Mediators of Weight Loss Maintenance in the Keep It Off Trial.

Background: An important step toward enhancing the efficacy of weight loss maintenance interventions is identifying the pathways through which successful interventions such as the Keep It Off trial have worked. Purpose: This study aimed to assess the viability of mediated relationships between the Keep It Off Guided intervention, conceptually and empirically grounded potential mediators, and weight. Repeated measurement of mediators and weight enabled documentation of the temporal ordering of intervention delivery and changes in mediators and in weight among participants randomized to the Guided intervention or Self-Directed comparison group. Methods: Total, direct, and indirect effects of the Guided intervention on weight change were calculated and tested for significance. Indirect effects were comprised of the influence of the intervention on three change scores for each mediator and the relationship between mediator changes and weight changes 6 months later. Results: Guided intervention participants regained about 2% less weight over 24 months than Self-Directed participants. Starting daily self-weighing accounted for the largest share of this difference, followed by not stopping self-weighing. Conclusions: Daily self-weighing mediated 24-month weight loss maintenance. Trial Registration Number: The trial is registered with ClinicalTrials.gov (Identifier: NCT00702455 www.clinicaltrials.gov/ct2/show/NCT00702455).

Reporting of treatment fidelity in behavioural paediatric obesity intervention trials: a systematic review.

Behavioural interventions for paediatric obesity are promising, but detailed information on treatment fidelity (i.e. design, training, delivery, receipt and enactment) is needed to optimize the implementation of more effective interventions. Little is known about current practices for reporting treatment fidelity in paediatric obesity studies. This systematic review, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, describes the methods used to report treatment fidelity in randomized controlled trials. Treatment fidelity was double-coded using the National Institutes of Health Fidelity Framework checklist. Three hundred articles (N = 193 studies) were included. Mean inter-coder reliability across items was 0.83 (SD = 0.09). Reporting of treatment design elements within the field was high (e.g. 77% of studies reported designed length of treatment session), but reporting of other domains was low (e.g. only 7% of studies reported length of treatment sessions delivered). Few reported gold standard methods to evaluate treatment fidelity (e.g. coding treatment content delivered). General study quality was associated with reporting of treatment fidelity (p < 0.01) as was the number of articles published for a given study (p < 0.01). The frequency of reporting treatment fidelity components has not improved over time (p = 0.26). Specific recommendations are made to support paediatric obesity researchers in leading health behaviour disciplines towards more rigorous measurement and reporting of treatment fidelity.

Physical changes in the home environment to reduce television viewing and sugar-sweetened beverage consumption among 5- to 12-year-old children: a randomized pilot study.

This study evaluated the feasibility of a home-based intervention to reduce sugar-sweetened beverage intake and television viewing among children. Lower income parents of overweight children aged 5-12 years (n = 40) were randomized to a home environment intervention to reduce television viewing with locking devices and displace availability of sugar-sweetened beverages with home delivery of non-caloric beverages (n = 25), or to a no-intervention control group (n = 15) for 6 months. Data were collected at baseline and 6 months. After 6 months, television viewing hours per day was significantly lower in the intervention group compared with the control group (1.7 [SE = .02] vs. 2.6 [SE = .25] hours/day, respectively, P < .01). Sugar-sweetened beverage intake was marginally significantly lower among intervention group compared to control group children (0.21 [SE = .09] vs. 0.45 [SE = .10], respectively, P < .09). Body mass index (BMI) z-score was not significantly lower among intervention compared to control children. Among a lower income sample of children, a home-based intervention reduced television viewing, but not sugar-sweetened beverage intake or BMI z-score.

Comparing US paediatric and adult weight classification at the transition from late teenage to young adulthood.

