Family meals are an important ritual in contemporary societies and many studies have reported associations of family meals with several biopsychosocial outcomes among children and adolescents. However, few representative analyses of family meals have been conducted in samples of adults, and adults may differ from young people in predictors and outcomes of family meal consumption. We examined the prevalence and predictors of adult family meals and body weight outcomes.

The cross-sectional 2009 Cornell National Social Survey (CNSS) included questions about the frequency of family meals, body weight as BMI and sociodemographic characteristics.

The CNSS telephone survey used random digit dialling to sample individuals.

We analysed data from 882 adults living with family members in a nationally representative US sample.

Prevalence of family meals among these adults revealed that 53 % reported eating family meals seven or more times per week. Predictive results revealed that adults who more frequently ate family meals were more likely to be married and less likely to be employed full-time, year-round. Outcome results revealed that the overall frequency of family meals among adults was not significantly associated with any measure of body weight. However, interaction term analysis suggested an inverse association between frequency of family meals and BMI for adults with children in the household, and no association among adults without children.

These findings suggest that family meals among adults are commonplace, associated with marital and work roles, and marginally associated with body weight only in households with children.

To determine the dietary patterns of a national sample of 2–8-year-old Australian children and to establish whether breast-feeding is associated with dietary patterns in this age group.

Cross-sectional study using 24 h recall data from the 2007 Australian National Children's Nutrition and Physical Activity Survey.

Australia.

A total of 2287 children aged 2–8 years.

Principal component factor analysis identified three distinct patterns. The ‘Non-core food groups’ pattern included food groups such as whole-fat dairy products, cheese, medium–high sugar-sweetened breakfast cereals and sweet biscuits, no fruit, reduced/low-fat dairy products and wholegrain bread/rolls. The ‘Healthy, meat and vegetable’ pattern included vegetables, red meat, fruit and wholegrain bread/rolls and was inversely associated with take-away foods and carbonated sugar-sweetened beverages. The ‘Combination’ pattern contained many food groups including candy (not chocolate based), pasta/rice products, nuts/seeds, cakes and chocolate, but no fruit or vegetables. Of the 2287 children, 2064 (89·3 %) had been breast-fed. A positive association was found between breast-feeding and the healthy, meat and vegetable pattern (r = 0·267) but not with the other two patterns. Higher scores on this pattern were also associated with younger age, lower BMI, higher birth weight, high likelihood of being in the less-disadvantaged Socio-economic Indexes for Areas category and less likelihood of the child's parents having a lower educational level.

These results provide suggestive evidence that breast-feeding during infancy is associated with a healthy dietary pattern in childhood and offers a likely pathway to explain the previously reported association between breast-feeding and chronic disease.

To gain insight into intervention components targeted specifically to mothers of young children that may contribute to attendance and effectiveness on physical activity and healthy eating.

Systematic literature searches were performed using MEDLINE, Embase and cited references. Articles were included if they evaluated the effectiveness of a lifestyle intervention to promote physical activity and/or healthy eating in an experimental design among mothers with young children (age 0–5 years). Data were extracted on study characteristics, intervention components targeted towards mothers with young children, attendance and effectiveness. Extracted data were analysed in a descriptive manner.

Eleven articles describing twelve interventions met the inclusion criteria. Of the six studies that measured attendance, two reported high attendance. Embedding the intervention within routine visits to child health clinics seems to increase attendance. Three studies found significant effects on physical activity and three on healthy eating. Effective interventions directed at physical activity included components such as counselling on mother-specific barriers or community involvement in intervention development and implementation. One of the three interventions that effectively increased healthy eating had components targeted at mothers (i.e. used targeted motivational appeals).

The number of experimental intervention studies for promoting physical activity and healthy eating among new mothers is limited. However, useful first recommendations can be set for targeting interventions towards mothers, in particular for promoting attendance and physical activity. More insight is required about the need for targeting health promotion programmes at new mothers, especially of those directed at nutritional behaviour.

To assess the relationship between obesity and sedentary behaviours, such as watching television or using a computer (‘screen-time’), and describe how this relationship varies between population subgroups.

Cross-sectional analysis of the relationship between obesity (BMI ≥ 30 kg/m2) and screen-time, adjusted for age, sex, income and education and compared according to a range of personal characteristics.

New South Wales, Australia.

A total of 91 266 men and women aged 45 years and above from the general population of New South Wales in 2006–2007 and providing self-reported information on height and weight and other factors.

