Pregnancy as a Risk Factor for Obesity: Lessons from the Stockholm Pregnancy and Weight Development Study

Pregnancy and maternal body weight development are intertwined in complicated patterns. In most studies, an increase in maternal body weight with age and parity has been reported. For women who develop obesity, pregnancies can, in retrospect, be identified as important triggering life events. In a retrospective analysis of 128 women at our Obesity Unit, 73% of these severely obese patients had retained more than 10 kg in connection with a pregnancy. For the general population, the effect of a pregnancy on future weight development is surprisingly difficult to predict. In The Stockholm Pregnancy and Weight Development Study, the effects of pregnancy on weight retention one year after delivery were studied in 1423 women. Data were collected retrospectively from routine pregnancy records and then extended prospectively 6 and 12 months after delivery. The mean weight retention associated with a pregnancy one year after delivery was estimated to about 0.5 kg, with a range of-12 to 26 kg. Fourteen percent of the women gained more than 5 kg. Weight increase during pregnancy was the strongest predict or for sustained weight retention 1 year later. Pre-pregnancy weight did not predict the weight development outcome. The lactation pattern had only a minor influence on weight development Smoking cessation was an important predictor for sustained weight increase. More weight retention was observed in those women who reported a change in lifestyle as regarded eating habits, meal patterns, and physical activity, suggesting that eventual body weight after pregnancy is more determined by the changes in association with that particular pregnancy than with the lifestyle before.     

Parity-Associated Body Weight: Modification by Sociodemographic and Behavioral Factors

This research examines the association between parity and body weight and how this relationship is modified by sociodemographic and behavioral factors. Using multiple linear regression analysis, the study assessed the relationship between parity and relative body weight (as Body Mass Index, BMI) and how this relationship interacts with seven sociodemographic and seven behavioral factors in a national sample of 5,707 women from the Second National Health and Nutrition Examination (NHANES II) survey. After adjusting for sociodemographic factors, the amount of weight associated with parity averaged about 0.5 kg per child. However, parity-associated weight differed by sociodemographic and behavioral factors, and was much larger in some subgroups. Among 18–45 year olds, the amount of weight associated with parity was greater in blacks than in whites, less in employed than unemployed white women but greater in employed than unemployed black women, less in smokers than nonsmokers, less in those with a high level of recreational exercise, and differed with the level of nonrecreational physical activity depending on race. Among 46–74 year olds, the amount of weight associated with parity was greater in married than unmarried women, and less in those who were active outside of recreation versus those who were less active. These results suggest that sociodemographic and behavioral variables modify the relationship between parity and body weight, and provide insight for identifying women who are at risk for having greater BMI with higher parity. This information may be applicable to the targeting and design of interventions to prevent postpartum weight retention.     

An Initial Evaluation of a Commercial Weight Loss Program: Short-Term Effects on Weight,Eating Behavior,and Mood

LOWE, MICHAEL R, KAREN MILLER-KOVACH, NEMA FRYE, AND SUZANNE PHELAN. An initial evaluation of a commercial weight loss program: short-term effects on weight, eating behavior, and mood. Obes Res. 1999;7:51–59. Objective : This paper describes an initial, 4-week evaluation of a commercial weight loss program. Research Methods and Procedures : Respondents (n = 985) to newspaper advertisements in two metropolitan areas were assigned to 4 weeks of either the Weight Watchers program or to a Self-Help condition. Weight loss, psychological vitality, and eating behavior were evaluated before and after the 4-week intervention. Results : Weight Watchers participants showed greater improvements than Self-Help participants on all measures; weight losses averaged 1.87 and 0.77 kg, respectively. The superior outcomes shown by Weight Watchers participants on measures of vitality and eating behavior were still evident when extent of weight loss was controlled. Weight losses across different sites, incomes, and levels of obesity were similar. Discussion : Although the present study's intervention and outcome assessments were short-term, the promising results obtained suggest that longer term studies should be undertaken.     