BACKGROUND: Although paediatric growth charts are recommended for weight assessment prior to age 20, many teenagers transition earlier to adult care where absolute body mass index (BMI) is used. This study examines concordance of weight classification in older teenagers using paediatric percentiles and adult thresholds. METHODS: BMI from 23 640 US teens ages 18-19 years were classified using paediatric BMI percentile criteria for underweight (< 5th), normal (5th to < 85th), overweight (85th to < 95th), obesity (≥ 95th) and severe obesity (≥ 120% × 95th percentile) and adult BMI (kg m(-2) ) criteria for underweight (< 18.5), normal (18.5-24.9), overweight (25-29.9) and obesity: class I (30-34.9), class II (35-39.9) and class III (≥ 40). Concordance was examined using the kappa (κ) statistic. Blood pressure (BP) from the same visit was classified hypertensive for BP ≥ 140/90. RESULTS: The majority of visits (72.8%) occurred in adult primary care. Using paediatric/adult criteria, 3.4%/5.2% were underweight, 66.6%/58.8% normal weight, 15.7%/21.7% overweight, 14.3%/14.3% obese and 4.9%/6.0% severely/class II-III obese, respectively. Paediatric and adult classification for underweight, normal, overweight and obesity were concordant for 90.3% (weighted κ 0.87 [95% confidence interval, 0.87-0.88]). For severe obesity, BMI ≥ 120% × 95th percentile showed high agreement with BMI ≥ 35 kg m(-2) (κ 0.89 [0.88-0.91]). Normal-weight males and moderately obese females by paediatric BMI percentile criteria who were discordantly classified into higher adult weight strata had a greater proportion with hypertensive BP compared with concordantly classified counterparts. CONCLUSIONS: Strong agreement exists between US paediatric BMI percentile and adult BMI classification for older teenagers. Adult BMI classification may optimize BMI tracking and risk stratification during transition from paediatric to adult care.

Prevalence of obesity and extreme obesity in children aged 3-5 years.

BACKGROUND: Early childhood adiposity may have significant later health effects. This study examines the prevalence and recognition of obesity and severe obesity among preschool-aged children. METHODS: The electronic medical record was used to examine body mass index (BMI), height, sex and race/ethnicity in 42,559 children aged 3-5 years between 2007 and 2010. Normal or underweight (BMI < 85th percentile); overweight (BMI 85th-94th percentile); obesity (BMI ≥ 95th percentile); and severe obesity (BMI ≥ 1.2 × 95th percentile) were classified using the 2000 Centers for Disease Control and Prevention growth charts. Provider recognition of elevated BMI was examined for obese children aged 5 years. RESULTS: Among 42,559 children, 12.4% of boys and 10.0% of girls had BMI ≥ 95th percentile. The prevalence was highest among Hispanics (18.2% boys, 15.2% girls), followed by blacks (12.4% boys, 12.7% girls). A positive trend existed between increasing BMI category and median height percentile, with obesity rates highest in the highest height quintile. The prevalence of severe obesity was 1.6% overall and somewhat higher for boys compared with girls (1.9 vs. 1.4%, P < 0.01). By race/ethnicity, the highest prevalence of severe obesity was seen in Hispanic boys (3.3%). Among those aged 5 years, 77.9% of obese children had provider diagnosis of obesity or elevated BMI, increasing to 89.0% for the subset with severe obesity. CONCLUSIONS: Obesity and severe obesity are evident as early as age 3-5 years, with race/ethnic trends similar to older children. This study underscores the need for continued recognition and contextualization of early childhood obesity in order to develop effective strategies for early weight management.

The epidemiology of weight counseling for adults in the United States: a case of positive deviance.

Weight counseling for adults is uncommonly performed by primary-care providers (PCPs), despite recommendations. In order to design effective primary-care interventions, a full understanding of the epidemiology of weight counseling in primary care is needed. Our objective was to measure the frequency of weight counseling at the level of the PCP. We performed a cross-sectional study of 21 220 US adult outpatient primary-care visits with 954 PCPs in 2007-2008, using data from the National Ambulatory Medical Care Survey (NAMCS). Most (58%) PCPs performed no weight counseling during any patient visits. A total of 85 (8.9%) PCPs provided 52% of all weight counseling and were categorized as 'positive deviant' (PD) physicians. Patients seeing PD physicians were older, less likely to be female and more likely to have hypertension, diabetes and obesity. Adjusting for patient characteristics strengthened the association between PD status and receipt of weight counseling during visits (adjusted odds ratio=13.2 (95% confidence interval 11.5-15.7)). In conclusion, a minority of PCPs provide the majority of primary-care weight counseling in the United States. Studies of these PCPs may help to identify practical methods to increase weight counseling in primary-care settings.

Long-term weight loss maintenance in the United States.

