M-HPRC Info Monthly December 2010

Colleagues, friends,

Here is the “Info Monthly” for December 2010 in four parts:

A. Announcements: e.g. announced Meetings, Conferences, Resources
B. News, i.e. print and electronic media stories, usually bylined
C. Reports, Essays, Commentaries, Policy Briefs, now including the National Academy of Sciences pubs
D. Research and Reviews: peer-reviewed journal articles

As usual, we trust that you will skim these contents for the pieces that matter to you most.

Thanks for all you do.

Robert H. Ross, PhD
Scientific Director, Maine-Harvard Prevention Research Center at the University of New England
December 20, 2010

A. Announcements

1. Nutrition & Diabetes. Online. Open access. High-Quality Research. Brought to you by the editorial team of The International Journal of Obesity, Nutrition & Diabetes is a peer-reviewed open access online journal that publishes full-length papers, reviews, and commentaries describing methodologies, mechanisms, and associations in relation to diabetes and nutrition related diseases.
2. Maine-Harvard Prevention Research Center Conference, January 21, 2011. Register now! Registration for the Maine Harvard Prevention Research Center's 10th Obesity Conference is now open. The focus of this year's conference is obesity
   prevention in child care settings. In addition to experts in Maine, there will be speakers from the University of North Carolina, the U.S. Centers for Disease Control and Prevention and from the Harvard Prevention Research Center. Please
   register early as space is limited. For Registration go to: www.acteva.com/booking.cfm?bevaid=211808. For a copy of the brochure go to: http://www.une.edu/mhprc/index.cfm. Starting Young: Improving the Nutrition and Physical Activity Environment for Pre-School Children. Senator Inn Augusta. January 21, 2011. 8:30- 2:00 pm Conference then 2:00 3:00 pm Starting Young NAP SACC Sites Technical Assistance Session with Dr. Dianne Stanton Ward.
3. To explore the excellent and informative National Coalition for Promoting Physical Activity website and to subscribe to the NCPPA Newsletter (at bottom right of the page) please go to http://www.ncppa.org/ where, for example, Issue 201, November 30, 2010, announces seven grants competitions as well as:
   
