Self-reported comorbidities among self-described overweight African-American and Hispanic adults in the United States: results of a national survey

Objective: To examine the concordance between self‐described weight status and BMI, the prevalence of self‐reported comorbidities, and the association between comorbidities and self‐rated health among overweight African‐American and Hispanic US adults. Methods and Procedures: A nationally representative sample of 537 African‐American and 526 Hispanic adults who were identified using a combination of random digit dialing and listed household sampling and self‐described as being slightly or very overweight participated in a telephone interview. Self‐reported height and weight were used to calculate BMI. Results: More than half of African Americans (56%) and one‐third of Hispanics (34%) who self‐described as “slightly” overweight would be classified as obese based on BMI. One‐third (33%) of African Americans reported high blood pressure, followed by arthritis (20%), high cholesterol (18%), and diabetes (15%). Among Hispanics, high cholesterol was the most frequently reported comorbidity (17%), followed by high blood pressure (15%), and difficulty sleeping (12%). Almost three‐quarters of African Americans surveyed (72%) reported that their overall health was good to excellent compared to 62% for Hispanics. Discussion: Self‐reported rates of obesity‐related comorbidities fall below what would be expected based on prevalence data derived from physiologic measures, suggesting a lack of awareness of actual risk. Despite the greater self‐reported prevalence of certain risk factors for poor health, African Americans have a more optimistic view of their overall health and weight status compared to Hispanics. Physicians have an important opportunity to communicate to their minority patients the serious health consequences associated with excess weight.     

BMI and Cervical Cancer Screening among White,African‐American,and Hispanic Women in the United States

Objectives: We examined cervical cancer screening by BMI in white, African‐American, and Hispanic women and explored women's reasons for not undergoing screening. Research Methods and Procedures: We used logistic regression to examine Pap testing in the preceding 3 years across BMI groups for white (n = 6419), African‐American (n = 1715), and Hispanic women (n = 1859) age 18 to 75 years who responded to the 2000 National Health Interview Survey. We used bivariable analyses to describe women's reasons for not undergoing testing and examined whether unscreened women received physician recommendations for screening. Results: Of 12, 170 women, 50% were normal weight, 26% were overweight, and 21% were obese. The proportion who reported Pap testing in the last 3 years was 86% in whites, 88% in African Americans, and 78% in Hispanics. After adjustment for sociodemographics, health care access, and illness burden, severely obese white women (BMI = 40+ kg/m²) were significantly less likely to undergo Pap testing (relative risk, 0.92; 95% CI, 0.83 to 0.99) compared with normal weight women. BMI was not associated with screening in African Americans or Hispanics. A higher proportion of obese white women than normal weight women cited putting off the test or embarrassment or discomfort as the primary reason for not undergoing screening. Among the unscreened, obese women were as likely as normal weight women to receive a physician recommendation to undergo screening. Discussion: Disparities in cervical cancer screening by body weight persist for white women with severe obesity. Disparities were not explained by differences in the rate of physician recommendations for screening, but obese white women may be more likely to delay screening or to find screening painful, uncomfortable, or embarrassing than normal weight white women. Efforts to increase screening among obese women should address women's reservations about screening.     

Stigmatized Students: Age,Sex, and Ethnicity Effects in the Stigmatization of Obesity

Objective: To assess the stigmatization of obesity relative to the stigmatization of various disabilities among young men and women. Attitudes across ethnic groups were compared. In addition, these findings were compared with data showing severe stigmatization of obesity among children. Research Methods and Procedures: Participants included 356 university students (56% women; mean age, 20.6 years; mean BMI, 23.3 kg/m²; range, 14.4 to 45.0 kg/m²) who ranked six drawings of same‐sex peers in order of how well they liked each person. The drawings showed adults with obesity, various disabilities, or no disability. These rankings were compared with those obtained through a similar procedure with 458 fifth‐ and sixth‐grade children. Results: Obesity was highly stigmatized relative to physical disabilities. African‐American women liked obese peers more than did African‐American men, white men, or white women [F (1, 216) = 4.02, p < 0.05]. Overweight and obese participants were no less stigmatizing of obesity than normal weight participants. Adults were more accepting than children of their obese peers [t (761) = 9.16, p < 0.001]. Discussion: Although the stigmatization of obesity was high among participants overall, African‐American women seemed to have more positive attitudes toward obesity than did white women, white men, or African‐American men. Participants’ weight did not affect their stigmatization of obesity: obese and overweight adults were as highly stigmatizing of obesity as non‐overweight adults. Such internalized stigmatization could help to explain the low self‐esteem and poor body image among obese young adults. However, adults seemed to have more positive attitudes about obesity than children. An understanding of the factors that limit the stigma of obesity among African‐American women could help efforts to reduce stigma.     

