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J. Michael Gonzalez-Campoy, MD, PhD, FACE1; Sachiko T. St. Jeor, PhD, RD2; Kristin Castorino, DO3; Ayesha Ebrahim, MD, FACE4; Dan Hurley, MD, FACE5; Lois Jovanovic, MD, MACE6; Jeffrey I. Mechanick, MD, FACP, FACN, FACE, ECNU7; Steven M. Petak, MD, JD, MACE, FCLM8; Yi-Hao Yu, MD, PhD, FACE9; Kristina A. Harris10; Penny Kris-Etherton, PhD, RD11; Robert Kushner, MD12; Maureen Molini-Blandford, MPH, RD13; Quang T. Nguyen, DO14; Raymond Plodkowski, MD15; David B. Sarwer, PhD16; Karmella T. Thomas, RD17

Sarah L. Booth, Ph.D., Vitamin K Laboratory, Jean Mayer USDAHuman Nutrition Research Center on Aging at Tufts University, Boston, MA; James F. Sallis, Ph.D., F.A.C.S.M., Department ofPsychology, San Diego State University, San Diego, CA; Cheryl Ritenbaugh, Ph.D., M.P.H., Kaiser Permanente Center for Health Research, Portland, O R James 0. Hill, Ph.D., Center for Human Nutrition, University of Colorado Health Sciences Center, Denver, CO; Leann L. Birch, Ph.D., Department ofHuman Development and Family Studies, Pennsylvania State University, University Park, PA; Lawrence D. Frank, Ph.D., College OfArchitecture, Georgia Institute of Technology, Atlanta, GA; Karen Glanz, Ph.D., M.P.H., Cancer Research Center of Hawaii, University of Hawaii, Honolulu, HI; David A. Himmelgreen, Ph.D., Department ofAnthropology, University of South Florida, Tampa, FL; Michael Mudd, Corporate Affairs, Kraft Foods, Inc., Northfield, IL; Barry M. Popkin, Ph.D., Department ofNutrition, Carolina Population Center, University of North Carolina, Chapel Hill, NC; Karyl A. Rickard, Ph.D., R.D., C.S.P., F.A.D.A., Nutrition and Dietetics Program, School ofAllied Health Sciences, Indiana University School of Medicine, Indianapolis, IN; Sachiko St. Jeor, Ph.D., R.D., Nutrition Education and Research Program, University of Nevada School of Medicine, Reno, W, Nicholas P. Hays, M.S., Energy Metabolism Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA.

Background: Bupropion and naltrexone are centrally active drugs that have shown potential efficacy – alone and in combination – for the treatment of obesity. Objective: To explore the efficacy and safety of naltrexone and bupropion alone and in a novel combination drug that utilizes sustained-release (SR) formulations of both drugs and to evaluate their efficacy in promoting weight loss. The mechanisms of action of these centrally acting drugs are discussed. Preclinical and clinical studies of bupropion and naltrexone alone and in combination are reviewed. Results/conclusions: Both bupropion and naltrexone have been shown individually to induce weight loss. Bupropion has greater efficacy as monotherapy. Naltrexone SR potentiates the effects of bupropion SR; thus, this synergistic combination has the potential for additional weight loss compared to monotherapy. Current Phase III trials will yield further safety and efficacy information regarding these drugs in combination.

This review provides current strategies for weight management in the elderly population as it can be different from young adults due to multiple factors: co-morbidities, polypharmacy, limitation of functional activities, social issues.The recommendations for weight management for all age groups include exercise, diet, pharmacotherapy and surgery. In the elderly population, because of changes in age-related body composition, reduced energy requirement and expenditure, the standard young adult recommendations cannot be applied directly. The goal of weight management in the elderly differs from the young adult. The preferred method is maintenance of weight rather than aggressive weight loss with achieving a healthy, functional, and good quality of life.The growing prevalence of obesity in the elderly population is becoming a major health problem and can affect functional status, can contribute to frailty and decline in activity, as well as worsening co-morbid medical problems. Practical recommendations for weight management in the elderly are challenging because of the obesity paradox in the elderly, and the lack of substantial research in this population. Individualized recommendations should be considered for elderly patients with a focus on the underlying medical problems, functional status and living environments.