Obesity prevalence was 21·4 %. Compared to individuals with <2 h of daily screen-time, the adjusted relative risks (RR) of obesity were 1·35 (95 % CI 1·26, 1·44), 1·70 (95 % CI 1·59, 1·82), 1·94 (95 % CI 1·81, 2·08) and 1·92 (95 % CI 1·80, 2·06) for 2–3, 4–5, 6–7 and ≥8 h, respectively. The increase in obesity with increasing screen-time was similar within categories of overall physical activity, but was attenuated in those in full-time paid work, compared to non-workers (P for interaction < 0·0001). Among non-workers, the overall obesity RR per 2 h increase in daily screen-time was 1·23 (95 % CI 1·21, 1·25) and was significantly elevated in all groups examined, ranging from 1·16 to 1·31 according to sex, level of age, education, income, smoking and fruit consumption. The RR did not differ significantly according to overall physical activity, region of residence and alcohol and vegetable consumption, but was substantially lower in disabled v. not-disabled individuals (P for interaction < 0·0001).

Obesity increases with increasing screen-time, independent of purposeful physical activity. This was observed in all population groups examined, although it is attenuated in full-time workers and disabled individuals.

To identify and describe factors associated with food shop (known as tuck shop in South Africa) and lunchbox behaviours of primary-school learners in South Africa.

Analysis of data collected in 2008 from a cross-sectional survey.

Sixteen primary schools in the Western Cape, South Africa.

A total of 717 grade 4 learners aged 10–12 years.

A 24 h recall established that 69 % of learners carried a lunchbox to school and 49 % had consumed at least one item purchased from the school food shop/vendor. Most lunchboxes contained white bread with processed meat, whereas the most frequent food shop/vendor purchase comprised chips/crisps. Learners who carried a lunchbox to school had significantly lower BMI percentiles (P = 0·002) and BMI-for-age (P = 0·034), compared with their counterparts. Moreover, they were younger, had higher standard-of-living and dietary diversity scores, consumed more meals per day, had greater self-efficacy and came from predominantly urban schools, compared with those who did not carry a lunchbox to school. Learners who ate food shop/vendor purchases had a lower standard-of-living score and higher dietary diversity and meal scores. Only 2 % of learners were underweight, whereas 19 % were stunted and 21 % were overweight/obese (BMI ≥ 25 kg/m2).

Children who carried a lunchbox to school appeared to have greater dietary diversity, consumed more regular meals, had a higher standard of living and greater nutritional self-efficacy compared with those who did not carry a lunchbox to school.

To assess the validity of a 148-item quantitative FFQ (QFFQ) that was developed for the Barbados National Cancer Study (BNCS) to determine dietary intake over 12 months and examine the dietary risk factors.

A cross-sectional validation study of the QFFQ against 4 d food diaries. Spearman’s rank correlations (ρ), intra-class correlation coefficients (ICC) and weighted κ were computed as measures of concordance, adjusting for daily variations in the food diaries. Cross-classification tables and Bland–Altman plots were created for further assessment.

BNCS is a case–control study of environmental risk factors for breast and prostate cancer in a predominantly African-origin population in Barbados.

Fifty-four individuals (21 years and older) were recruited among controls in the BNCS who were frequency-matched on sex and age group to breast and prostate cancer cases.

Similar mean daily energy intake was derived from the food diary (8201 kJ (1960 kcal)) and QFFQ (7774 kJ (1858 kcal)). Rho for energy and macronutrients ranged from 0·66 (energy) to 0·17 (dietary fibre). The percentage of energy from carbohydrates and protein showed the highest and lowest ICC among macronutrients (0·63 and 0·27, respectively). The highest weighted κ was observed for energy (0·45). When the nutrient intake was divided into quartiles, approximately 34 % of the observations were in the same quartile.

This investigation supports the validity of the QFFQ as a method for assessing long-term dietary intake except for dietary fibre, folate, vitamins A, E and B12. The instrument will be a useful tool in the analysis of diet–cancer associations in the BNCS.

To explore why there is a lack of acceptance among Western Australian (WA) adults of the Go for 2&5®fruit and vegetable social marketing message to consume at least five servings of vegetables per day.

A series of focus group discussions comprised of homogeneous groups varied by sex and age, until saturation of themes was achieved, followed by thematic analysis.

Part of qualitative research for the Go for 2&5® fruit and vegetable social marketing campaign in WA (2009 population: 2·2 million).

WA adults stratified by sex and age groups (18–29 and 30–55 years) drawn from the second and third quartiles of socio-economic disadvantage.