Gender,Race, and Obesity‐Related Quality of Life at Extreme Levels of Obesity

Objective: Research investigating obesity‐related quality of life (QOL) has shown that at increasing levels of overweight, individuals report more impaired QOL. Further, some research has indicated that white women suffer more impairment than men and African Americans. The current study sought to expand the existing literature by investigating an extreme subsample of the obese population. It was expected that participants in the current study would report more impaired obesity‐related QOL than in previous research conducted with less obese individuals. It was also hypothesized that race and gender groups would differ in obesity‐related QOL and that the relationship between degree of overweight and QOL would not be consistent across race and gender groups. Research Methods and Procedures: Impact of Weight on Quality of Life Questionnaire‐Lite Version data were collected from 512 individuals seeking gastric bypass surgery (mean BMI = 53.3) Results: Results confirmed the study hypotheses. In general, white women reported the most QOL impairment, despite having significantly lower BMI than other race/gender groups. Compared with previous studies, the observed relationships between BMI and QOL were somewhat attenuated. Discussion: Various domains of QOL may be differentially affected by degree of obesity; these relationships are not homogeneous throughout the obese population.     

Obesity and Sugar‐sweetened Beverages in African‐American Preschool Children: A Longitudinal Study

A representative sample of 365 low‐income African‐American preschool children aged 3–5 years was studied to determine the association between sugar‐sweetened beverage consumption (soda, fruit drinks, and both combined) and overweight and obesity. Children were examined at a dental clinic in 2002–2003 and again after 2 years. Dietary information was collected using the Block Kids Food Frequency Questionnaire. A BMI score was computed from recorded height and weight. Overweight and obesity were defined by national reference age‐sex specific BMI: those with an age‐sex specific BMI ≥85th, but <95th percentile as overweight and those with BMI ≥95th age‐sex specific percentile as obese. The prevalence of overweight was 12.9% in baseline, and increased to 18.7% after 2 years. The prevalence of obesity increased from 10.3 to 20.4% during the same period. Baseline intake of soda and all sugar‐sweetened beverages were positively associated with baseline BMI z‐scores. After adjusting for covariates, additional intake of fruit drinks and all sugar‐sweetened beverages at baseline showed significantly higher odds of incidence of overweight over 2 years. Among a longitudinal cohort of African‐American preschool children, high consumption of sugar‐sweetened beverages was significantly associated with an increased risk for obesity.     

Quality of life in Mexican-American children following a weight management program

Objective: The objective was to evaluate quality of life (QOL) in at‐risk‐for‐overweight and overweight Mexican‐American children after participating in 6 months of intensive weight management or self‐help. Research Methods and Procedures: Eighty sixth‐ and seventh‐grade at‐risk‐for‐overweight (BMI ≥85th to <95th percentile) and overweight (BMI ≥95th percentile) Mexican‐American children were randomly assigned to either intensive instructor‐led intervention (ILI) or self‐help (SH). The ILI condition included daily participation for 12 weeks in a school‐based program comprised of nutrition education, physical activity, and behavior modification, followed by ongoing monthly maintenance. QOL was assessed at baseline and 6 months via child self‐report PedsQL. QOL outcomes were compared across treatment groups, and the impact of change in zBMI on change in QOL was evaluated. Results: Children in the ILI condition not only achieved significantly greater weight loss (zBMI, ?0.13 ± 0.14; p < 0.001) but also significantly greater physical QOL improvements than those in the SH condition at 6 months (p < 0.05). Furthermore, physical QOL increases were associated with zBMI reduction (p < 0.05). However, neither psychosocial nor total QOL was significantly impacted by intervention or zBMI change. Discussion: These findings show that even modest decreases in zBMI after weight management result in improved physical QOL in Mexican‐American children. These results illustrate the clear need to include evaluation of QOL in the process of identifying effective weight management programs.     

