Eating Frequency is Associated With Energy Intake but Not Obesity in Midlife Women

Midlife women tend to gain weight with age, thus increasing risk of chronic disease. The purpose of this study was to examine associations between overweight/obesity and behavioral factors, including eating frequency, in a cross‐sectional national sample of midlife women (n = 1,099) (mean age = 49.7 years, and BMI = 27.7 kg/m²). Eating behaviors and food and nutrient intakes were based on a mailed 1‐day food record. BMI was calculated from self‐reported height and weight, and level of physical activity was assessed by self‐reported questionnaire. After exclusion of low‐energy reporters (32% of sample), eating frequency was not associated with overweight/obesity (P > 0.05) and was not different between BMI groups (normal, 5.21 ± 1.79; overweight, 5.16 ± 1.74; obese, 5.12 ± 1.68, P = 0.769). Adjusted logistic regression showed that eating frequency, snacking frequency, breakfast consumption, eating after 10 pm and consuming meals with children or other adults were not significantly associated with overweight/obesity. Total energy intake increased as eating frequency increased in all BMI groups, however, obese women had greater energy intake compared to normal weight women who consumed the same number of meals and snacks. Intake of fruit and vegetables, whole grains, dietary fiber, dairy, and added sugars also increased as eating frequency increased. While eating frequency was not associated with overweight/obesity, it was associated with energy intake. Thus, addressing total energy intake rather than eating frequency may be more appropriate to prevent weight gain among midlife women.     

Racial/Ethnic Differences in Weight Perception

The objective of this research was to estimate the prevalence of weight misperception among adults using the most recent nationally representative data, according to measured weight category and to assess the relationship between weight misperception and race/ethnicity. Height and weight were measured as part of the 1999–2006 National Health and Nutrition Examination Survey. The study sample consisted of 17,270 adults aged ≥20 years. BMI was categorized as underweight (BMI < 18.5), healthy weight (18.5 ≤ BMI < 25), overweight (25 ≤ BMI < 30), and obese (BMI ≥ 30). Subjects reported self‐perception of weight status. Among study subjects, 31.7% of healthy weight adults, 38.1% of overweight adults, and 8.1% of obese adults incorrectly perceived their weight category. Among obese men, the odds of weight misperception were higher for non‐Hispanic blacks (odds ratio (OR) = 3.0; 95% confidence interval (CI) = 2.0–4.5) compared to non‐Hispanic whites and for persons with less than a high school education (OR = 2.1; 95% CI = 1.3–2.1), compared to those with some college education. Among obese women, the odds of weight misperception were higher for non‐Hispanic blacks (OR = 3.4; 95% CI = 1.4, 3.1) and Mexican Americans (OR = 1.9; 95% CI = 1.2, 3.2) compared to non‐Hispanic whites and for persons with less than high school education compared to those with some college education (OR = 5.5; 95% CI = 3.3–9.3). Weight misperception is highly prevalent in the US population, and more frequent in racial/ethnic minorities, males, and in persons with lower educational levels. Addressing the issue of weight misperception may help address the problem of obesity in the United States by increasing awareness of healthy weight levels, which may subsequently have an impact on weight‐related behavior change.     

Pregravid Weight Is Associated With Prior Dietary Restraint and Psychosocial Factors During Pregnancy

The objective of this study was to investigate the association of pregravid weight status, previous dietary restraint, and psychosocial factors during pregnancy. We used data from the Pregnancy, Infection, and Nutrition study, which recruited 2,006 women at prenatal clinics before 20 weeks' gestation who were >16 years and English speaking. Institute of Medicine BMI cut points of underweight (<19.8), normal weight (19.8–26.0), overweight (>26.0–29.0), obese (>29.0–34.9), and an additional category extremely obese (≥35.0), were used to categorize weight status. Eight psychosocial measures and dietary restraint were assessed with regard to BMI; perceived stress, trait anxiety, depressive symptoms, internal locus of control (LOC), chance LOC, powerful others LOC, self‐esteem, and mastery. Linear regression was used to estimate associations, controlling for potential confounders. A significant trend was found between increasing pregravid weight categories and increasing scores for perceived stress, trait anxiety, depressive symptoms, powerful others LOC and dietary restraint, and decreasing scores for self‐esteem and mastery. In adjusted models, pregravid obesity was independently associated with perceived stress, trait anxiety, and depressive symptoms. Extreme obesity was independently associated with all measures except internal LOC. A strong linear association was found between increasing weight categories and dietary restraint. In conclusion, as pregravid weight increased, pregnant women were at greater risk of reporting higher scores on negative psychosocial state and dietary restraints, and reporting lower score on positive personal dispositions.     