Familiarity with the Go for 2&5® message was excellent. Understanding of what constitutes ‘two servings of fruit’ was excellent and regarded by participants as highly achievable. Understanding of what constitutes ‘five servings of vegetables’ was suboptimal with widespread overestimation contributing to the belief that it is unrealistic. Participants did not know how the 2&5 recommendation was formulated and believed that daily consumption of two servings of fruit and five of vegetables would confer no greater health benefit than one of fruit and three of vegetables. Participants assumed that the 2&5 recommendation was ‘aspirational’ in the sense that it was purposely exaggerated to simply encourage greater overall consumption.

A convincing case needs to be presented to WA adults as to why they should consume five servings of vegetables per day. Continuing efforts to educate incorporating what constitutes a serving will assist perceptions that the recommendation is realistic.

The present study aimed to examine the impact of non-wear activities registered in diaries when using accelerometers to assess physical activity (PA) in young adolescents.

Data arise from a large-scale cross-sectional study on PA. PA was objectively assessed using Actigraph™ accelerometers (Actigraph MTI, Manufacturing Technology Inc., Pensacola, FL, USA) during seven consecutive days. Non-wear time activity diaries were provided to register the activities for which the accelerometer was removed. After correction to deal with over-reporting, the registered minutes of PA were used to replace periods of non-wear time measured by the accelerometer.

Between October 2008 and May 2009 adolescents were recruited by home visits in Ghent (Belgium).

Young adolescents (n 513; 48·6 % boys) aged 13 to 15 years.

Of the total sample, 49·9 % registered at least one activity of moderate to vigorous intensity in the non-wear time activity diary. More adolescents registered an activity performed on a weekday than on a weekend day and the registered mean number of minutes of moderate to vigorous PA were higher on weekend days. Repeated-measures (M)ANOVA tests revealed a significant difference between the mean minutes with and without non-wear activities for all PA intensities, regardless of adolescents’ socio-economic status or gender. More adolescents achieved the PA recommendations after inclusion of the non-wear activities irrespective of accelerometer thresholds used.

The collection of information regarding non-wear time by non-wear time activity diaries when using accelerometers in 13–15-year-old adolescents can lead to different PA outcomes at the individual level and therefore can improve the ability to accurately measure PA.

The ready-meal market has grown considerably in recent years. At the same time, a degradation of traditional cooking skills has been observed. Ready meals are often rich in energy, fat and sugar and lack vegetables; however, studies investigating associations between ready-meal consumption, overweight and cooking skills are lacking. The present study examines whether demographic factors, overweight, beliefs about the nutritional value and taste of ready meals and cooking skills are associated with ready-meal consumption.

Cross-sectional survey.

Ready-meal consumption, weight status, cooking skills, beliefs about the taste and nutritional value of ready meals and demographic variables were assessed with self-administered questionnaires. Data were analysed with one-way ANOVA and multiple regression analysis.

A total of 1017 adults from the German-speaking part of Switzerland.

Men reported being more positive about ready meals and having fewer cooking skills compared with women. Overweight adults (BMI > 25 kg/m2) were more positive about nutrients and vitamins in ready meals compared with normal-weight adults. Ready-meal consumption was associated with cooking skills (β = −0·192), age (β =− 0·228), overweight (β = 0·129), nutritional value (β = −0·131), taste (β = −0·126), working status (β = 0·096) and gender (β = 0·084).

Cooking skills were identified as a strong predictor of ready-meal consumption. The importance of cooking skills as a barrier to healthy eating should be explored, as it is plausible that cooking skills will further decrease in the future. Next, the study provided evidence for an association between ready-meal consumption and overweight. Further research should examine the importance of ready meals for the overweight epidemic.

Research has suggested the abandonment of the traditional Mediterranean diet (MD) by youngsters for a more Westernized regime. The present study aimed (i) to delineate differences in the consumption of traditional Cretan dishes and key nutrients in the MD between two contiguous generations of women and (ii) define how these dietary changes contribute to the morbidity of the younger generation.

Cross-sectional.

The island of Crete, Greece.

Eighty pairs of mothers and daughters, all living in their own households, were recruited from Crete. Information regarding the consumption of traditional Cretan dishes and two previous-day recalls were collected. The health status of the participants was also recorded. Simple correspondence analysis (SCA) was used to assess associations between differences in the food intake of daughters compared with their mothers and the prevalence of disease.