The prevalence of overweight among children and adolescents has dramatically increased. There may be vulnerable periods for weight gain during childhood and adolescence that also offer opportunities for prevention of overweight. Overweight in children and adolescents can result in a variety of adverse health outcomes, including type 2 diabetes, obstructive sleep apnea, hypertension, dyslipidemia, and the metabolic syndrome. The best approach to this problem is prevention of abnormal weight gain. Several strategies for prevention are presented. In addition, treatment approaches are presented, including behavioral, pharmacological, and surgical treatment. Childhood and adolescent overweight is one of the most important current public health concerns.

On April 27 and 28, 2002, the American Heart Association (AHA) sponsored a scientific conference, “Obesity, a Worldwide Epidemic Related to Heart Disease and Stroke,” in Honolulu, Hawaii. The purpose of the conference was to develop a plan to reduce cardiovascular diseases (CVDs) associated with overweight and obesity. This report discusses the activities of the 4 working groups held before the conference, presentations at the conference, and extensive discussions among working group members after the conference. The primary objectives of this meeting were to The major findings of each working group are presented in this Executive Summary of the conference proceedings. The complete conference report with references is available online at http://www.circulationaha.org in the November 2, 2004, issue of Circulation . The prevalence of obesity is increasing in virtually all populations and age groups worldwide. Although this increase is most evident in the United States, it is not limited to the more developed, affluent nations of the world. The escalation in obesity rates reflects the upward shift in body weights of individual populations in response to environmental changes. BMI, or weight in kilograms per square meter of height (kg/m2), generally is accepted as a convenient measurement that provides a crude indication of body fat. The classifications of normal weight (BMI 18.5 to 24.9), overweight (BMI 25.0 to 29.9), and obesity (BMI >30.0) are somewhat arbitrary but are based on international analyses of the health impact of different BMIs. By using approaches similar to those used for birth cohort trends in cholesterol …

It has long been believed that adult somatic complaints are associated with early family dysfunction. Yet, few studies have examined this hypothesis in community samples, where medically unexplained symptom complaints are estimated to be very common. Given the potential population-wide impact of subthreshold symptom complaints as well as questions about the extent to which findings with patient populations generalize to broader samples of community adults, the present study examines the influence of distal family factors on current adult somatic complaints relative to demographic and other psychosocial predictors. Results based on multiple linear regression analysis indicated that, after controlling for the other variables, family-of-origin functioning did not predict adult somatic complaints. However, self-reported symptoms of current depressed mood and low internal locus of control were significantly linked to somatic complaints ( p ¼0.001). These results lend support to questions about the generalizability of findings based on psychiatric groups to broader community samples, highlight the robust relationship between contemporaneous attributions of lower internal control, depressed mood, and somatic complaints, and suggest that early family environment may not be the most important focus of attention for health professionals providing care to adults in the community.

Purpose To compare energy intake derived from a food frequency questionnaire (FFQ) with estimated energy expenditure in postmenopausal women participating in a large clinical study. Methods A total of 161,856 women aged 50 to 79 years enrolled in the Women's Health Initiative (WHI) Observational Study (OS) or Clinical Trial (CT) [including the Diet Modification (DM) component] completed the WHI FFQ, from which energy intake (FFQEI) was derived. Population-adjusted total energy expenditure (PATEE) was calculated according to the Harris-Benedict equation weighted by caloric intakes derived from the National Health and Nutrition Examination Survey. Stepwise regression was used to examine the influence of independent variables (e.g., demographic, anthropometric) on FFQEI-PATEE. Race, region, and education were forced into the model; other variables were retained if they increased model explanatory ability by more than 1%. Results On average, FFQEI was approximately 25% lower than PATEE. Regression results (intercept = −799 kcal/d) indicated that body mass index (b = −23 kcal/day/kg·m −2 ); age (b = 15 kcal/day/year of age); and study arm (relative to women in the OS, for DM women b = 169 kcal/d, indicating better agreement with PATEE) increased model partial R 2 > .01. Results for CT women not eligible for DM were similar to those of women in the OS (b = 14 kcal/d). There also were apparent differences by race (b = −152 kcal/d in Blacks) and education (b = −67 kcal/d in women with Conclusion This large, carefully studied population confirms previous observations regarding underestimates in self-reported caloric intake relative to estimates of metabolic need in younger women, and those with higher weight, with less education, and in Blacks. These differences, along with effects related to intervention assignment, underline the need for additional research to enhance understanding of errors in dietary measurement.

