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.     

Immigration and obesity among lower income blacks

Objective: Our objective was to examine the associations of nativity, immigrant generation, and language acculturation with obesity among lower income black adult men and women. Research Methods and Procedures: Data from 551 black adult men and women were collected from participants in the Healthy Directions‐Health Centers Study. Race/ethnicity and nativity were self‐reported. Language acculturation was defined using participants’ first language, preferred reading language, and language spoken at home. Mixed model logistic regression models were estimated to account for within‐health center clustering. Results: Foreign‐born blacks had a lower obesity risk, compared with all U.S.‐born participants, in multivariable analyses [odds ratio (OR) = 0.57, 95% confidence interval (CI), 0.38, 0.84]. Among U.S.‐born participants, those with foreign‐born parents were significantly less likely to be obese than individuals with U.S.‐born parents (OR = 0.54; 95% CI, 0.37, 0.80). Low‐moderate language acculturation also decreased the odds of being obese (OR = 0.45; 95% CI, 0.23, 0.88). Discussion: Our findings suggest a protective effect of foreign‐born status and low‐moderate language acculturation on obesity risk among lower income black immigrants. These data highlight the importance of more frequently examining nativity in obesity‐related research conducted among blacks.     

Body Mass Index and Mortality in Non-Hispanic Black Adults in the NIH-AARP Diet and Health Study

Background

Although the prevalence of obesity (body mass index, kg/m², BMI ≥30) is higher in non-Hispanic blacks than in non-Hispanic whites, the relation of BMI to total mortality in non-Hispanic blacks is not well defined.

Purpose

We investigated the association between BMI and total mortality in 16,471 non-Hispanic blacks in the NIH-AARP Diet and Health Study, a prospective cohort of adults aged 50–71 years.

Methods

During an average of 13 years of follow-up, 2,609 deaths were identified using the Social Security Administration Death Master File and the National Death Index. Cox proportional hazard models were used to estimate relative risks and two-sided 95% confidence intervals (CI), adjusting for potential confounders.

Results

Among individuals with no history of cancer or heart disease at baseline and had a BMI of 20 or greater, the relative risk for total death was 1.12 (95% CI:1.05, 1.19, for a 5-unit increase in BMI) in men and 1.09 (95% CI:1.03, 1.15) in women. Among never smokers with no history of cancer or heart disease at baseline, relative risks for total death for BMI 25–<30, 30–<35, 35–<40, and 40–50, compared with BMI 20–<25, were 1.27 (95% CI: 0.91, 1.78), 1.56 (95% CI: 1.07, 2.28), 2.48 (95% CI: 1.53, 4.05), and 2.80 (95% CI: 1.46, 5.39), respectively, in men and 0.78 (95% CI: 0.59, 1.04), 1.17 (95% CI: 0.88, 1.57), 1.35 (95% CI: 0.96, 1.90), and 1.93 (95% CI: 1.33, 2.81), respectively, in women.

Conclusions

Our findings suggest that overweight is related to an increased risk of death in black men, but not in black women, while obesity is related to an increased risk of death in both black men and women. A large pooled analysis of existing studies is needed to systematically evaluate the association between a wide range of BMIs and total mortality in blacks.     

Anthropometric risk factors for colorectal polyps in African-American women

Objective: Colorectal adenomas are thought to be precursor lesions to colorectal cancer, a leading cause of cancer incidence and mortality in African‐American women. Studies suggest that obesity is associated with risk of adenomas in white women, but little is known about the relation in African‐American women. We prospectively examined the association between selected anthropometric factors and colorectal polyps in African‐American women. Methods and Procedures: Data were obtained from the Black Women's Health Study (BWHS), a prospective cohort study of African‐American women. From 1997 to 2003, we followed 33,403 women aged ≥30 years with no prior diagnosis of cancer or polyps. Cox regression was used to estimate incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for risk of polyps, with adjustment for potential confounders. Results: After 211,797 person‐years of follow‐up, 1,189 cases of colorectal polyps were reported. The IRR comparing women with a current BMI ≥35 to <25 kg/m² was 1.35 (95% CI = 1.12–1.62), after adjustment for covariates including waist‐to‐hip ratio (WHR). Women who gained ≥30 kg since age 18 were 1.76 times as likely as those who gained <5 kg to report polyps (95% CI = 1.33–2.33). The IRR comparing the highest (≥0.87) to lowest (<0.71) quintiles of WHR was 1.26 (95% CI = 1.04–1.54), after adjustment for covariates including BMI. BMI at age 18, adult height, and waist circumference (BMI‐adjusted) were not materially associated with risk. Results were similar among women with a recent endoscopy. Discussion: Weight gain and obesity in adulthood may increase the risk of colorectal polyps in African‐American women.     

