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Contemporary spatial data collection techniques, analyses, and presentations have created new opportunities for public health analyses that sometimes render existing administrative and statistical boundaries unsuitable. This article presents an applied algorithm, regionalization with dynamically constrained agglomerative clustering and partitioning (REDCAP), to create regions other than pre-defined regions. The regions created in the study were based on the weight of youth in the continental United States. The REDCAP algorithm incorporates a spatial contiguity restriction to create regions with the same characteristics and value. The regions created overcome the existing challenge in cartography in which administrative and statistical regions are often used in presenting results. The study generated 10- and 25-class regions that reflected high and low obesity prevalence among US youth without using existing county and state boundaries. The results revealed new insights about regions comprising counties identified as having high obesity prevalence. Some of the counties identified in the established regions interestingly have not been recorded as at risk for high obesity prevalence in previous studies. A crucial advantage of the approach is that it minimizes the bias contained in existing administrative and statistical regions, a challenge in cartography. Furthermore, the approach effectively creates regions based on a specific theme and objective function. [ABSTRACT FROM AUTHOR]

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Christian weight loss programs in the United States are significant sites of evangelical negotiation between cultural distinction and cultural participation. First Place, a Christian weight loss program sponsored in churches across the country, both appropriates dominant American concerns about health and fears of obesity, and reinscribes them in a cultural context that gives religious meaning to this seemingly worldly pursuit. The author, basing herself on qualitative research, examines three critical areas in which First Place distinguishes itself from its secular counterparts and renders weight loss a spiritually significant task: motivation for weight loss, the problem of physical appearance, and the question of sin. The author argues that First Place is an example of both evangelical submission to and cultivation of cultural capital and symbolic power. [ABSTRACT FROM AUTHOR]

Summary: The growth pattern of healthy breastfed infants deviates to a significant extent from the NCHS/WHO international reference. In particular, this reference is inadequate because it is based on predominantly formula-fed infants, as are most national growth charts in use today. The WHO multicentre growth reference study (MGRS), aimed at describing the growth of healthy breastfed infants living in good hygiene conditions, was conducted between 1997 and 2003 in 6 countries from diverse geographical regions: Brazil, Ghana, India, Norway, Oman and the United States. The study combined a longitudinal follow-up of 882 infants from birth to 24 months with a cross-sectional component of 6669 children aged 18–71 months. In the longitudinal follow-up study, mothers and newborns were enrolled at birth and visited at home a total of 21 times at weeks 1, 2, 4 and 6; monthly from 2–12 months; and bimonthly in the 2nd year. The study populations lived in socioeconomic conditions favorable to growth. The individual inclusion criteria for the longitudinal component were: no known health or environmental constraints to growth, mothers willing to follow MGRS feeding recommendations (i.e., exclusive or predominant breastfeeding for at least 4 months, introduction of complementary foods by 6 months of age and continued breastfeeding to at least 12 months of age), no maternal smoking before and after delivery, single-term birth and absence of significant morbidity. Term low-birth-weight infants were not excluded. The eligibility criteria for the cross-sectional component were the same as those for the longitudinal component with the exception of infant feeding practices. A minimum of 3 months of any breastfeeding was required for participants in the study''s cross-sectional component. Weight-for-age, length/height-for-age, weight-for-length/height and body mass index-for-age percentile and Z-score values were generated for boys and girls aged 0–60 months. The full set of tables and charts is presented on the WHO website (www.who.int/childgrowth/en), together with tools such as software and training materials that facilitate their application. The WHO child growth standards were derived from children who were raised in environments that minimized constraints to growth, such as poor diets and infection. In addition, their mothers followed healthy practices such as breastfeeding their children and not smoking during and after pregnancy. The standards depict normal human growth under optimal environmental conditions and can be used to assess children everywhere, regardless of ethnicity, socioeconomic status and type of feeding. The standards explicitly identify breastfeeding as the biological norm and establish the breastfed child as the normative model for growth and development. They have the potential to significantly strengthen health policies and public support for breastfeeding. The pooled sample from the 6 participating countries allowed the development of a truly international reference that underscores the fact that child populations grow similarly across the world''s major regions when their health and care needs are met. It also provides a tool that is timely and appropriate for the ethnic diversity seen within countries and the evolution toward increasingly multiracial societies in the Americas and Europe as elsewhere in the world. The WHO standards provide a better tool to monitor the rapid and changing rate of growth in early infancy. They also demonstrate that healthy children from around the world who are raised in healthy environments and follow recommended feeding practices have strikingly similar patterns of growth. [Copyright &y& Elsevier]