CONTEXT: Although the rise in overweight and obesity in the United States is well documented, long-term weight loss maintenance (LTWLM) has been minimally explored. OBJECTIVE: The aim of this study is to estimate the prevalence and correlates of LTWLM among US adults. DESIGN, SETTING AND PARTICIPANTS: We examined weight data from 14 306 participants (age 20-84 years) in the 1999-2006 National Health and Nutrition Examination Survey (NHANES). We defined LTWLM as weight loss maintained for at least 1 year. We excluded individuals who were not overweight or obese at their maximum weight. RESULTS: Among US adults who had ever been overweight or obese, 36.6, 17.3, 8.5 and 4.4% reported LTWLM of at least 5, 10, 15 and 20%, respectively. Among the 17.3% of individuals who reported an LTWLM of at least 10%, the average and median weight loss maintained was 19.1 kg (42.1 pounds) and 15.5 kg (34.1 pounds), respectively. LTWLM of at least 10% was higher among adults of ages 75-84 years (vs ages 20-34, adjusted odds ratio (OR): 1.5; 95% confidence interval (CI): 1.2, 1.8), among those who were non-Hispanic white (vs Hispanic, adjusted OR: 1.6; 95% CI: 1.3, 2.0) and among those who were female (vs male, adjusted OR: 1.2; 95% CI: 1.1, 1.3). CONCLUSIONS: More than one out of every six US adults who has ever been overweight or obese has accomplished LTWLM of at least 10%. This rate is significantly higher than those reported in clinical trials and many other observational studies, suggesting that US adults may be more successful at sustaining weight loss than previously thought.

Mail and phone interventions for weight loss in a managed-care setting: weigh-to-be 2-year outcomes.

OBJECTIVE: Evaluate effectiveness of weight-loss interventions in a managed care setting. METHODS: Three-arm randomized clinical trial: usual care, mail, and phone intervention. Participants were 1801 overweight managed care organization (MCO) members. Measures included baseline height, weight at baseline and 24 months, self-reported weight at 18 months. Intervention and participation in other weight-related programs was monitored across 24 months. RESULTS: Weight losses were 2.2, 2.4, and 1.9 kg at 18 months in the mail, phone, and usual care groups, respectively. Mail and phone group weight changes were not significantly different from usual care (P<0.35). Weight losses at 24 months did not differ by condition (0.7 kg mail, 1.0 kg phone, and 0.6 kg usual care, P=0.55). Despite treatment availability over 24 months, participation diminished after 6 months. Participation was a significant predictor of outcomes in the mail and phone groups at 18 months and the mail group at 24 months. Cost-effectiveness of phone counseling was $132 per 1 kg of weight loss with mail and usual care achieving similar cost-efficiency of $72 per 1 kg of weight loss. CONCLUSION: Although mail- and phone-based weight-loss programs are a reasonably efficient way to deliver weight-loss services, additional work is needed to enhance their short- and long-term efficacy.

The comparative and cumulative effects of a dietary restriction and exercise on weight loss.

OBJECTIVE: To assess the independence of changes made in diet and physical activity for weight loss; and, to examine the comparative and cumulative effects of these behavioral changes on weight loss outcomes. DESIGN: The observational study is based on longitudinal data collected from 674 women and 288 men enrolled in a 2-year weight loss program introduced into a managed care setting. MEASUREMENTS: The outcome variable was body mass index (BMI) change from baseline to 2-year follow-up. Primary independent variables were changes in physical activity and dietary fat intake, assessed as continuous measures using the Paffenbarger Physical Activity Questionnaire and Block Fat Screener Questionnaire, respectively. Two-way ANCOVA was used to assess the relative effect on BMI of behavioral changes. RESULTS: Study results showed no preference for diet or physical activity change as a weight loss strategy. For both genders, the relationship between the two behaviors was synergistic rather than compensatory. Examination of the comparative benefits of behavioral changes indicated that, for women and men, restricting fat intake was more effective than increasing exercise for weight loss. While fat restrictions alone contributed to weight loss in both genders, exercise alone provided weight loss benefits to men, only. The cumulative effect of weight loss behaviors varied by gender. In women, an interaction was observed. The response of weight to fat restriction was greater among those who increased their exercise moderately or substantially. In men, there was no interaction; exercise increases helped to offset weight gain or provided small weight loss benefits at all levels of dietary fat change. CONCLUSION: Dietary changes appeared to be more effective than increased physical activity for weight loss. For women, the cumulative effect of concomitant changes in diet and exercise on weight loss was more than additive.

Binge eating disorder, weight control self-efficacy, and depression in overweight men and women.