   •The Road Runners Club Of America Seeks Applications For The Inaugural Runner Friendly Community Designation. There are many benefits for communities that earn the Runner Friendly Community designation. Learn more about the Runner Friendly Community designation program at http://www.RRCA.org/programs/runner-friendly-community/..About the RRCA. Founded in 1958, the RRCA is the oldest and largest national association of running clubs, running events, and runners. The mission of the RRCA is to promote running as a competitive sport and as healthy physical activity. The RRCA achieves their mission by promoting the common interests of its members by providing educational opportunities, programs, and services. The organization’s membership consists of over 1100 running clubs and events nationwide.
   • Eighth Active Living Research Annual Conference, February 22-24, 2011 San Diego, CA. The theme for the 2011 conference is Partnerships for Progress in Active Living: From Research to Action, which recognizes the importance of engaging experts from multiple disciplines to address critical public health issues, especially active living and obesity. Strong partnerships among researchers, policy-makers and community stakeholders are essential for identifying and implementing promising, sustainable solutions that are relevant to the people who are most affected. The 2011 conference will highlight successful partnerships that have evaluated or implemented policy or environmental approaches for increasing physical activity, decreasing sedentary behavior or preventing obesity, particularly among children and families.
   • National Bike Summit, March 8-10, 2011, Washington, D.C. There are more people riding bikes than ever. Yet half of all U.S. trips are three miles or less, and more than 90 percent are made by car. The National Bike Summit, sponsored by the League of American Bicyclists has improved bicycle-friendliness and livability in many communities, but the need and opportunity to improve physical activity, safety and livability in the U.S., while reducing congestion, greenhouse gas emissions and our dependence on oil – remains greater today than a decade ago. Now is the time to ask Congress to make strategic transportation investments that foster healthy people and healthy communities.
   • Draft Framework for the National Prevention and Health Promotion Strategy. The Surgeon General convened the National Prevention and Health Promotion Council this fall. They agreed on the framework for the National Prevention and Health Promotion Strategy (National Prevention Strategy) which includes the Vision, Goals, and Strategic Directions. The Council will use the framework to guide development of the National Prevention Strategy. You can view the draft framework at the title link above. Comments are being accepted on the draft until December 5, 2010.
   • Let’s Move Toolkit for Faith Based and Neighborhood Organizations. First Lady Michelle Obama recently launched Let’s
   Move Faith-based and Communities. Children learn many lessons about healthy living and well-being in faith- and community-based settings that set the foundation for their lifestyle as adults. Let’s Move has published a toolkit that is designed to help faith-based and neighborhood organizations transform neighborhoods, engage communities, and promote healthy choices. There are a variety of activities and resources provided in this toolkit and you are invited to
   explore the menu of options and to see which ones could work best for your organization.
   • IDEA FitnessConnect. IDEA FitnessConnect is the first free, all-inclusive national directory of fitness professionals,
   connecting more than 16 million consumers to more than 130,000 fitness professionals with credentials verified by the top 17 fitness certification bodies. Fitness professionals are able to register on the site at no charge and consumers can easily identify the types of professionals they are looking for in their geographic area of choice.
   • MyWellRewards wellness activity and incentive tracker will dramatically improve your wellness participation and decrease your workload... at the same time. See how it works right now. -Reduce your workload. -Increase wellness program participation. -Easily keep track program participation. -Get employees excited about wellness again. -Make your incentive program come to life. Test drive it for free. Just email Natalie to get a demo password Natalie@wellsteps.com and http://www.wellsteps.com/. See the financial impact of your wellness efforts. The ROI Calculator will show you bottom line. See the impact of your wellness efforts on employee health care costs, absenteeism and productivity. Based on the published ROI evidence, the ROI calculator from WellSteps is very easy to use and can provide you and management with tangible estimates of the financial impact of your wellness program.
4. Safe Routes to School E-News. Safe Routes to School E-News
   is a monthly email newsletter published by the Safe Routes to School National Partnership, a fast-growing network of nonprofit organizations, government agencies and professional groups that are working to set goals, share best practices, secure funding, and provide detailed policy input to implementing agencies for advancing the Safe Routes to School
   national movement.
5. Shape Up America! Newsletter Shape Up America! is a national initiative involving a broad-based coalition of industry, medical/health, nutrition, physical fitness, and related organizations and experts to promote healthy weight and increased physical activity in America. They publish an electronic newsletter.

