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Blood pressure (BP) assessment and management are important aspects of care for youth with obesity. This study evaluates data of youth with obesity seeking care at 35 pediatric weight management (PWM) programs enrolled in the Pediatric Obesity Weight Evaluation Registry (POWER). Data obtained at a first clinical visit for youth aged 3-17 years were evaluated to: (1) assess prevalence of BP above the normal range (high BP); and (2) identify characteristics associated with having high BP status. Weight status was evaluated using percentage of the 95

BackgroundAdherence to dietary interventions is a significant barrier in the treatment of childhood obesity. Time-limited eating (TLE) is a simple dietary approach that limits food intake to a given number of consecutive hours per day, but parental and youth acceptability of TLE in youth with obesity is unknown. This study explored the feasibility of utilizing TLE among parents and youth attending pediatric weight management (PWM).MethodsMembers of COMPASS (Childhood Obesity Multi-Program Analysis and Study System) developed a survey to assess the acceptability of TLE in families attending PWM, which included patient characteristics, current diet and sleep schedules, and interests in trying TLE. The survey was administered electronically via REDCap or manually to parents of patients between the ages of 8-17 years old and to patients 11-17 years old attending one of five PWM practices in the COMPASS network.ResultsPatients (n=213) were 13.0 ± 2.5 years old, 58% female, 52% White, 22% Black, 17% Hispanic/Latino, and 47% reported a diagnosed psychological disorder. On average, parents reported their child’s daily eating spanned 12.5 ± 1.9 hours (7:35am - 8:05pm) and included 5.6 ± 1.6 eating bouts (meals + snacks). Most parents reported being likely to try TLE ≤12 hours/d (TLE12: 66%), which was similar to the likelihood of following a nutrient-balanced diet (59%). Likelihood was lower for TLE ≤10 hours/d (TLE10: 39%) or ≤8 hours/d (TLE8: 26%) (pConclusionsTwo-thirds of parents with children attending PWM programs report interest in TLE ≤12 hours/d regardless of demographic characteristics, but interest wanes when limiting eating to ≤10 or ≤8 hours per day. Time-limited eating appears to be a feasible option in PWM settings provided treatment options are individualized based on the interests and barriers of patients and their families.

Background: The prevalence of severe obesity and electronic game use among youth has increased over time. Methods: We administered a survey assessing gaming and psycho-demographic characteristics to youth aged 11–17 attending five weight management programs. We conducted chi-square and logistic regression analyses to describe the association between class 3 severe obesity and gaming characteristics. Results: Four hundred twelve youth (51% female, 26% Black, 25% Hispanic, 43% White, and 44% with class 3 severe obesity) completed the survey. There was a stepwise relationship between time spent gaming and class 3 severe obesity, with 28% of those playing 2 to

Attrition in pediatric weight management negatively impacts treatment outcomes. A potentially modifiable contributor to attrition is unmet family expectations. This study aimed to evaluate the association between adolescent and parent/guardian treatment expectations and attrition.A prospective, nonrandomized, uncontrolled, single-arm pilot trial was conducted among 12 pediatric weight management programs in the Children's Hospital Association's FOCUS on a Fitter Future collaborative. Parents/guardians and adolescents completed an expectations/goals survey at their initial visit, with categories including healthier food/drinks, physical activity/exercise, family support/behavior, and weight management goals. Attrition was assessed at 3 months.From January to August 2013, 405 parents/guardians were recruited and reported about their children (203 adolescents, 202 children12 years). Of the 203 adolescents, 160 also self-reported. Attrition rate was 42.2% at 3 months. For adolescents, greater interest in family support/behavior skills was associated with decreased odds of attrition at 3 months [odds ratio (OR) 0.75, 95% confidence interval (CI) 0.57-0.98, p = 0.04]. The more discordant the parent/adolescent dyad responses in this category, the higher the odds of attrition at 3 months (OR 1.36, 95% CI 1.04-1.78, p = 0.02). Weight loss was an important weight management goal for both adolescents and parents. For adolescents with this goal, the median weight-loss goal was 50 pounds. Attrition was associated with adolescent weight-loss goals above the desired median (50% above the median vs. 28% below the median, p = 0.02).Assessing initial expectations may help tailor treatment to meet families' needs, especially through focus on family-based change and realistic goal setting.Clinicaltrials.gov NCT01753063.