Obesity and Menstrual Irregularity: Associations With SHBG,Testosterone, and Insulin

This cross‐sectional study aimed to examine the association between different body composition measures, menstrual cycle characteristics, and hormonal factors in a population‐based sample of young women. The study sample included 726 Australian women aged 26–36 years who were not currently taking hormonal contraceptives and were not currently pregnant or breast feeding. Anthropometric measures included BMI, waist circumference (WC), and waist‐hip ratio (WHR). Menstrual cycle characteristics were self‐reported and usual cycles defined as short (≤25 days), normal (26–34 days), or long (≥35 days). Cycles were defined as irregular if there were ≥15 days between the longest and shortest cycle in the past 12 months. Fasting serum levels of sex hormone‐binding globulin (SHBG), testosterone, insulin, and glucose were measured and the free androgen index (FAI) derived. Compared with those of normal weight, obese women had at least a twofold greater odds of having an irregular cycle, whether defined by BMI (odds ratio (OR) = 2.61; 95% CI = 1.28–5.35), WC (OR 2.28; 95% CI = 1.16–4.49), or WHR (OR = 2.27; 95% CI = 1.09–4.72). Body composition measures were significantly positively associated with fasting insulin, testosterone, and FAI, and negatively associated with SHBG (P < 0.01). Fasting insulin, SHBG, and FAI had the strongest influence on the associations between obesity and irregular cycles, with statistically significant ORs of having an irregular cycle being attenuated to near null values following adjustment. In conclusion, both overall and central obesity were significantly associated with having an irregular menstrual cycle. This association was substantially influenced by hormonal factors, particularly insulin and SHBG.     

Traditional Anthropometric Parameters Still Predict Metabolic Disorders in Women With Severe Obesity

It is well established that fat distribution rather than the total quantity of fat is the major determinant of cardiovascular risk in overweight subjects. However, it is not known whether the concept of fat distribution still makes sense in severely obese subjects. Particularly, the role of visceral fat accumulation and/or of adipocyte hypertrophy in insulin resistance (IR) has not been studied in this population. Therefore, the aim of this study was to clarify the determinants of metabolic disorders in severely obese women. We performed a cross‐sectional study in 237 severely obese women (BMI >35 kg/m²). We assessed total body fat mass and fat distribution by anthropometric measurements (BMI and waist‐to‐hip ratio (WHR)) and by dual‐energy X‐ray absorptiometry (DXA). In 22 women, we measured subcutaneous and visceral adipocyte size on surgical biopsies. Mean BMI was 44 ± 7 kg/m² (range 35–77), mean age 37 ± 11 years (range 18–61). Lipid parameters (triglycerides, high‐density lipoprotein cholesterol) and IR markers (fasting insulin and homeostasis model assessment (HOMA) index) correlated with fat distribution, whereas inflammatory parameters (C‐reactive protein, fibrinogen) correlated only with total fat mass. An association was observed between android fat distribution and adipocyte hypertrophy. Visceral adipocyte hypertrophy was associated with both IR and hypertension, whereas subcutaneous fat‐cell size was linked only to hypertension. Our results obtained in a large cohort of women showed that fat distribution still predicts metabolic abnormalities in severe obesity. Furthermore, we found a cluster of associations among fat distribution, metabolic syndrome (MS), and adipocyte hypertrophy.     