B. News

1. Experts On Aging: Stay Fit After 65 To Live Longer, Better, USA Today, November 21, 2010. Baby Boomers better think again if they're longing for a sedentary old age. Health experts at the annual meeting of the Gerontological Society of America this weekend shed new light on exercise's value as a strong tool in combating diseases often associated with aging. "How you live after age 65 is vitally important," says Laura Carstensen, director of the Stanford Center on Longevity. "Up until then, a healthy life is dominated by your genes. After that, it's predominantly about lifestyle. Exercise and nutrition become more important."
2. It’s Time for Recess: Just Keep on Moving. New York Times, November 22, 2010. We all know by now that we should be getting 30 minutes a day of moderate to vigorous physical activity on most days. Yet for all the proselytizing, wheedling and cajoling, only about 5 percent of the population has bought into the program. “Being sedentary is the norm in America,” writes Dr. Toni Yancey, a professor of health services at the University of California, Los Angeles. Thanks to the plethora of
   labor-saving devices and motorized vehicles, we now “spend most of our waking time sitting, reclining or lying down.” “Even activities that we still do regularly demand less exertion,” Dr. Yancey continued. “And the less people have to do, the more quickly they get tired when they exert themselves just a little bit, which of course discourages them from exercising.” Clearly, a new approach is needed. And Dr. Yancey is offering one that has already shown great promise to counteract what she calls “sedentary behavior disorder.”
3. Diabetes Requires Aerobic Plus Weight Exercise, Experts Say. USA Today, November 23, 2010. People with diabetes should mix aerobics with weight training to get the best results in lowering blood sugar, a new study suggests. The combination worked best for weight loss too, compared to aerobics or weight training alone. Blood sugar is fuel to muscles, and more sugar is burned during aerobic activity. Weight training builds more muscle, and both activities change muscle proteins in ways that enhance the process. "It's clear that doing both aerobic and strength training is superior to either alone," said lead author Dr. Tim Church of Pennington Biomedical Research Center in Baton Rouge, Louisiana. "It's almost like taking two different drugs." Patients in the study, published in Wednesday's Journal of the American Medical Association, achieved the results over nine months, exercising three days a week for about 45 minutes each session. "People can manage this amount of exercise," said Laurie Goodyear of Joslin Diabetes Center in Boston, who wasn't involved in the new study but does similar research. "They didn't have to go on a diet. This was purely an exercise effect."
4. Being A 'Good Sport' Can Be Critical To Maintaining Lifelong Physical Activity. Medical News Today, November 26, 2010. It's never fun riding the bench - but could it also make you less likely to be physically active in the future? That's one of the questions being explored by Mark Eys, an associate professor of kinesiology and physical education at Wilfrid Laurier University and the Canada Research Chair in Group Dynamics and Physical Activity. Eys is presenting his work as part of this week's Canada Research Chairs conference in Toronto. Eys, who also teaches out of the university's psychology department, is studying group cohesion - which, in sporting terms, is essentially that sense of camaraderie that often develops between teammates - and how it affects the willingness of teenagers to take part in physical activity long-term.
5. GPS Board Rejects Structured Recess For K-5 Kids. The Arizona Republic, November 26, 2010. The Gilbert Public Schools governing board has decided not to implement a proposed 30 minutes a day of structured physical activity for kindergarten to fifth-grade students. While board members, administrators and elementary school principals recognized the need for structured exercise and activity, the board during a meeting Tuesday said unstructured recess provides a social time for students, and allows them to be creative and choose their own activities in a day that's highly structured. "Our belief is that unstructured recess time aids children's cognitive development," said Superintendent Dave Allison. "Students can create their own recess and play." House Bill 2725, which was passed by the state legislature in the spring, requires each school board to conduct a public meeting before Dec. 31 to consider adopting such a policy, although adoption is up to each district. The student wellness policy would have required the district to provide kindergarteners to fifth graders a structured recess for 30 minutes a day. Unstructured recess time before or after lunch does not satisfy the requirement. Gilbert students in these grades have at least 15 minutes a day in unstructured recess time, along with their regular structured PE classes.
6. Hardy students spend a few minutes on the Minuteman. The Arlington Advocate, November 27, 2010. How do you get 350 students and their teachers engaged in 30 minutes of constant physical activity at the same time in the same place? In the case of the Hardy Elementary School, you take advantage of one of the greatest workout venues in town — the Minuteman Bikeway. On Nov. 17, before heading down the bike path as part of the Massachusetts Amateur Sports Associations Kid’s Fitness Challenge, the group warmed up by dancing the Cha Cha Slide, led by P.E. teacher Linda Flynn.
7. Study Shows Economic Value Of Open Space Preservation. Spring-Ford Reporter & Valley, November 29, 2010. Forget the bluebirds, the bog turtles and the spotted owls. Don’t look for any talk of endangered species, damsel fly larvae or deep discussions of biodiversity. Instead, pick up a report released last week by the GreenSpace Alliance and the Delaware Valley Regional Planning Commission and what you’ll find is an in-depth discussion of cash — cold hard cash. That’s because the study, as its name suggests, examines “The Economic Value of Protected Open Space.” As was the case during the recent debate over an open space referendum narrowly approved Nov. 2 by East Coventry voters, discussion about open space preservation usually revolves around how much it costs to buy or preserve the land and how much property tax revenue might be lost as a result. Supporters of such preservation efforts often point to studies done around the nation that show that the costs that accompany developed land — schools, fire, water, sewer and police services — vastly outweigh the tax revenue that land generates. Now they can point to a study — written by the Economy League of Greater Philadelphia, Econsult Corp. and Keystone Conservation Trust — that looks into their own backyard and clearly lays out what you get out of preserving open space there.
8. Getting Every Kid Into The Game. The Delta Optimist, November 29, 2010. An evening walk around any neighbourhood in Canada is often filled with one of the favourite sounds of summer — the muffled cheers, the encouraging roars of "Run!" or "Score!" or "Strike ’em out!" It's the sound of friendships, mentorships and physical educators all working together to form a team, reach a goal and make memories along the way. Thanks to dedicated organizations and individuals across the country, those sounds can be heard even among disadvantaged kids who might otherwise be left on the sidelines because they are unable to afford registration fees and proper equipment.
   