Obesity,End‐stage Renal Disease,and Survival in an Elderly Cohort With Cardiovascular Disease

Obesity is highly prevalent in African Americans and is associated with increased risk of End‐Stage Renal Disease (ESRD) and death. It is not known if the effect of obesity is similar among blacks and whites. The aim of this study is to examine racial differences in the association of obesity with ESRD and survival in elderly patients (age >65). Data were obtained for 74,167 Medicare patients with acute myocardial infarction (AMI) between February 1994 and July 1995. BMI was calculated as weight (kg) divided by height (m²). We evaluated the association of BMI class with ESRD incidence and death using multivariable Cox proportional hazards models, testing for race‐BMI interactions. Compared to whites, African Americans had higher BMI (26.9 vs. 26.0, P < 0.0001) and estimated glomerular filtration rate (72.4 ml/min/1.73 m² vs. 66.6 ml/min/1.73 m², P < 0.0001). Crude ESRD rates increased with increasing obesity among whites but not among blacks. However, after adjusting for age, sex, and other comorbidities, obesity was not associated with increased ESRD rate among blacks or whites and the interaction between race and BMI was not significant. Furthermore, for both races, patients classified as overweight, class 1 obese, or class 2 obese had similar, significantly better survival abilities compared to normal weight patients and the race BMI interaction was not significant. In conclusion, obesity does not increase risk of ESRD among black or white elderly subjects with cardiovascular disease (CVD). However, both obese blacks and whites, in this population, experience a survival benefit. Further studies need to explore this obesity paradox.     

Association of FTO Gene Variants With Adiposity in African‐American Adolescents

The prevalence of obesity continues to increase significantly, with the largest rise in the African‐American adolescents. Genetic contributions to obesity are being identified with the advent of genome‐wide association studies (GWAS). Specifically, variants of the fat mass and obesity associated (FTO) gene have been associated with obesity in populations of European descent. The studies in African Americans have been inconclusive. To further evaluate the association of the FTO gene and adiposity in African Americans, we genotyped 47 single‐nucleotide polymorphisms (SNPs), including seven SNPs previously reported to be significant in the literature in a cohort consisting of 561 non‐Hispanic white and 497 African‐American individuals. Analysis of our data showed 17 SNPs to be associated with BMI Z‐score (BMI‐Z) in our study population. The strongest association was found in the African Americans. The most significant SNP was rs8057044, which was associated with BMI‐Z in the African Americans (P = 0.00054). SNP rs9939609 was found to be significant in the non‐Hispanic white population (P = 0.028). Our data confirm the association between FTO and adiposity suggesting that FTO is a childhood obesity susceptibility gene. Our data also identify a novel SNP of the FTO gene (rs8057044) that is associated with measures of adiposity in the African‐American population.     

Overweight and obesity in an ethnically diverse rural school district: the Healthy Kids Project

Objective: Data on Native American children and adolescents are rarely reported along with other racial and ethnic groups. The Healthy Kids Project is part of an effort to describe the prevalence of overweight and obesity in a racially mixed rural area where Native American, Hispanic, African American, and white children reside. Methods and Procedures: We measured height and weight of students in Anadarko, Oklahoma public schools (n = 1,980) in 2002–2003. All available students (95.7%) whose parents had not opted out of school health assessments were included. From these data, we calculated BMI (weight (kg) / height (m²)) and used the International Obesity Task Force reference to classify children into BMI categories. Results: Native American, Hispanic, African American, and white children who live and attend school in the same surroundings are at risk of overweight and obesity. White children had the lowest combined prevalence of overweight and obesity (37.6%), and Native American children had the highest (53.8%) followed closely by African American (51.7%) and Hispanic children (50.5%). Discussion: The childhood obesity epidemic includes all racial and ethnic groups to different degrees. In a rural public school, Native American, Hispanic, and African children had higher rates of overweight/obesity than white children.     