As obesity has become a pressing health issue for American children, greater attention has been focused on how schools can be used to improve how students eat. Previously, we piloted the use of small prizes in an elementary school cafeteria to improve healthful food selection. We hoped to increase healthful food selection in all the elementary schools of a small school district participating in the United States Department of Agriculture Lunch Program by offering prizes to children who selected a Power Plate (PP), which consisted of an entrée with whole grains, a fruit, a vegetable, and plain low-fat milk. In this study, the PP program was introduced to 3 schools sequentially over an academic year. During the kickoff week, green, smiley-faced emoticons were placed by preferred foods, and children were given a prize daily if they chose a PP on that day. After the first week, students were given a sticker or temporary tattoo 2 days a week if they selected a PP. Combining data from the 3 schools in the program, students increased PP selection from 4.5% at baseline to 49.4% (p < 0.0001) during an intervention period of 2.5 school weeks. The school with the longest intervention period, 6 months, showed a PP selection increase of from 3.9% to 26.4% (p < 0.0001). In conclusion, giving small prizes as rewards dramatically improves short-term healthful food selection in elementary school children.

Obesity is associated with increased risk of many types of cancer. Less is known regarding associations between adipose depots and cancer risk. We aimed to explore relationships between adipose depots, risk of cancer, and obesity-related cancer (per NCI definition) in participants initially aged 70-79 years without prevalent cancer (1179 men, 1340 women), and followed for incident cancer for 13 years. Measures included body mass index (BMI), total adipose tissue from dual-energy X-ray absorptiometry, and computed tomography measures of visceral adipose tissue (VAT), abdominal subcutaneous adipose tissue, thigh intermuscular adipose tissue, and thigh muscle attenuation (Hounsfield unit, HU), where low HU indicates fatty infiltration. Hazard ratios (HR) and 95% confidence intervals (CIs) were estimated by Cox proportional hazards models adjusted for demographics, lifestyle variables, and medical conditions. During follow-up, 617 participants developed cancer of which 224 were obesity-related cancers. Total adipose tissue and VAT were positively associated with cancer risk among women (HR 1.14, 95% CI 1.01-1.30 per SD increase; HR 1.15, 95% CI 1.02-1.30 per SD increase). There were no associations with cancer risk among men. Total adipose tissue was positively associated with obesity-related cancer risk among women (HR 1.23, 95% CI 1.03-1.46 per SD increase). VAT was positively associated with obesity-related cancer risk among men (HR 1.30, 95% CI 1.06-1.60 per SD increase) and remained associated even with adjustment for BMI (HR 1.40, 95% CI 1.08-1.82 per SD increase). These findings provide insight into relationships between specific adipose depots and cancer risk and suggest differential relationships among men and women.

Objective: Regulatory measures, including taxes and subsidies on food and beverage products, food labelling requirements, regulation of food content and regulation of food marketing, have been proposed to encourage healthier eating and prevent obesity. The objective of this article is to explore the extent to which international trade agreements affect governments' choices to use such regulatory measures., Methods: It reviews key provisions of relevant World Trade Organization (WTO) agreements and their implications. Some insights can be gained by examining 2 recent developments in the WTO regarding tobacco control: a current dispute involving Australia's plain packaging law and its effect on trademarks, and a recent decision involving the United States law banning flavoured cigarettes., Results: This decision said that the ban did not restrict trade more than necessary to fulfil its legitimate health objective, but it was discriminatory because it banned imported products (clove cigarettes) while exempting domestic products (menthol cigarettes) with similar characteristics., Conclusion: The conclusion we can draw from this decision is that WTO member states probably enjoy a significant degree of latitude in developing food regulations as part of an obesity prevention strategy, so long as those do not disproportionately affect imported products and therefore raise questions of discrimination. The approach taken in this case encourages the adoption of public health policies that are consistent with strong scientific evidence, but may restrict governments' ability to make political compromises, which could frustrate some proposals. The ongoing development of WTO law will continue to affect policy choices in public health., (Copyright © 2013 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.)