The younger women showed increased intakes of rusks and meat dishes and decreased consumption of green vegetables, pulses and wine compared with their mothers. When nutrients were accounted for, only sugar consumption of the younger women surpassed the intake reported by their mothers. SCA associated hypercholesterolaemia in the daughters with increased cheese and meat intakes; allergies and respiratory problems were associated with lower cheese, fish and oil intakes; being overweight was associated with higher baked goods, oils, desserts, fish and alcohol intakes; and Fe-deficiency anaemia was associated with lower consumption of green vegetables.

Results showed that, although a trend towards a more Westernized diet was noted in the younger women, the differences between the two generations appear to be small. Therefore, in Crete, the MD is still the primary diet regime.

To review the evidence on the association between fruit and vegetable (F&V) consumption and risk of chronic disease, and to assess trends in the prevalence of low F&V consumption.

Systematic review and cross-sectional analyses of a Mediterranean cohort.

The Seguimiento University of Navarra (SUN) project (Spanish dynamic cohort of graduates).

A systematic review of prospective studies aimed to assess the relationship between fruit and/or vegetables consumption and chronic disease incidence was conducted. We also assessed 18 457 university graduates (59·4 % women; mean age = 39 (sd 12) years) enrolled in a dynamic cohort with permanently open recruitment. Baseline data were collected between 1999 and 2010 using a validated 136-item FFQ. Four definitions for low F&V consumption were used (<400 g/d, <200 g/4184 kJ (1000 kcal) per d, ≤2 servings/d and ≤1 serving/d). Multivariate-adjusted cross-sectional associations between the prevalence of low F&V consumption and the year of recruitment were estimated.

The systematic review found that a high F&V consumption is inversely associated with CVD incidence and mortality. This association is not so clear for cancer. Inconsistent findings have been reported for diabetes. In all, 13 % of participants in the SUN cohort did not meet the goal of consuming at least 400 g/d of F&V and 2·1 % of them did not reach >1 serving/d. Between 1999 and 2010 the consumption of F&V significantly increased.

Even among health-conscious university graduates, low F&V consumption is fairly prevalent. Although the temporal trends suggest an improvement, preventive strategies addressed to increase F&V consumption are needed.

To describe self-reported physical activity (PA) patterns in the various domains (school, home, transport, leisure time) and intensity categories (walking, moderate PA, vigorous PA) in European adolescents. Furthermore, self-reported PA patterns were evaluated in relation to gender, age category, weight status category and socio-economic status (SES).

Cross-sectional study.

Ten European cities.

In total, 3051 adolescents (47·6 % boys, mean age 14·8 (sd 1·2) years) completed an adolescent-adapted version of the validated International Physical Activity Questionnaire.

The total sample reported most PA during leisure time (485 min/week) and least PA at home (140 min/week). Boys reported significantly more school-based PA (P < 0·001), leisure-time PA (P = 0·003), vigorous PA (P < 0·001) and total PA (P = 0·002) than girls, while girls reported more home-based PA (P < 0·001) and walking (P = 0·002) than boys. Self-reported PA at school (P < 0·001), moderate PA (P < 0·001), vigorous PA (P < 0·001) and total PA (P < 0·001) were significantly higher in younger age groups than in older groups. Groups based on weight status differed significantly only in leisure-time PA (P = 0·004) and total PA (P = 0·003), while groups based on SES differed in all PA domains and intensities except transport-related PA and total PA.

The total sample of adolescents reported different scores for the different PA domains and intensity categories. Furthermore, patterns were different according the adolescents’ gender, age, weight status and SES.

Intake of nutrients may influence the risk of endometrial cancer (EC). We aimed to estimate the association of intake of individual nutrients from food and from food plus supplements with EC occurrence.

A population-based case–control study conducted in Canada (2002–2006).

Nutrient intakes from food and supplements were assessed using an FFQ. Logistic regression was used to estimate EC risk within quartile levels of nutrient intakes.

Incident EC cases (n 506) were identified from the Alberta Cancer Registry, and population controls were frequency- and age-matched to cases (n 981).

There existed little evidence of an association with EC for the majority of macronutrients and micronutrients examined. We observed a statistically significant increased risk associated with the highest, compared with the lowest, quartile of intake of dietary cholesterol (multivariable-adjusted OR = 1·51, 95 % CI 1·08, 2·11; P for trend = 0·02). Age-adjusted risk at the highest level of intake was significantly reduced for Ca from food sources (OR = 0·73, 95 % CI 0·54, 0·99) but was attenuated in the multivariable model (OR = 0·82, 95 % CI 0·59, 1·13). When intake from supplements was included in Ca intake, risk was significantly reduced by 28 % with higher Ca (multivariable-adjusted OR = 0·72, 95 % CI 0·51, 0·99, P for trend = 0·04). We also observed unexpected increased risks at limited levels of intakes of dietary soluble fibre, vitamin C, thiamin, vitamin B6 and lutein/zeaxanthin, with no evidence for linear trend.