Treatment of Morbid Obesity in Low‐income Adolescents: Effects of Parental Self‐monitoring

Objective: This study examined the extent to which consistency of self‐monitoring by participants and their parents was related to weight control over an initial period of 3 months within the context of a treatment program for morbidly obese low‐income minority adolescents. Research Methods and Procedures: Eighty‐three obese adolescents (mean age, 13.0 years; 51% boys; 92% African American; mean BMI, 43.0 kg/m²; mean BMI z‐score, 6.0) and at least one parent participated in a long‐term treatment program that included a very‐low‐fat dietary focus, weekly group cognitive‐behavior therapy, monthly nutrition education classes, a 12‐week physical therapy class, and medical monitoring. Results: Participants who self‐monitored on the majority of days compared with those who did not self‐monitor at all or who self‐monitored infrequently attended more sessions and generally lost more weight over the first 3 months. Although parents signed behavioral contracts committing to self‐monitor their own eating and exercising over the first month, only 12% did so. Nonetheless, participants whose parents self‐monitored were much more likely to self‐monitor consistently and lose weight during the first 3 months. Discussion: These results indicate that self‐monitoring is a cornerstone of successful weight control even for morbidly obese low‐income minority adolescents; targeting consistency of self‐monitoring among these high‐risk weight controllers and their parents should be just as important as it is for more affluent and less overweight adolescents.     

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.     

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.     

Adiposity in Childhood Is Related to C‐Reactive Protein and Adiponectin in Young Adulthood: From the Bogalusa Heart Study

To determine the association between cardiovascular (CV) risk factors in childhood and high‐sensitivity C‐reactive protein (hsCRP) and adiponectin in adulthood, 835 eligible white and African‐American young adult subjects (age range 24–42 years, average 34 years, 43% men, 31% African Americans) who had CV risk‐factor variable data from their childhood (20 years earlier, age range 5–18 years, average 14 years) were selected. Stepwise linear regression models revealed that mean logarithmic hsCRP level in adulthood was 0.02 greater with every increase of 1 mm in skinfold thickness in childhood, 0.25 greater for African Americans than whites, 0.36 greater for girls than boys, and 0.15 greater for every unit increase in BMI z score. Mean logarithmic adiponectin level in adulthood was 0.36 greater for girls than boys, 0.22 greater for whites than African Americans, and 0.01 less with every increase of 1 mm of childhood skinfold thickness. Seventy participants (8%) were overweight or obese in their childhood, and 64 of these (91%) remained obese in their young adulthood. In conclusion, childhood adiposity and African‐American race were associated with higher hsCRP and lower adiponectin levels in their adulthood. Skinfold thickness and BMI z score in childhood were the main obesity determinants for higher hsCRP and lower adiponectin levels in young adulthood.     

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.     

Accuracy of self-reported weight among bariatric surgery candidates: the influence of race and weight cycling

Objective: Research on the accuracy of self‐reported weight has indicated that the degree of misreporting (underestimating) weight is associated with increasing weight but is variable across patient groups. We examined the degree of discrepancy between actual and self‐reported BMI in severely obese bariatric surgery candidates, and whether the degree of accuracy varied by race and by eating‐related and psychological factors. Research Methods and Procedures: Participants were 179 obese female gastric bypass surgery candidates (31 black, 22 Hispanic, 126 white) who were asked to self‐report height and weight as part of a larger assessment battery. Actual height and weight were then measured and a discrepancy score was generated (actual BMI ? reported BMI). Results: In this group of severely obese patients, degree of misreporting was unrelated to BMI. The race groups did not differ in actual or self‐reported BMI but differed significantly in the degree of misestimation between self‐reported and actual BMI. Post hoc tests indicated that black women underestimated their BMI significantly more than white women; Hispanic women did not differ from the other race groups. No eating‐related or psychological variables assessed predicted percentage discrepancy; however, the accuracy in self‐reported weight was related to history of weight cycling. Discussion: Overall, obese bariatric surgery candidates were accurate in self‐report of weight, although the degree of accuracy differed by race and weight cycling history.     