Objective: To evaluate the effectiveness of meal replacements (MRs) in weight loss interventions in premenopausal women. Research Methods and Procedures: Overweight premenopausal women (n = 113; body mass index: 25 to 35 kg/m2; 30 to 50 years old) were randomized into three interventions: group A, a dietitian-led intervention; group B, a dietitian-led intervention incorporating MRs; and group C, a clinical office-based intervention incorporating MRs. In year 1, groups A and B attended 26 group sessions, whereas group C received the same educational materials during 26 10-minute office visits with a physician–nurse team. In year 2, participants attended monthly group seminars and drop-in visits with a dietitian. Results: For the 74 subjects completing year 1, weight loss in the office-based group C was as effective as the traditional dietitian-led group A (4.3 ± 6.5% vs. 4.1 ± 6.4%), while group B maintained a significantly greater weight loss (9.1 ± 8.9%; p < 0.02; mean ± SD). For the 43 subjects completing year 2, group B showed significant differences in the percentage of weight loss (−8.5 ± 7.0%) compared with group A (−1.5 ± 5.0%) and group C (−3.0 ± 7.0%; p < 0.001). Discussion: Study results showed that a traditional weight loss intervention incorporating MRs was effective as a weight loss tool in the medical office practice and in the dietitian-led group setting.

High-protein diets have recently been proposed as a “new” strategy for successful weight loss. However, variations of these diets have been popular since the 1960s. High-protein diets typically offer wide latitude in protein food choices, are restrictive in other food choices (mainly carbohydrates), and provide structured eating plans. They also often promote misconceptions about carbohydrates, insulin resistance, ketosis, and fat burning as mechanisms of action for weight loss. Although these diets may not be harmful for most healthy people for a short period of time, there are no long-term scientific studies to support their overall efficacy and safety. These diets are generally associated with higher intakes of total fat, saturated fat, and cholesterol because the protein is provided mainly by animal sources. In high-protein diets, weight loss is initially high due to fluid loss related to reduced carbohydrate intake, overall caloric restriction, and ketosis-induced appetite suppression. Beneficial effects on blood lipids and insulin resistance are due to the weight loss, not to the change in caloric composition. Promoters of high-protein diets promise successful results by encouraging high-protein food choices that are usually restricted in other diets, thus providing initial palatability, an attractive alternative to other weight-reduction diets that have not worked for a variety of reasons for most individuals. High-protein diets are not recommended because they restrict healthful foods that provide essential nutrients and do not provide the variety of foods needed to adequately meet nutritional needs. Individuals who follow these diets are therefore at risk for compromised vitamin and mineral intake, as well as potential cardiac, renal, bone, and liver abnormalities overall.

This document presents guidelines for reducing the risk of cardiovascular disease by dietary and other lifestyle practices. Since the previous publication of these guidelines by the American Heart Association,1 the overall approach has been modified to emphasize their relation to specific goals that the AHA considers of greatest importance for lowering the risk of heart disease and stroke. The revised guidelines place increased emphasis on foods and an overall eating pattern and the need for all Americans to achieve and maintain a healthy body weight (Table⇓). View this table: Table 1. Summary of Dietary Guidelines The major guidelines are designed for the general population and collectively replace the “Step 1” designation used for earlier AHA population-wide dietary recommendations. More individualized approaches involving medical nutrition therapy for specific subgroups (for example, those with lipid disorders, diabetes, and preexisting cardiovascular disease) replace the previous “Step 2” diet for higher-risk individuals. The major emphasis for weight management should be on avoidance of excess total energy intake and a regular pattern of physical activity. Fat intake of ≤30% of total energy is recommended to assist in limiting consumption of total energy as well as saturated fat. The guidelines continue to advocate a population-wide limitation of dietary saturated fat to

Increasing awareness of the relationship between diet and disease has prompted a notable increase in nutrition research. The focus of many of these studies continues to be on amount and type of fat in the diet. At the same time, a great deal of attention is being directed at other dietary components and their mode of action. The results are promising. More definitive answers must await future clinical trial data. However, the total dietary approach, including compliance measures, remains the foundation on which other nutrition recommendations should be based.

