OBJECTIVE:Our aim was to evaluate obesity risk knowledge, weight misperception, and diet and health-related attitudes among women intending to become pregnant compared to those not intending to become pregnant.DESIGN:We conducted a cross-sectional survey of health behaviors, including obesity risk knowledge, weight misperception, and diet and health-related attitudes among women (aged 16 to 40 years) attending reproductive health clinics in southeast Texas. Data were collected through self-administered questionnaires and chart review. Multivariable logistic regression analyses were performed to examine the association between pregnancy intention and obesity risk knowledge, weight misperception, and health-related attitudes after adjusting for age, race, income, and gravidity.RESULTS:Overall, 1,726 women completed the survey, of which 1,420 responded to a question on pregnancy intention. Of these, 126 stated they were intending to become pregnant. Obesity risk knowledge (adjusted odds ratio=1.14; 95% confidence interval [CI] 0.74 to 1.77) and weight misperception (adjusted odds ratio=1.17; 95% CI 0.75 to 1.83) did not differ between women intending and not intending to become pregnant. In addition, diet and health-related attitudes did not differ between these two groups (P>0.05 for all). Among women intending to become pregnant, 51% had low obesity risk knowledge and 31% misperceived their body weight. Further, 76% of these women felt confused about what constitutes a healthy diet, although 47% believed that their current diet was healthy and saw no reason to change their current eating patterns. While weight misperception did not differ significantly between the two groups, overweight women intending to become pregnant were more likely to misperceive their weight than obese women intending to become pregnant (71% vs 10%; P<0.001).CONCLUSIONS:There is a need for improved preconception counseling, especially for women intending to become pregnant, regarding the risks associated with being overweight or obese, misperception of body weight, and negative diet and health-related attitudes.

Background: Hyperpalatable foods (i.e., high in salt, sugar, or fat) have been shown to have addictive properties that may contribute to overeating. Prior studies conducted on food addiction behaviors are mostly based on white and middle-aged women. Data are not available, however, on reproductive-aged women from other races/ethnicities or low-income women. The purpose of this study was to examine the prevalence and correlates of food addiction among multiethnic women of low socioeconomic status. Methods: We conducted a cross-sectional survey of health behaviors, including food addiction according to the Yale Food Addiction Scale (YFAS) between July 2010 and February 2011 among 18- to 40-year-old low-income women attending reproductive-health clinics (N=1,067). Results: Overall, 2.8% of women surveyed met the diagnosis of food addiction. The prevalence of food addiction did not differ by age group, race/ethnicity, education, income, or body mass index categories, tobacco and alcohol use, or physical activity. However, it did differ by level of depression (p<0.01). The YFAS symptom count score significantly differed by race/ethnicity (p<0.01) with black women having higher scores than Hispanic women. Racial differences were also observed among some of the YFAS symptoms. Conclusion: These findings demonstrated a low prevalence of food addiction among low-income, reproductive-aged women. Racial differences were observed in the YFAS symptom count score, but not in the overall prevalence of food addition. Additionally, women with food addiction had higher levels of depression than women without food addiction.

BACKGROUND:Polycystic Ovary Syndrome (PCOS) affects approximately 15% of reproductive-age women and increases risk of insulin resistance, type 2 diabetes mellitus, cardiovascular disease, cancer and infertility. Hyperinsulinemia is believed to contribute to or worsen all of these conditions, and increases androgens in women with PCOS. Carbohydrates are the main stimulators of insulin release, but research shows that dairy products and starches elicit greater postprandial insulin secretion than non-starchy vegetables and fruits. The purpose of this study was to determine whether an 8-week low-starch/low-dairy diet results in weight loss, increased insulin sensitivity, and reduced testosterone in women with PCOS.METHODS:Prospective 8-week dietary intervention using an ad libitum low starch/low dairy diet in 24 overweight and obese women (BMI ≥ 25 kg/m2 and ≤ 45 kg/m2) with PCOS. Diagnosis of PCOS was based on the Rotterdam criteria. Weight, BMI, Waist Circumference (WC), Waist-to-Height Ratio (WHtR), fasting and 2-hour glucose and insulin, homeostasis model assessment of Insulin Resistance (HOMA-IR), HbA1c, total and free testosterone, and Ferriman-Gallwey scores were measured before and after the 8-week intervention.RESULTS:There was a reduction in weight (-8.61 ± 2.34 kg, p<0.001), BMI (-3.25 ± 0.88 kg/m2, p<0.001), WC (-8.4 ± 3.1 cm, p<0.001), WHtR (-0.05 ± 0.02 inches, p<0.001), fasting insulin (-17.0 ± 13.6 μg/mL, p<0.001) and 2-hour insulin (-82.8 ± 177.7 μg/mL, p=0.03), and HOMA-IR (-1.9 ± 1.2, p<0.001) after diet intervention. Total testosterone (-10.0 ± 17.0 ng/dL, p=0.008), free testosterone (-1.8 pg/dL, p=0.043) and Ferriman-Gallwey scores (-2.1 ± 2.7 points (p=0.001) were also reduced from pre- to post-intervention.CONCLUSION:An 8-week low-starch/low-dairy diet resulted in weight loss, improved insulin sensitivity and reduced testosterone in women with PCOS.

