Email updates

Keep up to date with the latest news and content from BMC Women's Health and BioMed Central.

This article is part of the supplement: Women's Health Surveillance Report

Open Access Highly Accessed Open Badges Report

Physical Activity and Obesity in Canadian Women

Shirley Bryan1* and Peter Walsh2

Author Affiliations

1 Centre for Chronic Disease Prevention and Control, Health Canada, 120 Colonnade Rd, Ottawa, Canada, K1A 0K9

2 Centre for Chronic Disease Prevention and Control, Health Canada, 120 Colonnade Rd, Ottawa, Canada, K1A 0K9

For all author emails, please log on.

BMC Women's Health 2004, 4(Suppl 1):S6  doi:10.1186/1472-6874-4-S1-S6

The electronic version of this article is the complete one and can be found online at:

Published:25 August 2004

© 2004 Bryan and Walsh; licensee BioMed Central Ltd

This is an open access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Health Issue

Overweight and obesity have been recognized as major public health concern in Canada and throughout the world. Lack of physical activity, through its impact on energy balance, has been identified as an important modifiable risk factor for obesity. Physical activity and obesity are also important risk factors for a variety of chronic diseases. This chapter provides an overview of the current state of physical activity and overweight/obesity among Canadian women.

Key Findings

For all ages combined more women (57%) than men (50%) are physically inactive (energy expenditure <1.5 KKD). Physical activity increases as income adequacy and educational level decrease. Physical inactivity also varies by ethnicity. The prevalence of both overweight (BMI 25.0 – 29.9 kg/m2) and obese (BMI ≥ 30 kg/m2) Canadian women has increased 7% since 1985. Obesity increases with age and is highest among women reporting low and lower middle incomes and lower levels of education. The prevalence of obesity is highest among Aboriginal women and men (28% and 22% respectively).

Data Gaps and Recommendations

There is currently no surveillance system in Canada to monitor the level of physical activity among children, those performing activity at work, at school or in the home. There is a gap in the knowledge surrounding socio-cultural and ecological determinants of physical activity and obesity and the associations of these to chronic disease among women and minority populations. Multi-sectoral policy interventions that act to decrease the broad systemic barriers to physical activity and healthy weights among all women are needed.


Overweight and obesity have been recognized as a major public health concern not only in Canada but also throughout the world. Physical activity, through its impact on energy balance, has been identified as an important modifiable risk factor for obesity. Both lack of physical activity and obesity are also important independent risk factors for the development of many chronic diseases that affect women and thereby place a substantial burden on the health care system. Despite this knowledge, the prevalence of obesity continues to increase among women, and only a small proportion of the female population is active enough to achieve health benefits.

The aim of this chapter is to provide an overview of the current state of physical activity and overweight/obesity among Canadian women. The health benefits of regular physical activity are also briefly reviewed. Attention is paid to the individual and systemic determinants of women's adoption of regular physical activity throughout their lifespan. A summary of the current Canadian recommendations for physical activity and the World Health Organization (WHO) recommendations for obesity prevention through regular physical activity are also provided. A detailed interpretation of the Canadian Community Health Survey provides prevalence rates of physical inactivity, overweight and obesity, and these are analyzed in relation to gender, socio-economic status, educational level and race. An analysis of trends is presented where the data are available.

Increasing Trends in Overweight and Obesity

The WHO reports that overweight and obesity are increasing worldwide at an alarming rate, in both developed and developing countries, and this trend is seen among adults and children alike. [1] Although genetic susceptibility may explain up to 40% of the obesity phenotype, [2] technological, lifestyle and cultural changes over the past 50 years are being implicated as the most likely cause of the recent obesity epidemic. [1] The most important factors associated with increased risk of overweight and obesity are physical inactivity and high-energy, dense diets over the medium or long term. It is becoming increasingly clear that maintenance of a healthy adult weight, through proper balance of caloric intake and regular physical activity, is a key factor in chronic disease prevention.

Economic Costs of Inactivity and Obesity

Physical inactivity and obesity, through their association with the development of chronic diseases, place a significant economic burden on the health care system. In 1999, $2.1 billion in direct health care costs in Canada were directly attributable to physical inactivity, equalling 2.5% of the total health care expenditures for that year. [3] In a study by Birmingham et al. [4] the total direct cost of obesity in Canada in 1997 was estimated to be over $1.8 billion, or 2.4% of the total health care expenditures for all diseases that year. Katzmarzyk et al. [3] inflated this number to reflect 1999 dollars and found that obesity accounted for approximately $2.0 billion in direct health care expenditures, which is comparable to the estimates for physical inactivity for that year.

