columbia who participated in the Behavioral Risk Factor Surveillance System from 1994 through 2005. To estimate changes in consumption according to dietary recommendations that were in place during the years examined, we used geometric mean and the percentage of people eating fruits or vegetables or both five or more times per day. Estimates were standardized for sex, age, and race/ethnicity and analyzed by multivariate regression., Results: From 1994 through 2005, the geometric mean frequency of consumption of fruits and vegetables declined slightly (standardized change: men and women, -0.22 times/day; men, -0.26 times/day; women, -0.17 times/day). The proportion of men and women eating fruits or vegetables or both five or more times per day was virtually unchanged (men, 20.6% vs 20.3%; women, 28.4% vs 29.6%); however, we found small increases for men aged 18 to 24 years and for women who were aged 25 to 34 years, non-Hispanic black, or nonsmokers. Consumption of fruit juice and non-fried potatoes declined for both sexes., Conclusion: The frequency of fruit and vegetable consumption changed little from 1994 through 2005. If consumption is to be increased, we must identify and disseminate promising individual and environmental strategies, including policy change.

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.

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.

Objective: To examine the prevalence and association of health-related quality of life (HRQOL) with trying to lose weight and with weight loss practices (eating fewer calories, physical activity, and both) among overweight and obese U.S. adults >/= 20 years of age., Research Methods and Procedures: This study used data from the 2001 to 2002 National Health and Nutrition Examination Survey, a continuous annual survey of the civilian non-institutionalized U.S. population. This analysis included those > or = 20 years of age with BMI > or = 25 (n = 2578) who responded to four standard HRQOL measures that assessed general health status and recent physical health, mental health, and activity limitation., Results: Among obese men, but not women, there were significant increasing linear trends in the adjusted prevalence of trying to lose weight as physically unhealthy and activity limitation days increased. Regardless of BMI or HRQOL, reducing calories was a common weight loss practice (66% to 86%). Except for recent activity limitation, respondents with BMI > or = 35 did not generally differ by HRQOL level in the attainment of recommended physical activity either alone or in combination with reduced calories, whereas those in the BMI 25 to 34.9 groups often differed significantly by HRQOL level. Specifically, increased unhealthy or activity limitation days were associated with reduced prevalence of attained physical activity., Discussion: Our findings indicate an association between trying to lose weight and a greater number of unhealthy days reported by obese men, suggesting that these men may be influenced by traditional clinical weight-loss counseling that is prompted by weight and comorbidity, whereas women had a high prevalence of trying to lose weight irrespective of weight and HRQOL. Assessment of HRQOL, especially measures that evaluate physical domains, could provide subjective information to assist with weight counseling.

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.

Background: Laboratory-based investigations indicate that the consumption of foods with a low energy density (kcal/g) decreases energy intake. Although low-energy-dense diets are recommended for weight management, relations between energy density, energy intake, and weight status have not been clearly shown in free-living persons., Objectives: A representative US sample was used to determine whether dietary energy density is associated with energy intake, the weight of food consumed, and body weight and to explore the influence of food choices (fruit, vegetable, and fat consumption) on energy density and body weight., Design: A cross-sectional survey of adults (n = 7356) from the 1994-1996 Continuing Survey of Food Intakes by Individuals and two 24-h dietary recalls were used., Results: Men and women with a low-energy-dense diet had lower energy intakes (approximately 425 and 275 kcal/d less, respectively) than did those with a high-energy-dense diet, even though they consumed more food (approximately 400 and 300 g/d more, respectively). Normal-weight persons had diets with a lower energy density than did obese persons. Persons with a high fruit and vegetable intake had the lowest energy density values and the lowest obesity prevalence., Conclusions: Adults consuming a low-energy-dense diet are likely to consume more food (by weight) but to have a lower energy intake than do those consuming a higher-energy-dense diet. The energy density of a variety of dietary patterns, including higher-fat diets, can be lowered by adding fruit and vegetables. Our findings support the hypothesis that a relation exists between the consumption of an energy-dense diet and obesity and provide evidence of the importance of fruit and vegetable consumption for weight management.

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.

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.