Prior studies show seven percent to nine percent of children demonstrate gaming behaviors that affect a child's ability to function (e.g., problem gaming), but none have examined the association between problem gaming and weight status. The objective of this study was to determine the prevalence of problem gaming among children enrolled in tertiary weight management programs. We administered a computer-based survey to a convenience sample of children aged 11-17 years enrolled in five geographically diverse pediatric weight management (PWM) programs in the COMPASS (Childhood Obesity Multi-Program Analysis and Study System) network. The survey included demographics, gaming characteristics, and a problem gaming assessment. The survey had 454 respondents representing a diverse cohort (53 percent females, 27 percent black, 24 percent Hispanic, 41 percent white) with mean age of 13.7 years. A total of 8.2 percent of respondents met criteria for problem gaming. Problem gamers were more likely to be white, male, play mature-rated games, and report daily play. Children in PWM programs reported problem gaming at the same rate as other pediatric populations. Screening for problem gaming provides an opportunity for pediatricians to address gaming behaviors that may affect the health of children with obesity who already are at risk for worsened health and quality of life.

OBJECTIVE This study aimed to examine whether 1-month BMI improvement is predictive of superior 6- and 12-month BMI changes in a national sample of youth in pediatric weight management treatment. METHODS Participants were 4- to 18-year-olds from the Pediatric Obesity Weight Evaluation Registry, a prospective study collecting data from 31 pediatric weight management programs across the United States. Response at 1 month was defined as ≥ 3% BMI reduction; success at 6 and 12 months was defined as ≥ 5% BMI reduction from baseline. Analyses used linear and logistic regression with robust variance estimation. RESULTS Primary analyses were completed with 687 participants (mean age 12.2 years). One-month responders demonstrated significant improvements in BMI compared with nonresponders at 6 months (BMI, -2.05 vs. 0.05; %BMI, -5.81 vs. 0.23; P

BACKGROUND AND OBJECTIVES As a distinct group, 2- to 5-year-olds with severe obesity (SO) have not been extensively described. As a part of the Expert Exchange Workgroup on Childhood Obesity, nationally-representative data were examined to better characterize children with SO. METHODS Children ages 2 to 5 (N = 7028) from NHANES (1999–2014) were classified as having normal weight, overweight, obesity, or SO (BMI ≥120% of 95th percentile). Sociodemographics, birth characteristics, screen time, total energy, and Healthy Eating Index 2010 scores were evaluated. Multinomial logistic and linear regressions were conducted, with normal weight as the referent. RESULTS The prevalence of SO was 2.1%. Children with SO had higher (unadjusted) odds of being a racial and/or ethnic minority (African American: odds ratio [OR]: 1.7; Hispanic: OR: 2.3). They were from households with lower educational attainment (OR: 2.4), that were single-parent headed (OR: 2.0), and that were in poverty (OR: 2.1). Having never been breastfed was associated with increased odds of obesity (OR: 1.5) and higher odds of SO (OR: 1.9). Odds of >4 hours of screen time were 1.5 and 2.0 for children with obesity and SO. Energy intake and Healthy Eating Index 2010 scores were not significantly different in children with SO. CONCLUSIONS Children ages 2 to 5 with SO appear to be more likely to be of a racial and/or ethnic minority and have greater disparities in social determinants of health than their peers and are more than twice as likely to engage in double the recommended screen time limit.

BACKGROUND AND OBJECTIVES: As a distinct group, 2- to 5-year-olds with severe obesity (SO) have not been extensively described. As a part of the Expert Exchange Workgroup on Childhood Obesity, nationally-representative data were examined to better characterize children with SO. METHODS: Children ages 2 to 5 (N = 7028) from NHANES (1999–2014) were classified as having normal weight, overweight, obesity, or SO (BMI ≥120% of 95th percentile). Sociodemographics, birth characteristics, screen time, total energy, and Healthy Eating Index 2010 scores were evaluated. Multinomial logistic and linear regressions were conducted, with normal weight as the referent. RESULTS: The prevalence of SO was 2.1%. Children with SO had higher (unadjusted) odds of being a racial and/or ethnic minority (African American: odds ratio [OR]: 1.7; Hispanic: OR: 2.3). They were from households with lower educational attainment (OR: 2.4), that were single-parent headed (OR: 2.0), and that were in poverty (OR: 2.1). Having never been breastfed was associated with increased odds of obesity (OR: 1.5) and higher odds of SO (OR: 1.9). Odds of >4 hours of screen time were 1.5 and 2.0 for children with obesity and SO. Energy intake and Healthy Eating Index 2010 scores were not significantly different in children with SO. CONCLUSIONS: Children ages 2 to 5 with SO appear to be more likely to be of a racial and/or ethnic minority and have greater disparities in social determinants of health than their peers and are more than twice as likely to engage in double the recommended screen time limit.