Health Implications

Physical activity throughout the lifespan may independently enhance women's and girls' health through the reduction of chronic disease risk and improved quality of life. Specifically, being physically active may decrease a woman's risk of developing coronary artery disease, [5] type 2 diabetes, [6] hypertension, [7] osteoporosis [8] and colon/colorectal cancer. [9] Epidemiologic studies have shown that participation in regular physical activity may also be protective against cognitive impairment, [10] dementia, [11,12] breast cancer, [13] hip fractures, [14] and a range of psychological outcomes, including anxiety, depression, stress and low self-esteem. [15] Regular physical activity may also increase longevity [16] and reduce the risk of prolonged disability in old age. [17]

Although some decrease in function, strength and stamina are unavoidable with age, the rate of decline can be diminished through supportive environments that promote better health through healthy levels of physical activity. [18] Healthy physical activity levels among older women can act to decrease the amount of weight gain experienced during menopause and may attenuate the accumulation of adipose tissue in the upper and central body regions after menopause. [19] Physical activity in the form of vigorous exercise and resistance training of moderate intensity can also decrease the risk of osteoporotic fracture among women, by preserving bone density or modestly increasing bone mineral content at clinically relevant sites. [8,20] Furthermore, regular physical activity can reduce the risk of falls and hip fractures among older adults. [21]

Maintenance of a healthy weight in adulthood may also decrease a woman's risk of many adverse health outcomes. Overweight and obesity are associated with an increased risk of type 2 diabetes, [6] coronary heart disease, [22,23] hypertension, [24] some cancers [25-27] and premature mortality. [28] Epidemiologic studies have also noted a decreased risk of ischemic stroke, [29] sleep apnoea and hypoventilation syndrome, [30,31] gallbladder disease [32] and osteoarthritis [33] among adults who have undergone weight loss.

The health consequences of childhood obesity are less well understood; however, an association between childhood physical activity levels, obesity and early chronic disease indicators (e.g. physical fitness and high blood pressure) has been identified. [34] Appropriate amounts of physical activity during childhood and adolescence are critical for the development of peak bone mass, an important predictor of osteoporosis and osteoporotic fractures later in life. [35-37] Children who exercise habitually have stronger bones than their non-active peers, and exercising during puberty is particularly efficacious in producing strong bones. [38]

The prevalence of childhood obesity has increased rapidly in the Canadian population, and unhealthy behaviour patterns (sedentary lifestyle, unhealthy eating) are being blamed for this increase. [39] As a consequence, the incidence of obesity-related chronic disease (e.g. type 2 diabetes) and precursors to chronic disease (e.g. hypertension) are also increasing among children with high BMI values. [40] Additionally, childhood overweight/obesity may lead to undesirable body image and poor self-esteem. [41,42] The state of childhood overweight and obesity is a major public health concern, since, once developed, the unhealthy lifestyle habits adopted during childhood and adolescence not only result in early manifestations of chronic disease but also tend to follow that individual throughout the lifespan. [43]

Despite this knowledge and the increased interest in and participation by women in sport and recreational activity over time, only a small proportion of the female population is active enough to achieve health benefits. At all ages, women and girls are less likely than males to participate in physical activity, and the more intense the activity, the greater this disparity. [18] From a long-term health perspective, decreased rates of physical activity among adolescent girls and older women are particularly worrisome.