Racial Differences in the Tracking of Childhood BMI to Adulthood

Objective: The possibility that there are racial differences in the patterns of BMI (kilograms per meter squared) change throughout life has not been examined. For example, the high prevalence of obesity among black women could result from a higher prevalence of obesity among black girls or because normal‐weight black girls experience larger BMI increases in adolescence or adulthood than do their white counterparts. Therefore, we examined the tracking of childhood BMI into adulthood in a biracial (36% black) sample. Research Methods and Procedures: Five‐ to 14‐year‐old children (2392) were followed for (mean) 17 years. Childhood overweight was defined as BMI ≥ 95th percentile, and adult obesity was defined as BMI ≥ 30 kg/m². Results: The tracking of childhood BMI differed between whites and blacks. Among overweight children, 65% of white girls vs. 84% of black girls became obese adults, and predictive values among boys were 71% (whites) vs. 82% (blacks). These racial differences reflected contrasting patterns in the rate of BMI change. Although the initial BMI of black children was not higher than that of white children, BMI increases with age were larger among black girls and overweight black boys than among their white counterparts. In contrast, relatively thin (BMI < 50th percentile) white boys were more likely to become overweight adults than were their black counterparts. Discussion: These findings emphasize the black/white differences in BMI changes with age. Because of the adult health consequences of childhood‐onset obesity, early prevention should be given additional emphasis.     

Lifecourse socioeconomic position and weight change among blacks: The Pitt County study

Objective: The elevated prevalence of obesity among U.S. blacks has been attributed to low socioeconomic position (SEP), despite inconsistent empirical findings. It is unclear whether low SEP at various lifecourse stages differentially influences adulthood BMI and BMI change. Research Methods and Procedures: Among 1167 black adults in the Pitt County Study, we examined independent cross‐sectional and longitudinal associations between SEP, measured in childhood and adulthood, and BMI and 13‐year BMI change. Low vs. high childhood SEP was measured by parental occupation and childhood household deprivation; low vs. high adulthood SEP was assessed by employment status, education, and occupation. Using childhood and adulthood SEP, four lifecourse SEP categories were created: low‐low, low‐high, high‐low, high‐high. Results: We found no consistent associations between SEP and BMI or BMI change among men. Among women, we observed the expected inverse association between SEP and BMI at baseline. In multivariable‐adjusted analyses, socioeconomically advantaged women demonstrated larger 13‐year increases in BMI: skilled vs. unskilled parental occupation (6.1 vs. 4.8 kg/m², p = 0.04); college‐educated vs. < high school (6.2 vs. 4.5 kg/m², p = 0.04); white‐collar vs. blue‐collar job (5.8 vs. 4.8 kg/m², p = 0.05); and high‐high vs. low‐low lifecourse SEP (6.5 vs. 4.6 kg/m², p = 0.02). Discussion: For women in this black cohort, lower SEP predicted earlier onset of obesity; however, low SEP was less predictive of BMI increases over time. Our findings demonstrate complex patterns of association between SEP and BMI change among black women.     

Factors for short-term outcomes in patients with a minor stroke: results from China National Stroke Registry