The Behavioral Characteristics of Individuals Who Lose Weight Unintentionally

MCGUIRE, MAUREEN T., RENA R. WING, MARY L. KLEM, AND JAMES O. HILL. The behavioral characteristics of individuals who lose weight unintentionally. Obes Res. Objective: To determine whether individuals who unintentionally lost weight differ from individuals who intentionally lost weight in behavioral characteristics related to chronic disease risk factors. Design: A random-digit dial telephone survey was conducted among a representative sample of American adults (n = 500). Subjects: Of the 500 individuals sampled, 139 were currently ≥10% below their lifetime maximum weight. These individuals were asked whether their weight loss was unintentional or intentional. Unintentional (n = 49) and intentional (n = 89) weight losers were compared on measures of dietary intake, physical activity, smoking, drinking, and self-reported health status. Results: Unintentional weight losers had higher levels of smoking and drinking, were less physically active, and were less concerned about their diet and fat intake. Unintentional weight losers did not report having higher levels of disease such as high blood pressure or diabetes. However, unintentional weight losers who reported having such diseases were more likely to report that their weight loss had no effect or had worsened their disorder. Discussion: Compared to intentional weight losers, those who lost their weight unintentionally reported engaging in more negative health behaviors that are related to disease morbidity and mortality. These data suggest that unintentional weight loss may be part of a cluster of behaviors that have a negative health impact.     

Associations of Body Mass and Body Fat Distribution with Parity Among African-American and Caucasian Women: The CARDIA Study

Associations of parity with body fat and its distribution are poorly understood; therefore, we examined the relationships between parity and obesity in young adult women. Body mass index (BMI), skin folds, and waist-hip ratio were compared in 1452 African-American and 1268 Caucasian nonpregnant women aged 18 to 30, adjusting for age (where no age-parity interactions were present), education, physical activity (assessed by questionnaire) and fitness (assessed by graded exercise test), dietary fat intake, alcohol and smoking. Adjusted mean BMI was significantly higher in African-American women aged 25–30 years with three or more children (28.5 kg/m²) than in those with two (27.0 kg/m²), one (26.2 kg/m²), or no children (26.3 kg/m²). Similar trends were found in Caucasians (BMI = 23.3, 23.4, 23.7, 25.0 kg/m² for parity = 0,1, 2, ≥ 3, respectively), but the mean BMI was significantly higher in African Americans in each parity group. The association between BMI and parity was not present among women 18–24 years of age. Skinfolds were directly associated with parity in African Americans only. Waist-hip ratios were generally lower among nulliparous than parous women in both ethnic groups; race differences were present only among nulliparas. In conclusion, parity was associated with BMI in women aged 25 to 30 years but did not explain ethnicity-related differences in body mass.     

Weight-Related Attitudes and Behaviors of Women Who Diet to Lose Weight: A Comparison of Black Dieters and White Dieters

Obesity is a significant health problem among black women in the United States. Black women are two to three times more likely than white women to be obese. The present study sought to examine race differences in attitudes and beliefs about dieting, motivations underlying dieting efforts, and actual dieting strategies and behaviors. To achieve this aim, a subset of female survey respondents (n = 324) was drawn from a pool of more than 20,000 subscribers to Consumer Reports. All survey respondents had made at least one dieting effort within 3 years of the time of the study. For this study, we used all black female respondents (n = 162) and a matched sample (i.e., matched on age, educational attainment, and personal income) of white women (n = 162). Black women did weigh significantly more than Caucasian women, therefore, BMI was used as a covariate in all subsequent analyses. Black and white women were significantly different in a number of domains. Compared to white women, black women experienced less social pressure about their weight, initiated dieting later in life, and were significantly less likely to diet at each developmental milestone. However, the two groups of women did not differ in reasons for undertaking their most recent dieting efforts, or in the types of weight loss strategies they had employed. Nor were there differences between the black and white women in methods for coping responses with dietary relapse or in rates of disordered eating. These findings are discussed in terms of their implications for both treatment and prevention of obesity in black women.     