Involvement in physical activity is closely intertwined with the social, economic and health status of women, and is associated with unique individual and environmental determinants of physical activity that vary across life situations. The most commonly reported barrier to women's participation in physical activity is lack of time due to family responsibilities, including child care, cooking, cleaning and other household-related tasks. [44-46] Other barriers often reported include lack of motivation, poor perception of health, lack of self-efficacy, lack of support from employers and lack of social support. [45,47] Cultural barriers to participation among women of ethnic minorities may include lack of knowledge of the importance of exercise, [48] differing value ascribed to physical activity, [49] health problems, [50] acceptance of larger body sizes, [51] lack of community support, differing social norms, [47] language barriers and culturally dictated familial roles. [47] Living environment and socio-economic status are also associated with important barriers to physical activity for women. These may include lack of safe places to exercise, tiredness due to physically demanding jobs, limited access to affordable or adequate facilities, lack of social support and child care resources, and a lack of both community resources for equipment and gender-sensitive programs. [52]

It is not well understood why the rates of physical activity among adolescent girls are lower than among boys. It has been suggested that these rates may reflect girls' attitudes towards exercise, which are rooted in unrealistic stereotypes of the active female body and constant reminders of their physical limitations. [18] Many teenaged girls report a desire to change their physical appearance to that of the currently fashionable and heavily marketed fashion model ideal. [53] Consequently, some girls strive to use physical activity as a means to repair and reshape their bodies to fit this ideal. [18] However, this vision of an unattainable goal may also result in decreased activity levels in other girls. Among females participating in high-performance athletics, body weight can be seen as an important predictor of success, and disordered eating behaviours and exercise patterns can become problematic. [54] Decreased physical activity among adolescent girls may also reflect limited access to high school physical education classes that provide pleasure and skill development in a non-threatening atmosphere. [18] Physical education programs continue to focus on male-oriented Western team sports that emphasize strength, power, competition and contact. [55] Such a curriculum denies active role models to Canadian girls of varying cultural backgrounds. [18,56]

Lower rates of participation in physical activity among older women may reflect barriers related to knowledge of the physical activity and its benefits, fear of falling, lack of access, lack of social support and environmental factors (e.g. poor weather, safe places to exercise). Older women may also cite their declining health and their perception of being too old as reasons for not participating. [57]

To date, health promotion activities to address physical activity and obesity have not taken into account the systemic and cultural pressures that shape female participation in physical activity and the maintenance of a healthy body weight. [18] Current Canadian guidelines for physical activity, promoted through Canada's Physical Activity Guide to Healthy Active Living, have been developed to provide Canadians with the information they need at an individual level. [58] These recommendations state that adults should perform a minimum of 30 to 60 minutes of moderate activity (e.g. brisk walking, biking, swimming) on most days of the week, starting slowly and building up the duration over time. Evidence suggests that this level of activity, which can be realized through a variety of activities that fit into each individual's lifestyle, is sufficient for cardiovascular/metabolic health. [43] Increasing the duration and intensity of physical activity over time may have a greater effect on some health outcomes but may be viewed as an unattainable goal for some of the population. [43]

The WHO has recently released recommendations for individuals about the level of activity recommended for the maintenance of a healthy body weight through regular physical activity. These recommendations state that a total of one hour of moderate-intensity activity, such as walking, on most days of the week, particularly for people with sedentary occupations, will decrease the likelihood of becoming overweight. [43] Recommendations such as the Canadian guidelines and the WHO recommendations are an important part of reducing the barriers of physical activity at the individual level, but if real progress is to be made, public health programs must now address the systemic barriers to participation in physical activity and the maintenance of healthy weights that women face.


Physical activity data were taken from the Canadian Community Health Survey (CCHS) 2000–2001 using the physical activity index variable. This is derived from an energy expenditure variable that is based on a number of questions dealing with self-reported leisure-time physical activity. The proportion of individuals classified as physically inactive was broken down by five-year age groups and sex. For the purpose of this report, physically inactive is defined as self-reported daily energy expenditure of less than 1.5 kilocalories per kilogram per day (KKD) and is equivalent to the energy expenditure associated with about one half-hour of walking at a leisurely pace. Additional analysis of those classified as physically inactive was performed according to income adequacy, highest level of education achieved and self-ascribed ethnicity.

Overweight and obesity status is most commonly reported in relation to body mass index (BMI) values. BMI is a simple ratio of weight (measured in kilograms) to height (measured in metres), such that BMI (kg/m2) = wt/ht2. BMI guidelines for healthy weights were adopted in Canada in 1988 and have recently been updated to reflect the current WHO guidelines. As outlined in Figure 1, and for the purposes of this report, overweight is defined as a BMI value of 25.0–29.9 kg/m2 and obese is defined as a BMI of ≥ 30 kg/m2.

thumbnailFigure 1. Health Risk Classification according to Body Mass Index (BMI) for Use with Adults aged 18 and older. Not for use with pregnant or lactating women. Source: Health Canada: Canadian guidelines for body weight classification in adults.