The Effect of Age on Weight‐Related Quality of Life in Overweight and Obese Individuals

The objective of the current study was to investigate the association between age and weight‐related quality of life in a broad range of overweight/obese individuals. Participants included 9,991 overweight and obese adults from a cross sectional database (mean age = 44.9, mean BMI = 38.3, 75.3% women, 73% white). Participants completed the Impact of Weight on Quality of Life‐Lite (IWQOL‐Lite), a measure of weight‐related quality of life. For the total sample, weight‐related quality of life was more impaired with increasing age for physical function, sexual life, and work. However, increasing age was associated with less impairment for self‐esteem and public distress. On the sexual life domain there was an interaction between age and gender. Men showed a steady decline in sexual life with increasing age, whereas women showed reduced scores on sexual life in all age groups beyond age 18–24.9. Of note, women's scores on all IWQOL‐Lite domains were significantly lower (more impaired) than men's. Thus, there are both positive as well as negative consequences of increasing age with respect to the impact of weight on quality of life in overweight and obese persons.     

Health perceptions and demographic characteristics associated with underassessment of body weight

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 ≥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.     

Characteristics Associated With Fasting Appetite Hormones (Obestatin,Ghrelin, and Leptin)

Obestatin, derived from the same gene as the hunger hormone ghrelin, may reduce food intake in animals. The role of obestatin in human physiology is unclear. We evaluated cross‐sectional associations between participant characteristics and fasting levels of obestatin as well two other hormones associated with energy balance, ghrelin and leptin. Data are from the baseline visit of the Optimal Macronutrient Intake Trial to Prevent Heart Disease (OMNI‐Heart) Trial that enrolled adults with elevated blood pressure (systolic 120–159 mm Hg or a diastolic of 80–99 mm Hg) but who were otherwise healthy. Partial Spearman's correlations and linear regression models estimated the association between age, gender, BMI, physical activity, and smoking with fasting hormones. Obestatin was directly associated with ghrelin (r = 0.45, P < 0.05). On average, overweight (BMI 25–30) and obese (BMI > 30) individuals had obestatin concentrations that were 12.6 (s.d. 8.8) and 25.4 (s.d. 8.4) pg/ml lower compared to normal weight (BMI < 25) individuals, respectively (P for trend = 0.002). Overweight (BMI 25–30) and obese (BMI > 30) individuals had ghrelin concentrations that were 161.7 (s.d. 69.6) and 284.7 (s.d. 66.5) pg/ml lower compared to normal weight (BMI < 25) individuals, respectively (P for trend <0.0001). A 5 unit increase in BMI was associated with 41.3% (s.d. 4.3%) (P < 0.0001) higher leptin. Obestatin and ghrelin are directly correlated and share the same patterns of association with participant characteristics. Modifiable risk factors for chronic diseases, such as BMI, are associated with fasting levels of leptin, obestatin, and ghrelin.     

Associations Between Perceived Weight Discrimination and the Prevalence of Psychiatric Disorders in the General Population

Despite the increased prevalence of weight discrimination, few studies have examined the association between perceived weight discrimination and the prevalence of current psychiatric disorders in the general population. This study utilized a subsample of overweight and obese individuals (N = 22,231) from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a cross‐sectional nationally representative study of noninstitutionalized US adults. Perceived weight discrimination is associated with substantial psychiatric morbidity and comorbidity. These results remained significant after adjusting for a potential confound, perceived stress. Moreover, social support did not buffer against the adverse effects of perceived weight discrimination on mental health. Controlling for BMI did not diminish the associations, indicating that perceived weight discrimination is potentially harmful to mental health regardless of weight. These results highlight the urgent need for a multifaceted approach to address this important public health issue, including interventions to assist overweight individuals in coping with the mental health sequelae of perceived weight discrimination.     