Objective Relationships were examined between hostility, weight status, weight cycling, dieting behaviors, and nutrition attitudes. Method Data were derived from the RENO Diet-Heart Study (RDHS), a 5-year prospective natural history (descriptive) study of weight fluctuations, behavior patterns, and cardiovascular (CVD) risk factors. Overweight versus normal-weight and weight-cycling versus non–weight-cycling men and women were compared on overt and covert hostility. Results Overweight subjects scored significantly higher than normal-weight individuals on covert but not overt hostility. Similarly, subjects with a history of weight fluctuation scored significantly higher on covert hostility than subjects without a history of weight cycling. Subjects who reported more hostility scored higher on measures of eating disinhibition, hunger, and dietary helplessness. Discussion The relationships among hostility, dieting behaviors, and nutrition attitudes could not be explained on the basis of general distress alone. The findings supported the hypothesis that the relationship between hostility and health is mediated by the association between hostility and health-related behaviors. © 1999 John Wiley & Sons, Inc. Int J Eat Disord 26: 37–42, 1999.

Why are some individuals more vulnerable to persistent weight gain and obesity than are others? Some obese individuals report factors that drive overeating, including lack of control, lack of satiation, and preoccupation with food, which may stem from reward-related neural circuitry. These are normative and common symptoms and not the sole focus of any existing measures. Many eating scales capture these common behaviors, but are confounded with aspects of dysregulated eating such as binge eating or emotional overeating. Across five studies, we developed items that capture this rewardbased eating drive (RED). Study 1 developed the items in lean to obese individuals (n = 327) and examined changes in weight over eight years. In Study 2, the scale was further developed and expert raters evaluated the set of items. Study 3 tested psychometric properties of the final 9 items in 400 participants. Study 4 examined psychometric properties and race invariance (n = 80 women). Study 5 examined psychometric properties and age/gender invariance (n = 381). Results showed that RED scores correlated with BMI and predicted earlier onset of obesity, greater weight fluctuations, and greater overall weight gain over eight years. Expert ratings of RED scale items indicated that the items reflected characteristics of reward-based eating. The RED scale evidenced high internal consistency and invariance across demographic factors. The RED scale, designed to tap vulnerability to reward-based eating behavior, appears to be a useful brief tool for identifying those at higher risk of weight gain over time. Given the heterogeneity of obesity, unique brief profiling of the reward-based aspect of obesity using a self-report instrument such as the RED scale may be critical for customizing effective treatments in the general population. © 2014 Epel et al.

Objective This study investigated the relationship between eating and weight behaviors and functioning in individuals' families of origin. Method: Subjects were 237 women and 242 men enrolled in the RENO (Relationship of Energy, Nutrition, and Obesity) Diet-Heart Study, a prospective 5-year study of the effects of weight fluctuation on cardiovascular disease risk factors in normal weight and obese adults. Variables of primary interest included subjects' body mass index (BMI), age of onset of obesity, eating attitudes, lack of control while eating, and family functioning. Results: In men, higher family cohesion was related to healthier eating attitudes and better control over eating, controlling for age, BMI, and adaptability, whereas higher adaptability (changing rules and poor leadership) was related to earlier onset of obesity and more disturbed eating attitudes. Cohesion and adaptability were not related to body weight or eating variables in women. Discussion: The lower societal pressure on men to be thin may increase the importance of family factors in influencing their shape and weight. © 1997 John Wiley & Sons, Inc. Int J Eat Disord 22: 213–218, 1997.