BMI was calculated from all non-pregnant respondents' self-reported weight and height. Individuals with a BMI value from 25.0 to 29.9 kg/m2 and a BMI value of 30 kg/m2 or more were classified for analysis by five-year age group and sex. Additional analysis of those classified as obese (BMI ≥ 30 kg/m2) was performed according to income adequacy, highest level of education achieved and self-ascribed ethnicity. BMI time trends are presented using data from the four national population surveys that collected self-reported height and weight and occurred at roughly five-year intervals: the 1985 and 1991 General Social Surveys (Health), the 1994–1995 National Population Health Survey and the Canadian Community Health Survey 2000–2001.


Data from the 2000–2001 CCHS indicate that 57% of females and 50% of males aged 12 years and older reported being physically inactive (Figure 2). This proportion has decreased slightly over time, down from 62% and 54% in 1994–1995 for women and men respectively (NPHS 1994–1995). For every age group, more females than males are inactive, and this sex disparity is greatest in the youngest and oldest age groups. These data indicate that 43% of girls who are of high school age (15 to 19 years) are inactive, a 13% higher proportion than that of girls aged 12 to 14 years. Although this relation is also seen for boys, the magnitude of change is much less (7%).

thumbnailFigure 2. Percentage Physically Inactive* by Age Group and Sex, Canada, 2000 Source: Canadian Community Health Survey, 2000–2001. Statistics Canada

As women age they become progressively more inactive, and reported inactivity is alarmingly high in the older age groups: 72% of Canadian women over the age of 70 are considered inactive, as compared with 56% of men in the same age group. As depicted in Figures 3 and 4, physical inactivity increases as income adequacy and educational level decreases, and this relation is stronger for women than men. Physical inactivity varies with ethnic group; 76% of Black women and 73% of South Asian women were classified as inactive (Figure 5).

thumbnailFigure 3. Percentage Physically Inactive by Sex and Income Adequacy* Canada, 2000 Source: Canadian Community Health Survey, 2000–2001. Statistics Canada

thumbnailFigure 4. Percentage Physically Inactive by Sex and Highest Level of Education, Canada, 2000 Source: Canadian Community Health Survey, 2000–2001. Statistics Canada

thumbnailFigure 5. Percentage Physically Inactive by Sex and Race, Canada, 2000 Source: Canadian Community Health Survey, 2000–2001. Statistics Canada.

As depicted in Figure 6, the prevalence of overweight increased in women between 1985 and 2000–2001, from 19% to 26%. Although overweight among men has also increased since 1985, there has been a slight decrease in the prevalence over the last five years (down from 44% in 1994–1995 to 40% in 2000–2001). Canadian trend data indicate that the prevalence of obesity (BMI ≥ 30 kg/m2) has steadily increased, from 7% to 14% in women and from 6% to 16% in men, since 1985 (Figure 7). Analysis of five-year age groups reveals that the prevalence of obesity among women increases with age, peaking in the 55 to 59 age category and decreasing steadily thereafter (Figure 8). An increase in obesity with age also occurs in the male population, with a peak in the 50 to 54 age group. These data also reveal a substantial increase in the prevalence of obesity during the young adult years in both men and women. For both sexes, between the age categories 15 to 19 and 25 to 29 years the prevalence increased by about 8%, from 3.3% to 11.5% and from 6% to 14% in women and men respectively.

thumbnailFigure 6. Proportion of Canadians Aged 20–64 With BMI >= 25 and <30 by Sex and Year of Survey Source: General Social Survey 1985 and 1991, National Population Health Survey 1994–1995, Canadian Community Health Survey, 2000–2001. Statistics Canada.

thumbnailFigure 7. Proportion of Canadians Aged 20–64 With BMI >= 30 by Sex and Year of Survey. Source: General Social Survey 1985 and 1991, National Population Health Survey 1994–1995, Canadian Community Health Survey, 2000–2001. Statistics Canada.

thumbnailFigure 8. Proportion of Canadians With BMI >= 30 by Sex and Five Year Age Group Source: Canadian Community Health Survey, 2000–2001. Statistics Canada.

