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Every expectant mom knows that sleep will be catch-as-catch-can after her baby is born. But sleepless nights plague women throughout pregnancy, too.

A National Sleep Foundation poll found that over three-quarters of women slept worse during pregnancy than they did when they weren't pregnant. What's more, new moms and pregnant women were more likely to suffer insomnia than any other group of women.

The reason: Pregnancy is uncomfortable. The discomforts that come with having a baby growing inside you don't go away when you turn out the light.

If you're accustomed to sleeping on your stomach or on your back, you must adjust to sleeping on your side. It will be physically impossible to lie on your stomach when you are heavy with child, and doctors warn against sprawling flat on your back. "There's some concern about that in the latter part of pregnancy," says Richard Henderson, MD, an obstetrician/gynecologist at St. Francis Hospital in Wilmington, Del. When you lie on your back, the weight of the pregnant uterus slows the return of blood to your heart, which reduces blood flow to the fetus. That means the baby is getting less oxygen and fewer nutrients.

Henderson says occasionally lying supine will not harm a developing fetus, but sleeping that way every night might. Nevertheless, you'll probably find that it's easier to sleep on your side as your tummy grows and grows.

Conventional wisdom holds that it's better to sleep on your left side than on your right. "For many, many years, the left side has been the preferred side," says Anne Santa-Donato, RN, spokeswoman for the Association of Women's Health, Obstetric, and Neonatal Nurses. "It became a habit" to tell women that. But she says it really does not matter which side you sleep on: "It's what the science has borne out over the years."

Placing a pillow between your legs or sleeping with a body-length pillow can make you more comfortable. Some women may prefer to give up the bed entirely, and instead sleep in a reclining chair. "That's perfectly acceptable," Santa-Donato says.

Minor Annoyances

A bulging tummy isn't the only thing that gets in the way of a good night's sleep. Heartburn is a common problem during pregnancy. Henderson says hormonal changes relax the muscle between the esophagus and the stomach, allowing stomach acid to burble up, causing acid reflux or heartburn. "Treat it as it occurs," he says. Take an over-the-counter antacid, and prop up your head with pillows to keep the stomach acid down.

"In some instances, heartburn is simply heartburn," Santa-Donato says. But it can also be a sign of other, more serious health problems, so you should mention it at your next checkup.

The need to urinate frequently -- because the uterus presses on the bladder -- may also keep you up during the night. This may be less of a problem if you simply limit what you drink before bed.

Some women say their dreams become more vivid and intense when they are pregnant, which further disturbs sleep. Carolyn D'Ambrosio, MD, director of the Center for Sleep Medicine at Boston's Tufts University, says she has heard of this, but she doesn't know of any scientific studies that have shown why, or how common it is. "I'm not sure that's absolutely established," she says.

Oh, boy. Here it comes again. The usual time of the year when you say you are going to trim down on both the junk food and where it ends up on the waistline.

The idea is as important as ever. But with America rediscovering the importance of family life, why not get everyone at home involved in the New Year's resolutions together? As the new year begins, try a new tactic to improve eating habits and the amount of time you spend with the family.

Now you don't have to turn into the Cleaver's. That's pretty unrealistic and just leads you down the dead-end street of abandoned resolutions anyway. Be practical and see what you can accomplish.

Think you can pick up a cookbook of easy low-fat meals and find a few you like?

Can you work more salad and veggies into the meals you already serve?

It's those simple changes that you make, implementing them one at a time, that have the best chance of catching on and becoming habit -- just like the number of times you'll be able to sit down and have a meal with all those other people living under your roof but on different schedules.

Pick a night -- at first, it may be weeks from now, if need be -- where everyone can plan to be home for dinner. Then see how many more nights each month it can realistically happen.

If getting everyone home for dinner during the week would require an administrative assistant to schedule and a psychiatrist to help you handle the stress, then maybe you can be a bit sneaky.

Remember the goal is to eat more healthy stuff and spend time together. What about scheduling a few family dinners on the weekends? That may be the best crack you get at everyone at home -- and you may even be cutting down on the weekend trips to the burger joint. That certainly means healthier eating and actually sticking with a New Year's resolution. And experts say you may get a few bonuses, too -- especially when it comes to parenting.

Breaking Bread Together Means Eating Better

Researchers will tell you that it is a healthy thing to eat together, especially if you can win more control over dinnertime. Children who eat frequently with their families, for example, and actually sit down together at the family dinner table have healthier diets than those who don't, according to a report by Matthew Gillman, MD, professor of ambulatory care and prevention at Harvard Medical School in Boston.

His study, published in Archives of Family Medicine, looked at nutritional habits of 16,000 U.S. boys and girls between the ages of 9 and 14.

Kids eating with their parents were eating less fast food, less soda, and consuming more fruits and vegetables, Gillman tells WebMD. Those kids, therefore, had a lower intake of saturated fats, which clog arteries, and carbohydrates, which raise blood sugar and are linked with diabetes and hardening of the arteries, he says.

And these early dietary habits affect teens' future cardiovascular health, according to another study presented at a meeting of heart specialists. That study showed that the more high-fat junk food teenagers ate, the worse their arteries looked -- and the more at risk they were for heart disease.

"What kids eat in childhood and adolescence does establish their dietary patterns over the longer term," says Gillman. "This means we have to set good, healthful patterns earlier in life."

Nov. 6, 2006 -- Reading picture books to 18- to 30-month-old toddlers helps them learn things about the real world, psychologists find.

One of the hardest tasks a child must learn is how to relate symbols to the real world. It's not clear to scientists exactly how early in life this process begins.

But it seems perfectly clear to parents. By the time their children are a year old, most parents spend a lot of time reading to them from picture books.

And they are doing a good thing, find psychologists Gabrielle Simcock, PhD, of the University of Queensland, Australia, and Judy DeLoache, PhD, of the University of Virginia.

"This common form of interaction, that takes place very early in children's lives, may provide an important source of information about the world around them," Simcock and DeLoache report.

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Learning New Information

Simcock and DeLoache tested 108 little boys and girls: 18-month-olds, 24-month-olds, and 30-month-olds. Kids of each age were divided into three groups. One group was read to from a book with photographs, the second group was read to from a book with color drawings of the photographs, and a third group wasn't read to at all.

The pictures showed a child going through the three steps of building a simple rattle -- putting a ball in a jar, attaching a stick to the jar, and shaking the assembled toy to make it rattle. The pictures came with simple text explaining the actions.

A researcher read the story to each child while pointing to the pictures. Then the child was given the ball, jar, and stick and encouraged to build a rattle.

None of the 18-month-olds, four of the 24-month-olds, and six of the 30-month olds actually finished building the rattle. But many of them got it at least partly right -- and nearly all of them were kids who'd been read to.

"Toddlers are capable of learning new information from picture-book-reading interactions like those frequently engaged in by parents and toddlers," Simcock and DeLoache conclude.

Older kids did best, of course. And all age groups did better after seeing the photographs than after seeing the drawings. This was particularly true for the youngest kids.

"The lower the level of physical similarity between symbol and [real object], the more difficult it is for very young children to exploit the relation between them," Simcock and DeLoache report. "The nature of the pictures in children's books can play a crucial role in learning from them."

The study appears in the November issue of Developmental Psychology.

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May 4, 2006 -- New research shows that "baby fat" isn't just for tots.

Preteens who are carrying extra pounds tend to stay overweight or obese as teens, experts report in BMJ Online First.

Jane Wardle, PhD, and colleagues didn't actually study babies. Instead, they studied more than 5,800 kids from London schools over five years.

The study started in 1999, when the kids were 11-12 years old.

The students' weight, height, and abdominal girth (waist circumference) were measured every year. All measurements weren't available for every child every year, but the data were plentiful enough to show whether kids gained or lost weight as they matured.

The short answer: "Children who are obese when they enter secondary school will very likely leave it obese," write Wardle and colleagues. Wardle is a clinical psychology professor at University College London.