9. http://www.npr.org/2010/11/23/131539669/switching-gears-more-commuters bike-to-work. NPR, November 29, 2010. One way National Geographic staffers in Washington, D.C., can get to know their company's CEO is to take him up on his long-standing offer: to go for a lunchtime bike ride. "Anyone still downstairs? OK, so we ready to go, guys?" National Geographic Society CEO John Fahey asks a group of about 20 employees. Fahey, an avid biker, says he's just trying to encourage a little exercise - and he wants the opportunity to get to know folks informally. As the group makes the 15-mile trek to Hains Point along the Potomac River and back, Fahey makes a point of chatting with everyone, staffers say. At National Geographic - which is a hub of outdoorsy, adventure-seeking types who think nothing of biking busy city streets – lots of the staffers who join Fahey for the lunchtime rides also use their bikes to get to and from work every day.
10. Sports Participation Does Not Guarantee That Children Get Enough Physical Activity. Red Orbit, December 7, 2010. Only about one-fourth of children participating in organized sports-such as baseball, softball or soccer-receive the government-recommended amount of physical activity during team practices, according to a report posted online today that will appear in the April 2011 print issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. National guidelines recommend that children and teens perform 60 minutes of moderate to vigorous physical activity each day, but fewer than half of children and 10
    percent of teens meet these guidelines, according to background information in the article. "The American Academy of Pediatrics recommends youth sports as a means of obtaining physical activity as well as social benefits," the authors write, and an estimated 44 million American youth participate in an organized sports program.
11. More Students Opting out of Phys Ed Classes Despite Obesity Epidemic. ABC News, December 14, 2010. More Students Opting Out of Phys Ed Classes Despite Obesity Epidemic. Once a mainstay of the school day, physical education classes have fallen by the wayside for many American students, despite a massive push by doctors, nutritionists and even the first lady to get children more active.

C. Reports, Essays, Commentaries, Policy briefs

1. New Institute of Medicine Report Calls for Cohesive National Strategy to Measure the Public's Health. Report Also Recommends Increased Focus on Social Determinants of Health. A new Robert Wood Johnson Foundation (RWJF)- commissioned Institute of Medicine (IOM) report reinforces the urgency to address health not just in the doctor’s office but where it starts—in our homes, schools, jobs and communities. The report, For the Public’s Health: The Role of Measurement in Action and Accountability, argues that one reason Americans live shorter, sicker lives than people in many other countries is this country’s lack of national coordination when it comes to gathering, analyzing and communicating health information that focuses on the underlying factors that contribute to poor health. The report’s authors review current approaches to measuring the public’s health and make seven specific recommendations for a road map to improvement. Among those recommendations, the authors call on the Department of Health and Human Services (HHS) to develop standards for health data that can be used on the national, state and local levels; urge an increased federal focus on the
   non-clinical factors that affect how healthy we are, such as access to affordable, healthy foods and safe places to exercise; and ask HHS to support the increased use of data-driven tools and models, such as health impact assessments, that can assess and predict potential health-related outcomes of policies, plans and projects.
2. Institute of Medicine: Preventing Childhood Obesity. Authors:Jeffrey P. Koplan, Catharyn T. Liverman, and Vivica A. Kraak, Editors, Committee on Prevention of Obesity in Children and Youth. Description: Children's health has made tremendous strides over the past century. In general, life expectancy has increased by more than thirty years since 1900 and much of this improvement is due to the reduction of infant and early childhood mortality.
   