Objectives To study natural weight changes and to develop a weight classification system that can identify weight maintainers, gainers, and losers. Design/outcome A prospective, observational study in which weight changes over five annual measurements were evaluated. In the weight classification system used, changes greater than 5lb defined weight maintenance, gain, or loss. Subjects/settings Subjects were healthy, normal-weight and overweight, men and women (mean age=44.1+14.1 years) in the Relationships of Energy, Nutrition, and Obesity to Cardiovascular Disease Risk Study. Prospective data for 385 of the original 508 subjects for whom actual weights were available for each of the 5 years (1985 to 1990) were used to classify and characterize subjects by weight-change categories. Statistical analyses Cross-tabulations (with χ 2 tests) and hierarchical log-linear analyses (with partial χ 2 tests) to examine the relationships of categorical variables; analyses of variance (with F tests) for continuous measures. Results Over the 4-year interval, 46% of subjects were classified as maintainers, 34% as gainers, and 20% as losers. Over shorter 1-year epochs, more subjects were maintainers (62%) and fewer subjects were gainers (22%) or losers (16%). Maintainers had fewer and smaller magnitudes of weight fluctuations and showed fewer deleterious changes in health risk factors than gainers. Applications Weight changes of greater than ±5lb can classify a person as a weight maintainer, gainer, or loser. Although annual weight changes were used in this study, a weight change of more than 5lb between any two points in time may suggest nonmaintenance of weight or weight instability that needs further evaluation.

Objective: The primary purpose of this study was to compare obese versus nonobese adults and weight cyclers versus maintainers on measures of dietary helplessness, nutrition concern, dietary restraint, and disinhibition. Method: Dietary helplessness, nutrition concern, dietary restraint, and disinhibition were assessed in 385 healthy obese and nonobese men and women in the RENO Diet-Heart Study, a 5-year prospective investigation of cardiovascular risk factors, weight cycling, and lifestyle. Results: The results indicated that dietary helplessness and disinhibition were significantly greater in obese individuals, subjects with a history of weight cycling, and weight fluctuators (prospectively measured). Women were found to score significantly higher than men on measures of dietary helplessness, disinhibition, and cognitive restraint. Discussion: The role of nutrition attitudes is discussed in relation to dietary self-regulation, weight fluctuation, and management of body weight. © 1995 by John Wiley & Sons, Inc.

This investigation attempted to determine psychological correlates of weight fluctuation in a sample of 497 normal weight and obese adults who were enrolled in a prospective, natural history study. Subjects were stratified by gender, obesity, and age and classified as weight maintainers, gainers, or losers based on their changes in weight over a 1-year period. Subjects were further classified as either weight fluctuators or nonfluctuators based on historical self-report. Nonfluctuators reported significantly higher general well-being, greater eating self-efficacy, and lower stress than weight fluctuators, regardless of body weight. Weight maintainers had more favorable eating self-efficacy related to negative affect than weight gainers. Results suggest that weight fluctuation is strongly associated with negative psychological attributes in both normal weight and obese individuals. Future research should focus on the assessment and treatment of weight fluctuation and on weight maintenance, irrespective of weight status. © 1995 by John Wiley & Sons, Inc.

Weight dissatisfaction, dieting, and weight change, assessed by questionnaires, were studied in 471 subjects stratified by gender, age (20–60+years) and weight (normal/obese), participating in the RENO Diet Heart Study. Female and obese subjects had more weight dissatisfaction, dieting, and binges and were more overweight in adolescence. Females and

Weight management plays a central role in preventing many diseases that affect women. Lifelong hormonal, psychological, and environmental influences on women elicit a set of behavioral and biological responses distinctive from men that place them at increased risk for overall weight concerns, weight gain, and obesity. Limitations of current treatment call for increased research to improve our understanding and guide efforts in this important aspect of women's health. Research needs to be conducted to define realistic and obtainable weight goals and to design educational strategies to promote health and self-esteem. Research in the field of weight management should be directed to understanding gender differences, etiologies, and effective treatments.