Weight Problems Were Common

Obesity is three times more common in the U.K. and U.S. than it was 20 years ago, Wardle's team notes.

Obese adolescents often become obese adults, the researchers add. Of course, there are exceptions to that pattern. Weight isn't written in stone; a person's future may be different from his past.

At the study's start, nearly a quarter of the students -- who were still preteens -- were overweight or obese. Specifically, between 17% and 19% were overweight; another 6% or 7% were obese.

Girls -- especially black girls -- and kids from low-income families were more likely to be overweight or obese, the study shows.

Extra Pounds Often Stayed Put

Over the years, the researchers found "no change in the rates of overweight and obese combined" and "no reduction in the proportion classed as 'healthy weight.'"

"The number of students who moved from overweight/obese to normal weight (7.6%) was very similar to the number who moved from normal weight to overweight/obese (7.0%)," write Wardle and colleagues.

If extra fat "is present in early adolescence (taken here as age 11), it is highly likely to persist," the researchers write. In other words, preteens' "baby fat" (which the British researchers call "puppy fat") tended to last into the teen years.

Bucking the Trend

Many kids have weight problems. But they're still kids, and they're not done growing. Some children may also be sensitive to weight issues or eating disorders.

Here are some tips to help kids reach a healthy weight:

• See a doctor. Get expert advice to make sure kids' special dietary needs are met. Encourage activity.
• Limit portion sizes. For instance, order a medium or small size when eating out.
• Eat at home more often. It's easier to control portions (and ingredients) when you're dishing out the food.
• Don't single children out. Instead, make healthy eating and activity a family project.

Curious about how U.S. kids rate for excess weight? The CDC recently reported these statistics for U.S. kids, as of 2003-2004:

• Among kids 2-5 years old, 12% are at risk of being overweight (in the 85th weight percentile for their sex and age) and 14% are already overweight (in the 95th percentile).
• Among kids 6-11 years old, 18% are at risk of being overweight and 19% are overweight.
• Among kids 12-19 years old, 17% are at risk of being overweight and 17% are overweight.

Oct. 19, 2005 -- Want kids to exercise more? You may want to use their fondness for TV to encourage them.

That strategy worked in a small study presented at the North American Association for the Study of Obesity's annual scientific meeting, held in Vancouver, Canada.

TV viewing has been linked to childhood obesity, note the researchers. They included Gary Goldfield, PhD, of Children's Hospital of Eastern Ontario in Canada.

Goldfield's team struck a bargain with kids about TV time and physical activity. All they needed were pedometers -- little devices that count steps taken and distance walked or run. By the way, pedometers aren't just for kids. In April, other researchers showed that pedometers can be good motivators for adults who don't like to exercise.

Walk to View

Goldfield's study included 29 obese children aged 8-12. For eight weeks, all of the kids wore pedometers.

Fourteen kids were told that they would earn an hour of TV-viewing time for every 400 counts on their pedometers. The other kids didn't get TV time as a reward for walking.

The results:

• Overall physical activity rose 69% in the TV group, compared with 16% in the other group.
• Moderate-to-vigorous physical activity rose 35% in the TV group and dropped 6% in the other group.

A trend toward better BMI (body mass index) was also seen in the TV group, the study shows.

Tube Time Dropped

TV time dropped for both groups. The drop was bigger in those who had to earn TV-viewing time, but not by much (34% vs. 24%).

The study was short and small. Still, the researchers say TV may be effective at motivating kids to be active.

June 17, 2005 - Serve your preschoolers supersized food portions and you'll likely wind up with supersized kids.

A new study shows that, unlike some calorie-conscious adults, children don't eat less at dinner if they eat a big lunch and are more likely to eat whatever portion size is put on their plate.

Researchers say those findings suggest that parents and caregivers may bear a greater responsibility for controlling children's weight and preventing childhood obesity than some realize.

"We found that the more food children are served, the more they eat, regardless of what they've eaten previously in the day, including how big their breakfast was," says researcher David Levitsky, professor of nutritional sciences at Cornell University, in a news release. "We also found that the more snacks children are offered, the greater their total daily food and calorie intake."

Portion Size Matters to Kids' Weight

In the study, which appears in the June issue of Appetite, researchers monitored how much 16 preschool children, aged 4-6, ate for about a week in day care centers and had their parents keep food diaries of what they ate at home in the evenings and on weekends.

The results showed that how much food was served to the children had the biggest impact on how much they ate in a meal or snack, regardless of the calorie or fat content of that meal or other meals eaten within the previous 24 hours.

The study also showed that children who were offered snacks between meals did not eat less at subsequent meals.

Researchers say these findings conflict with earlier studies that suggested that children may be better than adults at regulating their food intake. But they say those studies were done under laboratory conditions and may not represent how children eat under real-life conditions.

"We found that portion size is, by far, the most important factor in predicting how much a child will eat," says Levitsky. "These findings suggest that both the onus of controlling children's weight -- both in causing overweight in children as well as in its prevention -- must rest squarely in the hands of parents and other caregivers."

Feb. 17, 2005 -- It's a basic principle of driving safety: Take care when you back up. But it's time for a reminder -- and new solutions, says the CDC.

The CDC has issued its latest count of nonfatal motor vehicle injuries involving children aged 1-14 years. During 2001-2003, an estimated 7,475 children went to hospital emergency rooms for those injuries, says the CDC in its Morbidity and Mortality Weekly Report. That's nearly 2,500 cases per year.

The numbers are based on 168 back-over injuries. CDC researchers used census data to project national figures.

The accidents happened when the children were hit or rolled over by a motor vehicle moving in reverse. Thankfully, most kids (78%) were treated and released from the emergency departments with minor injuries.

Greatest Danger for Youngest Kids

Little kids are harder for drivers to see and can dart behind cars without realizing the danger, compared with older children. Preventive measures can be taken to reduce these risks, says the CDC.

Overall, most children had minor cuts and scrapes (56%). Those were more common for older children, rising from nearly half of injured children aged 1-4 to about 63% of those aged 10-14.

Four in 10 had more serious injuries, such as fractures or internal injuries. Fewer older children had those problems (17% of those aged 10-14 yet and 40% of those aged 1-4).

More than half of back-over injuries affected the arms and legs (54%), while 28% were on the head, face, or neck.

Child Pedestrians at Higher Risk

Most of the hurt children (86%) were on foot. Young pedestrians sustained back-over injuries six times as often as those on bicycles or tricycles.

About six in 10 back-over accidents happened at home (47%) or on public property (32%). At least 40% of the accidents occurred in driveways or parking lots, says the CDC.

Safety Tips

To help protect kids from back-over injuries, the CDC offers this advice:

• Adults should supervise kids around motor vehicles. That includes children playing near parked cars.
• Drivers should look carefully for children before and while backing up.
• Park in garages or driveways and keep the keys out of children's reach.

It's also possible to make cars and driveways safer, says the CDC. Options include:

• Fencing off driveways
• Changing straight driveways to a curved path, eliminating the need to back up
• Fencing off play areas away from driveways and streets
• Updating cars with new technology. Back-up warning alarms, sensing devices, and cameras can alert drivers to out-of-sight objects such as small children, says the CDC.

Oct. 21, 2004 -- Whooping cough is still alive and well contrary to what most parents think.

Betty May Graham first thought her 14-year-old son, Zach, had a bad cold or the flu when his coughing began two autumns ago. Within a few weeks, though, the coughing fits became so violent that he would frequently vomit after having one.

"One morning he was coughing so hard he was having trouble breathing. That is when I got really scared," she tells WebMD.

When a pulmonary specialist diagnosed whooping cough, known medically as pertussis, Graham says she was shocked.

"He had had all of his shots as a baby, and I just assumed that he was protected," she says.