OBJECTIVE: To examine binge eating, depression, weight self-efficacy, and weight control success among obese individuals seeking treatment in a managed care organization. DESIGN: Gender-stratified analyses of associations between binge eating, depression, weight self-efficacy, and weight change, using data from a randomized clinical trial that compared low-cost telephone-based, mail-based, and usual care interventions for weight loss. SUBJECTS: A total of 1632 overweight individuals (460 men, 1172 women; mean age: 50.7 y; mean body mass index: 34.2 kg/m(2)) were recruited from a large Midwestern US managed care organization. MEASUREMENTS: Height and weight were measured by study personnel at baseline, and self-reported weight was assessed at 6 and 12 months; self-reported depression status, binge eating, and self-efficacy for weight control were assessed at baseline. RESULTS: Lifetime prevalence rates for depression and probable binge eating disorder were high. Weight self-efficacy was inversely related to weight in both men and women. For women, depression was associated with lower weight self-efficacy and higher body weight. Women reporting depression or lower weight self-efficacy at baseline had less weight loss success at 6 and 12 months. Depression, binge eating disorder, and weight self-efficacy were not significantly associated with weight loss success in men. CONCLUSION: Negative emotional states are highly prevalent and predict poor treatment outcomes, particularly for obese women. As obese women with clinical depression typically are excluded from intervention studies, further research on how to address the intersection of obesity intervention and mood management may be warranted.

Mail and phone interventions for weight loss in a managed-care setting: Weigh-To-Be one-year outcomes.

OBJECTIVE: To describe methods, recruitment success, and 1-y results of a study evaluating the effectiveness of phone- and mail-based weight-loss interventions in a managed care setting. DESIGN: Randomized clinical trial with three groups, that is, usual care, mail intervention, and phone intervention. SUBJECTS: In total, 1801 overweight members of a managed-care organization (MCO). MEASUREMENTS: Height, weight, medical status, and weight-loss history were measured at baseline. Participation in intervention activities was monitored for 12 months in the two active treatment groups. Self-reported weight was obtained at 6 and 12 months. RESULTS: More individuals assigned to mail treatment started it (88%) than did those assigned to phone treatment (69%). However, program completion rates were higher in the phone (36%) than mail (7%) intervention. The mean weight losses were 1.93, 2.38, and 1.47 kg at 6 months in the mail, phone, and usual care groups, respectively. The differences between the phone and usual care groups were statistically significant. The mean weight losses at 12 months did not differ by treatment group (2.28 kg mail, 2.29 kg phone, and 1.92 kg usual care). Greater weight loss was seen in men, older participants, and those with no prior experience in a weight-loss program. Heavier participants and those who reported current treatment for depression lost less weight. CONCLUSION: Although mail- and phone-based weight-loss programs can be delivered to large numbers of people in an MCO setting, additional work is needed to enhance their clinical efficacy as well as to assess their costs.

Internalization of the sociocultural ideal: weight-related attitudes and dieting behaviors among young adolescent girls.

Questionnaires returned from 234 fifth and sixth graders from 24 Girl Scout Troops in the Midwest showed that 29.3% of all girls and 68.7% of those who were dieting thought they were overweight. Most of those who were trying to lose weight were using healthy methods, but a few were using dangerous methods. Very few were unhappy with their weight, shape, and various body parts. Most appeared to be aware of the influence of media on body image and were accepting of a wide range of body shapes and sizes among themselves and their friends.

Smokers with multiple behavioral risk factors: how are they different?