The prevalence of obesity is highest among women reporting low and lower middle incomes and women reporting lower levels of education (Figures 9 and 10). The reverse trend is seen among men: those with higher income and higher levels of education have the highest prevalence of obesity. The prevalence of obesity is high among Aboriginal women and men (Figure 11) as well as among Black women.

thumbnailFigure 9. Percentage Obese (BMI >= 30) by Sex and Income Adequacy*Canada, 2000 Source: Canadian Community Health Survey, 2000–2001. Statistics Canada.

thumbnailFigure 10. Percentage Obese (BMI >= 30) by Sex and Highest Level of Education, Canada, 2000 Source: Canadian Community Health Survey, 2000–2001. Statistics Canada.

thumbnailFigure 11. Percentage Obese (BMI >= 30) by Sex and Race, Canada, 2000 Source: Canadian Community Health Survey, 2000/01. Statistics Canada.


Data Limitations

Data collection for the CCHS 2000–2001 occurred through random selection of one respondent per household who was 12 years of age or older, among a representative sample of Canadian households in all provinces, excluding the territories, Indian Reserves, Canadian Forces Bases and some remote areas. Therefore, these data are not representative of those populations in Canada that were not included in the survey. The CCHS is a telephone survey and is therefore limited to collection of self-reported data.

The physical activity index was derived from total energy expenditure, based on all leisure-time physical activities reported by the respondent. Physical activities performed at work (e.g. work-related labour activity), at school (e.g. physical education classes) or in the home (e.g. household chores) are not included in the calculation of this index, which may lead to an underestimate of the actual amount of activity performed by some respondents. In general, most studies show that self-reports do not provide accurate estimates of the absolute amount of physical activity. [59] Recalling past physical activity is a highly complex cognitive task, which may differentially affect the young and very old. [60] The use of ambiguous terms such as "physical activity," "moderate intensity" and "leisure time" may also affect a person's response, since the definition of these terms may differ between respondents and investigators. [59] Another limitation of self-reported physical activity levels is social desirability bias, which can lead to over-reporting of physical activity. [61] Finally, survey questions may limit or not assess the primary modes of activity for certain gender, age, cultural, occupational or income groups. Few self-reported measures have been developed for or validated in distinct demographic, ethnic or cultural groups. [59]

In the case of BMI, when individuals self-report these values they tend to overestimate their height and underestimate their weight, which leads to an underestimate of actual BMI value. [62] This under-reporting appears to be consistent across socio-economic strata but occurs more often among women and girls, [63] the elderly [64], and heavier and taller BMI respondents. [65] Conversely, underweight individuals tend to over-report weight. [65] Studies have concluded that self-reported data tend to underestimate the prevalence of overweight and obesity in a population by approximately 10%. [66,67]

While BMI is correlated with body fat, it is not a measure of body fat or body composition and is useful for general weight classification only. BMI fails to distinguish between individuals in whom the excess weight is fat and those who are particularly muscular. [68] Self-reported BMI is not valid for children under 12 years or adults over 60 years of age as these groups are likely to either not know their height or weight or to report these in error. [69-71] In general, BMI is more valuable when used in conjunction with waist-to-hip circumference ratio or waist circumference measurements, [72] but these measurements were not collected in the four surveys used in this analysis.

Data and Knowledge Gaps

• There is currently no surveillance system in Canada to monitor the level of physical activity and body composition of children.

• There is currently no collection of measured body composition or physical activity levels of Canadians.

• Physical activities performed at work (e.g. work-related labour activity), at school (e.g. physical education classes) or in the home (e.g. household chores) are not captured through current Canadian surveillance activities.

• There is a gap in the knowledge surrounding the socio-cultural and ecological determinants of physical activity for girls and women of various cultural backgrounds throughout the lifespan.

• Current knowledge on the associations between physical activity, obesity and chronic disease has been derived from studies performed on predominantly Caucasian males. More research is needed to understand these associations among women and minority populations.

• Data and knowledge surrounding the indirect health care costs associated with physical inactivity and obesity are lacking.


Policy Recommendations

• The recognition by governments of all levels that targeted funding for physical activity and physical education within the school system is essential, given the evidence showing that school-based interventions lead to increased participation in physical activity in school-aged children.

• Development and adoption of Canadian standards for measuring, reporting and monitoring body composition in children under 12 years and adults over 60 years of age, since self-reported BMI is not valid in these age groups.