To examine influence of nutrition knowledge on weight loss behaviors among low-income reproductive-age women. We conducted a self-administered cross-sectional survey of health behaviors including socio-demographic characteristics, nutrition knowledge, and weight loss behaviors of 16–40 year old women (n = 1,057) attending reproductive health clinics located in Southeast Texas between July 2010 and February 2011. Multiple linear regression and multivariable logistic regression analyses were performed to identify correlates of nutrition knowledge and examine its association with various weight loss behaviors after adjusting for confounders. The mean nutrition knowledge score was low (5.7 ± 2.8) (possible score 0–15). It was significantly lower among African American women than whites (P < .001). Obese women (P = .002), women with high school enrollment/diploma (P = .030), and some college hours/degree (P < .001) had higher nutrition knowledge scores than their counterparts. The higher score of nutrition knowledge was significantly associated with higher odds of engaging in healthy weight loss behaviors: eating less food [odds ratio (OR) 1.12, 95 % confidence interval (CI) 1.06–1.18], switching to foods with fewer calories (OR 1.10, 95 % CI 1.04–1.16), exercising (OR 1.10, 95 % CI 1.04–1.16), eating more fruits/vegetables/salads (OR 1.11, 95 % CI 1.06–1.17) and less sugar/candy/sweets (OR 1.09, 95 % CI 1.04–1.15). However, it was not associated with unhealthy weight loss behaviors, such as using laxatives/diuretics or inducing vomiting. Nutrition knowledge is low among reproductive-age women. An increase in nutrition knowledge may promote healthy weight loss behaviors.

Polycystic ovary syndrome (PCOS) affects between 4%-18% of reproductive-aged women and is associated with increased risk of obesity and obesity-related disease. PCOS is associated with hyperinsulinemia, which is known to impair fat oxidation. Research shows that carbohydrates from dairy and starch-based foods cause greater postprandial insulin secretion than carbohydrates from nonstarchy vegetables and fruits. The purpose of this study was to determine whether an ad libitum 8-week low-starch/low-dairy diet would improve fasting and postprandial fat oxidation after a high saturated fat liquid meal (HSFLM) in overweight and obese women with PCOS. Prospective 8-week dietary intervention using a low-starch/low-dairy diet in 10 women (body mass index ≥25 kg/m(2) and ≤45 kg/m(2)) with PCOS. Indirect calorimetry was used at fasting and for 5 h following consumption of the HSFLM to determine respiratory exchange ratio (RER), macronutrient oxidation, and energy expenditure (EE) at week 0 and week 8. Participants had a reduction in body weight (-8.1 ± 1.8 kg, p < 0.05) and fasting insulin (-19.5 ± 8.9 μg/mL, p < 0.05) after dietary intervention; however, these were not significantly correlated with improved fat oxidation. There was a reduction in fasting RER, and fasting and postprandial carbohydrate oxidation, and an increase in fasting and postprandial fat oxidation after adjusting for body weight. There was also significant difference in incremental area under the curve from pre- to post-diet for fat (0.06 ± 0.00 g/kg per 5 h; p < 0.001) and carbohydrate oxidation (-0.29 ± 0.06 g/kg per 5 h; p < 0.001), but not for RER or EE. In conclusion, an 8-week low-starch/low-dairy diet increased fat oxidation in overweight and obese women with PCOS.

OBJECTIVE: To evaluate the nutritional habits and weight management strategies of women trying to conceive as compared with women not trying to conceive. METHODS: This was a cross-sectional survey of health behaviors including nutritional habits and weight management strategies of women aged 16–40 years who were low income, racially diverse, (n=1,711), and attending reproductive health clinics. Multivariable logistic regression analyses were performed to examine the association between pregnancy intention and various health behaviors after adjusting for demographic variables, gravidity, and obesity status. RESULTS: A total of 8.9% (n=153) of the participants stated they were trying to get pregnant. Women trying to conceive were more likely than those not trying to have participated in a number of unhealthy weight loss practices in the past year. These included taking diet pills, supplements, or herbs (13.5% compared with 8.8%; adjusted odds ratio [OR] 1.97, 95% confidence interval [CI] 1.11–3.49), using laxatives or diuretics or inducing vomiting (7.7% compared with 3.0%; adjusted OR 2.70, CI 1.23–5.91), and fasting for 24 hours (10.7% compared with 5.5%; adjusted OR 2.15, CI 1.03–4.51). There were no significant differences between the two groups in amount of exercise, current smoking status, or current alcohol consumption Furthermore, fruit, green salad and other vegetables, and intake of soda and fast food were unrelated to pregnancy intention. CONCLUSION: This study highlights that women trying to conceive are more likely to participate in unhealthy and potentially dangerous weight loss practices than women not trying to conceive. LEVEL OF EVIDENCE: II