Disability,Arthritis, and Body Weight among Adults 45 Years and Older

Objectives : To examine the association between body weight and disability among persons with and without self‐reported arthritis. Research Methods and Procedures : Data were analyzed for noninstitutionalized adults, 45 years or older, in states that participated in the Behavioral Risk Factor Surveillance System. Self‐reported BMI (kilograms per meter squared) was used to categorize participants into six BMI‐defined groups: underweight (<18.5), normal weight (18.5 to <25), overweight (25 to <30), obese, class 1 (30 to <35), obese, class 2 (35 to <40), and obese, class 3 (≥40). Results : Class 3 obesity (BMI ≥ 40) was significantly associated with disability among participants both with and without self‐reported arthritis. The adjusted odds ratio (AOR) for disability in participants with class 3 obesity was 2.75 [95% confidence interval (CI) = 2.22 to 3.40] among those with self‐reported arthritis and 1.77 (95% CI = 1.20 to 2.62) among those without self‐reported arthritis compared with those of normal weight (BMI 18.5 to <25). Persons with self‐reported arthritis who were obese, class 2 (BMI 35 to <40) and obese, class 1 (BMI 30 to <35) and women with self‐reported arthritis who were overweight (BMI 25 to <30) also had higher odds of disability compared with those of normal weight [AOR = 1.72 (95% CI = 1.47 to 2.00), AOR = 1.30 (95% CI = 1.17 to 1.44), and AOR = 1.18 (95% CI = 1.06 to 1.32), respectively]. Discussion : Our findings reveal that obesity is associated with disability. Preventing and controlling obesity may improve the quality of life for persons with and without self‐reported arthritis.     

Genetic Contributions to Body Weight in Mice: Relationship of Exploratory Behavior to Weight

Objective: The A/J and C57BL/6J mouse strains differ markedly in their exploratory behavior and their weight gain on a high‐fat diet. We examined the genetic contributions of exploratory behavior to body weight and tested for shared, pleiotropic loci influencing energy homeostasis. Research Methods and Procedures: Segregating (A×B6)F2 intercross (n = 514) and (B6AF1×A/J)N2 backcross (N = 223) populations were studied, phenotyping for weight and exploratory behaviors. Relationships among traits were analyzed by correlations. Weight traits were dissected with a genome‐wide scan. Results: Modest correlations were found between exploratory behaviors and weight, explaining 2% to 14% of the variance. Quantitative trait loci (QTL) for body weight at 8 weeks (wgt8), 10 weeks (wgt10), and 2‐week weight gain (difference between weeks 8 and 10) on a 6% fat diet were mapped. Two QTL on chromosome 1 (peaks at 66 cM and 100 cM; Bw8q1) affected wgt8 [likelihood of the odds ratio (Lod), 3.0 and 4.4] and wgt10 (Lod, 2.2 and 3.4), respectively. In the backcross, a significant QTL on chromosome 4 (peak at 66 cM; Bw8q2) affected wgt 8 (Lod, 3.3) and wgt10 (Lod, 3.1). For 2‐week weight gain, suggestive QTL were mapped on chromosomes 4 and 6. The chromosome 6 QTL region overlaps a human 7q locus for obesity. A search for between‐strain sequence polymorphisms in the leptin and NPY genes was unrevealing. Discussion: In mice, loci influencing exploratory activity play a modest role in body‐weight regulation. Some forms of obesity may emerge from loci regulating normal body weight.     

Dieting Status and Its Relationship to Weight,Dietary Intake,and Physical Activity Changes Over Two Years in a Working Population

