practice applications
Eating More . . . Nourishing Less
T
he obesity epidemic in this coun-
try continues to rage. The Na-
tional Center for Health Statis-
tics reported that between 1980 and
2002, obesity prevalence doubled in
adults over age 20 years and tripled
in children and adolescents aged 6 to
19 years (1). Data were analyzed
from the National Health and Nutri-
tion Examination Survey, a com-
plex, multistage probability sample
of noninstitutionalized males and
females across ethnic groups. The
only reported shred of hope was that
among adult women (approximately
one third of whom are obese), no
significant increase in the rate of obe-
sity was observed between 1999-
2004, while the rate did increase in
men and children overall, and espe-
cially among nonwhites (1).
Since previous data from the Na-
tional Health and Nutrition Exami-
nation Survey had reported that over-
all self-reported energy intake among
children and adolescents has not sig-
nificantly increased, it is assumed
that decreased physical activity may
be a major factor in the growing obe-
sity epidemic (2). Among the majority,
intakes of total fat, saturated fat, and
cholesterol were in excess of recom-
mended amounts for that era and soft
drinks contributed approximately 8%
of calorie intake among overweight
children (2). Since milk consumption
simultaneously decreased during that
time, the overall net intake of calcium,
magnesium, vitamin D, and other re-
lated dairy nutrients also decreased as
well.
This pattern suggests that among
overweight children nutrient quality
is inferior despite adequate or exces-
sive calorie intake. This pattern fol-
lowed long term might be predicted to
adversely influence risk factors for a
variety of chronic diseases including
© 2007 by the American Dietetic Association
metabolic syndrome. Yet, juxtaposed
with that prospect are recent data
from the Coronary Artery Risk Devel-
opment in Young Adults Study docu-
menting the absence of developing
metabolic syndrome commonly asso-
ciated with aging when there is no
increase in body mass index (3). In
other words, prevention of weight
gain is a powerful way to reduce risk
of metabolic syndrome that is often
the precursor of hypertension, type 2
diabetes, dyslipidemia, and other car-
diovascular diseases.
Furthermore, if diet quality suffers
in the face of advancing obesity, as is
reported in this month’s Journal, are
immunological compromises likely as
well? What chance is there for expe-
riencing healthful aging in the face of
these adverse conditions?
MORE THIS MONTH
Do beverage patterns contribute to
overall diet quality and body mass in-
dex in children?
LaRowe and colleagues (p 1124) fur-
ther explore these associations and
suggest some age-related influences
that impact overall nutrient quality
and bear consideration.
Roseman and colleagues (p 1139)
also report on cross sectional data from
7-day recalls of fruits, vegetables, milk,
soft drinks, and breakfast consumption
in over 4,000 middle school students
in Kentucky. Students with healthy
weights exhibited eating patterns that
included more fruits and vegetables,
milk, and breakfast consumption than
overweight students. Although no causal
associations can be derived from these
data, the associations of certain eating
patterns and behavior are clearly
worth noting.
Similarly, Clarke and colleagues (p
1146) report predictors of weight loss
in a tri-ethnic community of low-in-
Journal of the AMERICAN DIETETIC ASSOCIATION
EDITOR’S OUTLOOK
come mothers. The authors were in-
terested in attitudes and behaviors
rather than specific dietary patterns.
Overall, less satisfaction with appear-
ance and enhanced nutrition knowl-
edge were important influences on
weight loss in this population of low-
income mothers.
Also, Tinker and colleagues (p 1155)
present data from the Women’s Health
Initiative regarding the predictors of
dietary change to maintenance of a
low-fat diet. Data from over 19,500
women were analyzed. The women
who best adhered to the diet were
those who attended the most sessions
and regularly self-monitored their di-
ets. Another notable finding was the
importance of optimism regarding
successful outcomes.
These and other topics this month
will add sizzle to your summer read-
ing.
Best regards.
Linda Van Horn, PhD, RD
Editor-in-Chief
doi: 10.1016/j.jada.2007.05.026
References
1. Ogden CL, Carroll MD, Curtin LR, McDowell
MA, Tabak CJ, Flegal KM. Prevalence of
overweight and obesity in the United States,
1999-2004. JAMA. 2006;295:1549-1555.
2. Troiano RP, Briefel RR, Carroll MD, Bialos-
tosky K. Energy and fat intakes of children
and adolescents in the United States: Data
from the National Health and Nutrition Ex-
amination Surveys. Am J Clin Nutr. 2000;
72(suppl 5):1343S-1353S.
3. Lloyd-Jones DM, Liu K, Colangelo LA, Yan
LL, Klein L, Loria CM, Lewis CE, Savage P.
Consistently stable of decreased body mass
index in young adulthood and longitudinal
changes in metabolic syndrome components:
The Coronary Artery Risk Development in
Young Adults Study. Circulation. 2007;115:
1004-1011.
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