Several studies suggest that perceived psychosocial stress is associated with increased risk of stroke; however results are inconsistent with regard to definitions and measurement of perceived stress, features of individual study design, study conduct and conclusions drawn and no meta-analysis has yet been published. We performed a systematic review and meta-analysis of studies assessing association between perceived psychosocial stress and risk of stroke in adults.The results of the meta-analysis are presented. Systematic searches of MEDLINE, EMBASE, CINAHL, PsycInfo, and Cochrane Database of Systematic Reviews were undertaken between 1980 and June 2014. Data extraction and quality appraisal was performed by two independent reviewers. Hazard ratios (HR) and odds ratios (OR) were pooled where appropriate. 14 studies were included in the meta-analysis, 10 prospective cohort, 4 case–control design. Overall pooled adjusted effect estimate for risk of total stroke in subjects exposed to general or work stress or to stressful life events was 1.33 (95 % confidence interval [CI], 1.17, 1.50; P < 0.00001). Sub-group analyses showed perceived psychosocial stress to be associated with increased risk of fatal stroke (HR 1.45 95 % CI, 1.19,1.78; P = 0.0002), total ischaemic stroke (HR 1.40 95 % CI, 1.00,1.97; P = 0.05) and total haemorrhagic stroke (HR 1.73 95 % CI, 1.33,2.25; P > 0.0001).A sex difference was noted with higher stroke risk identified for women (HR 1.90 95 % CI, 1.4, 2.56: P < 0.0001) compared to men (HR 1.24 95 % CI, 1.12, 1.36; P < 0.0001). Current evidence indicates that perceived psychosocial stress is independently associated with increased risk of stroke.     

Maternal Obesity and Breast‐feeding Practices Among White and Black Women

Despite the increase in obesity among women of reproductive ages, few studies have considered maternal obesity as a risk factor for breast‐feeding success. We tested the hypothesis that women who are obese (BMI = 30–34.9) and very obese (BMI ≥35) before pregnancy are less likely to initiate and maintain breast‐feeding than are their normal‐weight counterparts (BMI = 18.5–24.9) among white and black women. Data from 2000 to 2005 South Carolina Pregnancy Risk Assessment Monitoring System (PRAMS) were used. The overall response rate was 71.0%; there were 3,517 white and 2,846 black respondents. Black women were less likely to initiate breast‐feeding and breast‐fed their babies for a shorter duration than white women. Compared to normal‐weight white women, very obese white women were less likely to initiate breast‐feeding (odds ratio: 0.63; 95% confidence interval (CI) = 0.42, 0.94) and more likely to discontinue breast‐feeding within the first 6 months (hazard ratio (HR) = 1.89; 95% CI: 1.39, 2.58). Among black women, prepregnancy BMI was neither associated with breast‐feeding initiation nor with breast‐feeding continuation within the first 6 months. Because very obese white women are less likely to initiate or continue breast‐feeding than other white women, health professionals should be aware that very obese white women need additional breast‐feeding support. Lower rates of breast‐feeding among black women suggest that they should continue to be the focus of the programs and policies aimed at breast‐feeding promotion in the United States.     

Randomized Trial of a Behavioral Weight Loss Intervention for Low‐income Women: The Weight Wise Program

Low‐income women in the United States have the highest rates of obesity, yet they are seldom included in weight loss trials. To address this research gap, components of two evidence‐based weight loss interventions were adapted to create a 16‐week intervention for low‐income women (Weight Wise Program), which was evaluated in a randomized trial with the primary outcome of weight loss at 5‐month follow‐up. Participants were low‐income women (40–64 years) with a BMI of 25–45. Of 143 participants, 72 were randomized to the Weight Wise Program (WWP) and 71 to the Control Group (CG). Five‐month follow‐up data were obtained from 64 (89%) WWP and 62 (87%) CG participants. With baseline values carried forward for missing data, WWP participants had a weight change of ?3.7 kg compared to 0.7 kg in the CG (4.4 kg difference, 95% confidence interval (CI), 3.2–5.5, P < 0.001). For systolic blood pressure (SBP), change in the WWP was ?6.5 mm Hg compared to ?0.4 mm Hg among controls (6.2 mm Hg difference, 95% CI, 1.7–10.6, P = 0.007); for diastolic BP (DBP), changes were ?4.1 mm Hg for WWP compared to ?1.3 mm Hg for controls (2.8 mm Hg difference, 95% CI, 0.0–5.5, P = 0.05). Of the 72 WWP participants, 64, 47, and 19% lost at least 3, 5, and 7% of their initial body weight, respectively. In conclusion, the WWP was associated with statistically significant and clinically important short‐term weight loss.     

