What is the future of medicine in the public sphere, as expressed through its professional organizations? Will the profession continue to be just one of many competing interest groups, whose influence will continue to wane? Or is there a basis on which the professional organizations of medicine might assume a new position of moral leadership in American health care? This latter question is seldom asked, perhaps because the answer seems preordained by our understanding of the recent past and projection of that past into the future. Notwithstanding its direct stake in many health policy questions and its perennial ranking near the top of political contributors, organized medicine has become conspicuous politically by its marginality among a cacophony of players, demoted from center stage and seen as just another self-interested player.Moreover, strong competition has developed over the issue of quality, a topic long monopolized by medical organizations through their control of education, training, and credentialing of physicians. Quality is now seen as a legitimate concern for purchasers, managed care plans, provider organizations, politicians, and consumers and is the subject of serious measurement and reporting efforts under a variety of auspices. Quality improvement of patient care requires effective management of complex

BackgroundWe examine the relationship between time use choices and healthy body weight as measured by survey respondents' body mass index (BMI). Using data from the 2006 and 2007 American Time Use Surveys, we expand upon earlier research by including more detailed measures of time spent eating as well as measures of physical activity time and sedentary time. We also estimate three alternative models that relate time use to BMI.ResultsOur results suggest that time use and BMI are simultaneously determined. The preferred empirical model reveals evidence of an inverse relationship between time spent eating and BMI for women and men. In contrast, time spent drinking beverages while simultaneously doing other things and time spent watching television/videos are positively linked to BMI. For women only, time spent in food preparation and clean-up is inversely related to BMI while for men only, time spent sleeping is inversely related to BMI. Models that include grocery prices, opportunity costs of time, and nonwage income reveal that as these economic variables increase, BMI declines.ConclusionsIn this large, nationally representative data set, our analyses that correct for time use endogeneity reveal that the Americans' time use decisions have implications for their BMI. The analyses suggest that both eating time and context (i.e., while doing other tasks simultaneously) matters as does time spent in food preparation, and time spent in sedentary activities. Reduced form models suggest that shifts in grocery prices, opportunity costs of time, and nonwage income may be contributing to alterations in time use patterns and food choices that have implications for BMI.

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Objective: To describe how the time spent in food-related activities by Americans has changed over the past 30 years. Design: Data from four national time diary surveys, spanning 1975-2006, are used to construct estimates of trends in American adults' time spent in food-related activities. Multivariate Tobits assess how food-related activities have changed over time controlling for sociodemographic and economic covariates. Results: Both bivariate and multivariate estimates reveal that between 1975 and 2006, American women's time spent in food preparation declined substantially, whereas the time spent in these activities by American men changed very little. On the contrary, grocery shopping time increased modestly for both men and women. The primary eating time (i.e. time when eating/drinking was the respondent's main focus) declined for both men and women over this historical period, and the composition of this time changed with less primary eating time being done alone. Concurrently, secondary eating time (i.e. time when something else had the respondent's primary attention, but eating/drinking simultaneously occurred) rose precipitously for both women and men between 1975 and 1998. Conclusions: The total time spent in eating (i.e. primary plus secondary eating time) has increased over the past 30 years, and the composition of this time has shifted from situations in which energy intake can be easily monitored to those in which energy intake may be more difficult to gauge. Less time is also being spent in food preparation and clean-up activities. Future research should explore possible links between these trends and Americans' growing obesity risk.

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