The results of our study suggest a positive association between dietary cholesterol and EC risk and an inverse association with Ca intake from food sources and from food plus supplements.

To examine the reliability and convergent validity of physical activity (PA) and inactivity estimates obtained with the past-week Modifiable Activity Questionnaire (PWMAQ).

The PWMAQ, an interviewer-administered questionnaire, was administered twice, one week apart, during visits 3 and 4 of six total visits. Intra-class correlation coefficients (ICC) between administrations of the PWMAQ were used to assess the reliability of summary estimates. Spearman rank-order correlation coefficients (ρ) were used to examine the associations of PWMAQ summary estimates with temporally matched and averaged accelerometer data in all participants and then stratified by whether the data were reflective of usual PA.

Data were obtained from the Evaluation of Physical Activity Measures in Middle-Aged Women (PAW) study.

Sixty-six women, mean age 52·6 (sd 5·4) years.

The reliability of the PWMAQ physical inactivity estimate suggested substantial agreement over one week (ICC = 0·77, 95 % CI 0·57, 0·82; P < 0·0001). With the exception of light-intensity PA, the PWMAQ leisure PA estimate was significantly associated with averaged accelerometer data (ρ = 0·33–0·76; P < 0·05). For both temporally matched and averaged accelerometer data, correlation coefficients were higher between the PWMAQ estimate and moderate-walk- to vigorous-intensity PA in those who indicated that reported activity was reflective of usual PA; however, the association with moderate-lifestyle-intensity PA was higher in those reporting that data were not reflective.

The PWMAQ is a reliable and valid measure of leisure PA levels in middle-aged women and supports subsequent studies evaluating this questionnaire in other population subgroups.

The promotion of healthy lifestyles is one of the major goals of governments and international agencies all over the world. Wholegrain cereals are rich in nutrients and many phytochemical compounds, with recognised benefits for health, including dietary fibre, a number of phenolic compounds, lignans, vitamins and minerals and other bioactive components. The aim of the present work is to review the fundamental studies that support the consumption of wholegrain cereals and bread to prevent chronic diseases.

Descriptive review considering human studies.

Subjects included in randomised intervention trials and cohort studies from different countries published up to 2010.

Several studies show consistently that subjects who ingest three or more portions of foods per day based on wholegrain cereals have a 20–30 % lower risk of CVD than subjects who ingest low quantities of cereals. This level of protection is not observed with the ingestion of refined cereals, these being even higher than with the intake of fruit and vegetables. Likewise, high intake of wholegrain cereals and their products, such as whole-wheat bread, is associated with a 20–30 % reduction in the risk of type 2 diabetes. Finally, protection against the risk of colorectal cancer and polyps, other cancers of the digestive tract, cancers related to hormones and pancreatic cancer has been associated with the regular consumption of wholegrain cereals and derived products.

The regular intake of wholegrain cereals can contribute to reduction of risk factors related to non-communicable chronic diseases.

The main purpose of the study was to investigate the feasibility of using workplaces to increase the fruit consumption of participants by increasing fruit availability and accessibility by a minimal fruit programme. Furthermore, it was investigated whether a potential increase in fruit intake would affect vegetable, total energy and nutrient intake.

A 5-month, controlled, workplace study where workplaces were divided into an intervention group (IG) and a control group (CG). At least one piece of free fruit was available per person per day in the IG. Total fruit and dietary intake was assessed, using two 24 h dietary recalls at baseline and at endpoint.

Eight Danish workplaces were enrolled in the study. Five workplaces were in the IG and three were in the CG.

One hundred and twenty-four (IG, n 68; CG, n 56) healthy, mainly normal-weight participants were recruited.

Mean daily fruit intake increased significantly from baseline to endpoint only in the IG by 112(se 35) g. In the IG, mean daily intake of added sugar decreased significantly by 10·7(se 4·4) g, whereas mean daily intake of dietary fibre increased significantly by 3·0(se 1·1) g. Vegetable, total energy and macronutrient intake remained unchanged through the intervention period for both groups.