The present study prospectively examined changes in dietary intake, physical activity and weight associated with self-reported efforts to lose weight in a cohort of 3671 men and women sampled from the general population. Dieting efforts, dietary intake, physical activity and weight were measured at two points in time, 24 months apart. At baseline, current dieters reported consuming fewer dairy products, sweets, meat, soft drinks and fried potatoes (all p's < .0001), and engaging more frequently in high-intensity physical activity (p < .0001) than those not currently dieting. At follow-up, current dieters reported consuming fewer sweets (p < .0001) and fried potatoes (p < .0008), and engaging more frequently in moderate-intensity physical activity (p < .02) than those not currently dieting. Prospectively, those who initiated weight-loss diets showed the largest decrease in consumption of sweets (p < .0001), soft drinks (p < .0001), and fried potatoes (p < .01), and increase in frequency of high-intensity physical activity (p < .0001) and moderate-intensity physical activity (p < .007). Those initiating weight-loss diets were the only group to lose weight (1 lb.). Those dieting at baseline but not at follow-up gained the most weight (4 lbs.). Self-reports of current dieting correspond to reported changes in dietary intake and physical activity, and to measured changes in weight over the same time period. Individuals who report dieting to lose weight have healthier eating and exercise patterns than those who do not report dieting.     

Lean and Weight Stable: Behavioral Predictors and Psychological Correlates

Objective: To examine behavioral characteristics associated with being lean and weight stable during adulthood. Research Methods and Procedures: Participants included 165 white married couples who were part of a larger longitudinal study. Participants’ height and weight were measured on three occasions at 2‐year intervals. Men and women were classified as being lean and weight stable (the target group) if they had a BMI < 25 at baseline and maintained their weight within 5% of baseline at 2nd and 4th year follow‐up. Individuals not fulfilling these criteria were included in the comparison group. Group differences in background characteristics including childhood weight status, BMI at each occasion, dieting history, and mental and physical health history were examined. In addition, multiple measures of dietary intake and physical activity were obtained and used to predict the likelihood of being in the target group. Results: Men (N = 22) and women (N = 36) in the target group had lower mean BMI scores at each occasion, were less overweight during childhood, were less likely to have dieted in the past year, and rated themselves as being more healthy than men and women in the comparison group. No differences were identified in mental health. Relative to the comparison group, women in the target group reported higher levels of physical activity and higher levels of physical activity among their spouses, and men in the target group reported healthier dietary patterns. Discussion: Results from this study suggest that being lean and weight stable in adulthood is linked to childhood weight status in combination with dietary and activity patterns during adulthood.     

Relationships Between Changes in Body Composition and Changes in Cardiovascular Risk Factors: The SOS Intervention Study

SJÖSTRÖM, C DAVID, LAUREN LISSNER, LARS SJÖSTROM. Relationships between changes in body composition and changes in cardiovascular risk factors: The SOS Intervention Study. Relationships between 2-year changes in body composition (estimated from computed tomography-validated anthropometry based on sagittal trunk diameter, weight, and height), adipose tissue (AT) distribution, and cardiovascular risk factors (blood pressure, lipids, glucose, insulin, uric acid) were examined in 842 treated adults with severe obesity with weight changes from ?95. 5 to +30. 6 kg. Although the change (Δ) of visceral AT mass (expressed in % total AT) for a given change in body mass index (ΔBMI) was 6-fold larger in men than in women, Δwaist and Δwaist/hip were similar in both sexes. In men, risk factor changes were similarly related to Awaist, Abodyweight, and ΔBMI, whereas in women, Δbodyweight seemed to be the single independent variable with the highest explanatory power. In multivariate regressions adjusted for ΔBMI and baseline conditions, Δvisceral AT mass was more strongly associated with risk factor changes than were Δwaist and ?waist/hip. When using a three-compartment model (lean body mass, subcutaneous and visceral AT masses) plus neck and thigh girths (indicators of subcutaneous AT distribution), risk factor changes were related both to ?subcutaneous and ?visceral AT masses but not to Δlean body mass. In agreement with cross-sectional findings, Δneck was positively and Δthigh was negatively related to some risk factor changes. Thus, the use of waist as a single risk factor indicator seems less effective for epidemiological studies than the simple anthropometric measures presented here, which are able to separate the effects of visceral AT mass, subcutaneous AT mass, and subcutaneous AT distribution on metabolic parameters under both cross-sectional and longitudinal conditions.     