Context: Ingesting high-sodium drinks pre-exercise can improve thermoregulation and performance. Athletic trainers (19%) give athletes pickle juice (PJ) prophylactically for cramping. No data exist on whether this practice affects aerobic performance or thermoregulation. Objective: To determine if drinking 2 mL/kg body mass of PJ, hypertonic saline, or deionized water (DIW) pre-exercise affects aerobic performance or thermoregulation. Design: Crossover study. Setting: Controlled laboratory study. Patients or Other Participants: Nine euhydrated men (age = 22 ± 3 years, height = 184.0 ± 8.2 cm, mass = 82.6 ± 16.0 kg) completed testing. Intervention(s): Participants rested for 65 minutes. During this period, they ingested 2 mL/kg of PJ, hypertonic saline, or DIW. Next, they drank 5 mL/kg of DIW. Blood was collected before and after ingestion of all fluids. Participants were weighed and ran in the heat (temperature = 38.3°C ± 1°C, relative humidity = 21.1% ± 4.7%) at increasing increments of maximal heart rate (50%, 60%, 70%, 80%, 90%, 95%) until exhaustion or until rectal temperature exceeded 39.5°C. Participants were weighed postexercise so we could calculate sweat volume. Main Outcome Measure(s): Time to exhaustion, rectal temperature, changes in plasma volume, and sweat volume. Results: Time to exhaustion did not differ among drinks (PJ = 77.4 ± 5.9 minutes, hypertonic saline = 77.4 ± 4.0 minutes, DIW = 75.7 ± 3.2 minutes; F2,16 = 1.1, P = .40). Core temperature of participants was similar among drinks (PJ = 38.7°C ± 0.3°C, hypertonic saline = 38.7°C ± 0.4°C, DIW = 38.8°C ± 0.4°C; P = .74) but increased from pre-exercise (36.7°C ± 0.2°C) to postexercise (38.7°C ± 0.4°C) (P < .05). No differences were observed for changes in plasma volume or sweat volume among drinks (P > .05). Conclusions: Ingesting small amounts of PJ or hypertonic saline with water did not affect performance or select thermoregulatory measures. Drinking larger volumes of PJ and water may be more effective at expanding the extracellular space.

Background: Primary care offers a promising setting for promoting parenting practices that shape healthy eating and physical activity behaviors of young children. This study assessed the impact of a parent-based, primary care intervention on the feeding habits, health behaviors, and body mass index (BMI) of 2&ndash, 5 year olds with elevated or rapidly-increasing BMI. Methods: Four private pediatric offices in West Michigan were assigned as control (n = 2) or intervention (n = 2) sites based on patient load and demographics. Treatment families were recruited at well-child visits to receive physician health-behavior counseling and four visits with a registered dietitian nutritionist (RDN) over a 6-month period. Intervention outcomes were age- and sex-specific BMI metrics, including BMI z-scores and percent of the 95th percentile (%BMIp95), the Family Nutrition and Physical Activity survey (FNPA), and the Feeding Practices and Structure Questionnaire (FPSQ). Results: Of 165 enrolled families, 127 completed follow-up measures (77% retention). Mean (&plusmn, SD) FNPA scores improved in treatment vs. control (4.6 &plusmn, 4.6 vs. 0.1 &plusmn, 4.2, p &lt, 0.001), and screen time (h/day) decreased (&minus, 0.9 &plusmn, 1.8 vs. 0.3 &plusmn, 1.1, 0.001). Non-responsive feeding practices (i.e., reward for behavior (p = 0.006) and distrust in appetite (p &lt, 0.015)) and structure-related feeding practices (structured meal timing (p &lt, 0.001)) improved in treatment parents vs. controls. Reductions in child BMI measures did not differ between groups. Conclusions: Families with preschool children participating in a low-intensity, primary care intervention improved obesogenic health behaviors, parent feeding habits, and child screen time, but not child adiposity. Future research should assess the sustainability of these family lifestyle improvements, and evaluate their future impact on the health and development of the children.