Background: During the past 20 years, adult obesity rates have doubled in the United States. The National Institutes of Health (NIH) issued guidelines in 1998 recommending that healthcare professionals advise obese patients to lose weight. We examined trends in physician counseling for weight loss during 1994-2000, characteristics of obese adults receiving advice to lose weight in 2000, and the association in 2000 between receiving advice and attempting to lose weight., Methods: We analyzed 1994, 1996, 1998, and 2000 data from the Behavioral Risk Factor Surveillance System (BRFSS), a state-based telephone survey of noninstitutionalized adults from 48 states and the District of Columbia. We limited the analysis to obese respondents who had visited physicians for a routine medical checkup during the previous 12 months (n = 61,968)., Results: Among obese patients, the proportion who received advice to lose weight decreased from 42.3% (se = 0.79) in 1994 to 40.3% (se = 0.55) in 2000. We observed declines in receipt of advice for almost all subgroups. Respondents in the youngest and oldest age groups and those without health insurance had the largest significant declines. Patients who reported receiving advice to lose weight had 2.8 the odds of trying to lose weight as those who did not receive advice (95% confidence interval, 2.5, 3.2)., Conclusion: Despite the 1998 NIH guidelines and increases in morbid obesity, the proportion of obese persons who reported being counseled by a healthcare professional has declined slightly. Because counseling might be associated with weight loss attempts, barriers to counseling need to be identified and addressed.

Background: Although walking is a popular leisure-time activity, a substantial amount of total daily walking occurs in non-leisure contexts (i.e., occupation, transportation, and household work). Because non-leisure walking is not assessed by traditional leisure-time activity surveys, total walking among U.S. adults may be underestimated. This study describes walking estimates obtained from a measure of leisure-time activity and a specific measure of total walking in all contexts., Methods: A national sample of adults (n=6626), selected by random-digit dialing, was surveyed between May 1999 and November 2000. Estimates of walking prevalence and of weekly time spent walking were examined from two separate modules: (1) an assessment restricted to leisure-time activity, and (2) an assessment of total walking., Results: Walking prevalence based on the total walking module was nearly double that based on the leisure-time module (81% vs 43%, respectively). The median weekly minutes of walking also nearly doubled using the total walking module (239 vs 130 minutes, respectively). Among those with jobs involving substantial walking, median weekly walking minutes were more than three times greater with the total walking module (476 vs 130 minutes, respectively)., Conclusions: U.S. adults, particularly those with jobs involving walking, do a substantial amount of walking not captured by traditional leisure-time activity surveys. This may affect the appropriate targeting of physical activity interventions, as well as the evaluation of the effectiveness of physical activity promotions and policies. However, further characterization of non-leisure walking is needed to determine its contribution to health and meeting physical activity guidelines.

Purpose: Physical activity is an integral part of weight control programs, but recommended amounts vary. The objectives of this study were to describe the prevalence and characteristics of those who reported using exercise as a weight loss strategy (N=14,716), and to determine the prevalence of meeting various institutionally recommended levels of physical activity (N=8538) among that population., Methods: Data were obtained from the 1998 National Health Interview Survey, a face-to-face nationally representative household interview. Questions on leisure-time physical activity were analyzed using SUDAAN., Results: Among those who reported trying to lose weight, 55% reported using exercise as a weight loss strategy alone, and of those, 58% reported eating fewer calories. The prevalence of using exercise as a weight loss strategy was directly associated with education and inversely associated with age and body mass index. Among those who reported using exercise as a weight loss strategy, 57% met the minimal 1998 National Institutes of Health recommendation of >or=150 min.wk; 46% met the lower end of the 2001 American College of Sports Medicine recommendation of 200 min.wk; and 30% met the upper end for 300 min.wk. Only 19% met the 2002 Institute of Medicine recommendation of 420 min.wk., Conclusions: Despite the importance of physical activity in a weight loss program, only about half of the persons trying to lose weight reported using exercise. Even among those, only slightly more than half met the minimal recommendations for physical activity. Efforts are needed to aid those trying to lose weight to incorporate appropriate levels of physical activity into their weight loss strategy.

Objective: The authors examined vitamin/supplement (V/S) use and its relationship to sociodemographics, health behaviors, and health conditions among adults in 13 states., Methods: This investigation used 2001 data from a cross-sectional study of non-institutionalized adults aged > or = 18 years, the Behavioral Risk Factor Surveillance System., Results: Of 45,415 respondents with complete data (18,723 males and 26,692 females), 56.5% (n=5,652) reported current V/S use. After adjusting for age, sex, race/ethnicity, and education, the authors found a statistically significant association between V/S use and positive health risk behavior (adjusted odds ratio [OR]=1.46; p<0.001). Also, WS use was found to increase with age (p<0.001). No association was found between V/S use and the absence of specific chronic disease conditions (adjusted OR=0.93; p=0.052)., Conclusions: People who used V/S in the states surveyed were more likely to demonstrate positive health risk behaviors than those who did not report V/S use. Thus it appears that individuals who are most likely to use V/S are least likely to need V/S. It is crucial that individuals report quantity and frequency of V/S use when providing medical or diet histories to health care providers.