Excess Weight and the Risk of Incident Coronary Heart Disease Among Men and Women

Overweight and obesity have been prospectively associated with the risk of coronary heart disease (CHD). Less clear is the relation of excess weight to risk of CHD among men and women with comorbid conditions, and the proportion of CHD risk attributable to excess weight in the US population. To assess the risk of CHD associated with excess weight among men and women with and without associated comorbid conditions, and determine the population attributable risk of CHD associated with excess weight. The study population consisted of two prospective cohorts, the Health Professionals Follow‐up Study (HPFS) (N = 42,351 men; age range at baseline, 39–75 years) and the Nurses' Health Study (NHS) (N = 76,703 women; age range at baseline, 39–65 years). A total of 2,771 incident cases of CHD among the men and 2,359 among the women were documented over the 16 years of follow‐up. Overall, the relative risk (RR) of CHD associated with BMI ≥30 kg/m² compared with BMI 18.5–22.9 kg/m² was 2.13 (95% confidence interval (CI), 1.82–2.48) among the men and 2.48 (95% CI, 2.20–2.80) among the women. The risk of CHD increased with BMI, both with and without the presence of comorbid conditions. Our estimates suggest that more than a third of all incident CHD in US men and women may be attributed to excess weight. Excess weight is associated with increased risk of CHD among men and women, both alone and in combination with comorbid conditions, though the results require careful interpretation. A substantial proportion of incident CHD may be attributed to excess weight.     

Overweight and Obesity in Young and Middle Age and Early Retirement: The ARIC Study

The objective of this study was to examine associations between weight status in young and middle age and early retirement in African‐American and white men and women. Data were from the Atherosclerosis Risk in Communities (ARIC) study. Analyses were restricted to participants aged 45–55 years at baseline (n = 6,483). Associations between weight status at age 25 and ages 45–55 and age at early retirement (prior to age 65) over 9 years of follow‐up were examined using proportional hazard regression analyses in models stratified by race and gender. Models were adjusted for education, household income, health insurance status, occupation, occupational physical activity, marital status, smoking, and field center. Between 18.7 and 21.6% of African‐American and white men and women reported retiring prior to age 65. Although not always statistically significant, overweight and obesity were associated with early retirement in all but white women. Overweight (BMI ≥ 25 kg/m²) at age 25 was significantly associated with early retirement in African‐American women (hazard ratio (95% confidence interval): 1.62 (1.17–2.23)) and white men (1.32 (1.12–1.57)). There was also a trend between overweight at age 25 and early retirement in African‐American men (1.43 (0.99–2.07)). Obesity (BMI ≥ 30 kg/m²) in middle age was significantly associated with early retirement in white men only (1.32 (1.03–1.69)). Furthermore, overweight at age 25 and obesity at ages 45–55 were associated with early retirement for health reasons among African‐American and white men and women. In conclusion, analyses of the economic impact of obesity may need to consider its effects on early retirement.     

Racial/Ethnic Disparities in Obesity Among US‐born and Foreign‐born Adults by Sex and Education

This study examines sex and education variations in obesity among US‐ and foreign‐born whites, blacks, and Hispanics utilizing 1997–2005 data from the National Health Interview Survey on 267,585 adults aged ≥18 years. After adjusting for various demographic, health, and socioeconomic factors via logistic regression, foreign‐born black men had the lowest odds for obesity relative to US‐born white men. The largest racial/ethnic disparity in obesity was between US‐born black and white women. High educational attainment diminished the US‐born black–white and Hispanic–white disparities among women, increased these disparities among men, and had minimal effect on foreign‐born Hispanic–white disparities among women and men. Comprehension of these relationships is vital for conducting effective obesity research and interventions within an increasingly diverse United States.     

The Longitudinal Association From Obesity to Depression: Results From the 12‐year National Population Health Survey

Prior observational studies have investigated the association between obesity and depression but evidence remains weak and mixed. There has been a call for high‐quality longitudinal studies to elucidate the etiologic relationship from obesity to depression. The main objective of this study was therefore to investigate whether obesity was a risk factor for depression in a nationally representative sample followed for 12 years. Seven waves of data collection (1994–1995 to 2006–2007) were obtained from the National Population Health Survey (NPHS). Our analyses included 10,545 adults without depression at baseline. Past‐year major depression episode (MDE) was assessed from the Composite International Diagnostic Interview‐Short Form for Major Depression (CIDI‐SFMD). Obesity was estimated using baseline BMI from self‐reported weight and height (obesity: BMI ≥30 kg/m²). Kaplan–Meier survival curves were generated and Cox proportional hazard regression modeling was used to estimate the risk of MDE by obesity status, controlling for sociodemographic and health and lifestyle variables. We found that obesity at baseline did not significantly predict subsequent MDE in women (adjusted hazard ratio (AHR): 1.03, 95% confidence interval (CI) 0.84–1.26) and negatively predicted MDE in men (HR: 0.71, CI 0.51–0.98), after adjusting for important confounders. In summary, our findings suggest that obesity is a significant (negative) predictor of depression in adult men but not in women. These results moderate prior evidence supporting a positive link from obesity to depression.     

