title: Discretionary calorie intake a priority for obesity prevention: results of rapid participatory approaches in low-income US communities.
abstract: BACKGROUND
  Since resources are limited, selecting the most promising targets for obesity interventions is critical. We examined the relative associations of physical activity, fruit and vegetable consumption and 'junk food' consumption with BMI and the prevalence of relevant policies in school, work, food outlets and health-care settings.
  
  
  METHODS
  We conducted intercept surveys in three low-income, high-minority California communities to assess fruit, vegetable, candy, cookie, salty snacks and sugar-sweetened beverage consumption and self-reported height, weight and physical activity. We also assessed relevant policies in selected worksites, schools and health-care settings through key informant interviews.
  
  
  RESULTS
  Data were collected from 1826 respondents, 21 schools, 40 worksites, 14 health-care settings and 29 food outlets. The average intake of salty snacks, candy, cookies and sugar-sweetened beverages was estimated at 2226 kJ (532 kcal) daily, 88% higher than the US Department of Agriculture/Department of Health and Human Services guidelines recommend. Energy from these sources was more strongly related to BMI than reported physical activity, fruit or vegetable consumption. Policies to promote healthy eating and physical activity were limited in worksites. Fruits and vegetables were less salient than junk food in community food outlets.
  
  
  CONCLUSIONS
  Targeting consumption of salty snacks, candy cookies and sugar-sweetened beverages appeared more promising than alternative approaches.
authors.affiliation: RAND Corporation, Santa Monica, Santa Monica, CA 90407, USA. dcohen@rand.org
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Cohen
authors.forename: Roland
authors.initials: R
authors.lastname: Sturm
authors.forename: Marielena
authors.initials: M
authors.lastname: Lara
authors.forename: Marylou
authors.initials: M
authors.lastname: Gilbert
authors.forename: Scott
authors.initials: S
authors.lastname: Gee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002140:California; D002149:Energy Intake; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000517:prevention & control*; D011203:Poverty; D014481:United States; D055815:Young Adult