The present study showed that it is feasible to increase the average fruit intake at workplaces by simply increasing fruit availability and accessibility. Increased fruit intake possibly substituted intake of foods containing added sugar. In this study population the increased fruit intake did not affect total energy intake.

To demonstrate test–retest reliability (reproducibility) of a new self-administered lifetime diet questionnaire, with a focus on foods relevant to cognitive health in older age.

The reproducibility of dietary recall over four or five life periods was assessed by administering the questionnaire at two time points to an older cohort. The period between questionnaire administrations was 7 weeks. Polychoric correlations measured the association between recall at time 1 and time 2 and the weighted κ statistic measured the level of recall agreement for food groups across the two administrations of the questionnaire.

Adelaide, South Australia.

Fifty-two cognitively healthy, older-age, community-dwelling adults completed the Lifetime Diet Questionnaire; mean age 81·8 (sd 4·4) years, range 70–90 years.

The questionnaire showed very good reproducibility in this sample with a mean polychoric correlation coefficient of 0·81 between administration at time 1 and time 2, and an average weighted κ of 0·49 for the level of recall agreement between food groups.

The demonstrated reliability of this lifetime diet questionnaire makes it a useful tool to assess potential relationships between long-term dietary intake and later-age cognitive outcomes.

To evaluate adolescents’ abilities to identify foods and estimate the portion size of foods consumed in order to inform development of the mobile telephone food record (mpFR).

Data were collected from two samples of adolescents (11–18 years). Adolescents in sample 1 participated in one lunch (n 63) and fifty-five of the sixty-three adolescents (87 %) returned for breakfast the next morning. Sample 2 volunteers received all meals and snacks for a 24 h period. At mealtime, sample 1 participants were asked to write down the names of the foods. Sample 2 participants identified foods in an image of their meal 10–14 h postprandial. Adolescents in sample 2 also estimated portion sizes of their breakfast foods and snacks.

Sample 1 identified thirty of the thirty-eight food items correctly, and of the misidentified foods all were identified within the correct major food group. For sample 2, eleven of the thirteen food items were identified correctly 100 % of the time. Half of the breakfast and snack foods had at least one portion size estimate within 10 % of the true amount using a variety of measurement descriptors.

The results provide evidence that adolescents can correctly identify familiar foods and they can look at an image of their meal and identify the foods in the image up to 14·5 h postprandial. The results of the present study not only inform the development of the mpFR but also provide strong evidence of the use of digital images of eating occasions in research and clinical settings.

To assess the national prevalence of short stature, underweight, overweight and obesity in 6-year-old Iranian children before school entry.

Cross-sectional nationwide survey.

Mandatory national screening programme before entrance to elementary school in 2008 in Iran.

All Iranian children entering public and private elementary schools.

The study population comprised 862 433 children (48·4 % girls, 77·2 % urban resident). Overall, 6·5 % of children had short stature, 19·1 % were underweight, 12·8 % were overweight and 3·4 % were obese. There was no significant difference in terms of gender, but considerably larger differences were documented among various provinces.

The double burden of nutritional disorders among young children warrants a multi-faceted national policy with evidence-based local programmes. Such planning needs a comprehensive surveillance system and centralized data registry for children’s growth.

The prevalence of overweight and obesity is increasing in most countries, including Germany. The idea of estimating the population-wide energy gap that is likely responsible for the epidemic has recently been introduced and discussed.

Using published estimates of body weight from population-based data of national health surveys (1985–2002), the energy gap was calculated by estimating the distribution of the rate of weight gain within the German population (25–69 years of age) and the amount of excess energy storage that is responsible for this population-wide pattern of weight gain.

Germany.

A representative sample of 26 614 participants (12 984 men, 13 630 women).

The average annual weight gain was 0·22 kg for men and 0·32 kg for women over the 17-year period. An estimated 90 % of the population gained < 0·54 kg/year. Assuming that each kilogram of weight gained represents 32238 kJ (7700 kcal), the estimated energy accumulation was 19 kJ (4·64 kcal)/d in men and 28 kJ (6·75 kcal)/d in women aged 25–69 years. The distribution of estimated energy accumulation for 90 % of the German population was < 50 kJ (12 kcal)/d.

With an assumed energy efficiency of 50 %, the findings suggest that weight gain could be prevented in 90 % of the German population with < 100 kJ (24 kcal) reduction in energy intake or increase in energy expenditure per day. Theoretically, further weight gain might be prevented using a small-changes approach that emphasizes the importance of making small changes in physical activity and food intake.