Weight Loss Attempts and Attitudes toward Body Size,Eating, and Physical Activity in American Indian Children: Relationship to Weight Status and Gender

Objective: This study examined dieting, weight perceptions, and self‐efficacy to eat healthy foods and engage in physical activity and their relationships to weight status and gender among American Indian elementary schoolchildren. Research Methods and Procedures: Data for this study were collected as part of the baseline examination for the Pathways study. Participants were 1441 second‐ through third‐grade American Indian children in 41 schools representing seven tribes in Arizona, New Mexico, and South Dakota who filled out a questionnaire and had heights and weights taken. Results: Forty‐two percent of the children were overweight or obese. No differences were found between overweight/obese and normal weight children for healthy food intentions or self‐efficacy. Heavier children (especially those with body mass index > 95th percentile) were more likely to have tried to lose weight or were currently trying to lose weight. No gender differences were found. Normal weight children chose a slightly heavier body size as most healthy compared with overweight/obese children. Discussion: The results indicate that children are concerned about their weight and that weight modification efforts are common among overweight American Indian children. School, community, and family‐based programs are needed to help young people adopt lifelong healthful eating and physical activity practices.     

The Fen-Phen Finale: A Study of Weight Loss and Valvular Heart Disease

Objective : To assess weight loss, as well as the prevalence of valvular heart disease, in 21 obese women who completed 2 years of treatment by fenfluramine and phentermine (fen-phen) in June 1997. Research Methods and Procedures : Patients were 21 of 22 women who had completed a 1-year, open-label trial of fen-phen combined with lifestyle modification. This study describes the results of a second year of treatment. The presence of valvular heart disease, defined as aortic regurgitation of mild or greater severity and/or mitral regurgitation of moderate or greater severity, was assessed using two-dimensional, color Doppler and pulsed- and continuouswave Doppler examinations. Results : At 2 years, the 21 patients had a mean reduction in initial weight of 13.9 ±10.1%, which was significantly (p<<0.001) smaller than their 1-year loss of 17.1 ±8.7%. Nine of 21 patients reported that they took fen-phen irregularly during the last 4 months of the study because of fears of developing health complications. These nine patients had a 2-year weight loss of 8.7 ± 7.5%, compared with a significantly (p<0.04) larger loss of 17.6 ± 10.5% for participants who reported taking medication regularly. Six of 20 (30%) patients met criteria for valvular heart disease. None of the six had signs or symptoms of this condition. Discussion : Fenfluramine was withdrawn from the market on September 15, 1997 because of concerns that it was associated with valvular heart disease. The present findings are discussed in terms of the potentially favorable long-term benefits of combining lifestyle modification with weight loss medications that are both safe and effective.     

Comparison of Attitudes and Behaviors Related to Nutrition,Body Size,Dieting, and Hunger in Russian,Black-American,and White-American Adolescents

Attitudes and behaviors related to nutrition are known to differ between white-American and black-American adolescents, however, little is known about teenagers from Russia. We hypothesized that, compared with white-American or black-American teenagers, Russian teenagers would prefer a larger body size, be less likely to diet, and be less concerned about being overweight. Self-administered questionnaires were completed by 196 students in Moscow, 326 white-American, and 239 black-American adolescents who attended school in North Carolina (mean age = 16). Ideal body mass index (BMI) was calculated from measured height and the response to the question, “What do you consider to be your ideal weight?” Mean ideal BMI was higher in black-American boys (25.1) and girls (21.4) than in white-American boys (22.1) and girls (19.2), and Russian boys (21.8) and girls (19.1). After controlling for BMI, black-American girls were less than half as likely to report dieting compared with white-American girls. There were no significant differences among white-American girls and Russian girls, and there were no ethnic differences between boys in the prevalence of dieting. White-American girls and black-American girls were much more likely to identify being overweight as an important nutritional concern than were Russian girls (odds ratios >10), and there were no ethnic differences among boys. We conclude that preferences for body size, the prevalence of dieting, and concerns about being overweight were similar in Russian and white-American teens, with the exception of Russian teenaged girls who were less likely than American girls to identify being overweight as an important concern. Overall, weight-related attitudes and behaviors in Russian teenagers were more similar to those of white-American teenagers than those of black-American teenagers.     