• Development of Canadian standards for measuring and reporting physical activity levels that are valid for the general population, including children and all minority subgroups.

• Multi-sectoral policy interventions (e.g. health, education, urban development, recreation, industry, transportation) that act to decrease the broad systemic barriers to physical activity and healthy weights among women.

• Integrated approaches using behaviour change as a model for lifestyle changes while addressing the issues related to supportive environments for women in various life stages.

• Targeted interventions that aim to decrease the unique barriers of marginalized Canadians (e.g. women, lower income groups, Aboriginal Canadians, older adults and other special populations).

• Recognition of the importance of the psychological determinants of physical inactivity and overweight/obesity and strategies to help women overcome them.


The views expressed in this report do not necessarily represent the views of the Canadian Population Health Initiative, the Canadian Institute for Health Information or Health Canada.


  1. Subcommittee on Planning and Programming of the Executive Committee of Pan American Health Organization, World Health Organization

    Obesity, diet, and physical activity: provisional agenda item 9.5 2003. OpenURL

  2. Bouchard C, Perusee L, et al.: The genetics of human obesity. In Handbook of Obesity. Edited by Bray GA, Bouchard C, James WPT. New York: Marcel Dekker; 1998:157-190. OpenURL

  3. Katzmarzyk PT, Gledhill N, Shephard RJ: The economic burden of physical inactivity in Canada.

    Can Med Assoc J 2000, 163(11):1435-1440. OpenURL

  4. Birmingham CL, Muller JL, Palepu A, Spinelli JJ, Anis AH: The cost of obesity in Canada.

    Can Med Assoc J 1999, 160(4):483-488. OpenURL

  5. Fletcher GF, Blair SN, Blumenthal J, Caspersen C, Chaitman B, Epstein S, Falls H, Froelicher ES, Froelicher VF, Pina IL: Statement on exercise: benefits and recommendations for physical activity programs for all Americans. A statement for health professionals by the Committee on Exercise and Cardiac Rehabilitation of the Council on Clinical Cardiology, American Heart Association.

    Circulation 1992, 86(1):340-344. PubMed Abstract OpenURL

  6. Hu FB, Manson JE, Stampfer MJ, Colditz G, Liu S, Solomon CG, Willet WC: Diet, lifestyle and the risk of type 2 diabetes mellitus in women.

    N Engl J Med 2001, 345(11):790-797. PubMed Abstract | Publisher Full Text OpenURL

  7. Reaven PD, Barrett-Connor E, Edelstein S: Relation between leisure-time physical activity and blood pressure in older women.

    Circulation 1991, 83(2):559-565. PubMed Abstract OpenURL

  8. Heinonen A, Oja P, Sievanen H, Pasanen M, Vuori I: Effect of two training regimens on bone mineral density in healthy perimenopausal women: a randomized controlled trial.

    J Bone Miner Res 1998, 13(3):483-490. PubMed Abstract | Publisher Full Text OpenURL

  9. Colditz GA, Cannuscio CC, Frazier AL: Physical activity and reduced risk of colon cancer: implications for prevention.

    Cancer Causes Control 1997, 8(4):649-667. PubMed Abstract | Publisher Full Text OpenURL

  10. Hebert R, Lindsay J, Verreault R, Rockwood K, Hill G, Dubois MF: Vascular dementia: incidence and risk factors in the Canadian study of health and aging.

    Stroke 2000, 31(7):1487-1493. PubMed Abstract | Publisher Full Text OpenURL

  11. Lindsay J, Laurin D, Verreault R, Hebert R, Helliwell B, Hill GB, McDowell I: Risk factors for Alzheimer's disease: a prospective analysis from the Canadian Study of Health and Aging.

    Am J Epidemiol 2002, 156(5):445-453. PubMed Abstract | Publisher Full Text OpenURL

  12. Laurin D, Verreault R, Lindsay J, MacPherson K, Rockwood K: Physical activity and risk of cognitive impairment and dementia in elderly persons.