Objective Research indicates that risk of obesity increases as physical activity (PA) decreases; however, the reciprocal effect has been rarely studied. The present investigation was conducted to determine the contribution of obesity on objectively measured PA over 20 months. Design and Methods A prospective cohort design with 254 middle-aged women was employed. Body fat percentage (BF%) was measured using Bod Pod, and obesity was defined as BF% ≥32%. PA was assessed objectively using 7-day accelerometry at baseline and ∼20 months later at follow-up. Results Of the 254 subjects, 124 were obese (49%) at baseline. Mean BF% was 32.1 ± 7.8 and average age was 41.7 ± 3.1 years. Mean weekly PA was 2.79 ± 0.85 million activity counts for all participants. Over the 20-month period, PA decreased significantly more in obese women (−8.1% ± 27.1%) than in nonobese women (0.3% ± 31.7%) after adjusting for confounders (F = 5.3, P = 0.022). Moderate plus vigorous PA levels also decreased more in obese women (−28.1 ± 73.6 min/week) than in nonobese women (−5.9 ± 66.8 min/week), after adjusting for covariates (F = 7.84; P = 0.0055). Conclusions It appears that obese women tend to reduce PA over time at a faster rate than nonobese women. Evidently, obesity is a risk factor for decreasing PA over time in middle-aged women.

Background: This investigation evaluated seasonal changes in preschoolers’ (3-5 years) sedentary time and physical activity (PA) during childcare. Methods: Sixty-two children from 4 preschools in Fargo, North Dakota had their sedentary behavior and PA objectively assessed during 2 separate weeks of childcare. Children wore accelerometers for 5 consecutive days, once each in the fall (October/November) and winter (January/February). Separate analyses were conducted to evaluate seasonal changes in full-day, indoor only, and outdoor only sedentary time and PA during childcare. Results: When expressed relative to accelerometer wear time, the full-day rate of sedentary time accumulation (minutes/hour) increased significantly from fall to winter (p < 0.001), while accumulation rates for all other PA variables (light PA, moderate PA, moderate-to-vigorous PA, and activity counts) significantly declined during this period (all p’s < 0.001). No significant changes in accumulation rates for sedentary time or PA (light PA, moderate PA, moderate-tovigorous PA, and activity counts) were noted for either indoor or outdoor time between seasons. Conclusions: Childcare-related sedentary time and PA can dramatically vary across seasons., {"references":["Ogden, C. and M. Carroll. Prevalence of obesity among children and adolescents: United States, trends 1963-1965 through 2007-2008. 2010 [cited 2011 September 19th]; Available from: http://www.cdc.gov/nchs/data/hestat/ obesity_child_07_08/obesity_child_07_08.htm","Must A, Anderson SE. Effects of obesity on morbidity in children and adolescents. Nutr Clin Care 2003; 6: 4-12","Francis SL, Stancel MJ, Sernulka-George FD, Broffitt B, Levy SM, Janz KJ. Tracking of TV and video gaming during childhood: Iowa Bone Development Study. Int J Behav Nutr Phys Act 2011; 8: 100. http://dx.doi.org/10.1186/1479-5868-8-100"]}

The purpose was to determine the relationship between insulin resistance (IR) and risk of gaining body fat percentage (BF%), body weight, and abdominal fat over 18 months. A prospective cohort study was conducted using a sample of 226 women. IR was assessed using fasting blood insulin and glucose levels to calculate homeostatic model assessment (HOMA). Participants were divided into High (4th quartile) Moderate (2nd and 3rd quartiles), and Low (1st quartile) HOMA categories. BF% was estimated using plethysmography (Bod Pod), weight was measured in a standard swimsuit, and abdominal fat was indexed using the average of two circumferences taken at the umbilicus. Participants wore accelerometers and completed weighed food logs for 7 consecutive days to control for the effect of physical activity (PA) and energy intake, respectively. On average, women in the High HOMA group decreased in BF% (-0.48 ± 3.60), whereas those in the Moderate (0.40 ± 3.66) and Low HOMA (1.17 ± 3.15) groups gained BF% (F = 5.4, P = 0.0211). Changes in body weight showed a similar dose-response relationship (F = 4.7, P = 0.0317). However, baseline IR was not predictive of changes in abdominal fat (F = 0.8, P = 0.3635). Controlling for several covariates had little effect on gains in BF% and weight, but adjusting for initial BF% and/or initial weight nullified changes in BF% and weight across the IR groups. In conclusion, women with High HOMA tend to gain significantly less BF% and weight than women with low or moderate HOMA. The decreased risk appears unrelated to several covariates, except initial BF% and weight levels, which seem to play key roles in the relationships.