3. http://economyleague.org/node/1468 . A recent study in a 5 county area of Southeastern Pennsylvania determined that $795 million in medical costs was avoided annually in the area through physical activity that takes place on protected open space in the region. In addition, the study estimated that estimated that businesses in southeastern Pennsylvania avoid $485 million in lost productivity costs per year as a result of the physical activities their employees engage in on protected open space in the region. Economic Value of Protected Open Space in Southeastern Pennsylvania Report. November 16, 2010, By the Economy League of Greater Philadelphia, Econsult Corporation and the Keystone Conservation Trust for The GreenSpace Alliance and the Delaware Valley Regional Planning Commission.
4. http://ptjournal.apta.org/content/87/5/525.full. Half of 269 transitionally frail women, ages 70 years or older, took part in a 48-week tai chi course, and half participated in a wellness education program. After one year, those who practiced tai chi reported significant improvement in physical dimensions and in ambulation categories. Women in both groups reported no changes in health status. Tai Chi And Perceived Health Status In Older Adults Who Are Transitionally Frail: A Randomized Controlled Trial. Greenspan AI, Wolf SL, Kelley ME, O'grady M., National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.
5. Obesity Rising Across All Income Levels: CDC. HealthDay News, Dec 14, 2010. Two reports from the U.S. National Center for Health Statistics show that the obesity epidemic is hitting young and older Americans across the economic spectrum. The NCHS, part of the U.S. Centers for Disease Control and Prevention, released the reports on Tuesday. Looking at both adults and children, they compared obesity rates using national data from 1988 to 1994 and from 2005 to 2008, using data from the National Health and Nutrition Examination Survey. Overall, "the prevalence of obesity increased in adults at all income and education levels," during that time, the authors said, and the same general trend held for American children. They noted that by 2008 more than a third of American adults were obese, as well as nearly 17 percent of children and adolescents aged 2 to 19 years. There were some disparities based on income. For example, among adult males, obesity was similar across income levels, although for black and Hispanic men rates of obesity tended to rise along with income. On the other hand, higher-income women were less likely to be obese compared to their less affluent peers. Among children, low family income was tied to a higher likelihood of obesity, but the association was not consistent across all racial and ethnic groups. The NCHS team also stressed that "most obese children and adolescents are not low income," defined as below 130 percent of the poverty line. In terms of education, the researchers found no significant trend linking education and a tendency toward obesity for men. However, women with college degrees were less likely to be obese compared to
   women without higher education. Children raised in homes where the head of household had a college degree were less prone to become obese versus kids raised in households headed by someone without such education. However, this relationship was not consistent across race and ethnicity groups, the NCHS report found. 
   "Low Income Children and Adolescents More Likely To Be Obese" , National Center for Health Statistics
   "Obesity Prevalence in Men Similar at All Income Levels" , National Center for Health Statistics.

D. Research and Reviews

1. Child overweight/obesity

1.1. Determinants, Risk factors, Co-occurring conditions
1.1.1. Puder JJ, Munsch S. Psychological correlates of childhood obesity. Int J Obes (Lond). 2010 Dec;34(S2):S37-S43. PubMed PMID: 21151145. http://www.ncbi.nlm.nih.gov/pubmed/21151145

1.2. Disparities
1.2.1. Belcher BR, Berrigan D, Dodd KW, Emken BA, Chou CP, Spruijt-Metz D. Physical activity in US youth: effect of race/ethnicity, age, gender, and weight status. Med Sci Sports Exerc. 2010 Dec;42(12):2211-21. PubMed PMID: 21084930.
1.2.2. Haman F, Fontaine-Bisson B, Batal M, Imbeault P, Blais JM, Robidoux MA. Obesity and type 2 diabetes in Northern Canada's remote First Nations communities: the dietary dilemma. Int J Obes (Lond). 2010. Dec;34(S2):S24-S31. PubMed PMID: 21151143. http://www.ncbi.nlm.nih.gov/pubmed/21151143