Long‐Term Weight Development in Women: A 15‐Year Follow‐up of the Effects of Pregnancy

Objective: The aim of this study was to evaluate how well prepregnancy BMI, gestational weight gain, and postpartum weight retention predict retention of weight 15 years later among parous women. Research Methods and Procedures: The Stockholm Pregnancy and Women's Nutrition (SPAWN) study is a long‐term follow‐up study of women who delivered children in 1984 to 1985 (n = 2342). The participants initially filled out questionnaires about their eating and exercise habits, social circumstances, etc. before, during, and at 1 year after pregnancy. Anthropometric data were also sampled. Fifteen years later, these women were invited to take part in the follow‐up study. Anthropometric measurements were collected, and similar questions were asked. Five hundred sixty‐three women participated in the SPAWN 15‐year follow‐up study. The sample was divided into groups to examine three presumably critical time periods: 1) overweight and normal weight before pregnancy; 2) low, intermediate, and high weight gainers during pregnancy; and 3) low, intermediate, and high weight retainers at 1 year after pregnancy. Results: The overweight women did not gain more weight during pregnancy or retain more weight at 1 year follow‐up. High weight gainers during pregnancy retained more weight at the 1‐year and the 15‐year follow‐ups. High weight retainers had gained more during pregnancy and retained it at the 15‐year follow‐up. Fifty‐six percent of the high weight gainers during pregnancy ended up in the high weight retainers group. Discussion: Women who are overweight before pregnancy do not have a higher risk of postpartum weight retention than normal weight women. Thus, it is not necessarily the initially overweight woman who should be the target or focus of weight control programs during or after pregnancy. Both high weight gainers and high weight retainers had higher BMI at the 15‐year follow‐up, although only 56% of the high weight gainers during pregnancy were also classified as high weight retainers at the 1‐year follow‐up. Weight retention at the end of the postpartum year predicts future overweight 15 years later.     

Physical Activity,Obesity, and Cardiovascular Risk Factors in Children. The Belgian Luxembourg Child Study II

GUILLAUME, MICHÈLE, LEIF LAPIDUS, PER BJÖRNTORP, ANDRE LAMBERT. Physical activity, obesity, and cardiovascular risk factors in children. The Belgian Luxembourg Child Study II. Physical activity was measured in relation to cardiovascular (CV) risk factors in a randomly selected population of 1028 children from Province de Luxembourg in Belgium, a mainly rural area with a high prevalence of such risk factors among adults and children. Physical activity was estimated as participation in sport activities, a major indicator of leisure-time physical activity in schoolchildren, and physical inactivity was estimated as frequency and duration of television (TV) watching. Boys participated more frequently in sport activities than girls did (p=0. 001). A majority of the children watched TV daily. After age adjustment, bodyweight (girls, p<0. 012; boys, p<0. 027) and, in boys, body mass index (BMI) (p<0. 039) were related to days per week of TV watching. No significant relationships with other CV risk factors remained after adjustments for BMI. In analyses of independent contributions of age, TV watching, and sports activity on CV risk factors, age showed highly significant relationships. In boys, TV showed relationships with BMI (P<0. 04) and (borderline) with systolic blood pressure, independent of age and sports activity, whereas the latter was significantly related to subscapular skinfold (p<0. 04) and (borderline) with triceps skinfold and cholesterol. In girls, no significant independent contributions to risk factor associations were found. The father's education was directly associated with sports activities, whereas the mother being a housewife showed negative relationships to physical activity and positive to TV watching in their children, suggesting socioeconomic influence on the activity patterns of children. Furthermore, registrations suggested less physical activity in the most rural part of the area. It is concluded that children in this mainly rural area watch TV frequently. In boys, physical inactivity, measured both as TV watching and as registrations of sports activities, contributes independently to body fat mass. In girls, no contribution or weaker contributions of physical inactivity were found. This suggests that contributory factors leading to obesity might be different in girls and boys.     