BMI vs. waist circumference for identifying vascular risk

Objective: Current guidelines recommend measurement of both BMI and waist circumference (WC) in individuals with BMI between 25.0 and 34.9 kg/m². We investigated the relative contributions of BMI and WC toward identifying risk of adverse vascular events in a community‐based sample. Methods and Procedures: We evaluated Framingham Study participants (n = 4,195 person‐examinations, 53% women) using pooled logistic regression to assess the incremental prognostic utility of WC in predicting risk of a first cardiovascular disease (CVD) event in the three BMI categories (normal, <25 kg/m²; overweight, 25 to <30 kg/m²; obese, ≥ 30 kg/m²) and to assess the incremental prognostic utility of BMI and WC separately for predicting risk of a first cardiovascular event. Results: On follow‐up (16 years), 430 participants (158 women) had experienced a first CVD event. In overweight women, but not in overweight men, larger WC was found to be an independent predictor of CVD incidence, longitudinally (in women, multivariable‐adjusted odds ratio (OR) per s.d. increment in WC 1.86, 95% confidence interval (CI) = 1.03–3.36, P = 0.04; in men adjusted OR per s.d. increment in WC 0.91, 95% CI 0.60–1.38, P = 0.66). In obese individuals and in those with normal BMI, WC was not associated independently with incident CVD. When BMI and WC were analyzed separately for predicting risk of a first cardiovascular event, the c statistics associated with the multivariable CVD models incorporating BMI vs. WC were nearly identical in men and women. Discussion: Knowledge of WC aids identification of vascular risk among overweight women. Among normal weight or obese women and men (regardless of BMI category) WC did not appear to substantially add to prediction of risk of vascular events.     

Overall and central obesity and risk of type 2 diabetes in U.S. black women

Objective: Obesity has risen to epidemic proportions in the United States, leading to an emerging epidemic of type 2 diabetes. African‐American women are disproportionately affected by both conditions. While an association of overall obesity with increasing risk of diabetes has been documented in black women, the effect of fat distribution, specifically abdominal obesity, has not been studied. We examined the association of BMI, abdominal obesity, and weight gain with risk of type 2 diabetes. Research Methods and Procedures: During eight years of follow‐up of 49,766 women from the Black Women's Health Study, 2472 incident cases of diabetes occurred. Cox proportional hazard models were used to estimate incidence rate ratios (IRRs), with control for age, physical activity, family history of diabetes, cigarette smoking, years of education, and time period of data collection. Results: Sixty‐one percent of participants had a BMI ≥25 kg/m² (WHO definition of overweight). Compared with a BMI of <23 kg/m², the IRR for a BMI of >45 kg/m² was 23 (95% confidence interval, 17.0 to 31.0). The IRR for the highest quintile of waist‐to‐hip ratio relative to the lowest was 2.3 (95% confidence interval, 2.0 to 2.7) after control for BMI. Furthermore, at every level of BMI, an increased risk was observed for high waist‐to‐hip ratio relative to low. Discussion: Central obesity, as well as overall obesity, is a strong risk factor for diabetes in African‐American women. Efforts to reduce the prevalence of obesity in African‐American women are of paramount importance.     

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 in 70‐Year‐Old Subjects as a Risk Factor for 15‐Year Coronary Heart Disease Incidence