1.3. Prevalence, Incidence

1.4. Physical activity and Nutrition
1.4.1. Leek D, Carlson JA, Cain KL, Henrichon S, Rosenberg D, Patrick K, Sallis JF. Physical Activity During Youth Sports Practices. Arch Pediatr Adolesc Med. 2010 Dec 6. [Epub ahead of print] PubMed PMID: 21135319. http://www.ncbi.nlm.nih.gov/pubmed/21135319

1.5. Intervention, Outcomes, including Cost
1.5.1. Ciampa PJ, Kumar D, Barkin SL, Sanders LM, Yin HS, Perrin EM, Rothman RL. Interventions aimed at decreasing obesity in children younger than 2 years: a systematic review. Arch Pediatr Adolesc Med. 2010 Dec;164(12):1098-104. PubMed PMID: 21135337. http://www.ncbi.nlm.nih.gov/pubmed/21135337

1.6. Measurement

2. Adult overweight/obesity

2.1. Determinants, Risk factors, Co-occurring conditions
2.1.1. Berrington de Gonzalez A, Hartge P, Cerhan JR, Flint AJ, Hannan L, MacInnis RJ, Moore SC, Tobias GS, Anton-Culver H, Freeman LB, Beeson WL, Clipp SL, English DR, Folsom AR, Freedman DM, Giles G, Hakansson N, Henderson KD, Hoffman-Bolton J, Hoppin JA, Koenig KL, Lee IM, Linet MS, Park Y, Pocobelli G, Schatzkin A, Sesso HD, Weiderpass E, Willcox BJ, Wolk A, Zeleniuch-Jacquotte A, Willett WC, Thun MJ. Body-mass index and mortality among 1.46 million white adults. N Engl J Med. 2010 Dec 2;363(23):2211-9. PubMed PMID: 21121834. http://www.ncbi.nlm.nih.gov/pubmed/21121834
2.1.2. Int J Obes (Lond). 2010 Dec;34(12):1667-83. Epub 2010 Jun 22. The chronobiology, etiology and pathophysiology of obesity. Garaulet M, Ordovás JM, Madrid JA. Faculty of Biology, Department of Physiology, Campus of Espinardo, University of Murcia, Murcia, Spain. The effect of CD on human health is an emerging issue. Many records link CD with diseases such as cancer, cardiovascular, cognitive impairment and obesity, all of them conducive to premature aging. The amount of sleep has declined by 1.5 h over the past century, accompanied by an important increase in obesity. Shift work, sleep deprivation
and exposure to bright light at night increase the prevalence of adiposity. Animal models have shown that mice with Clock gene disruption are prone to developing obesity and MetS. This review summarizes the latest developments with regard to chronobiology and obesity, considering (1) how molecular clocks coordinate metabolism and the specific role of the adipocyte; (2) CD and its causes and pathological consequences; (3) the epidemiological evidence of obesity as a chronobiological illness; and (4) theories of circadian disruption and obesity. Energy intake and expenditure, relevance of sleep, fat intake from a circadian perspective and psychological and genetic aspects of obesity are examined. Finally, ideas about the use of chronobiology in the treatment of obesity are discussed. Such knowledge has the potential to become a valuable tool in the understanding of the relationship between the chronobiology, etiology and pathophysiology of obesity. PMID: 20567242 [PubMed - in process] http://www.ncbi.nlm.nih.gov/pubmed/20567242
2.1.3. Int J Obes (Lond). 2010 Dec;34(S2):S32-S36. Clinical diagnosis of metabolic and cardiovascular risks in overweight children: early development of chronic diseases in the obese child. L'allemand-Jander D. Children's Hospital of Eastern Switzerland, St Gallen, Switzerland. Childhood overweight (body mass index (BMI)>90th centile) poses a major public health problem in so far as adult diseases manifest themselves
already during childhood. In this review, after examining the prevalence of metabolic and cardiovascular diseases, the issue of whether BMI or other clinical parameters are valid tools to predict co-morbidities in children is discussed. Data of 2001-2008 are reviewed, including several studies conducted on more than 260 000 overweight and obese children in Germany and Switzerland. Apart from non-metabolic comorbidities, namely musculoskeletal complications and attention deficit/hyperactivity disorders in up to 74% and up to 58% of overweight children, respectively, at least one cardiovascular and metabolic risk factor was seen in 52% of the overweight children, mostly high blood pressure (35%) with increased left ventricular mass or arterial stiffness. Signs of fatty liver disease or dyslipidemia were found in up to 29 and 32% of the children, respectively. Type 2 diabetes was found in less than 0.7% of the children, and an elevated fasting glucose or glucose intolerance in 3%. Irrespective of BMI, the quality of fat and protein intake predicted hypertension or insulin resistance, and fructose predicted lower (and more atherogenic) particle size of low-density lipoprotein-cholesterol. Out of the adiposity markers, waist circumference was closely correlated with insulin resistance and the components of the metabolic syndrome. In conclusion, risk factors are found in more than half of the overweight children, most frequently high blood pressure or
dyslipidemia, and were mainly related to waist circumference, but also to BMI and fat mass. \ Even in the presence of normal BMI, screening for cardiovascular risk factors is advocated in each child with elevated waist circumference, but its cut-off points still remain to be validated. The increased occurrence of orthopedic and psychiatric complaints may detrimentally influence health-related lifestyle and obesity therapy. PMID: 21151144 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/pubmed/21151144