Whooping Cough Outbreaks Increasing

Graham is not alone. A newly published survey shows that fewer than one in five parents of teens questioned considered whooping cough an illness of concern, despite the fact that outbreaks in middle and high schools have increased in recent years.

"Parents tend to think that if their kids have been vaccinated they don't have to worry, and while that is true for younger children, it isn't true for teens and young adults," adolescent medicine specialist Amy Middleman, MD, of Baylor College of Medicine in Houston, tells WebMD.

The current pertussis immunization schedule calls for five doses of vaccine to be given by age 6, and protection typically lasts between five and 10 years after the last dose of vaccine is given. The decreased immune protection as the vaccine wears off leaves many teens unprotected against the illness.

In the survey, conducted by the Society for Adolescent Medicine, just 15% of parents questioned could accurately identify the duration of protection for whooping cough.

Despite increasing vaccination of infants and young children, the diagnosis of whooping cough has nearly tripled over the last two decades. This is partly due to better ways of identifying the disease, but it is also due to a real increase among adolescents and young adults, experts say. Almost 40% of whooping cough cases reported in 2003 occurred in children between the ages of 10 and 19, according to figures from the U.S. Centers for Disease Control and Prevention. In 2003 there were 11,000 cases of whooping cough reported to the CDC, the highest reported in nearly 40 years. One thousand cases of whooping cough were reported in 1976.

Booster Vaccine

The U.S. Food and Drug Administration is now considering a proposal to add pertussis to booster vaccines now given to 11- and 12-year-olds. Pediatric infectious disease specialist Sarah Long, MD, says the move could be an important step toward protecting teens and highly vulnerable infants who have not yet been fully vaccinated.

"We are looking at the data right now to get a better understanding of the safety and efficacy of doing this," says Long, who is a spokeswoman for the American Academy of Pediatrics.

While whooping cough is rarely life threatening in teens and young adults, spasmodic coughing fits often last for months and can dramatically impact daily life. Outbreaks occur rapidly as a result of being exposed to an infected person.

Zach Graham, who lives in New Hampshire and is a competitive downhill skier, says it took him almost five months to feel normal again after his bout with whooping cough. Early on, his mom says, he had coughing fits that led to vomiting as many as 18 times a day. And even after the racking coughing subsided, lingering weakness caused him to miss much of the ski season.

"My goal was to be on the Junior Olympic team," says Zach, who is now 16. "My coaches and I agreed that I could do it if I set my mind to it, but then I came down with whooping cough. It took so much out of me that there was no way I could train at the level I needed to."

Aug. 5, 2004 -- The number of new mothers who start breastfeeding their infants and stick with it for six months or more varies widely from state to state in the U.S., according to a new CDC report.

The study shows the national average for exclusive breastfeeding for six months in 2003 was 14.2%, and only Oregon had an exclusive-breastfeeding rate of more than 25% at six months.

It's the first time the CDC has released state-by-state data on breastfeeding rates.

The American Academy of Pediatrics recommends that babies be breastfed exclusively -- with no baby formula -- for the first six months of life. To see how your state fared on this recommendation, see the table below.

¹ Exclusive breastfeeding is defined in this study as only breastmilk and water - no solids or other liquids.

Source: 2003 National Immunization Survey, Centers for Disease Control and Prevention, Department of Health and Human Services

"With this new information, state health departments can compare the breastfeeding rates in their states and communities with national objectives," says Donna Stroup, PhD, acting director of the CDC's Coordinating Center for Health Promotion, in a news release. "The information will help agencies concentrate their efforts where they are most needed and develop targeted programs to promote breastfeeding."

Breastfeeding by State

The information in the report was gathered from the CDC's 2003 National Immunization Survey which surveyed mothers in 50 states, the District of Columbia, and selected geographic regions within the states.

According to the survey, only six states -- Hawaii, Idaho, Oregon, Utah, Vermont, and Washington -- met all of the following Healthy People 2010 objectives for breastfeeding:

• 75% of new mothers initiate breastfeeding.
• 50% continued to breastfeed for at least six months.
• 25% continued to breastfeed for at least 12 months.

Fourteen states met the first objective of having at least 75% of new mothers initiate breastfeeding. The top five states in this category were Oregon (88%), Washington (88%), Utah (85.5%), Idaho (83.8%), and California (83.7%).

Eight states met the second goal of having 25% or more of mothers continuing to breastfeed for at least 12 months. The top states in this category were Hawaii (31%), Vermont (30%), and Alaska (28.9%).

Researchers also found that lower-income mothers and non-Hispanic black mothers had consistently lower rates of breastfeeding compared with others.

Breastfeeding Benefits Mother and Baby

"It's important for new and expectant mothers to know that breast milk is the ideal food for newborns and young babies. It's inexpensive, convenient, and it's uniquely tailored to meet all of a baby's nutritional needs for the first six months of life," says William Dietz, MD, director of CDC's division of nutrition and physical activity, in the release. "Also, breastfed babies tend to gain less unnecessary weight that can contribute to overweight and obesity later in life."

Researchers say breast milk contains valuable antibodies that can protect infants from infection. Babies who are breastfed also have less frequent diarrhea and fewer ear infections and respiratory infections.

Mothers who breastfeed also burn more calories, which makes it easier for them to return to their pre-pregnancy weight. Research also shows women who breastfeed have lower rates of certain breast and ovarian cancers.

May 11, 2004 -- Thanks to the pneumonia vaccine, fewer young children are developing pneumonia. But black children still have the highest risk.

The pneumonia immunization program, initiated by the CDC four years ago, is one of very few vaccine programs given priority status for certain minority groups -- specifically, black children, writes Brendon Flannery, PhD, with the CDC's National Center for Infectious Diseases. His report appears in this week's Journal of the American Medical Association.

In his report, Flannery outlines the progress made thus far. While fewer black children now develop pneumonia, there still remains a big disparity among ethnic groups.

Black Children Still at High Risk

Flannery provides data on pneumonia cases in seven metropolitan areas/regions: San Francisco; the state of Connecticut; the Atlanta metropolitan area; the Baltimore, Md., metropolitan area; Minneapolis and St. Paul, Minn.; Rochester, N.Y.; and Portland, Ore.

Among 14,025 children included in the 2002 survey, 62% were white, 35% were black, 3% were Asian/ Pacific Islander or American Indian/Alaska Native; and 4% were Hispanic.

Comparing 1998 (prevaccine era) statistics with 2002 statistics, Flannery found dramatic decreases in annual rates of pneumonia.

In whites the annual rates of pneumonia cases fell from 19 cases per 100,000 white people to almost 12 cases for every 100,000 white persons.

During that same time period, the study showed that for the black American population the annual rate of pneumonia also fell, from 54.9 cases per 100,000 to 26.5 cases per 100,000.

Based on this information the researchers showed that in 2002:

• There were 14,730 fewer pneumonia cases among white children compared with 8,789 fewer pneumonia cases among black children.
• Compared with the prevaccine era, pneumonia rates were lower for whites in all age categories than for blacks, but the greatest reductions were in children younger than 2 years old.
• Among children younger than age 2, there were 77% fewer white and 89% fewer black cases of pneumonia in 2002.
• Among children aged 2 to 4 there were 51% fewer cases of pneumonia among whites and 66% fewer cases among blacks with pneumonia.

By 2002, more children were getting vaccines:

• 74% of white children and 68% of black children (aged 19 to 35 months) in these states had received at least one dose of the pneumococcal vaccine shot.
• 43% of white and 39% of black children younger than age 3 had received three or more doses.

The pneumonia vaccine "is clearly an important tool for reducing this excess risk," writes Flannery.

SOURCE: Flannery, B. Journal of the American Medical Association (JAMA), May 12, 2004; vol 291: pg 2197-2203.

Feb. 4, 2004 -- Kids with cerebral palsy greatly improve after undergoing an intensive training technique, research shows.

The treatment was developed for adult stroke patients who lose the use of one side of the body. Like stroke patients, kids with cerebral palsy often have paralysis or poor function on one side.