Objective: To examine the variation in the prevalences of obesity and type 2 diabetes in weight loss counseling by health providers and in other potential obesity-related determinants in 100 metropolitan statistical areas in the United States., Research Methods and Procedures: We performed a cross-sectional study using data from the 2000 Behavioral Risk Factor Surveillance System, the largest telephone survey of health behaviors in the United States, of age-adjusted prevalence of obesity, type 2 diabetes, intake of >or=five servings of fruits and vegetables per day, participation in 150 minutes of leisure-time physical activity per week, receipt of weight management advice, and reports of trying to lose or maintain weight among men and women more than 18 years old., Results: The age-adjusted prevalence of obesity ranged from 13.1% to 30.0% and that of type 2 diabetes from 3.3% to 9.2%. Among participants who had visited a physician for a routine checkup in the previous 12 months, 13.1% to 27.1% of all participants recalled receiving advice from a health professional about their weight, and 11.7% to 34.6% of overweight or obese participants recalled receiving advice to maintain or lose weight., Discussion: Significant differences in the prevalence of obesity and self-reported type 2 diabetes and in medical practice patterns regarding weight management advice exist among metropolitan statistical areas. These results suggest important opportunities to investigate reasons for these variations that could potentially be used to mitigate the current epidemic of obesity and to identify areas where obesity and diabetes prevention efforts may need to be targeted.

Compared with younger adults, older people experience additional health, social, and environmental conditions that affect their dietary intake. To identify those additional dimensions and examine them in association with fruit and vegetable intake, data of 4,622 participants in NHANES III (1988-1994), ages 60 years and over, were analyzed using multivariate logistic regression modeling. Results showed that participants at highest risk of consuming fruits and vegetables in the lowest quartile were those socially isolated, with missing pairs of posterior teeth, with poor self-reported health and those who were obese. To prevent downward spiraling health, barriers must be addressed in intervention programs.

Background: Americans spend over $33 billion annually on weight-loss products and services. Although weight-control methods are of considerable public health interest, few national data on weight-loss practices are available. This paper examines the prevalence of specific weight-loss practices among U.S. adults trying to lose weight., Methods: Data from the 1998 National Health Interview Survey, which was conducted through face-to-face interviews of a nationally representative sample of U.S. adults (n =32,440), were analyzed in 2003., Results: Twenty-four percent of men and 38% of women were trying to lose weight. Attempting weight loss was less common among normal weight (body mass index [BMI]<25 kg/m(2)) people (6% men, 24% women) than overweight (BMI>/=25 to 30 kg/m(2)) people (28%, 49%) or obese (BMI>/=30 kg/m(2)) people (50%, 58%). Among those trying to lose weight, the most common strategies were eating fewer calories (58% men, 63% women); eating less fat (49%, 56%); and exercising more (54%, 52%). Less frequent strategies were skipping meals (11% men, 9% women); eating food supplements (5%, 6%); joining a weight-loss program (3%, 5%); taking diet pills (2%, 3%); taking water pills or diuretics (1%, 2%); or fasting for >/=24 hours (0.6%, 0.7%). Only one third of all those trying to lose weight reported eating fewer calories and exercising more., Conclusions: Increased efforts are needed among all those trying to lose weight to promote effective strategies for weight loss, including the use of calorie reduction and increased physical activity.

Background: The biological variability in serum retinol concentrations has never been examined in a large sample, and its effect on population distribution estimates and the clinical assessment of vitamin A status is unknown., Objective: We evaluated the biological CV of serum retinol and examined the effect of the CV on both population distribution estimates and clinical assessments of vitamin A status by using data from the third National Health and Nutrition Examination Survey, 1988-1994., Design: We described the biological CV [(SD/x) x 100] and examined associations between the CV and other factors via multivariate analysis of variance and linear regression. We used linear regression to predict the mean retinol concentration from a single concentration and established 95% CIs for each participant. We estimated the adjusted prevalence of inadequate vitamin A status (retinol < 1.05 micromol/L) on the basis of the CIs. We estimated an uncertainty range for serum retinol concentrations for which the CIs included the established cutoff., Results: The mean biological CV across all strata was 6.45%. The biological CV varied significantly between racial-ethnic groups (P < 0.05). Prevalence estimates of inadequate serum retinol concentrations were reduced after adjustment for the total variation, with an adjusted overall prevalence of 0.62% compared with an unadjusted prevalence of 2.63%., Conclusions: The actual population prevalence of inadequate vitamin A status may be 75% lower than the estimates previously reported. Confirmation of vitamin A status may be needed for persons in the United States with observed serum retinol concentrations near the recognized cutoff.