Health Related Behaviours in Normal Weight and Overweight Preschoolers of a Large Pan-European Sample: The ToyBox-Study

The aim of this study was to investigate the associations of health related behaviours (HRB) with Body Mass Index (BMI) in preschoolers, and to study the likelihood of being overweight/obese in relation to compliance with recommended HRB. The sample consisted of 3301 normal weight and overweight/obese preschoolers (mean age: 4.7 years; 52% boys, 85% normal weight) from six European countries (Belgium, Bulgaria, Germany, Greece, Poland, Spain). Height and weight were measured, total daily step counts were registered during six days, and HRB were assessed with validated parental surveys in 2012. Multiple linear and logistic regression analyses were performed. Only few HRB were significantly associated with BMI. In boys, higher water intake and higher soft drink and higher fruit consumption were significantly associated with higher BMI. Boys drinking less water than recommended were less likely to be overweight/obese (OR = 0.60), while boys who consume soft drinks were more likely to be overweight/obese (OR = 1.52). In girls, higher water intake, higher vegetable consumption, and more TV time on weekend days were significantly associated with higher BMI. Girls eating less vegetables than recommended were less likely to be overweight/obese (OR = 0.62), and girls who engaged in quiet play for more than 90 minutes on weekend days were more likely to be overweight/obese (OR = 1.64). In general, the associations between HRB and BMI or being overweight/obese were limited and mainly related to dietary intake. Awareness campaigns for caregivers should stress that HRB of young children are important and independent of children’s weight status.     

Gender Differences in the Relationship between Personality Dimensions and Relative Body Weight

Objective: The relationship between body mass index (BMI: kg/m²) and personality seems to differ for men and women, although these effects may be driven by the extremes of the BMI distribution. It is unclear whether these associations exist for most individuals in the relatively normal range of BMI scores, excluding the thinnest and heaviest extremes in the population. We tested the association of BMI with neuroticism, extraversion, and psychoticism with a trimmed BMI sample. Research Methods and Procedures: Using a cross‐sectional design, we tested the association of BMI with the aforementioned psychological variables in a British population‐based sample. Participants were 7889 adult men and women (30 to 50 years old) selectively sampled from four counties in west England. Participants reported their height and weight and completed the Eysenck Personality Inventory (EPQ). We tested the association of BMI with the EPQ subscales among individuals with BMI ≥19.16 kg/m² and ≤37.78 kg/m², i.e., the approximate 5th and 95th percentiles. Results: Despite elimination of extreme BMIs, different associations between BMI and EPQ subscales emerged for men and women. Among women, increasing BMI was significantly associated with increased neuroticism and reduced extraversion. Among men, increasing BMI was associated with increased extraversion and psychoticism. In all cases, the magnitude of the association was very small. Discussion: Increasing BMI was associated with potentially poorer adjustment among women but better adjustment among men. These findings are consistent with recent reports and, taken together, suggest that these patterns are not accounted for solely by the extremes of the BMI distribution.     

Physical Activity in Relation to Long‐term Weight Maintenance After Intentional Weight Loss in Premenopausal Women

The type and amount of physical activity (PA) needed for prevention of weight regain are not well understood. We prospectively examined the associations between patterns of discretionary PA and 6‐year maintenance of intentional weight loss among 4,558 healthy premenopausal women who were 26–45 years old in 1991 and had lost >5% of their body weight in the previous 2 years. Participants reported their PA and weight in 1991 and 1997. The outcome was weight regain, defined as regaining in 1997 >30% of the lost weight between 1989 and 1991. Between 1991 and 1997, 80% of women regained >30% of their previous intentional weight loss. An increase of 30 min/day in total discretionary activity between 1991 and 1997 was associated with less weight regain (?1.36 kg, 95% confidence interval (CI) = ?1.61, ?1.12), particularly among overweight women (BMI ≥25) (?2.45 kg, ?3.12 to ?1.78). Increased jogging or running was associated with less weight regain (?3.26 kg; ?4.41 to ?2.10) than increased brisk walking (?1.69 kg; ?2.15 to ?1.22) or other activities (?1.26 kg; ?1.65 to ?0.87). Compared to women who remained sedentary, women were less likely to regain >30% of the lost weight if they maintained 30+ min/day of discretionary PA (odds ratio (OR) = 0.69, 0.53 to 0.89) or increased to this activity level (OR = 0.48, 0.39 to 0.60). Conversely, risk was elevated in women who decreased their activity. Increased PA, particularly high intensity activities, is associated with better maintenance of weight loss. The benefits of activity were greater among overweight/obese than normal weight women.     

