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One third of American adults are overweight. That disturbing bit of data from phase 1 of the third National Health and Nutrition Examination Survey (NHANES III) quickly grabbed headlines in both the medical and popular media. The unsettling news that some 58 million US adults are overweight was widely reported in medical journals, health newsletters, government reports, and even a cover story in Time.

NHANES III, the most recent of four national cross-sectional surveys conducted by the National Center for Health Statistics, reports anthropometric data for 8,260 adults aged 20 years or older that were collected from 1988 to 1991 (1). The NHANES III analyses defined "overweight" as a body mass index value >= 27.8 for men and >= 27.3 women, which represents approximately 124% of desirable body weight for men and 120% of desirable body weight for women.

Data from NHANES III document a dramatic increase of about 3.6 kg in the mean body weight of US adults during the decade since NHANES II was conducted in 1976 to 1980. This alarming weight gain was found in both genders and across all age and cultural groups. Between the 1988-1991 and 1976-1980 surveys, the percentage of adults considered to be overweight jumped from 25.4% to 33.4%. By comparison, during the 20 years covered by the first three national surveys, the percentage of overweight adults rose only 1%. Given this trend, it seems apparent that the goal set by the Healthy People 2000 objectives -- reducing the percentage of overweight US adults to 20% by the end of the century -- will not be met. The challenge to all of us concerned about diet and health issues is to determine why this pervasive, and relatively sudden, increase in body weight occurred and how it might be reversed.

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