Objective: We quantified maternal misclassification of child weight status and examined determinants associated with maternal perceptions of child weight status., Methods: Data from the Third National Health and Nutrition Examination Survey (1988-1994) were used. The sample included 5500 children (aged 2-11 years) with maternal interview data. Maternal perceptions of children's weight status were compared with measured weights and statures from which body mass index (BMI; weight/stature2; kg/m2) percentiles and z scores were determined. Frequency analyses determined the percentages of mothers considering their child to be "overweight," "underweight," or "about the right weight." Multivariable logistic regression analyses determined predictors of maternal misclassification of overweight children (> or =95th BMI-for-age percentile) and those at risk for overweight (> or =85th to <95th BMI-for-age percentile)., Results: Nearly one third (32.1%) of mothers reported their overweight child as "about the right weight." Younger children and those with lower BMI-for-age z scores had significantly greater odds of maternal underclassification of child overweight status. For children at risk for overweight, 14.0% of mothers reported sons to be "overweight," whereas 29.0% considered daughters to be "overweight." Odds of maternal misclassification of at-risk children as "overweight" were significantly greater for daughters, older children, children with higher BMI-for-age z scores, and children whose mothers had a lower BMI. Race/ethnicity was not a significant predictor in either model., Conclusions: Nearly one third of mothers misclassify overweight children as being lower than their measured weight status. Mothers are more likely to identify daughters who are at risk of overweight as being "overweight" than they are sons.

Background: Several studies have shown that girls who undergo menarche at a relatively young age tend to be more obese as adults. However, because childhood (pre-menarcheal) levels of weight and height are associated with an earlier menarche, the increased prevalence of adult obesity among early maturers may largely reflect the persistence of childhood obesity into adulthood., Methods: We examined these interrelationships among 1179 girls (65% white, 35% black) who were examined as children (mean age, 9 y), adolescents, and adults (mean age, 26 y) in the Bogalusa Heart Study., Results: Both white and black women who reported that they underwent menarche before age 12 y had, on average, higher adult levels of weight (+10 kg), body mass index (BMI, +4 kg/m2) and skinfold thicknesses (+6 mm) than did women who underwent menarche after age 13.5 y. However, relatively fat children tended to undergo menarche earlier than did thinner children, with each standard deviation increase in pre-menarcheal BMI increasing the odds of early menarche (<12 y) by approximately 2-fold. Stratified and regression analyses indicated that (1) adult obesity was more strongly associated with childhood obesity than with menarcheal age, and (2) about 60% to 75% of the apparent effect of menarcheal age was due to the influence of childhood obesity on both menarcheal age and adult obesity., Conclusions: Although additional longitudinal studies are needed, it is likely that the importance of early menarche in adult obesity has been overestimated. Most of apparent influence of menarcheal age on adult obesity is attributable to the association of childhood obesity with both menarcheal age and adult obesity.

Objective: To describe weight-control practices and receipt of weight-loss advice among obese people with asthma., Research Methods and Procedures: We analyzed data from the 2000 Behavioral Risk Factor Surveillance System., Results: Among 13953 participants with current asthma, 27.3% had a body mass index of >or=30 kg/m2. Overall, 48.1% of participants with asthma reported trying to lose weight (64.1% among overweight or obese participants and 72.9% among obese participants). Among participants with asthma who were trying to lose or maintain weight, 74.7% reported trying to reduce their energy and/or fat intake, and 57.8% reported using physical activity. Approximately 29.7% were using the recommended combination of energy and/or fat intake reduction and physical activity of >or=150 min/wk. During the 12 months before the interview, 16.2% of overweight and 44.9% of obese participants with asthma reported receiving advice to lose weight. Among obese participants receiving weight-loss advice, 82.9% reported trying to lose weight compared to 63.8% of participants who did not receive such advice., Discussion: Health professionals can play an important role in educating their patients with asthma about the importance of weight control and assisting their overweight and obese patients in setting appropriate weight goals and helping them achieve those goals.