OBJECTIVE: To examine demographic, behavioral and dietary correlates of frequency of fast food restaurant use in a community-based sample of 891 adult women. DESIGN: A survey was administered at baseline and 3 y later as part of a randomized, prospective intervention trial on weight gain prevention. SUBJECTS: Women (n 891) aged 20 ± 45 y who enrolled in the Pound of Prevention study. MEASUREMENTS: Frequency of fast food restaurant use, dietary intake, demographic and behavioral measures were self-reported. Dietary intake was measured using the 60-item Block Food Frequency Questionnaire. Body weight and height were directly measured. RESULTS: Twenty-one percent of the sample reported eating 3 fast food meals per week. Frequency of fast food restaurant use was associated with higher total energy intake, higher percentage fat energy, more frequent consumption of hamburgers, French fries and soft drinks, and less frequent consumption of ®ber and fruit. Frequency of fast food restaurant use was higher among younger women, those with lower income, non-White ethnicity, greater body weight, lower dietary restraint, fewer low-fat eating behaviors, and greater television viewing. Over 3 y, increases in frequency of fast food restaurant use were associated with increases in body weight, total energy intake, percentage fat intake, intake of hamburgers, French fries and soft drinks, and with decreases in physical activity, dietary restraint and low-fat eating behaviors. Intake of several other foods, including fruits and vegetables, did not differ by frequency of fast food restaurant use. CONCLUSION: Frequency of fast food restaurant use is associated with higher energy and fat intake and greater body weight, and could be an important risk factor for excess weight gain in the population.

Contents 1. Obesity and the global burden of disease 2. Prevalence, trends and economics 3. Targets for action 4. The action agenda 5. Potential solutions 6. Tracking outcomes 7. Glossary of terms 8. Key references and further reading 9. Case studies: Available on Nature website at www.naturesj.com=ijo=index.html

OBJECTIVES: This present study describes weight control strategies used by a heterogeneous sample of US adults and their associations with weight and behaviour change over time. DESIGN: A prospective cohort study. PARTICIPANTS: Participants for this study were 1120 US adults recruited from the community who enrolled in a threeyear intervention study to examine methods for preventing age-related weight gain. MEASURES: Measured body weight and self-reported behaviours related to body weight (dieting practices, dietary intake and physical activity) were completed annually for four years. RESULTS: Over 70% reported using each of the following dieting strategies at least once in four years: increase exercise (82.2%); decrease fat intake (78.7%); reduce food amount (78.2%); and reduce calories (73.2%). Cumulative duration of use of these behaviours was brief (for example, even the most common behaviours were used only 20% of the time). Global reports of dieting were not predictive of weight change over time. However, a dose ± response relationship was observed between reported duration of use of several speci®c weight loss strategies over the four years and change in behaviours and weight gain. CONCLUSIONS: These ®ndings suggest that public health recommendations for weight control may need to place greater emphasis on persistence of weight control behaviours.

This study examined the prevalence, distribution and correlates of successful weight loss and successful weight maintenance over three years in a community-based sample of 854 subjects aged 20 ± 45 at baseline. More than half (53.7%) of the participants in the study gained weight within the ®rst twelve months, only one in four (24.5%) successfully avoided weight gain over three years, and less than one in twenty (4.6%) lost and maintained weight successfully. The ®ndings underscore the importance of current public health efforts to prevent weight gain, and suggest that without much greater efforts to promote and support weight control the prevalence of obesity will continue to rise.

OBJECTIVES: The aims of the present study were to examine the prevalence and correlates of binge eating in a nonclinical sample of women and to examine whether associations differed by overweight status. DESIGN: Cross-sectional comparison of women based on self-reported binge eating status (large amount of food eaten and feelings of lack of control during these eating episodes) and overweight status (measured body weight: overweight de®ned as body mass index (BMI) ! 27.3 kgam 2 ). PARTICIPANTS: Subjects were 817 women aged 20 ± 45 y from the community who enrolled in a three year prospective intervention study to examine methods for preventing age-related weight gain. MEASURES: Body weight was measured at baseline and three-year follow-up. Self-report measures of binge eating, dieting practices, eating and exercise behaviours, depression, self-esteem and stressful life events were collected at the three-year follow-up. RESULTS: The prevalence of binge eating in the past six months was 9% among normal weight women and 21% among overweight women. The frequency of binge eating was low ( b 50% of binge eaters binged less than once per week) and did not signi®cantly differ by body weight status. Compared to non-binge eaters, binge eaters reported more dieting practices, more extreme attitudes about weight and shape, and higher levels of depression and stressful life events. Binge eating was not related to habitual eating and exercise behaviours. In multivariate models, weightashape importance (odds ratio (OR) 3.33; 95% con®dence intervals (95% CI) 2.10, 5.29), depression (OR 1.73; 95% CI 1.07, 2.79) and history of intentional weight loss episodes (OR 1.68; 95% CI 1.03, 1.13) were independently associated with increased odds of binge eating. CONCLUSIONS: Binge eating is about twice as prevalent among overweight women, compared to normal weight women, in a nonclinical sample, but has similar correlates (that is, dieting, depression, weightashape preoccupation). Prospective research is needed to determine whether there are causal associations between binge eating, depression, dieting and weight gain.