At the start of therapy, a cast is used to immobilize the child's good arm. The child then undergoes intensive training: six hours a day for 21 consecutive days.

Edward Taub, PhD, of the University of Alabama, Birmingham, and colleagues tested the treatment on nine kids with cerebral palsy. Another nine kids underwent standard physical therapy. The children ranged in age from 7 months to 8 years. The findings appear in the February issue of Pediatrics.

"The intervention produced a large improvement in the use of the more-affected extremity," Taub and colleagues report. "The children exhibited [an average of] 9.3 new motor behaviors and patterns of functional behavior that had not been observed before the relatively brief three-week therapy period. [These gains] were sustained over a six-month follow-up period, with parental reports of important developmental and social-emotional benefits for the children."

Hidden behind this medical jargon are moving stories of incredible improvement among kids getting the new treatment for cerebral palsy:

• Several of the children began crawling for the first time.
• One child who seemed totally unaware of his weak arm began using the arm to make controlled, coordinated movements. He was able to crawl "commando" style, and to push himself up on his arms.
• Two children began to sit independently.
• A 4-year-old boy who had never used his weak arm began to play ball. Within six months he was able to go fishing with his father and, using a special glove, to play Little League baseball.
• Many parents reported that their children had increased social skills.

Taub and colleagues believe the main factor behind the treatment's success is the "concentrated, extended nature of the training." They strongly suggest that health care payers support more intensive treatment for children with cerebral palsy.

SOURCE: Taub, E. Pediatrics, February 2004; vol 113: pp 305-312.

Parenting is no walk in the park, especially on the days when your little angel, whether he's 6 or 16, decides to act like a demon.

If it's the temper tantrum in the toy store over the latest video game, or the daily fight over math homework, or the food fight in a restaurant on Friday night, parents have a choice: To react in a way that will only make matters worse when the bell rings for round two, or respond like the calm, cool, and collected parents we see on TV shows like Nanny 911 -- after weeks of live-in, televised therapy.

What is the secret to their success, other than public humiliation?

"Overall, with any scenario, the worst thing a parent can do that helps bratty behavior blossom is to not set clear expectations and not have consequences to a child's behavior," says Jenn Berman, PhD, a psychologist in private practice in Beverly Hills who specializes in family therapy.

Experts offer advice on the top 10 parenting pitfalls that will help you raise a well-behaved child -- instead of a brat.

The TV Toy

It's Saturday morning, you're doing laundry, the kids are watching their morning cartoons, and it happens: Your middle child sees the toy of his dreams on TV, starts in with the begging, and doesn't let up.

Brat-building response: "A lot of kids see things on TV -- games, food, or dolls -- and then they start nagging until they get it," says Berman. "If you run to the store to buy your child exactly what they want, then you've taught them that nagging is an effective tool for getting their way."

Angel-building response: "You can say, 'It's a cool toy. Let me find out how much it is, and I can help you save your allowance for it,'" says Berman. "You are teaching your child to work toward a goal --instead of giving in. It helps the child learn about goals, saving money, and it's a good response for both parent and child."

The Bribes

You're having your boss over for dinner on Friday night, and while you begged your sister to watch the kids for the evening, no such luck. Is it time to start bribing them to be quiet with expensive sneakers or the latest handbag from Dolce & Gabbana?

Brat-building response: "Parents often try to buy good behavior by getting their kids expensive gifts," says Berman. "And then they say, 'I don't understand why she isn't better behaved? I get her everything she wants!'" These cool gifts lose their meaning and the child feels entitled and less well behaved."

Angel-building response: "Allow the child the opportunity to earn what you give them, and set limits around their expectations," says Berman. "Tell them, 'You can get one pair of shoes within this amount of money.' Teach them early on how to make choices."

The Sleepover

Her bags are packed and she's ready to go to the sleepover, except for one thing: She forgot to ask for your permission.

Brat-building behavior: Even though she's screaming bloody murder, if you let her get away with it once, she'll do it again, and again and again. "You've taught your child that screaming long enough will get her what she wants, and now you've created your own private hell," Berman tells WebMD.

Angel-building behavior: "As a parent, it is always considerate and helpful to let a child know your thinking, so your child knows why you don't want her to go to the sleepover, so it doesn't seem like you are being unreasonable," says Berman. "But if you shared your reasoning, and she keeps yelling, you have to stand your ground."

Sept. 18, 2000 -- My daughter is 4 years old, and I knew it was time to worry. She's beautiful and trusting and weighs 30 pounds. Would she have any idea what to do if someone tried to overpower her? Would she muster the courage to scream and kick?

Those are the kinds of questions that haunt parents these days, and I knew it was high time to do something about my concerns. But where to start? Every day, it seemed, there were "teachable moments," yet so far I'd done no conscious teaching. What about all those personal safety tips that children should be drilled in -- "Don't talk to strangers" and the like? Instead, I was worried about what I might be teaching without thinking about it -- my polite exchanges, for instance, with the male stranger in the supermarket checkout and the panhandler on the street?

What messages was my daughter taking away from such encounters?

FBI statistics indicate that last year 2,100 juveniles were reported missing every single day -- that's 750,000 for the year. Of these, the National Center for Missing and Exploited Children listed more than 114,000 cases involving physical threats or harm and nearly 32,000 cases as involuntary kidnappings or abductions. Our children are at risk. And, like me, most parents worry endlessly but feel uncertain about what to teach our children and how to protect them without scaring them to death.

It's hard for parents, says Donna Chaiet, president and founder of Prepare and Impact Personal Safety, a national series of hands-on child safety programs, because they are so uncertain about their own ability to protect their children. "Parents aren't nervous about showing a child how to safely use scissors or cautiously cross the street, because we know how to do those things," she says. "But when it comes to child [personal] safety, we have enormous anxiety about how to do it right."

Rethinking Some of the Old Rules

Talking to people like Chaiet, I realized that I needed to relearn some things myself. A lot of what I was taught when I was young has since been reconsidered.

Take the old notion of "stranger danger." It turns out that of all children that are reported as kidnapped in the United States each year, fewer than 100 of them were the victims of someone they didn't know at all, according to Gavin de Becker, a leading expert on predicting violent behavior and the author of the best-selling book "Protecting the Gift." Besides, "stranger" isn't an easy concept for a young child to grasp. At what point in a conversation does someone cease being a stranger? What about that man in the grocery store line?

De Becker says that the real safety issue isn't strangers, but strangeness -- inappropriate behavior and a child's vulnerability to the process of being persuaded. Rather than concentrating on the distinction between stranger and friend, says the new thinking, we should educate our children about common lures and ploys; teach them to trust their own feelings when something isn't quite right; and reassure them that it's OK to say no to adults -- including those they may know well -- who do or say something that makes them feel uncomfortable or scared (see Your Children Can Help Protect Themselves).

Feb. 15, 2006 -- Calcium and Vitamin D supplements may help protect some older women's hips -- but only when taken regularly, a new study shows.

The study, published in The New England Journal of Medicine, followed more than 36,000 healthy, postmenopausal women for an average of seven years.

Women who were assigned to take calcium and vitamin D twice daily -- and did so -- were 29% less likely to fracture their hips than those who got fake supplements (placebo). Women not adhering to the daily vitamins had only a slightly lower risk of hip fractures compared with placebo.

However, calcium and vitamin D supplements didn't seem to cut the women's risk of other bone fractures, write the researchers. They included Rebecca Jackson, MD, of Ohio State University.

"This all really points to the ability of women at highest risk of osteoporosis to make their own informed choices about the supplements they take," Jackson says in a news release.

The study was part of the Women's Health Initiative, which has covered a wide range of women's health issues.

Bone Health Debate

A journal editorial takes a slightly different view.

"Unfortunately, although the trial was well conducted, the results ... leave many questions unanswered," writes editorialist Joel Finkelstein, MD, of Boston's Massachusetts General Hospital.