Body Weight and Health Status: Importance of Socioeconomic Position and Working Conditions

Objective: To examine the association between relative body weight and health status and the potential modifying effects of socioeconomic position and working conditions on this association. Research Methods and Procedures: The data were derived from three identical cross‐sectional surveys conducted in 2000, 2001, and 2002. Respondents to postal surveys were middle‐aged employees of the City of Helsinki (7148 women and 1799 men, response rate 67%). BMI was based on self‐reported weight and height. Health status was measured by the Short‐Form 36 subscales and component summaries. Results: Body weight was inversely associated with physical health, but in mental health, differences between BMI categories were small and inconsistent. In women, physical health deteriorated monotonically with increasing BMI, whereas in men, poor physical health was found among the obese only. Socioeconomic position did not modify the association between BMI and health. In women, the association between body weight and physical health became stronger with decreasing job control and increasing physical work load, whereas in men, a similar modifying effect was found for high job demands. Discussion: Body weight was associated with physical health only. Lower levels of relative weight in women than in men may be associated with poor physical health. High body weight combined with adverse working conditions may impose a double burden on physical health.     

Relationship of BMI,Waist Circumference,and Weight Change with Use of Health Services by Older Adults

Objective: To examine the relationship of BMI, waist circumference (WC), and weight change with use of health care services by older adults. Research Methods and Procedures: This was a prospective cohort study conducted from 2001 to 2003 among 2919 persons representative of the non‐institutionalized Spanish population ≥60 years of age. Analyses were performed using logistic regression, with adjustment for age, educational level, size of place of residence, tobacco use, alcohol consumption, and presence of chronic disease. Results: Obesity (BMI ≥ 30 kg/m²) and abdominal obesity (WC >102 cm in men and >88 cm in women) in 2001 were associated with greater use of certain health care services among men and women in the period 2001–2003. Compared with women with WC ≤ 88 cm, women with abdominal obesity were more likely to visit primary care physicians [odds ratio (OR): 1.36; 95% confidence limit (CL): 1.06–1.73] and receive influenza vaccination (OR: 1.30; 95% CL: 1.03–1.63). Weight gain was not associated with greater health service use by either sex, regardless of baseline BMI. Weight loss was associated with greater health service use by obese and non‐obese subjects of both sexes. In comparison with those who reported no important weight change, non‐obese women who lost weight were more likely to visit hospital specialists (OR: 1.45; 95% CL: 1.02–2.06), receive home medical visits (OR: 1.61; 95% CL: 1.06–2.45), be hospitalized (OR: 1.88; 95% CL: 1.29–2.74), and have more than one hospital admission (OR: 2.31; 95% CL: 1.19–4.47). Discussion: Obesity and weight loss are associated with greater health service use among the elderly.     

Weight Loss Is Associated With Increased Serum 25‐Hydroxyvitamin D in Overweight or Obese Women

Low circulating concentrations of vitamin D metabolites have been associated with increased risk for several diseases and clinical conditions. Large observational studies and surveys have shown that obesity is independently associated with lower serum 25‐hydroxyvitamin D (25(OH)D) concentration. Few studies have examined the effect of weight loss on serum 25(OH)D concentration. The purpose of this study was to prospectively examine the effect of weight loss on serum 25(OH)D concentration. Data were collected from 383 overweight or obese women who participated in a 2‐year clinical trial of a weight‐loss program, in which 51% (N = 195) lost at least 5% of baseline weight by 24 months, 18% (N = 67) lost 5–10%, and 33% (N = 128) lost >10%. Women who did not lose weight at 24 months had an increase in serum 25(OH)D of 1.9 (9.7) ng/ml (mean (SD)); 25(OH)D increased by 2.7 (9.1) ng/ml for those who lost 5–10% of baseline weight; and 25(OH)D increased by 5.0 (9.2) ng/ml for those who lost >10% of baseline weight (P = 0.014). At baseline, 51% (N = 197) of participants met or exceeded the recommended serum concentration of 20 ng/ml. By study end, 64% (N = 230) of overweight or obese women met this goal, as well as 83% (N = 20) of those whose weight loss achieved a normal BMI. These findings suggest that weight loss, presumably associated with a reduction in body fat, is associated with increased serum 25(OH)D concentration in overweight or obese women.     