Objective: To investigate the role of obesity in general and waist circumference (WC) and BMI in particular as risk factors for 15‐year incidence of coronary heart disease (CHD) in the elderly. Research Methods and Procedures: This prospective study was based on 1597 (737 males and 860 females) 70‐year‐olds free from CHD and participants of three birth cohorts examined in 1971 to 1972 (Cohort I), 1976 to 1977 (Cohort II), and 1981 to 1982 (Cohort III) at Göteborg, Sweden. Fifteen‐year incidence of CHD (fatal and nonfatal) was ascertained from follow‐up examinations and registers. Relative risk (RR) for first ever CHD in reference to the lowest quartiles of WC and BMI was calculated from Cox regression. Results: In males, RRs for CHD in the highest WC and BMI quartiles were 1.36 [95% confidence interval (CI) 1.00 to 1.85] and 1.42 (95% CI 1.04 to 1.92), respectively, after adjustment for cohorts, smoking habits, diabetes, systolic blood pressure, and total cholesterol. In men, the risk associated with WC was independent of BMI. Neither WC nor BMI was related to CHD risk in females. After exclusion of first 5‐year all‐cause deaths, the adjusted RRs in the highest WC and BMI quartiles in males were 1.47 (95% CI 1.06 to 2.04) and 1.42 (1.04 to 1.92), respectively. In females, a significantly higher RR of 1.41 (95% CI 1.02 to 1.94) was observed in the second BMI quartile only after such exclusions. Discussion: WC, an indicator of both central and general obesity, appears to be a stronger predictor of CHD than BMI in elderly males, but in females, obesity was not a risk factor for CHD.     

Development of Overweight Associated with Childbearing Depends on Smoking Habit: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Objective: To prospectively evaluate whether childbearing leads to development of overweight in women and to evaluate the role of other known risk factors. Research Methods and Procedures: A prospective, multicenter observational study, the Coronary Artery Risk Development in Young Adults (CARDIA) Study from 1986 to 1996, examined subjects at baseline and in follow‐up years 2, 5, 7, and 10. Included were 998 (328 black and 670 white) nulliparous women, age 18‐30 years, who were not overweight at baseline. Relative odds for incident overweight (BMI ≥ 25 kg/m²) associated with parity change (0, 1, or 2+) and risk factors were estimated using discrete‐time survival models adjusted for baseline and time‐dependent covariates. Results: Parity change‐association with development of overweight depended on smoking habit (interaction, p < 0.001). In multivariate adjusted models, 1 and 2+ births vs. 0, respectively, were associated with increased risk for development of overweight among never smokers [odds ratio (OR) = 2.66; 95% confidence interval (CI): 1.80, 3.93, and 2.10, 95% CI: 1.24, 3.56] and decreased risk among current smokers (OR = 0.41; 95% CI: 0.17, 0.96, and 0.36, 95% CI: 0.08, 1.65). Risk was increased for black vs. white race (OR = 3.49; 95% CI: 2.59, 4.69), frequent weight cycling (OR = 1.45; 95% CI: 1.03, 2.04), and high school education or less (OR = 2.21; 95% CI: 1.50, 3.26) and was decreased for highest physical activity quartile (OR = 0.62; 95% CI: 0.43, 0.90). Discussion: Childbearing contributes to development of overweight in nonsmokers but not in smokers, where development of overweight is less likely in women who bear children. Race, education, and behaviors are important factors in development of overweight in young women.     

Work stress, obesity and the risk of type 2 diabetes: gender-specific bidirectional effect in the Whitehall II study

Psychosocial work stress has been linked to higher risk of type 2 diabetes (T2DM), with the effect being consistently higher among women than men. Also, work stress has been linked to prospective weight gain among obese men but weight loss among lean men. Here, we aimed to examine the interaction between work stress and obesity in relation to T2DM risk in a gender‐specific manner. We studied 5,568 white middle‐aged men and women in the Whitehall II study, who were free from diabetes at analysis baseline (1993). After 1993, diabetes was ascertained at six consecutive phases by an oral glucose tolerance test supplemented by self‐reports. Cox regression analysis was used to assess the association between job strain (high job demands/low job control) and 18‐year incident T2DM stratifying by BMI (BMI <30 kg/m² vs. BMI ≥30 kg/m²). Overall, work stress was associated with incident T2DM among women (hazard ratio (HR) 1.41: 95% confidence intervals: 1.02; 1.95) but not among men (HR 0.87: 95% confidence interval 0.69; 1.11) (P_INTERACTION = 0.017). Among men, work stress was associated with a lower risk of T2DM in nonobese (HR 0.70: 0.53; 0.93) but not in obese individuals (P_INTERACTION = 0.17). Among women, work stress was associated with higher risk of T2DM in the obese (HR 2.01: 1.06; 3.92) but not in the nonobese (P_INTERACTION = 0.005). Gender and body weight status play a critical role in determining the direction of the association between psychosocial stress and T2DM. The potential effect‐modifying role of gender and obesity should not be ignored by future studies looking at stress‐disease associations.