OBJECTIVE: The first aim of the present investigation was to examine cross-sectional differences between smokers who engage in additional health risk behaviors (i.e., high-fat diets and low physical activity levels) and those who do not that could affect readiness for smoking cessation treatment and treatment prognosis. The second aim was to examine prospective associations between risk factor status and smoking outcomes (i.e., cessation and quit attempts). DESIGN: Data were derived from baseline and 1-year follow-up surveys for the SUCCESS project, a randomized trial of worksite smoking interventions conducted in 24 worksites in Minneapolis/St. Paul, Minnesota. Included in the analyses were 2,149 study participants who reported smoking at baseline. METHODS: Current smokers were categorized into one of three "risk groups": the "1 additional risk factor" group (i.e., either low physical activity level or high dietary fat intake), the "2 additional risk factor" group (i.e., both low physical activity and high dietary fat intake), and the "smoker only" group (i.e., neither low physical activity nor high dietary fat intake). Mixed model regression analyses examined cross-sectional associations between risk group status and baseline demographic variables, smoking dependency, social environments for smoking, and health problems. Prospective associations between baseline risk group status and 1-year follow-up cessation attempts and quits were also examined. RESULTS: At baseline, risk factor status was associated with smoking dependency for both men and women. Women smokers with at least one additional risk factor reported a greater number of cigarettes smoked per day, higher Fagerstrom Nicotine Dependence scores, and lower self-efficacy for refraining from smoking in a variety of situations compared with smokers with no additional risk factors. Men smokers with at least one additional risk factor reported higher Fagerstrom Nicotine Dependence scores compared with smokers with no additional risk factors. Women smokers with at least one additional risk factor were more likely to report being encouraged to quit by co-workers compared with smokers with no other risk factors. No relationship between risk factor status and social pressure to quit was observed among men. Prospective analyses indicated that baseline risk factor status was marginally related to smoking outcome at 1-year follow-up; however, these relationships were attenuated considerably when controlling for smoking dependence. Relationships between risk factor status and smoking outcomes were stronger for men. CONCLUSION: Results indicated that the presence of multiple health risk behaviors was related to more serious problems with smoking. However, the presence of additional risk factors did not strongly affect prognosis for smoking cessation.

The behavioral determinants of exercise: implications for physical activity interventions.

In light of the well-documented health benefits of physical activity and the fact that the majority of adult men and women are inactive, promoting regular physical activity is a public health priority. This chapter reviews current research findings regarding the determinants of exercise behavior. It also discusses the implications of this knowledge for individual and public health recommendations and intervention strategies for promoting physical activity. The discussion is predicated on the belief that physical activity is a complex, dynamic process. During their lives, individuals typically move through various phases of exercise participation that are determined by diverse factors. This chapter discusses physical activity determinants in two broad categories: individual characteristics, including motivations, self-efficacy, exercise history, skills, and other health behaviors; and environmental characteristics such as access, cost, and time barriers and social and cultural supports.

Predictors of weight gain in the Pound of Prevention study.

OBJECTIVES: This study examined cross-sectional and prospective relationships between macronutrient intake, behaviors intended to limit fat intake, physical activity and body weight. DESIGN: The overall goal was to identify diet and exercise behaviors that predict and/or accompany weight gain or loss over time. Specific questions addressed included: (a) are habitual levels of diet or exercise predictive of weight change; (b) are habitual diet and exercise levels associated cross-sectionally with body weight; and (c) are changes in diet and exercise associated with changes in body weight over time? PARTICIPANTS: Subjects were a sample of community volunteers (n=826 women, n=218 men) taking part in a weight gain prevention project over a 3-year period. MEASURES: Body weight was measured at baseline and annually over the study period. Self-report measures of diet and exercise behavior were also measured annually. RESULTS: Among both men and women, the most consistent results were the positive association between dietary fat intake and weight gain and an inverse association between frequency of physical activity and weight gain. Individuals who weighed more both ate more and exercised less than those who weighed less. Individuals who increased their physical activity level and decreased their food intake over time were protected from weight gain compared to those who did not. Frequency of high-intensity physical activity was particularly important for both men and women. Additionally, women who consistently engaged in higher levels of moderate physical activity gained weight at a slower rate compared to women who were less active. CONCLUSIONS: Overall results indicated that both cross-sectionally and prospectively, the determinants of weight and weight change are multifactorial. Attention to exercise, fat intake and total energy intake all appear important for successful long term control of body weight.

Weight-loss practices, nutrition beliefs, and weight-loss program preferences of urban American Indian women.

OBJECTIVE: To describe health beliefs, weight concern, dieting practices, and weight-loss program preferences of American Indian women residing in an urban setting. DESIGN: Face-to-face interviews using a semistructured questionnaire were conducted and height and weight were measured. SUBJECTS/SETTING: Subjects were 203 American Indian adult women in an urban community setting. STATISTICAL ANALYSIS: Frequency distributions and chi 2 analysis were performed using the Statistical Analysis System software. RESULTS: About two-thirds of the subjects were overweight. Most women were concerned about obesity and reported attempting to manage their weight. Healthful weight-loss practices (e.g., eating more fruits and vegetables, increasing physical activity) were used most frequently. However, unhealthful practices, such as skipping meals/fasting, using laxatives/diuretics, and self-induced vomiting were also mentioned. Regular bingeing was reported by 10% of respondents. APPLICATIONS: Weight-management intervention efforts should focus on helping clients modify their diet and physical activity patterns. Low-cost programs offered in convenient locations would attract more participants, as would the provision of child care. Education about the dangers and ineffectiveness of unhealthful weight-loss practices will be necessary, given the high rates of such behaviors in this population.