Individuals with Prader-Willi Syndrome (PWS) present hypotonia, low lean mass and a fairly low amount of spontaneous ambulatory physical activity (PA), possibly influencing bone mineral density (BM...

This paper describes FitKids360, a stage 2 pediatric weight management program. FitKids360 is a physician-referred, multicomponent, low-cost healthy lifestyle program for overweight and obese youth 5–16 years of age and their families. FitKids360 provides an evidence-based approach to the treatment of pediatric overweight by targeting patients’ physical activity, screen time, and dietary behaviors using a family-centered approach. The intervention begins with a two-hour orientation and assessment period followed by six weekly sessions. Assessments include lifestyle behaviors, anthropometry, and the Family Nutrition and Physical Activity (FNPA) survey, which screens for obesogenic risk factors in the home environment. Outcomes are presented from 258 patients who completed one of 33 FitKids360 classes. After completing FitKids360, patients increased moderate to vigorous physical activity by 14 minutes (P=0.019), reduced screen time by 44 minutes (P<0.001), and improved key dietary behaviors. Overall, FNPA scores increased by 9% (P<0.001) and 69% of patients with “high risk” FNPA scores at baseline dropped below the “high risk” range by followup. Patients also lowered BMIs (P=0.011) and age- and sex-adjusted BMIz-scores (P<0.001) after completing the 7-week program. We hope this report will be useful to medical and public health professionals seeking to develop stage 2 pediatric obesity programs.

Research indicates that risk of obesity increases as physical activity (PA) decreases; however, the reciprocal effect has been rarely studied. The present investigation was conducted to determine the contribution of obesity on objectively measured PA over 20 months.A prospective cohort design with 254 middle-aged women was employed. Body fat percentage (BF%) was measured using Bod Pod, and obesity was defined as BF% ≥32%. PA was assessed objectively using 7-day accelerometry at baseline and ∼20 months later at follow-up.Of the 254 subjects, 124 were obese (49%) at baseline. Mean BF% was 32.1 ± 7.8 and average age was 41.7 ± 3.1 years. Mean weekly PA was 2.79 ± 0.85 million activity counts for all participants. Over the 20-month period, PA decreased significantly more in obese women (-8.1% ± 27.1%) than in nonobese women (0.3% ± 31.7%) after adjusting for confounders (F = 5.3, P = 0.022). Moderate plus vigorous PA levels also decreased more in obese women (-28.1 ± 73.6 min/week) than in nonobese women (-5.9 ± 66.8 min/week), after adjusting for covariates (F = 7.84; P = 0.0055).It appears that obese women tend to reduce PA over time at a faster rate than nonobese women. Evidently, obesity is a risk factor for decreasing PA over time in middle-aged women.

We assessed the roles of energy intake and physical activity in the relationships among television (TV) viewing, body composition, and obesity using high-quality measurement methods. Adult women (n = 300) reported TV viewing behavior, which was categorized into infrequent (≤ 1 h/day), moderate (2 h/day), and frequent (≥ 3 h/day) viewing. Body fat percentage (BF%) was assessed using plethysmography (Bod Pod) and BMI was calculated from height and body weight. Energy intake and physical activity, including time spent in sedentary, moderate, and vigorous physical activity (PA), were objectively measured using 7-day weighed food records and 7-day accelerometry, respectively. The mean BF% of frequent TV viewers (34.6 ± 6.9%) was significantly greater (F = 3.9, P = 0.0218) than those of moderate (31.5 ± 6.7%) and infrequent viewers (30.8 ± 7.0%); however, BMI did not differ across the TV viewing groups (F = 0.8, P = 0.4172). Controlling statistically for differences in age, education, time in sedentary activity, time in moderate activity, and energy intake, considered individually, had no influence on the relationships between TV viewing and BF%, nor TV and BMI. Moreover, the relationship between TV and BF% remained significant after adjusting for differences in BMI (F = 3.6, P = 0.0276). However, adjusting for total PA reduced the relationship between TV and BF% to nonsignificance (F = 2.5, P = 0.0810), as did time spent in vigorous PA (F = 2.2, P = 0.1307). These data suggest a strong relationship between TV viewing and BF%. This association appears to be due, in part, to differences in total PA, particularly vigorous PA, but not time spent in sedentary activity, moderate activity, or energy intake.