Obesity and Medicare Expenditure: Accounting for Age‐Related Height Loss

To determine the relationship between BMI and Medicare expenditure for adults 65‐years and older and determine whether this relationship changes after accounting for misclassification due to age‐related height loss. Using a cross sectional study design, the relationship between BMI and fee‐for‐service Medicare expenditure was examined among beneficiaries who completed the Medicare Current Beneficiary Survey (MCBS) in 2002, were not enrolled in Medicare Health Maintenance Organization, had a self‐reported height and weight, and were 65 and older (n = 7,706). Subjects were classified as underweight, normal weight, overweight, obese (obese I), and severely obese (obese II/III). To adjust BMI for the artifactual increase associated with age‐related height loss, the reported height was transformed by adding the sex‐specific age‐associated height loss to the reported height in MCBS. The main outcome variable was total Medicare expenditure. There was a significant U‐shaped pattern between unadjusted BMI and Medicare expenditure: underweight $4,581 (P < 0.0003), normal weight $3,744 (P < 0.0000), overweight $3,115 (reference), obese I $3,686 (P < 0.0039), and obese II/III $4,386 (P < 0.0000). This pattern persisted after accounting for height loss: underweight $4,640 (P < 0.0000), normal weight $3,451 (P < 0.0507), overweight $3,165 (reference), obese I $3,915 (P < 0.0010), and obese II/III $4,385 (P < 0.0004) compared to overweight. In older adults, minimal cost is not found at “normal” BMI, but rather in overweight subjects with higher spending in the obese and underweight categories. Adjusting for loss‐of‐height with aging had little affect on cost estimates.     

Elderly People With Low Body Weight May Have Subtle Low‐grade Inflammation

Low‐grade inflammation, which plays important roles in the development of fatal diseases, is commonly observed in obese people. However, this has not been evaluated in lean people, who have relatively increased mortality risk compared with people of normal weight. Here, we elucidate the association between systemic low‐grade inflammation and low body weight, with particular emphasis on aging. We examined the relationship between circulating C‐reactive protein (CRP) and BMI in a cross‐sectional study of 2,675 apparently healthy adults who had undergone a medical check‐up. Overall, subjects with low BMI (<21.0 kg/m², n = 585) showed a favorable cardiovascular profile without being undernourished. In the elderly (≥55 years old), logarithmic CRP (LogCRP) showed a sigmoid curve against BMI with a base at BMI 21.0–22.9 kg/m², but not against waist circumference (WC), even in nonsmokers. In contrast, in middle‐aged people, LogCRP showed an almost linear relationship with both BMI and WC. LogCRP levels in elderly nonsmokers with low BMI, but not normal or high BMI, were significantly higher than those in middle‐aged with corresponding BMI (P < 0.05). After adjustment for age, sex, smoking status, and weight change over the past 2 years, the adjusted means of LogCRP still had a similar sigmoid curve against BMI in the elderly. These results suggest that elderly people with low body weight may have subtle low‐grade inflammation irrespective of a favorable cardiovascular risk, which remains to be confirmed in further studies.     

Ethnic and sex variations in overweight self-perception: relationship to sedentariness