"It seems reasonable to recommend that women consume the recommended daily levels of calcium and vitamin D through diet, supplements, or both," Finkelstein writes. "But one message is clear: Calcium with vitamin D supplementation by itself is not enough to ensure optimal bone health."

"Calcium with vitamin D supplementation is akin to the ante for a poker game: It is where everyone starts," he continues. A woman at significant risk of fracture "probably needs something more."

Real Supplements vs. Fakes

The researchers gave half the women calcium and vitamin D supplements. The other half got fake supplements (placebo). The women didn't know which pills they'd gotten.

The women took one pill twice daily at meals. The real supplements each contained 500 milligrams of calcium and 200 international units of vitamin D.

Many women already had several factors in their bones' favor before the study started, Jackson's team notes.

For one thing, the women, even in the placebo group, were getting lots of calcium in their diets at the start of the study.

Also, more than half the women in both treatment groups were taking hormone replacement therapy, which can help bone strength. Plus, the women's average BMI was 29 (overweight but not obese). Larger people tend to have stronger bones than skinny people.

All of these factors may have weakened the findings of the study. While vitamin D and calcium supplements may help prevent bone fractures, the benefits were small.

Stronger Hips

During the study, 374 women fractured their hips. That's fewer fractures than the researchers expected, which may have made it harder to draw conclusions.

At the end of the study the results revealed that women taking the real supplements as directed were also those that were the least likely to have hip fractures.

The real supplements were also linked to a "small but significant" 1% increase in bone density, note Jackson and colleagues. Possibly, higher doses of vitamin D would have helped, the researchers note.

Kidney stones -- tiny chunks of minerals including calcium -- were 17% more common among women taking the real supplements, the study shows.

April 4, 2005 - Eating two cloves of garlic a day will keep your doctor away, animal studies show.

The finding has nothing to do with bad breath. It relates to a much more serious problem -- a potentially lethal form of high blood pressure in the lung's blood vessels called primary pulmonary hypertension. It's a major cause of fatal heart failure.

In primary pulmonary hypertension, blood has a hard time leaving the right side of the heart. The culprit: tight blood vessels in the lungs. Symptoms include: shortness of breath, especially during exercise; chest pain; and fainting episodes. The exact cause of primary pulmonary hypertension is unknown.

Garlic may be coming to the rescue, suggest David D. Ku, PhD, and colleagues at the University of Alabama, Birmingham.

Ku's team recently found that allicin -- a compound found in garlic -- prevents a mild form of pulmonary hypertension in rats. Now they find that the garlic compound prevents a much more severe form of pulmonary hypertension in rats.

Ku reported the findings in a presentation to Experimental Biology 2005, held April 2-6 in San Diego.

"These findings confirm our earlier reports and further demonstrate that garlic is also protective against the development of chronic pulmonary hypertension and that the preservation of [lung blood-vessel function] may represent an important mechanism," say researchers.

Human studies, of course, will be needed to see whether garlic keeps humans as healthy as it does lab rats. Meanwhile, it can't hurt to eat a little garlic every day, Ku says, in a news release. How much? He says the amount of allicin given the rats would, in human doses, come out to about two cloves of garlic a day.

Keep your salad luscious and low-fat

Ahh, salads. Cool, colorful, crispy, and super-healthy ... sometimes.

The truth is that not all salads are created equal, nutritionally speaking. There are basically two nutrition issues with salads:

• Are they packed with high-nutrition, low-calorie goodies?
• Are they loaded down with fatty, higher-calorie dressings?

Obviously, you want the answer to the first question to be a resounding "YES!" and the answer to the second to be "No way!"

Start building your better salad with darker-colored greens, like spinach, romaine lettuce, and chicory, which tend to have the biggest dose of important nutrients and phytochemicals. You can also tip the nutrition scales by adding other nutrient-rich fruits and veggies to your salad (kidney beans, carrots, broccoli, tomatoes, etc.).

Once you've put together a nutrient-rich salad, the trick is not to make it a high-fat one by adding fatty extras like croutons and cheese, or by drenching it with high-fat dressing. If you follow that rule, eating plenty of salads not only adds nutrition but helps to keep your diet - and you -- low in fat.

"The bottom line is that low-fat diets that are loaded with vegetables and fruits and other high-fiber, low-calorie foods may indeed help keep the pounds off," says Bonnie Liebman, MS, nutritionist for the Center for Science in the Public Interest.

Liebman puts regular salad dressing in the same category as other fat-filled "extras" like mayonnaise, cream cheese and butter. If you aren't convinced, consider these numbers:

• Just 2 tablespoons of Girard's regular Caesar dressing has 150 calories and 15 grams of fat.
• Just 2 tablespoons of Wishbone Chunky Blue Cheese has 160 calories and 17 grams of fat.
• Just 2 tablespoons of Hidden Valley Ranch contains has 140 calories and 14 grams of fat.

So what kind of dressing should you use? According to Jennifer Anderson, managing editor of the Allrecipes.com recipe website, there are two basic types of salad dressings: creamy and vinaigrette.

"The creamy style has a base of sour cream, mayonnaise, buttermilk, heavy cream, yogurt, or some combination of ingredients, while vinaigrettes have a base of oil and vinegar," says Anderson.

Although a variety of dressings is always welcome, oil-and-vinegar based dressings, for the most part, have the nutritional advantage. A study published in the American Journal of Clinical Nutrition in 2003 found that women who used oil-and-vinegar salad dressings frequently (at least five times a week) had a 50% lower risk of fatal coronary artery disease than those who rarely ate this type of dressing. This link persisted even after the researchers adjusted for heart disease risk factors and consumption of vegetables.

The good news is that whichever type of dressing you prefer, you can find good-tasting, lower-calorie versions in every supermarket. Here are six tasty, store-bought dressings we tested, all with 8 grams or less of fat per 2 tablespoons:

• Hidden Valley Ranch Light
• Ken's Steakhouse Lite Raspberry
• Wishbone Red Wine
• Wishbone Raspberry Hazelnut Vinaigrette
• Newman's Own Lighten Up! Light Balsamic Vinaigrette
• Newman's Own Lighten Up! Lowfat Sesame Ginger

But the list certainly doesn't end there. In the table below, you'll find dozens more bottled dressings that meet our "light" criteria of 8 grams or less of fat per serving, along with calorie counts (dressings with more sweeteners are higher in calories) and sodium tally (look for those with 300 mg or less). We've also listed the type of oil used to make the dressing. If you choose types with canola or olive oil, you'll be getting the healthier monounsaturated fat, and, in the case of canola oil, good-for-you omega-3 fatty acids as well.

Of course, choosing the right salad dressing is only half of the battle. It's just as important to pay attention to the amount of dressing you add. The serving size on the label of your salad dressing may say 2 tablespoons, but lots of people use twice that amount. (If you're eating out and order your dressing on the side, use the small spoon and measure about three spoonfuls over your salad. This will get you about 1 1/2 tablespoons of dressing.)

Don't you just love summer? All the watermelon and strawberries you can eat, plus farm-fresh corn on the cob and green beans. What's not to love?

This is the time of year when my crisper is chock-full of produce choices. This is the time of year when I venture out to my local farmer's market almost every Saturday with a $20 bill in my pocket, just waiting to see what the growers in my area have in store for me that week. Summer bliss!

In honor of summer, I've pulled together an assortment of quick and painless recipes that celebrate the fruit and vegetable bounty we're lucky enough to experience this time of year.

Lemon Poppy Seed Dressing

Journal as: 1 teaspoon oil OR 2 teaspoons light margarine/butter

This is a light summer dressing for any vegetable salad, or you can use it as a dip for raw summer vegetables.

