OBJECTIVE: To examine demographic, behavioral and dietary correlates of frequency of fast food restaurant use in a community-based sample of 891 adult women. DESIGN: A survey was administered at baseline and 3 y later as part of a randomized, prospective intervention trial on weight gain prevention. SUBJECTS: Women (n 891) aged 20 ± 45 y who enrolled in the Pound of Prevention study. MEASUREMENTS: Frequency of fast food restaurant use, dietary intake, demographic and behavioral measures were self-reported. Dietary intake was measured using the 60-item Block Food Frequency Questionnaire. Body weight and height were directly measured. RESULTS: Twenty-one percent of the sample reported eating 3 fast food meals per week. Frequency of fast food restaurant use was associated with higher total energy intake, higher percentage fat energy, more frequent consumption of hamburgers, French fries and soft drinks, and less frequent consumption of ®ber and fruit. Frequency of fast food restaurant use was higher among younger women, those with lower income, non-White ethnicity, greater body weight, lower dietary restraint, fewer low-fat eating behaviors, and greater television viewing. Over 3 y, increases in frequency of fast food restaurant use were associated with increases in body weight, total energy intake, percentage fat intake, intake of hamburgers, French fries and soft drinks, and with decreases in physical activity, dietary restraint and low-fat eating behaviors. Intake of several other foods, including fruits and vegetables, did not differ by frequency of fast food restaurant use. CONCLUSION: Frequency of fast food restaurant use is associated with higher energy and fat intake and greater body weight, and could be an important risk factor for excess weight gain in the population.

Contents 1. Obesity and the global burden of disease 2. Prevalence, trends and economics 3. Targets for action 4. The action agenda 5. Potential solutions 6. Tracking outcomes 7. Glossary of terms 8. Key references and further reading 9. Case studies: Available on Nature website at www.naturesj.com=ijo=index.html

OBJECTIVES: This present study describes weight control strategies used by a heterogeneous sample of US adults and their associations with weight and behaviour change over time. DESIGN: A prospective cohort study. PARTICIPANTS: Participants for this study were 1120 US adults recruited from the community who enrolled in a threeyear intervention study to examine methods for preventing age-related weight gain. MEASURES: Measured body weight and self-reported behaviours related to body weight (dieting practices, dietary intake and physical activity) were completed annually for four years. RESULTS: Over 70% reported using each of the following dieting strategies at least once in four years: increase exercise (82.2%); decrease fat intake (78.7%); reduce food amount (78.2%); and reduce calories (73.2%). Cumulative duration of use of these behaviours was brief (for example, even the most common behaviours were used only 20% of the time). Global reports of dieting were not predictive of weight change over time. However, a dose ± response relationship was observed between reported duration of use of several speci®c weight loss strategies over the four years and change in behaviours and weight gain. CONCLUSIONS: These ®ndings suggest that public health recommendations for weight control may need to place greater emphasis on persistence of weight control behaviours.

This study examined the prevalence, distribution and correlates of successful weight loss and successful weight maintenance over three years in a community-based sample of 854 subjects aged 20 ± 45 at baseline. More than half (53.7%) of the participants in the study gained weight within the ®rst twelve months, only one in four (24.5%) successfully avoided weight gain over three years, and less than one in twenty (4.6%) lost and maintained weight successfully. The ®ndings underscore the importance of current public health efforts to prevent weight gain, and suggest that without much greater efforts to promote and support weight control the prevalence of obesity will continue to rise.

OBJECTIVES: The aims of the present study were to examine the prevalence and correlates of binge eating in a nonclinical sample of women and to examine whether associations differed by overweight status. DESIGN: Cross-sectional comparison of women based on self-reported binge eating status (large amount of food eaten and feelings of lack of control during these eating episodes) and overweight status (measured body weight: overweight de®ned as body mass index (BMI) ! 27.3 kgam 2 ). PARTICIPANTS: Subjects were 817 women aged 20 ± 45 y from the community who enrolled in a three year prospective intervention study to examine methods for preventing age-related weight gain. MEASURES: Body weight was measured at baseline and three-year follow-up. Self-report measures of binge eating, dieting practices, eating and exercise behaviours, depression, self-esteem and stressful life events were collected at the three-year follow-up. RESULTS: The prevalence of binge eating in the past six months was 9% among normal weight women and 21% among overweight women. The frequency of binge eating was low ( b 50% of binge eaters binged less than once per week) and did not signi®cantly differ by body weight status. Compared to non-binge eaters, binge eaters reported more dieting practices, more extreme attitudes about weight and shape, and higher levels of depression and stressful life events. Binge eating was not related to habitual eating and exercise behaviours. In multivariate models, weightashape importance (odds ratio (OR) 3.33; 95% con®dence intervals (95% CI) 2.10, 5.29), depression (OR 1.73; 95% CI 1.07, 2.79) and history of intentional weight loss episodes (OR 1.68; 95% CI 1.03, 1.13) were independently associated with increased odds of binge eating. CONCLUSIONS: Binge eating is about twice as prevalent among overweight women, compared to normal weight women, in a nonclinical sample, but has similar correlates (that is, dieting, depression, weightashape preoccupation). Prospective research is needed to determine whether there are causal associations between binge eating, depression, dieting and weight gain.