Objective: With increasing frequency, health promotion messages advocating physical activity are claiming weight loss as a benefit. However, messages promoting physical activity as a weight loss strategy may have limited effectiveness and cross‐cultural relevance. We recently found self‐perceived overweight to be a more robust correlate of sedentary behavior than BMI in Los Angeles County adults. In this study, we examined ethnic and sex differences in overweight self‐perception and their association with sedentariness in this sample. Research Methods and Procedures: We conducted bivariate and multivariate analyses of cross‐sectional survey data from a representative sample of Los Angeles County adults. Results: Women were more likely to perceive themselves to be overweight than men overall (73.2% of overweight/non‐obese and 24.1% of average weight women vs. 44.5% of overweight/non‐obese and 5.6% of average weight men) and within each ethnic group. African‐Americans were least likely (41.3% of overweight/non‐obese African‐Americans self‐identified as overweight) and whites were most likely to consider themselves overweight (60.6% of overweight/non‐obese whites self‐identified as overweight). Overweight (vs. average weight) self‐perception was correlated with sedentariness among average weight adults (45.3% vs. 33.0%, p < 0.001), overweight adults (43.4% vs. 33.6%, p < 0.001), men (average and overweight: 38.4% vs. 27.8%, p < 0.001), overweight whites (41.9% vs. 29.7%, p = 0.0012), and African‐Americans and Latinos (41.6% vs. 33.9%, p = 0.005). Discussion: These data suggest that our society's emphasis on weight loss rather than lifestyle change may inadvertently discourage physical activity adoption/maintenance among non‐obese individuals. However, further research is needed, particularly from prospective cohort and intervention studies, to elucidate the relationship between overweight self‐perception and healthy lifestyle change.     

Long-term effects of obesity on employment and work limitations among U.S. Adults, 1986 to 1999

Objective: To determine the relationships between BMI and workforce participation and the presence of work limitations in a U.S. working‐age population. Research Methods and Procedures: We used data from the Panel Study of Income Dynamics, a nationwide prospective cohort, to estimate the effect of obesity in 1986 on employment and work limitations in 1999. Individuals were classified into the following weight categories: underweight (BMI < 18.5), normal weight (18.5 ≤ BMI < 25), overweight (25 ≤ BMI < 30), and obese (BMI ≥ 30). Using multivariable probit models, we estimated the relationships between obesity and both employment and work disability. All analyses were stratified by sex. Results: After adjusting for baseline sociodemographic characteristics, smoking status, exercise, and self‐reported health, obesity was associated with reduced employment at follow‐up [men: marginal effect (ME) ?4.8 percentage points (pp); p < 0.05; women: ME ?5.8 pp; p < 0.10]. Among employed women, being either overweight or obese was associated with an increase in self‐reported work limitations when compared with normal‐weight individuals (overweight: ME +3.9 pp; p < 0.01; obese: ME +12.6 pp; p < 0.01). Among men, the relationship between obesity and work limitations was not statistically significant. Discussion: Obesity appears to result in future productivity losses through reduced workforce participation and increased work limitations. These findings have important implications in the U.S., which is currently experiencing a rise in the prevalence of obesity.     

Maternal serum leptin during pregnancy and infant birth weight: The influence of maternal overweight and obesity

Objective:

Few studies have examined whether the distinct metabolic patterns found in obese and nonobese pregnant women have different effects on the growing fetus. Our objective was to estimate the influence of longitudinal variation in maternal serum leptin levels on variation in infant birth weight in overweight/obese versus normal‐weight women.

Design and Methods:

In a prospective cohort of 286 gravidas, maternal weight and serum leptin levels at 6–10, 10–14, 16–20, 22–26, and 32–36 weeks gestation were measured. Effects of leptin levels on infant birth weight adjusted for gestational age at delivery (aBW) were analyzed using a linear regression model that accounted for the relationship of time‐varying predictors to the log‐transformed leptin concentrations.

Results:

Different relationships of aBW to maternal serum leptin and its rate of change across pregnancy were exhibited by overweight/obese and normal‐weight gravidas. For normal‐weight women, aBW is not associated with either the magnitude of the logarithm of the leptin concentration or with its rate of change in either the first or second half of pregnancy. Conversely, for overweight/obese women, an increase in the rate of change in maternal serum leptin in the second half of pregnancy is significantly associated with a decrease in aBW. This effect is distinct from that of maternal weight.

Conclusion:

Differences in the effect of maternal serum leptin on fetal growth between overweight/ obese and normal‐weight women suggest metabolic and physiologic heterogeneity between these groups. Such differences may be involved in the long‐term physiologic effects of the obese intrauterine environment on the health of the offspring.