1/4 cup light mayonnaise
1/4 cup fat-free sour cream
1/4 cup fat-free half-and-half or low-fat milk
2 tablespoons white sugar
2 tablespoons Splenda (or increase the sugar to 4 tablespoons and leave out the Splenda)
2 tablespoons distilled white vinegar
1 tablespoon poppy seeds
1 teaspoon finely chopped lemon peel

• Add light mayonnaise, fat-free sour cream, fat-free half-and-half, sugar and Splenda, vinegar, poppy seeds, and lemon peel to a small bowl and whisk together until smooth.
• Cover and keep in refrigerator until ready to serve.

Yield: One cup (8 servings)

Per 2-tablespoon serving: 55 calories, 1.5 g protein, 6.3 g carbohydrate, 3 g fat, 0.5 g saturated fat, 0.3 mg cholesterol, 0.1 g fiber, 70 mg sodium. Calories from fat: 47%.

Baked Asparagus with Balsamic Sauce

Journal as: 1 cup vegetables without added fat

1 bunch fresh asparagus, white ends trimmed off (the bunch should weigh about 1 pound)
Canola cooking spray
Salt and pepper to taste
1 tablespoon whipped butter
1 tablespoon light soy sauce
1 1/2 teaspoons balsamic vinegar

• Preheat oven to 400 degrees. Arrange asparagus spears in a 9 x 13-inch baking dish (or similar). Coat the top of asparagus with canola cooking spray, then season with salt and pepper to taste.
• Bake asparagus until tender (about 10 minutes depending on thickness of spears).
• Melt butter in a small, nonstick saucepan over medium heat, then remove pan from heat. Stir in the soy sauce and vinegar to make a sauce. Pour the sauce over the baked asparagus spears and serve.

Yield: 4 servings

Per serving: 47 calories, 3 g protein, 6 g carbohydrate, 2.2 g fat, 1.2 g saturated fat, 5 mg cholesterol, 2.5 g fiber, 148 mg sodium (not including salt to taste). Calories from fat: 35%.

Savory Sugar Snap Peas (or Green Beans)

Journal as: 1 cup vegetables without added fat

1/2 pound sugar snap peas or green beans (trim off the ends)
2 teaspoon olive oil
1 tablespoon chopped shallots
1/2 teaspoon Italian seasoning
Salt to taste (optional)

• Preheat oven to 450 degrees. Place snap peas in a single layer in a 9 x 9-inch square or round baking dish. Drizzle olive oil over the top of the snap peas and toss to coat the beans.
• Sprinkle the shallots, Italian seasoning and salt (if desired). Bake until tender but still firm (6-8 minutes).

Yield: 4 servings

Per serving: 48 calories, 1.5 g protein, 5.5 g carbohydrate, 2.3 g fat, 0.3 g saturated fat, 0 mg cholesterol, 2 g fiber, 2 mg sodium. Calories from fat: 42%.

June 7, 2005 -- Skipping exercise for a week or two may cramp your mood, says a study that turned regular exercisers into couch potatoes.

"We were able to measure negative results from withdrawal of exercise in just two weeks," says researcher Ali Berlin, MS, in a news release. Berlin works at the military's Uniformed Services University of the Health Sciences. She presented her findings in Nashville, Tenn., at the American College of Sports Medicine's annual meeting.

Stick to It

The take-home message: Once you start exercising, keep it up. That doesn't mean becoming a slave to the Stairmaster or a fanatic about any particular workout. Adjustments may be necessary from time to time.

For example, "if someone is a regular jogger or bicyclist and find they cannot do the activity for a short time, they need to do something else like walking until they can resume their preferred activity," says Berlin.

Forced to Take a Break

Berlin's study included 40 regular exercisers. "We were not looking at elite athletes; the study participants were people who are regularly active at a moderate level," says Berlin.

First, the participants took mood and fitness tests. Next, half were forbidden from exercising for two weeks. The others were told to follow their normal fitness routine.

The tests were repeated one and two weeks later. The results showed that the forced exercise "vacation" didn't recharge anyone's batteries. Instead, it left the former exercisers feeling worse than before.

It's one of those strange-but-true health facts: The more active you are, the more energy you have. That is, as long as you're not ill or engaging in ridiculous amounts of exercise that push the body too hard.

The CDC recommends that adults get at least 30 minutes of moderate-intensity physical activity five or more days per week.

No Exercise, Crummy Mood

"After one week we began to see changes," says Berlin. After two weeks, those changes had deepened. Two weeks of slothfulness had pushed the former exercisers into a grim state.

By then, they were significantly more tense, tired, and less vigorous. The more out of shape they became, the more their mood and energy level worsened. "What this tells us is that any interruption in a regular fitness routine can have a negative [impact]," says Berlin.

So what's a person to do when the weather is miserable or time seems scarcer than usual? Get creative. Tweak your routine, choosing other activities to stay physically and mentally fit, Berlin suggests.

Health care workers may also want to keep an eye out for depression symptoms in exercisers who get sidelined by injury or illness, she says.

Whether you're eyeing a 5K, 10K, half marathon, or even a marathon, one thing is for sure -- your next race promises to be your farthest and your fastest.

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Nervous? Excited? Don't know where to start? Don't fret, we are here to help. Follow our expert-approved, 10-step plan to train for your next long-run.

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Good luck!

Step 1. Pick a race, any race.

"The first step is to pick the race that you want to enter," says fitness trainer Kathy Kaehler of Hidden Hills, Calif. "This way you have a date in mind, a time frame to train within and a goal," she tells WebMD. Find out about local races by visiting your local roadrunner's club. Not sure if you have one? Visit the Road Runner's Club of America website at http://www.rrca.org for a list of local clubs. Click on your state for a list of local races.

Step 2. Get a physical before you get physical.

"Before you begin, it's a good idea to see your doctor and get a thorough physical examination -- particularly if you have not had one in several years or if until now you have been fairly sedentary," says Lewis G, Maharam, MD, medical director of the New York City Marathon and NYC Triathlon, among others. "This exam should include an exercise stress test (preferably done on a treadmill) to try and make sure that you have no obvious heart problems that might surface if you exercise too hard."

Step 3. Find a running partner or group

Once your doctor has given you the 'all-clear,' the next step is to find someone to train with. "Partners and groups are motivating because you are accountable to a group and pushed by people -- some of whom are better than you," Kaehler says. "If you can't find a club, then try to find a running partner who is equivalent to your fitness level." Local running stores and your local runner's club can help you find groups. Many major road races, particularly marathons, also have classes for the benefit of runners training for their event. The park and recreation departments in many cities often provide jogging programs for interested parties. In addition, many charity organizations, notably The Leukemia & Lymphoma Society's Team In Training, offer training programs and help runners raise money for the cause.

Step 4. Dress for success

Though clothes do not make the runner, there is no substitute for the right running shoe, Maharam tells WebMD. "There should be about a thumbnail's length between the longest toe and the end of the shoe. Without this much space, you can lose your toe nails," he cautions. Your best bet is to go to a specialty shop to buy running-specific shoes because the staff will better trained at fitting them. Replace your running shoes every 350 to 500 miles because they lose shock absorption and other protective qualities with use. What's more, "make sure you choose synthetic socks," Maharam says. "Unlike cotton, synthetic material wicks away moisture and fluid; preventing blisters and the wearing away of your feet."

Step 5. Train to train

"Most people start running with a health or fitness goal in mind such as losing weight or being healthier rather than a specific race," says master's champion runner and coach Gordon Bakoulis, author of How to Train for and Run Your Best Marathon. "You should really be doing a base of 10 to 20 miles a week before you start training for your first long run." Once you have established a baseline, then training can begin. Remember that the amount of time it takes to train for a race depends on the distance as well as your fitness level, she says. In general, marathon training can take anywhere from six months to a year.

Sallie Elizabeth has always had large breasts and a big bottom, and she has accepted them as part of her genetic makeup. But when cellulite appeared in the back of her upper leg, she "freaked out" and resolved to do something about it.