Diet is a cornerstone of cardiovascular disease (CVD) prevention and treatment efforts. Step I and Step II diets are widely recommended as the first line of CVD intervention.1 At the core of this dietary guidance are the recommendations to decrease saturated fat and cholesterol and to consume more fruits, vegetables, and whole grain products. Information from an extensive database, especially regarding saturated fat, indicates that these diets significantly lower blood cholesterol levels, a major risk factor for CVD. Consequently, it is beyond debate that these diets reduce CVD risk. Since the advent of Step I and Step II diets, nutritionists have sought to develop effective implementation strategies, including identifying dietary patterns that augment the beneficial effects of these diets. Recent findings indicate that we are making impressive progress in attaining these goals. There is provocative evidence from the Lyon Diet Heart Study2 suggesting that a Mediterranean-style, Step I diet (emphasizing more bread, more root vegetables and green vegetables, more fish, less beef, lamb and pork replaced with poultry, no day without fruit, and butter and cream replaced with margarine high in α-linolenic acid) has effects that may be superior to those observed for the usual Step I diet. These findings raise the interesting, but not yet corroborated, question of whether a modified Step I diet (ie, a Mediterranean-style Step I diet) that features a dietary pattern consistent with the new American Heart Association (AHA) Dietary Guidelines may augment the Step I or Step II diets that are presently implemented in clinical practice. Defining a Mediterranean-style diet is challenging given the broad geographical region, including at least 16 countries, that borders the Mediterranean Sea. As would be expected, there are cultural, ethnic, religious, economic, and agricultural production differences that result in different dietary practices in these areas and that …

A predictive equation for resting energy expenditure (REE) was derived from data from 498 healthy subjects, including females (n = 247) and males (n = 251), aged 19-78 y (45 +/- 14 y, mean +/- SD). Normal-weight (n = 264) and obese (n = 234) individuals were studied and REE was measured by indirect calorimetry. Multiple-regression analyses were employed to drive relationships between REE and weight, height, and age for both men and women (R2 = 0.71): REE = 9.99 x weight + 6.25 x height - 4.92 x age + 166 x sex (males, 1; females, 0) - 161. Simplification of this formula and separation by sex did not affect its predictive value: REE (males) = 10 x weight (kg) + 6.25 x height (cm) - 5 x age (y) + 5; REE (females) = 10 x weight (kg) + 6.25 x height (cm) - 5 x age (y) - 161. The inclusion of relative body weight and body-weight distribution did not significantly improve the predictive value of these equations. The Harris-Benedict Equations derived in 1919 overestimated measured REE by 5% (p less than 0.01). Fat-free mass (FFM) was the best single predictor of REE (R2 = 0.64): REE = 19.7 x FFM + 413. Weight also was closely correlated with REE (R2 = 0.56): REE = 15.1 x weight + 371.

Background: A school-wide nutrition program was established in 1982 and a required medical nutrition course (MNC) was established in 1985 at the University of Nevada School of Medicine. Emphasis was placed on developing an integrated curriculum and on using innovative methods to incorporate nutrition into the existing curriculum. Objective: The objective of this review was to establish a baseline and make positive curricular changes to comply with the recommendations of the Liaison Committee on Medical Education for accreditation. The MNC and the nutrition curriculum were evaluated as part of this 3-y comprehensive, school-wide evaluation process. Design: The MNC was invited for review (December 2004) because of its position in the curriculum (first year), special content and methods, and relation to other courses. A review team, which consisted of the Assistant Dean for Medical Education (who chaired the team), a curriculum coordinator, faculty representatives, and a medical student, was appointed. The MNC coordinator prepared a review book that included the requested documentation. The initial 3-h review meeting culminated in a formal evaluation and recommendations. Follow-up meetings at 1 mo and 1 y were scheduled. Results: The review was a positive process that reaffirmed the uniqueness of the nutrition program at the University. It supported the MNC as an important part of the required curriculum. Recommendations included use of the Web, encouragement to identify new opportunities with interested faculty, and a structure to further integrate and align nutrition into existing courses. Conclusions: A positive, proactive review process supports the importance of nutrition in the medical school curriculum and encourages further integration.