2.2. Disparities

2.3. Prevalence, Incidence
2.3.1. Hughes E, Li Y, Brown J, Geathers S, Elam-Evans L; Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Surveillance for certain health behaviors among States and selected local areas - United States, 2008. MMWR Surveill Summ. 2010 Dec 10;59(10):1-221. PubMed PMID: 21150869. http://www.ncbi.nlm.nih.gov/pubmed/21150869. Adults who were overweight (BMI ≥25.0
and <30.0): 33% to 40% for states and territories, 31% to 46% for selected MMSAs, and 28% to 50% for counties. Adults aged ≥20 years who were obese (BMI ≥30.0): 20% to 34% for states and territories, 15% to 40% for MMSAs, and 13% to 40% for counties.What does “MMSA” mean? http://www.cdc.gov/brfss/smart/faqs.htm#1 The acronym “MMSA” refers to metropolitan statistical areas, micropolitan statistical areas, and metropolitan divisions. These geographic subdivisions are designated by the U. S. Office of Management and Budget and used by the U. S. Census Bureau as of June 2003. The general concept of a metropolitan or micropolitan statistical area is that of a core area containing a substantial population nucleus, together with adjacent communities and all having a high degree of economic and social integration. Metropolitan statistical area — Group of counties that contain at least one urbanized area of 50,000 or more inhabitants (e.g., Atlanta-Sandy Springs-Marietta, GA). Micropolitan statistical area — Group of counties that contain at least one urban cluster of at least 10,000 but less than 50,000 inhabitants (e.g., Willimantic, CT). Metropolitan division — A smaller group of counties within a metropolitan statistical area of 2.5 million or more inhabitants (e.g., Boston-Quincy, MA within Boston-Cambridge-Quincy, MA-NH Metropolitan
Statistical Area)

2.4. Physical activity and Nutrition
2.4.1. Hankinson AL, Daviglus ML, Bouchard C, Carnethon M, Lewis CE, Schreiner PJ, Liu K, Sidney S. Maintaining a high physical activity level over 20 years and weight gain. JAMA. 2010 Dec 15;304(23):2603-10. PubMed PMID: 21156948. http://www.ncbi.nlm.nih.gov/pubmed/21156948

2.5. Intervention, Outcomes, including Cost

2.6. Measurement