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A friend recommended endermologie, a deep massage treatment using a motorized device with two adjustable rollers and controlled suction. The device is said to improve the look of cellulite by gently folding and unfolding the skin for smooth and regulated deep-tissue movement.

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The cellulite is "less visible," she says, noting her smoother, softer skin. "I feel healthier. My circulation has improved ... and I feel more relaxed."

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To keep up the effects, the 20-something model visits Smooth Synergy, a cosmedical spa in Manhattan, once or twice a week for 35-minute sessions with the endermologie machine and a technician.

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Elizabeth may be enjoying her cellulite-busting experience, but experts raise eyebrows at many tools or treatments purported to reduce the appearance of cellulite, trim fat in specific areas, shed pounds, or build muscle -- particularly if they claim to replace exercise and good nutrition.

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"They're a waste of money," says Richard Cotton, a spokesman for the American Council on Exercise and chief exercise physiologist for myexerciseplan.com.

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If that is the case, then a sizeable chunk of currency could be going down the drain. According to a Federal Trade Commission (FTC) weight loss advertising trend report, in the year 2000 alone, consumers spent an estimated $34.7 billion on weight-loss products and programs.

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While it is not known how much of that accounts for sales of unproven or fraudulent merchandise, an FTC study of weight loss ads from different media shows that nearly 40% of ads make at least one false claim, and an additional 15% make at least one claim that is very likely false, or lacks proof.

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To add to the number soup: Results from a national health survey conducted between 1999 and 2000 indicate that more than six out of every 10 Americans are overweight or obese, a figure that has increased dramatically in recent years.

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Another recent survey that looked at the attitudes of Americans adults toward their own weight found that despite the fact that two-thirds of men were considered overweight, only about half (51%) said they wanted to lose weight versus 68% of women who said they wanted to lose weight.

Put it all together and there are arguably more people wanting to use weight loss products, and according to the government's trend report, the "marketplace has responded with a proliferating array of products and services, many promising miraculous, quick-fix remedies."

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There are, indeed, numerous therapies, including weight loss programs and dietary supplements. Then there are the popular treadmills, bun and ab rollers, the body bow, and bun and thigh max.

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For this piece, however, WebMD looked only into passive exercise devices such as electrical muscle stimulators and toning tables, cellulite reduction therapies, and gels, creams, eyeglasses, earrings and similar doodads marketed for weight loss, and muscle-building.

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Granted, not all remedies may be the same, but health professionals say far too many of them can't be trusted.

Oct. 4, 2006 -- Given the choice, children choose sodas and other sugar-sweetened drinks three times more often than any other item from school vending machines.

A new study shows 71% of children's purchases from school vending machines are sodas and other sugar-sweetened drinks, and those drinks make a significant contribution to children's total daily sugar and calorie intake.

In light of the growing childhood obesityobesity epidemic in the U.S., researchers say the results are likely to add fuel to the debate over offerings at school vending machines.

In addition, researchers also found that children who eat at fast-food restaurants are more likely to drink sugar-sweetened beverages than those who don't.

Sugar Sells at School Vending Machines

In the study, published in the Journal of the American Dietetic Association, researchers analyzed the dietary habits and purchases of nearly 1,500 students in 10 Massachusetts middle schools with vending machines that sold soda or other sugar-sweetened beverages. Sugar-sweetened beverages included regular soda, fruit drinks, and iced tea.

The students were asked about vending-machine purchases and visits to fast-food restaurants in the preceding week. Of the 646 students who reported using school vending machines, 71% reported buying sugar-sweetened sodas or other beverages, including 68% of 505 students who bought one to three vending machine items and 79% of 141 students who bought four or more.

Overall, sugar-sweetened drinks were purchased by almost three times as many students than the next popular item: water.

Researchers found the number of items purchased at school vending machines was directly related to the overall sugar intake of the children. The average number of servings of sugar-sweetened drinks per day increased by 20% among those who purchased one to three items from school vending machines per week and by 70% among those with four or more vending machine purchases per week when compared with children who did not make any vending machine purchases.

Researchers also found that children who ate at fast-food restaurants were also more likely to drink sugar-sweetened beverages than those who didn't visit fast-food outlets.

"These findings suggest that school vending machines and fast-food restaurants make independent contributions to total [sugar-sweetened beverage] intake that increase with repeated exposure or use," write researcher Jean Wiecha, PhD, of the Harvard School of Public Health, and colleagues.

May 12, 2006 -- New research offers more evidence that weight loss surgery has a dramatic impact on the hormones that drive hunger, and the findings could help advance the search for better drugs to treat obesity.

The study involved nine morbidly obese patients who had gastric bypass surgery.

Just six weeks after surgery, secretions of the hunger-reducing hormones peptide YY (PYY) and glucagons-like peptide 1 (GLP-1) were significantly altered in the patients. Although patients had lost weight, they "were still markedly obese," write the researchers.

Surgery and Satiety

PYY and GLP-1 have been shown to play a role in appetite control by signaling the body that it is no longer hungry after meals.

Blood tests were done to check the levels of PYY and GLP-1 after fasting and also after drinking a liquid test meal. Prior to surgery, the researchers found that secretions of the two hormones were not increased in response to the liquid test meal as would be expected.

Six weeks after surgery, the hormones were significantly elevated in the nine patients after they consumed the same test meal. PYY and GLP-1 hormonal responses after meals were twice as great in the surgically treated patients as in obese patients who did not have the surgery, even though the subjects in both groups had similar BMIs.

The fasting levels of PYY and GLP-1 six weeks after surgery were not significantly increased from the levels before surgery.

Participants' hunger ratings were lower after surgery compared with before surgery. The ratings were especially lower after consuming the test meal.

The findings, reported in the May issue of The Journal of Clinical Endocrinology and Metabolism, suggest that it is the surgery itself that drives the hormonal changes and not the weight loss that results from it.

"We know that something is going on with hunger following weight loss surgery, and we believe that it is related to hormones," researcher Josep Vidal, MD, PhD, tells WebMD. "But we probably don't have the whole picture yet."

Investigating Hunger Hormones

Just a few years ago, most research was focused on the appetite-stimulating hormone ghrelin. Studies showed dramatic differences in ghrelin secretions among obese patients who had undergone gastric bypass operations and those who had other types of surgery or no surgery at all.

But it quickly became clear that ghrelin did not tell the whole story, and research efforts have broadened to include other appetite-regulating hormones like PYY and GLP-1.

At least one GLP-1-like substance is under investigation as an appetite suppressant.

Vital and colleagues say their findings, if confirmed, could lead to the development of new weight loss drugs that mimic the hormonal changes seen with surgery.

Obesity researcher Nana Gletsu, PhD, of Atlanta's Emory University School of Medicine, tells WebMD that future weight loss drugs will probably target hormones in the brain and the hunger hormones found in the gut.

But she adds that there is more to hunger than hormones.

"Hunger and satiety are very complex," she says, "Hormones certainly influence hunger, but so do mental and environmental factors, such as time of day and stress levels. You may have hormones from your stomach telling you that you are hungry or full, but they are not the only signals you are receiving."

Oct. 24, 2005 (St. Louis) -- Obesity is not only an epidemic in this country, it is a global explosion. Researchers say "globesity" is out of control, and the health care community has ideas to help stem the tide of expanding waistlines.

A panel of experts shared ideas at the American Dietetic Association Food and Nutrition Conference and Exhibition on how to put a dent in the obesity problem.

Panel members Jim Hill, PhD, John Foreyt, PhD, and W. Phillip James, MD, DSc, all agreed that the environment needs to change if we are to have an impact on the serious consequences of obesity and turn strategies into solutions. There is no simple solution to this very complex problem; taking small steps to tackle the problem is a great beginning.

Causes and Consequences

The trend of increasing numbers of adults with excess weight continues. According to the 1999-2000 National Health and Nutrition Examination Survey (NHANES), more than 64% of U.S. adults are either overweight or obese.