Dynamic processes that occur over the life span determine the development of obesity and associated chronic diseases. Perturbations, or “insults,” that determine excessive weight gain leading to obesity may occur anytime from before conception to embryonic, fetal, infant, childhood, adolescent, and adult life. These insults can affect both somatic growth and the maturation of metabolic systems and may include a range of determinants, including societal, lifestyle, biological, and genetic factors that often act in concert with one another. A life-course approach to chronic disease (Figure 1) classifies determinants in several different ways.1 A critical period refers to a specific period of development when an insult has lasting effects on the structure or function of organs, tissues, and body systems. When the insult is not completely deterministic, these periods may be referred to as sensitive rather than critical. Effects during critical periods may act alone or be modified by later insults. Alternatively, some insults may act at any period of development; they may accumulate over time independently or be correlated through clustering. These models are useful in helping determine which early life factors are important in the assessment of later disease. Although age-dependent risk factors may vary worldwide, identification of common critical or sensitive periods and plausible determinants will help improve overall treatment and prevention of obesity over the life span. Figure 1. Life-course approach to obesity. BW indicates birth weight and PP BMI, prepregnancy body mass index. Small birth weight is associated with higher mortality from cardiovascular disease and higher levels of risk factors for cardiovascular disease, including type 2 diabetes mellitus and hypertension. These relationships suggest that part of the risk for cardiovascular disease may be “programmed” in utero. Programming occurs when an event in a crucial, early period of life permanently alters structure or function.2 Higher …

Since its release in 1992, the Food Guide Pyramid has become one of the most recognized nutrition education tools in US history. As such, it has been subject to criticism, particularly in several recent media reports that implicate it as the culprit in America's current obesity epidemic. What these reports often overlook, however, is that the diets of many Americans do not adhere to the dietary guidelines illustrated by the Pyramid, refuting the notion that the Pyramid is the cause of the nation's obesity problem. Data indicate that the more likely causes of escalating obesity rates are increased per capita caloric consumption and larger portion sizes, along with a lack of adequate physical activity. Although the Pyramid graphic was designed more than a decade ago, it still communicates three key concepts that continue to be the cornerstone of federal dietary guidance: variety, proportionality, and moderation. As such, it remains a viable and relevant nutrition education tool, especially when used by dietetics professionals as a component of individualized, comprehensive nutrition education and behavior modification interventions. As the United States Department of Agriculture begins to investigate whether the food intake patterns illustrated by the Pyramid are in need of updating, research is urgently needed to determine how nutrition education tools, including the Pyramid, can be most effectively implemented to help consumers adopt healthful eating behaviors and to improve the public health of America.

Most physicians do not have the benefit of in-house registered dietitians to facilitate patient evaluation and create treatment plans. Fortunately, with the new tools that are available to physicians and patients, energy balance can be evaluated. Then, a balanced deficit diet can be encouraged to achieve a weight management goal while maintaining healthy food intake patterns. Patients should also be counseled regarding weight maintenance diets to prevent weight gain. A low-fat diet is preferred because the patient will benefit from improved cardiac risk as a result of weight loss and a restricted saturated fat content is healthier. Other diets and approaches are acceptable if they are hypocaloric and do not negatively impact the patient's health (eg, some high-protein, high-fat diets can increase lipid levels; high-carbohydrate diets can increase triglycerides in patients who have type 2 diabetes). As patients lose weight, further increases in physical activity and exercise should be emphasized to help maintain lost weight. It is also helpful from a behavioral perspective to encourage patients to monitor their weight, food intake, and physical activity. Medical offices can support patients by providing weekly or biweekly weigh-ins to track progress and provide ongoing feedback. Patients should be reminded that the ultimate goal of any weight management program is gradual, incremental weight losses that are maintained over time. Sustainable and enjoyable changes in eating practices and physical activity patterns must be made along with a lifelong commitment to health.

Background: Evidence suggests substantial comorbidity between symptoms of somatization and depression in clinical as well as nonclinical populations. However, as most existing research has been retrospective or cross-sectional in design, very little is known about the specific nature of this relationship. In particular, it is unclear whether somatic complaints may heighten the risk for the subsequent development of depressive symptoms. Methods: We report findings on the link between symptoms of somatization (assessed using the SCL-90-R) and depression 5 years later (assessed using the CES-D) in an initially healthy cohort of community adults, based on prospective data from the RENO Diet-Heart Study. Results: Gender-stratified multiple regression analyses revealed that baseline CES-D scores were the best predictors of subsequent depressive symptoms for men and women. Baseline scores on the SCL-90-R somatization subscale significantly predicted subsequent self-reported symptoms of depressed mood 5 years later, but only in women. However, somatic complaints were a somewhat less powerful predictor than income and age. Conclusions: Our findings suggest that somatic complaints may represent one, but not necessarily the most important, risk factor for the subsequent development of depressive symptoms in women in nonclinical populations. The results also highlight the importance of including social variables in studies on women’s depression as well as conducting additional research to further examine predictors of depressive symptoms in men.