Polycystic ovary syndrome (PCOS) affects approximately 5 million women of reproductive age in the United States and is associated with increased risk of obesity, cardiovascular disease, cancer and infertility. Hyperinsulinemia worsens hyperandrogenemia in women with PCOS and makes weight loss difficult. Research shows that carbohydrates from dairy and starch-based foods have greater insulinogenic properties than carbohydrates from non-starchy vegetables and fruits. The purpose of this study was to determine whether an 8-week dietary intervention eliminating insulinogenic foods results in successful weight loss and improved anthropometric measurements in women with PCOS. Prospective cohort including women with PCOS, age 18 to 45 years. Twenty-one participants enrolled, and 18 completed the study (3 did not complete the study due to noncompliance). Baseline weight, BMI, waist and hip circumference were recorded. Patients received 1 hour of dietary instruction from a registered dietician at the beginning of the study. Written instructions for foods to eat and to avoid were provided. No calorie counting was required. Participants were permitted to eat lean meats, non-starchy vegetables, nuts and low sugar fruits ad libitum until the point of satiety. Patients returned in 8 weeks for repeat weight and anthropometric measurements. Mean weight loss was 18.7 +/- 4.6 pounds (8.5 +/- 2.1 kg, p<.0001). Mean reduction of BMI was 3.2 +/- 0.8 (p<.0001). Mean reduction in waist circumference was 3.4 +/- 1.3 inches (8.6 +/- 3.3 cm, p<.0001). Mean reduction in hip circumference was 2.3 +/- 1.0 inches (5.8 +/- 2.5 cm, p<.0001). An 8-week low starch/low dairy diet resulted in significant weight loss and reduction in waist and hip circumference in PCOS patients. The dietary modification was well-tolerated and required no calorie or carbohydrate counting and no additional exercise.

Polycystic ovary syndrome (PCOS) is associated with clinical and laboratory hyperandrogenism. Hyperandrogenism is exacerbated by hyperinsulinemia. Foods containing high levels of starch and dairy induce an exacerbated insulinotropic response. The purpose of the study was to determine the effect of an 8-week low starch/low dairy diet on clinical and laboratory evidence of hyperandrogenism. Prospective cohort including women with PCOS ages 18 to 45 years. Twenty-one participants with PCOS were enrolled. 18 completed the study (3 did not complete the study due to noncompliance). Participants received 1 hour of dietary instruction from a registered dietician at the beginning of the study. Participants were permitted to eat ad libitum lean meats, non-starchy vegetables, nuts and low sugar fruits to the point of satiety. Participants returned in 8 weeks for repeat testing. Testosterone and free testosterone assays were run by one laboratory (Quest Diagnostics Nichols Institute, San Juan Capistrano, CA). Ferriman-Gallwey scores were performed by one physician at the beginning and end of the 8-week dietary intervention. Following an 8-week dietary modification, change in total and free testosterone levels were not normally distributed (p=.049 and p=.013 respectively). Both total testosterone levels (median change= -7.0, IQR=31.0ng/dL; p=.065) and free testosterone levels decreased (median change= -0.25pg/mL, IQR=4.4pg/mL; p=.200) though the change was not statistically significant. However, modified Ferriman-Gallwey hirsutism scores were reduced (median change= -2.0, IQR=5.0; p=.018) despite only 8-weeks of intervention. Reduction in modified Ferriman-Gallwey hirsutism scores were achieved after a brief 8-week dietary modification. Further studies are needed to determine if dietary intervention may be successful in lowering total and free testosterone levels in women with PCOS.

The objectives of this study were to collect data on the barriers to healthful eating among university students and to obtain student feedback regarding a proposed nutrition labeling program to promote healthy eating on campus. The location was a major university in the southwest. The Logic Model guided the development of focus group questions related to the barriers that university students face. To collect quantitative data regarding nutrition knowledge and health consciousness, a Nutrition Knowledge and Health Consciousness Scale (NKHCS) was used. After completing the scale, 30 students participated in four focus groups. Three themes emerged from the focus groups: the need for increased availability of healthy foods, the ability to sample healthy foods, and nutrition labeling of foods. This mixed method approach to the study provided both qualitative and quantitative data, and the results provided important insights from students regarding the development of university-based nutrition education programs.