The U.S. is not alone. Australia, the U.K., Germany, Croatia, Greece, Finland, and many other countries have a high prevalence of overweight adults, according to the International Obesity Task Force web site.

"The cause of the obesity epidemic around the globe is multifaceted and complex," says James. "Developed countries have spent large sums of money to provide mechanical, electronic, and physical aids to remove the need to do any physical activity so people burn fewer calories each day."

According to James, "this is further compounded by intense marketing and availability of inexpensive food that is high in calories, fat, and sugar."

Well-known health consequences of obesity include type 2 diabetes, cardiovascular disease, sleep apnea, liver abnormalities, and negative psychological consequences.

These conditions are not limited to adults and are being seen in the growing number of overweight and obese children.

Excess weight has been associated with an increased risk of some cancer.

In men and women, being obese or overweight has been linked with an increased risk for kidney cancer. In women, breast, ovarian, cervical and uterine cancer risk all increase with excess body weight.

According to NAASO, The Obesity Society, obese women have a 1.5-fold greater risk for endometrial cancer and a twofold greater risk for postmenopausal breast cancer.

One Small Step at a Time

"We need to focus our attention on health, well-being, and the improvement of the quality of life that small changes can achieve," says Foreyt. Don't think of a diet-and-exercise overhaul; think small steps to halt weight gain and then move on to weight loss.

"If we could simply stop gaining weight, it would be a substantial first step toward reducing globesity" says Hill, one of the founders of America on the Move, which popularized the pedometer.

His advice: make small changes that add up to at least 100-200 fewer calories daily. Eat one less cookie, leave a few bites of the fast-food burger, and walk 2,000 more steps each day to help weight maintenance.

Pedometers keep track of how far a person walks or runs. They also keep track of the number of steps a person takes. That -- plus advice to take 10,000 steps a day -- seems to help motivation for people who don't like to exercise.

Changing behavior is admittedly one of the most difficult tasks health care professionals face, panel members told the audience of registered dietitians. "Taking small steps seem to be the most reliant way for doctors and dietitians to help get people to change the way they eat and exercise," says Foreyt.

Everyone is looking for the magic bullet but it does not exist, he says. "It starts and ends with personal responsibility."

April 15, 2005 -- Diets that lower carbohydrates may not get any extra advantage from boosting protein.

When diets substitute proteins for carbohydrates, studies show greater fat loss in women. But it's not known whether the effect is due to the increased protein content of the diets or the reduction in carbohydrates, write the researchers.

However, Australian researchers find that when they put a small group of obese men and women on two different low-carb diets -- high and low protein -- weight loss results did not differ.

The study appears in the April 1 edition of The American Journal of Clinical Nutrition.

"In previous studies, we have shown differences between high-protein diets and lower-protein diets when we substituted protein for carbohydrate and kept fat constant," says Peter M. Clifton, FRACP, PhD, of the University of Adelaide's medicine department.

"The question: Was it protein or the carbohydrates? This study suggested that perhaps it was the decrease in carbohydrates, rather than the increase in protein that made the difference we saw previously," Clifton tells WebMD in an email.

Do Carbs Count More Than Protein?

Participants were 73 obese men and women; none had type 2 diabetes. They were divided into two groups for a 12-week diet.

Both diets cut carbs to the same level: no more than 30% of total daily calories. One diet featured low-fat (29% total calories), high-protein (24% total calories) items. It was based on lean meat, poultry, and low-fat dairy foods, says Clifton's study.

The other low-carb diet had a standard amount of protein (8% total calories) and a higher amount of monounsaturated fat (45% total calories). Those menus included lean meat, poultry, higher-fat milk, and oil and nuts high in monounsaturated fat.

After 12 weeks of the calorie-restricted diet -- followed by four weeks of a maintenance diet -- the two groups had no differences in weight loss, fat or lean-mass loss, insulin resistance (a risk factor signaling heart disease and type 2 diabetes), or fasting cholesterol and triglyceride levels.

On average, the low-fat, high-protein group lost about 21 pounds. The average weight lost by the high-fat, standard-protein group was 22.5 pounds.

Both diets were well tolerated; no negative side effects were seen. Neither plan hurt bone mass or kidney function, says the study.

Participants said they were less hungry after the low-fat, high-protein meal, both at the beginning and end of the study. However, "having a lower desire to eat did not translate into a lower intake," Clifton tells WebMD.

The diets' long-term effects aren't known. Neither are the results for people who aren't obese (body mass index of 30 or higher).

Which Diet Is Best?

Calories count on any diet, and sticking to the diet is important. "Most studies have shown that energy intake and not macronutrient composition is the key determinant of total weight loss," says Clifton's study. Macronutrients include fats, carbohydrates, and proteins.

Researcher's Perspective

"I don't think low-carbohydrate diets are quite as popular here [in Australia] as in the U.S.A.," says Clifton.

When asked what he would tell obese people considering either diet, he says, "For a short-term -- say, 12-week weight loss -- I would not say anything. But long term, I would recommend at least 100 grams of carbohydrates from bran cereals, fruit, and vegetables to keep micronutrient intake normal and bowel function normal."

Other studies have recommended favoring complex carbohydrates (in fruits, vegetables, whole grains, and legumes) over simple carbohydrates, which include sugary foods and refined grains.

Don't forget that exercise is the other half of effective weight loss. Check with a doctor about changing your food or fitness habits.

Nov. 16, 2004 -- A widely prescribed epilepsy drug that has shown promise for helping obese people lose weight is also helping them continue to keep the pounds off.

Obese people who lost weight by restricting calories continued to lose weight after taking Topamax and were more likely to keep it off long term, in a study reported by researchers in Denmark.

Ten months into the study, dieters who took Topamax had lost almost twice as much weight as those taking placebo pills, even though both groups initially lost similar amounts of weight by restricting calories before beginning the medication.

The Danish study ended early because Topamax manufacturer Johnson and Johnson Pharmaceuticals is developing a time-release version of the drug that it hopes will minimize side effects and be more appropriate for dieters.

"The initial data on Topamax are very impressive," weight loss specialist Samuel Klein, MD, tells WebMD. "It does appear to be more effective than the currently available drug therapies in terms of taking the weight off and keeping it off. But you have to remember that these are preliminary studies."

Dieters Kept Losing

The study included obese people who lost 8% or more of their body weight by restricting daily calories to about 800-1,000 calories per day for two months. At the end of the two-month period, the successful dieters were started on either low or high doses of Topamax or placebo pills. All the dieters also underwent lifestyle modification counseling designed to promote healthy eating habits.

At the end of week 44, dieters taking low-dose Topamax had lost 15%, and high-dose Topamax dieters lost 17% of their initial body weight, compared with a 9% weight loss among dieters who took a placebo. Dieters taking the epilepsy drug continued to lose weight over the course of the study, while those taking placebos did not.

The most common side effect seen among Topamax dieters was paresthesia, a tingling, "pins and needles" sensation in the extremities, which occurred in 46% of patients taking the lower dose of the drug and 73% of those taking the higher dose.

Topamax use has also been linked to problems with memory. In this study, 18% of dieters taking higher doses of the drug reported memory problems, compared with 14% of those taking the lower dose and 6% of those taking placebo. The study is reported in the October 2004 issue of the journal Obesity Research.

A New Beginning

Klein says Topamax is one of several promising medications poised to usher in a new era of drug treatment for obesity.

The experimental weight loss drug Acomplia made headlines last week when researchers reported that it also helped dieters lose weight and keep it off long term. There are also reports that the drug, which targets the brain's pleasure center, may prove to be effective for smoking cessation. French pharmaceutical firm Sanofi-Aventis reportedly plans to seek FDA approval for Acomplia by the middle of next year.

"I think this signals the beginning of a new surge of medications for weight loss that address unique neurological pathways in the brain," says Klein, who directs the Washington University Center for Human Nutrition. "That is certainly exciting."