This study investigated whether symptoms of depression and anxiety were related to the development of elevated blood pressure in initially normotensive adults. The study's hypothesis was addressed with an existing set of prospective data gathered from an age-, sex-, and weight-stratified sample of 508 adults. Four years of follow-up data were analyzed both with logistic analysis, which used hypertension (blood pressure > or =140 mm Hg systolic or 90 mm Hg diastolic) as the dependent variable, and with multiple regression analysis, which used change in blood pressure as the dependent variable. Five physical risk factors for hypertension (age, sex, baseline body mass index, family history of hypertension, and baseline blood pressure levels) were controlled for in the regression analyses. Use of antidepressant/antianxiety and antihypertensive medications were controlled for in the study. Of the 433 normotensive participants who were eligible for our study, 15% had missing data in the logistic regression analysis focusing on depression (n = 371); similarly, 15% of the eligible sample had missing data in the logistic regression using anxiety as the psychological variable of interest (n = 370). Both logistic regression analyses showed no significant relationship for either depression or anxiety in the development of hypertension. The multiple regression analyses (n = 369 for the depression analysis; n = 361 for the anxiety analysis) similarly showed no relationship between either depression or anxiety in changes in blood pressure during the 4-year follow-up. Thus, our results do not support the role of depressive or anxiety symptoms in the development of hypertension in our sample of initially normotensive adults.

Purpose.To examine compliance with the guideline for dietary fat (i.e., 30% of total daily calories) and covariates of fat intake in a cohort of adults using both 24-hour recall and food frequency questionnaire (FFQ).Design.Prospective, observational cohort study over 5 years.Setting.Community-based sample in Reno, Nevada.Subjects.Equal numbers of male and female, lean and overweight adults (n = 508), recruited from 1985 to 1986, of whom 348 completed all relevant surveys.Measures.Subjects underwent repeated anthropometric measures and completed extensive surveys on diet, weight cycling, lifestyle, and physical activity.Results.Mean fat intake by 24-hour recall declined from 36.9% to 33.6% of calories between years 1 and 5 (p < .001), while calorie intake increased (p = .2). As measured by FFQ at year 2, mean fat intake was 39.1 % of calories, and only 11.8% of subjects were in compliance with the guideline for dietary fat intake. Fat intake by FFQ at year 2 was statistically higher than by 24-hour recall in year 1 for lean women (p = .02) and lean men (p = .02), but not for the overweight of either gender, and was significantly higher than the year 5 24-hour recall for all categories of gender and weight (p < .001). Calorie intake, gender, and body mass index were significant in regression models that explained less than 10% of total variability in fat intake (r2= .08; p < .01).Conclusions.Compliance with the nationally recommended level of dietary fat intake was poor in this cohort, especially as measured by FFQ. Variability in fat intake was largely unexplained by host characteristics, including education. Further study is required to corroborate secular trends in population fat intake, elucidate the determinants of such intake, and identify cost-effective strategies for reducing the consumption of dietary fat.

Recent studies have suggested that weight changes may be related to disease risk independent of weight status. A critical step in testing this assertion is the measurement of weight change and so-called “weight cycling”. However intuitive the concept of weight cycling may appear, research in this area is hampered by complex methodological issues. This article discusses various measures of nominal weight cycling, including the standard deviation, coefficient of variation, regression techniques, and cycles. A cycle is a sequence of a gain followed by a loss or vice versa. The various measures are compared in seven hypothetical cases created to illustrate their strengths and weaknesses. Superior performance of the cycles measure over the coefficient of variation, number of fluctuations, and simple regression methods is argued. The linkage of the cycles measure with the statistical theory of runs also provides a basis for testing the significance of weight fluctuations or other variables that may cycle, such as blood lipids, etc. The cycles measure and runs test provide a viable definition for identifying weight cycling and a tool for evaluating the critical amount of weight gained and/or lost in relationship to risk.