High density lipoprotein (HDL) cholesterol is inversely related to coronary heart disease prevalence. Despite the fact that obese patients have lower plasma HDL-cholesterol concentrations, there are few prospective studies on the effect of weight loss on HDL-cholesterol. Consequently, plasma lipoprotein levels were measured in 15 obese females before and after a 10 week weight loss program. Mean weight loss was 8.6 +/- 3.9 kg (P less than 0.001). Total plasma cholesterol and low density lipoprotein-cholesterol did not change significantly. Plasma triglyceride levels decreased (P less than 0.05) as did HDL-cholesterol (P less than 0.02). A subgroup of 11 of the subjects had repeat lipid measurements 8 months after the start of treatment. Mean weight loss at this time was 12.8 +/- 0.8 kg (P less than 0.01). No subject had returned to her pretreatment weight but mean weight loss was not significantly different from the 10 week value. At 8 months all lipid values, including HDL-cholesterol, had returned to their pretreatment value. By multiple regression analysis HDL-cholesterol decreased with increasing relative weight but also decreased with increasing rate of weight loss. These results suggest that negative caloric balance produces a decrease in HDL-cholesterol that in prospective studies may obscure the inverse relationship between HDL-cholesterol and indices of obesity.

The Heart Healthy Program is a health education project developed for elementary school students. It was designed to 1) increase their consumption of complex carbohydrates, and decrease their consumption of saturated fat, cholesterol, sodium, and sugar; 2) increase their level of habitual physical activity; and 3) generalize these changes to other family members. The overall program and 12 class lessons were designed using informative instruction, participatory classroom activities, personal goal setting, parent handouts, feedback, and reinforcement. The program was evaluated using a time-series experimental design with all students in three 4th grade classes at School 1 and three 5th grade classes at School 2. Evaluation Elevated blood lipids and blood pressures among significant proportions of school-age children have been documented in large-scale epidemiological studies. 1-6 These "risk" factors for the development of cardiovascular disease may be influenced by habitual diet and activity patterns. The diets of children and adolescents in the United States share the same deficits and excesses characteristic of the entire population: over 40 per cent of calories eaten are from fat; saturated fat accounts for 15 to 18 per cent of the calories; and average dietary cholesterol is well in excess of 300 mg per day.'0 Some young persons are also quite sedentary." Changing children's health habits may be a key element in promoting widespread adoption of a healthier life style that could lead to reduction of cardiovascular risk behavior and disease events in the population. At the same time, working with children in schools might prove beneficial in helping the adults around them change as well. Primary prevention of cardiovascular disease may be dependent upon health education programs capable of promoting meaningful behavior changes. '2' 13 We evaluated the effectiveness of a school-based program in changing elementary students' eating and exercise habits. The Heart Healthy Program was designed to accomplish three objectives: 1) increase elementary students' con- Editor's Note: See also related editorial in this issue, p. 5. was conducted using direct observation of eating and activity, as well as paper-and-pencil assessments of knowledge and attitude. Results indicated substantial changes in eating behavior at school, knowledge about heart health, food preferences, and family eating patterns as reported by parents. Observed changes in exercise were minimal during treatment, and were related to seasonal sports activities at follow-up. Eating habit changes persisted over a four-month follow-up which spanned summer vacation. These outcomes suggest that school programs developed using specific techniques can be effective in facilitating important behavior changes at school and at home. (Am J Public Health 1981; 71:15-23.) sumption of complex carbohydrates, and decrease their consumption of saturated fat, cholesterol, sodium, and sugar; 2) increase their physical activity; and 3) generalize these changes to...

of intentional and unintentional weight loss in a population-based sample of women aged 55 to 69 years. Obes Res. 1995;3:163-170.Although both overweight and body weight fluctuation a r e related to chronic disease risk, little is known about the history of and reasons for body weight change in the general population. This paper reports the incidence of intentional and unintentional weight loss episodes during adulthood in.a population-based sample of 26,261 women aged 55 to 69 years. Intentional weight loss episodes of each of four amounts (5-9, 10-19, 20-49, SO+ lbs.) and unintentional weight loss episodes of 20 or more lbs. were recalled for each of three age periods (18-39, 40-54, 55+ years). A t least one intentional weight loss episode of 5 or more Ibs. was reported by 69% of women, 46% reported at least one intentional weight loss episode of 10 or more Ibs, and 25% reported at least one intentional weight loss episode 20 or more Ibs. At least one unintentional weight loss episode of 20 or more Ibs. was reported by 29% of the women. Reasons for weight losses of 20 or more Ibs. were also recalled. Women who had intentionally lost 20 or more Ibs. were more likely to report weight losses due to low-calorie diets, exercise and weight loss groups, while women who had unintentionally lost 20 or more Ibs. were more likely to report weight losses due to depression or stress. These findings question the common assumption that weight losses in adult women are primarily intentional and emphasize the need to distinguish the reasons for weight loss in studies examining the relationship between body weight changes and health outcomes.