Pediatricians’ Own Weight: Self‐perception,Misclassification, and Ease of Counseling

Objectives: Pediatricians underdiagnose overweight and feel ineffective at counseling. Given the relationship between physicians’ health and health habits and counseling behaviors, we sought to determine the 1) percentage of pediatricians who are overweight; 2) accuracy of pediatricians’ own weight status classification; and 3) relationship between weight self‐perception and perceived ease of obesity counseling. Research Methods and Procedures: This study was a cross‐sectional, mail survey of North Carolina pediatricians that queried about their weight status and ease of counseling. Accuracy of pediatricians’ self‐classification of weight status was compared with BMIs derived from self‐reported height and weight. Using logistic regression, controlling for potential confounding variables, we examined the association between weight perception and ease of counseling. Results: The unadjusted response rate was 62%, and the adjusted response rate was 71% (n = 355). Nearly one‐half (49%) of overweight pediatricians did not identify themselves as such. Men had greater adjusted odds of misclassifying overweight than women [odds ratio (OR), 3.61; 95% confidence interval (CI) = 1.81, 7.21]. Self‐classified “thin” pediatricians had nearly six times the odds of reporting more counseling difficulty as a result of their weight than “average” weight pediatricians (OR = 5.69; 95% CI = 2.30, 14.1), and self‐identified “overweight” pediatricians reported nearly four times as great counseling difficulty as “average” weight physicians (OR = 3.84; 95% CI = 1.11, 13.3), after adjustment for self‐reported BMI weight status and other potential confounders. Discussion: The roles that physician weight misclassification and self‐perception potentially play in influencing rates of obesity counseling warrant further research.     

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.     

Sex,Race/Ethnicity,Socioeconomic Status,and BMI in Relation to Self‐Perception of Overweight

Objective: To compare the self‐perception of overweight in the study population according to sex, race/ethnicity, and socioeconomic status and to compare the self‐perception of overweight among individuals classified as normal weight, overweight, and obese. Research Methods and Procedures: Data from 5440 adults who participated in the 1994 to 1996 Continuing Survey of Food Intakes by Individuals and the Diet and Health Knowledge Survey conducted by the U.S. Department of Agriculture were analyzed. Data for analysis included self‐perceived weight status, self‐reported weight and height, and demographic and socioeconomic data. Underweight individuals, defined as those with a body mass index <18.5 kg/m², were excluded from the analysis. Results: Self‐perception of overweight was more common in women compared with men and in whites compared with blacks or Hispanics. Both the correct and incorrect perception of overweight was more common in normal weight and overweight white women compared with black women. More overweight and obese white men correctly perceived their overweight status compared with black men. Multiple logistic regression showed that the odds ratio of perceived overweight was significantly higher in women, whites, and individuals with higher body mass index, higher income, and higher education. Discussion: Self‐perceived overweight varied by sex, race/ethnicity, and socioeconomic status. Erroneous perception of body weight may have important health and behavioral implications. In particular, a considerable proportion of overweight men may be at risk of obesity if they continue to perceive themselves as having normal weight.     

Bright Start: Description and Main Outcomes From a Group‐Randomized Obesity Prevention Trial in American Indian Children

The aim of the Bright Start study was to develop and test the effectiveness of a school environment intervention, supplemented with family involvement, to reduce excessive weight gain by increasing physical activity and healthy eating practices among kindergarten and first‐grade American Indian children. Bright Start was a group‐randomized, school‐based trial involving 454 children attending 14 schools on the Pine Ridge Reservation in South Dakota. Children were followed from the beginning of their kindergarten year through the end of first grade. Main outcome variables were mean BMI, mean percent body fat, and prevalence of overweight/obese children. The goals of the intervention were to: increase physical activity at school to at least 60 min/day; modify school meals and snacks; and involve families in making behavioral and environmental changes at home. At baseline, 32% of boys and 25% of girls were overweight/obese. Although the intervention was not associated with statistically significant change in mean levels of BMI, BMI‐Z, skinfolds or percentage body fat, the intervention was associated with a statistically significant net decrease of 10% in the prevalence of overweight. Intervention children experienced a 13.4% incidence of overweight, whereas the control children experienced a corresponding incidence of 24.8%; a difference of ?11.4% (P = 0.033). The intervention significantly reduced parent‐reported mean child intakes of sugar‐sweetened beverages, whole milk, and chocolate milk. Changes in duration of school physical activity were not significant. Because obesity is the most daunting health challenge facing American Indian children today, more intervention research is needed to identify effective approaches.     

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.