Primary prevention of disordered eating among preadolescent girls: feasibility and short-term effect of a community-based intervention.

OBJECTIVE: To evaluate a community-based intervention aimed at the primary prevention of disordered eating among preadolescent girls. DESIGN: Girl Scout troop members were randomized into control and intervention groups. Program feasibility and effect at postintervention and 3-month follow-up were evaluated. SUBJECTS/SETTING: 226 girls (mean age = 10.6 years, standard deviation = 0.7) from 24 Girl Scout troops. INTERVENTION: Six 90-minute sessions focusing on media literacy and advocacy skills. MAIN OUTCOME MEASURES: Evaluation focused on program satisfaction and short-term effect on dieting behaviors, body image attitudes, and media knowledge, attitudes, and habits. STATISTICAL ANALYSES: Performed t tests, chi 2 tests, and analyses of covariance including troop as a random source of variation. RESULTS: At baseline, 29% of the girls were trying to lose weight. The program had a notable positive influence on media-related attitudes and behaviors including internalization of sociocultural ideals, self-efficacy to impact weight-related social norms, and print media habits. A modest program effect on body-related knowledge and attitudes was apparent at post-intervention (i.e., on body size acceptance, puberty knowledge, and perceived weight status) but not at follow-up. Significant changes were not noted for dieting behaviors, but they were in the hypothesized direction. Satisfaction with the program was high among girls, parents, and leaders. APPLICATIONS/CONCLUSIONS: It is feasible to use community youth settings, such as the Girl Scouts, to implement interventions to prevent disordered eating behaviors. The program led to positive trends in outcome variables; however, longer and more intensive interventions are needed for lasting changes in body image and dieting behaviors.

Age of initiation, smoking patterns, and risk in a population of working adults.

BACKGROUND: Early age of initiation is a significant risk factor for long-term dependent smoking and may also relate to other unhealthy behaviors and increased likelihood of illness, independent of duration of smoking. METHODS: The current study assessed age of initiation in relation to cigarette dependence, interest in quitting, social environment pertaining to smoking, behavioral risk factors, and current health problems. Subjects were 2120 current daily smokers in 24 worksites in the Minneapolis/St. Paul, Minnesota, metropolitan area. RESULTS: Findings were surprisingly consistent with early age of initiation predicting more dependent smoking, less interest and confidence in ability to quit, poorer diet, less use of seat belts, more illness and hospitalization, and greater likelihood of smoking among partner/spouse, friends, and co-workers. CONCLUSIONS: The overall strength of the findings was unexpected. Early initiation of regular smoking predicted a significant constellation of risk factors throughout adulthood. Interventions that significantly delay smoking onset, even in the absence of permanent prevention, could have important public health implications.

Mistreatment due to weight: prevalence and sources of perceived mistreatment in women and men.

OBJECTIVE: Previous research has documented prejudicial attitudes and discrimination against overweight people. Yet the extent to which overweight people themselves perceive that they have been mistreated because of their weight has not been carefully studied. The purpose of this study was to examine the prevalence of perceived mistreatment due to weight and sources of perceived mistreatment. METHODS AND PROCEDURES: A non-clinical sample of healthy adults (187 men and 800 women) enrolled in a weight gain prevention program comprised the study population. A self-administered questionnaire was used to measure perceived mistreatment due to weight. RESULTS: Overall, 22% of women and 17% of men reported weight-related mistreatment. The most commonly reported sources of mistreatment among women were strangers (12.5%) and a spouse or loved one (11.9%). Men were most likely to report mistreatment by a spouse or loved one (10.2%) and friends (7.5%). Somewhat surprisingly, sex differences in perceived weight-related mistreatment were significant only for stranger as the source. Perceived weight-related mistreatment was positively associated with body mass index (BMI) (r = 0.39, p<0.0001). Reported mistreatment was nearly ten times as pervalent among individuals in the highest quartile of the BMI distribution (42.5%) than among those in the lowest BMI quartile (5.7%), but was significantly greater than zero in all but the very lean. DISCUSSION: Perceived mistreatment due to weight is a common experience and is not restricted to the morbidly obese. Results are discussed in light of the sociocultural value for thinness.