4 páginas, The aim of this study was to examine the associations between objectively measured moderate-to-vigorous physical activity (MVPA) and central body fat (CBF) indicators by anthropometry and dual energy X-ray absorptiometry (DXA) in young children. This study comprised 110 children aged 3-8 years. The associations between MVPA and CBF measures by anthropometry (waist circumference, waist-to-height ratio, skinfold thicknesses [subscapular, suprailiac, trunk-to-extremity and trunk-to-total skinfold ratios] and total trunk-to-waist circumference), DXA (trunk fat) and a combination of both (total trunk skinfolds-to-trunk fat by DXA) were examined by linear regression. Levels of MVPA showed a significant inverse association with 8 of 9 indicators of CBF after controlling for age, gender and height, and fat-free mass. When total fat mass measured by DXA was included into the model, levels of MVPA remained significantly associated with 6 of 9 indicators of CBF. The results highlight the plausible role of MVPA on CBF in young children but longitudinal studies are necessary.

[Objective]: To examine the effect of sedentary behavior on blood pressure (BP) in young children using different indicators of sedentariness., [Design]: Cross-sectional study., [Setting]: A rural Midwestern US community., [Participants]: Children aged 3 to 8 years (N = 111)., [Intervention]: Adiposity was assessed using dual energy x-ray absorptiometry. Objective measurements of sedentary activity were obtained from the accelerometers that participants wore continuously for 7 days. Measurements of television (TV) viewing, computer, and screen time (TV + computer) were obtained via parent report., [Main Outcome Measures]: Systolic and diastolic BP., [Results]: The sample spent a mean of 5 hours per day in sedentary activities, of which 1.5 hours were screen time. Accelerometer-determined sedentary activity was not significantly related to systolic BP or diastolic BP after controlling for age, sex, height, and percentage of body fat. However, TV viewing and screen time, but not computer use, were positively associated with both systolic BP and diastolic BP after adjusting for potential confounders. Participants in the lowest tertile of TV and screen time had significantly lower levels of systolic and diastolic BP than participants in the upper tertile., [Conclusions]: Sedentary behaviors, particularly TV viewing and screen time, were associated with BP in children, independent of body composition. Other factors that occur during excessive screen time (eg, food consumption) should also be considered in the context of sedentary behavior and BP development in children., This work was supported in part by a York University Faculty of Arts Research Grant, American Heart Association Beginning-Grant-in-Aid No. 0665500Z (Dr Eisenmann), a University of Nebraska at Kearney Grant (Dr Heelan), and scholarship AP2006-02464 from the Spanish Ministry of Education and Science (Mr Martinez-Gomez).

SOFT DRINK CONSUMPTION AND CHANGES IN BODY COMPOSITION IN 170 WOMEN: A 4-YEAR PROSPECTIVE STUDY Jared M. Tucker Department of Exercise Sciences Master of Science Background: In recent history, there have been significant increases in both soft drink consumption and the prevalence of obesity throughout the developed world. To help curb the obesity epidemic, a better understanding of the behaviors contributing to weight and fat gain is vital. Objective: To examine the extent to which soft drink consumption is predictive of changes in body composition in middle-aged women over a 4-year period, while statistically controlling for age, energy intake, physical activity, and menopause status. Design: A prospective cohort design over 48 months with no intervention. Self-reported soft drink consumption was used to predict changes in body weight and body fat percentage over the study period. Subjects included 170 healthy women (mean: 41.5 yrs at baseline). Soft drink consumption and menopause status were measured by questionnaire. Body weight was assessed using a calibrated, electronic scale, and total body fat percentage was measured using dual energy x-ray absorptiometry (DEXA). Energy intake was estimated using 7-day, weighed, food records. Results: Women who primarily consumed sugar-sweetened soft drinks gained significantly more weight than those who consumed diet soft drinks or no soft drinks (p = 0.022), even after controlling for confounding variables, except energy intake, which weakened the relationship by 28%. Changes in body fat were unrelated to the type of soft drink consumed. Women who consumed 7+ soft drinks per week gained significantly less body fat (p = 0.015) and body weight (p = 0.052) over the 4-year study compared to women who consumed fewer soft drinks per week. Further investigation revealed that women who consumed 7+ soft drinks per week did so almost exclusively in the form of diet soft drinks (87%). Conclusions: Drinking sugar-sweetened soft drinks significantly increases risk of weight gain compared to consuming diet soft drinks or no soft drinks over a 4-year period. It appears that this relationship is partly due to differences in energy intake among those who drink different types of soft drinks. Thus, it appears that consuming diet soft drinks or no soft drinks instead of sugar-sweetened soft drinks may be a worthwhile method of preventing weight gain.