Should body size preference be a target of health promotion efforts to address the epidemic of obesity in Afro-Caribbean women?

OBJECTIVE: To determine if 1) Afro-Caribbean women prefer large body sizes, 2) the body size preference of Afro-Caribbean men and women are associated, 3) women's preferences are associated with increased risk of obesity or with weight management behaviors. DESIGN: Population samples of 314 and 487 women, ages 20-55 years, were recruited on Barbados and Dominica with response rates of 74% and 77%, respectively. Body size preferences, stress related variables, and demographic data were ascertained by questionnaire. Height and weight were also measured. On Barbados, body preference data were collected from male partners of participants, and data on intentions to perform weight management behaviors were collected from 175 women. RESULTS: Most women preferred body sizes within normal limits, although women on Dominica had a slightly larger ideal body size (IBS) than did Barbadian women (P<.05). On both islands, the size that women thought men preferred was related to their IBS (P<.0001). Likewise, IBS was associated with increased odds of being overweight (P<.001), however most overweight women (>75%) wanted to be smaller. IBS was not related to the intention to exercise or to eat high fat foods. CONCLUSIONS: It is unlikely that body size preference poses a barrier to intervention efforts to reduce the prevalence of overweight in Afro-Caribbean women.

Is prospective payment inhibiting the use of nutrition support services? Discussion and research implications.

Much concern has been generated about the impact of the diagnosis-related group (DRG) prospective payment system on a variety of medical treatments. In particular, high technology medical or surgical applications, such as enteral and parenteral nutrition support, are often perceived as cost-increasing rather than cost-reducing. The threat to the use of nutrition support services relates to the non-existence of an effective reimbursement scheme for recovery of labor costs for the services. High overhead and relatively expensive hard- and software may price nutrition services out of the health care system if an appropriate reimbursement plan is not developed. To address the obvious lack of provision for reimbursement of nutrition support services under the DRG system, several cost-benefit issues related to the provision of nutrition support must be addressed. Empirical data are necessary to determine the clinical significance of these procedures relative to severity and duration of illness and subsequent associated length-of-stay issues; and the cost-benefit justification of nutrition support for acute and chronically ill patients. The purpose of this discussion is not to propose such a system of reimbursement but rather to present a framework for the development and justification of a revised DRG reimbursement plan to cover adequately the cost of providing enteral and parenteral nutrition support services.