Weight and BMI over 6 years in Korean Children: Relationships to Body Image and Weight Loss Efforts

Objective: To investigate the relationships among longitudinal weight status, body dissatisfaction, and attitude to weight loss among Korean children from the age of 7‐8 to 13‐14 years old. Research Methods and Procedures: 351 Korean school children's heights and weights were measured at the ages of 7‐8 and 13‐14 years old; at the age of 13‐14, they completed a questionnaire about body dissatisfaction and weight loss efforts. Results: At the age of 7‐8, 15.7% of children were overweight by International Obesity Task Force standards, as compared with 26.2% at the age of 13‐14. Of the 55 7‐ to 8‐year‐old overweight children, 85.5% were still overweight at the age of 13‐14 years old. Greater concerns about body image and stronger desires to be thinner were observed among stable overweight children and among those in whom there had been a rapid increase in BMI over the 6‐year study period. Girls favored thinner shapes than did boys, regardless of their weight status or BMI changes. In girls, the level of body dissatisfaction was related only to weight loss desire, regardless of weight status or changes in BMI. In boys, however, weight loss desire was related only to weight loss attempts and was independent of weight status, BMI changes, and level of body dissatisfaction. Discussion: Regardless of weight status, changes in BMI should be considered when dealing with body dissatisfaction and attitudes to weight loss in children.     

Do Children Lose and Maintain Weight Easier Than Adults: A Comparison of Child and Parent Weight Changes From Six Months to Ten Years

Recent research has shown weight maintenance for obese preadolescent children over 60 and 120 month intervals, while studies on adults consistently show they fail to maintain weight loss. This paper is designed to examine differences in percent overweight changes at 6, 60 and 120 months in obese parents and children from 113 families who participated in randomized controlled outcome studies evaluating family-based behavioral treatment. Analyses showed children had significantly greater changes in percent overweight than their parents at each time point. Chi-Square and Logistic Regression analyses showed children were more likely than their parents at each time point to have percent overweight decreases greater than 20%, with over 20% of the children and less than 1% of the parents showing changes this large. The implications of these results for weight control are discussed. These results suggest there may be differences in the efficacy of treating obesity in children versus adults.     

Asthma and Maternal Body Mass Index Are Related to Pediatric Body Mass Index and Obesity: Results from the Third National Health and Nutrition Examination Survey

Objective: Clinical research has shown an increased prevalence of obesity in children with asthma. This study was designed to assess the relationship between asthma and pediatric body mass index (BMI) in a national database and to examine factors that may modify this relationship. Design: The cross‐sectional relationship between asthma and pediatric BMI and obesity (BMI ≥ 85th percentile) was studied. Variables that may influence the relationship between asthma and pediatric BMI, such as race/ethnicity and television watching were included in the model for the total sample. A smaller sample of 3009 white and African American youth were studied in regression models including maternal BMI. Study Population: A nationally representative crosssectional sample of 5154 children and adolescents of 6 to 16 years of age from the Third National Health And Nutrition Examination Survey. Results: In the full sample, asthma and television watching were related to BMI, accounting for 3% of the variance in BMI. When maternal BMI was included in the nonHispanic sample, television watching, maternal BMI, and the interaction of maternal BMI and asthma were related to youth BMI, accounting for 15% of the variance. The standardized BMI z‐score for those youth without asthma and no maternal obesity was 0.06, which increased to 0.33 if the youth had asthma, to 0.70 if the youth did not have asthma but the mother was obese, and to 1.71 if the youth had asthma and the mother was obese. Asthma, television watching, and maternal BMI were independent predictors of youth obesity. Conclusions: BMI and prevalence of obesity is higher in youth with asthma. Pediatric BMI, but not obesity, is also related to the interaction of asthma and maternal BMI in white and African American youth. Comorbidity of asthma and obesity may complicate treatment of either condition, and prevention of obesity should be encouraged for asthmatic children.