    Arch Neurol 2001, 58(3):498-504. PubMed Abstract | Publisher Full Text OpenURL

  13. Friedenreich CM, Bryant HE, Courneya KS: Case-control study of lifetime physical activity and breast cancer risk.

    Am J Epidemiol 2001, 154(4):336-347. PubMed Abstract | Publisher Full Text OpenURL

  14. Hoidrup S, Sorensen TI, Stroger U, Lauritzen JB, Schroll M, Gronbaek M: Leisure-time physical activity levels and changes in relation to risk of hip fracture in men and women.

    Am J Epidemiol 2001, 154(1):60-68. PubMed Abstract | Publisher Full Text OpenURL

  15. Lawlor DA, Hopker SW: The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials.

    BMJ 2001, 322(7289):763-767. PubMed Abstract | Publisher Full Text | PubMed Central Full Text OpenURL

  16. Ferrucci L, Izmirlian G, Leveille S, Phillips CL, Corti MC, Brock DB, Guralnik JM: Smoking, physical activity, and active life expectancy.

    Am J Epidemiol 1999, 149(7):645-653. PubMed Abstract OpenURL

  17. Leveille SG, Guralnik JM, Ferrucci L, Langlois JA: Aging successfully until death in old age: opportunities for increasing active life expectancy.

    Am J Epidemiol 1999, 149(7):654-664. PubMed Abstract OpenURL

  18. Vertinsky P: "Run, Jane, Run": central tensions in the current debate about enhancing women's health through exercise.

    Women and Health 1998, 27(4):81-111. Publisher Full Text OpenURL

  19. Kohrt WM, Malley MT, Dalsky GP, Holloszy JO: Body composition of healthy sedentary and trained, young and older men and women.

    Med Sci Sports Exerc 1992, 24(7):832-837. PubMed Abstract OpenURL

  20. Nelson ME, Fiatarone MA, Morganti CM, Trice I, Greenberg RA, Evans WJ: Effects of high intensity strength training on multiple risk factors for osteoporotic fractures: a randomised controlled trial.

    JAMA 1994, 272:1909-1913. PubMed Abstract | Publisher Full Text OpenURL

  21. Campbell AJ, Robertson MC, Gardner MM, Norton RN, Tilyard MW, Buchner DM: Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women.

    BMJ 1997, 315(7115):1065-1069. PubMed Abstract | Publisher Full Text OpenURL

  22. Eckel RH, Krauss RM: American Heart Association call to action: obesity as a major risk factor for coronary heart disease.

    Circulation 1998, 97:2099-2100. PubMed Abstract | Publisher Full Text OpenURL

  23. Manson JE, Willett WC, Stampfer MJ, et al.: Body weight and mortality among women.

    N Engl J Med 1995, 333:677-685. PubMed Abstract | Publisher Full Text OpenURL

  24. Eckel RH: Obesity in heart disease.

    Circulation 1997, 96:3248-3250. PubMed Abstract | Publisher Full Text OpenURL

  25. Lee IM, Paffenbarger RS Jr: Quetelet's index and risk of colon cancer in college alumni.

    J Natl Cancer Inst 1992, 84(17):1326-1331. PubMed Abstract | Publisher Full Text OpenURL

  26. Giovannucci E: Obesity, gender, and colon cancer.

    Gut 2002, 51(2):147. PubMed Abstract | Publisher Full Text OpenURL

  27. Huang Z, Hankinson SE, Colditz GA, Stampfer MJ, Hunter DJ, Manson JE, Hennekens CH, Rosner B, Speizer FE, Willett WC: Dual effects of weight and weight gain on breast cancer risk.

    JAMA 1997, 278(17):1407-1411. PubMed Abstract | Publisher Full Text OpenURL

  28. Fontaine KR, Redden DT, Wang C, Westfall AO, Allison DB: Years of life lost due to obesity.

    JAMA 2003, 289(2):187-193. PubMed Abstract | Publisher Full Text OpenURL

  29. Rexrode KM, Hennekens CH, Willett WC, et al.: A prospective study of body mass index weight change, and risk of stroke in women.

    JAMA 1997, 277:1539-1545. PubMed Abstract | Publisher Full Text OpenURL

  30. Bjorntorp P: Classification of obese patients and complications related to the distribution of surplus fat.

    Am J Clin Nutr 1987, 45:1120-1125. PubMed Abstract OpenURL

  31. Redline S, Strohl KP: Recognition and consequences of obstructive sleep apnea hypopnea syndrome.

    Otolaryngol Clin North Am 1999, 32:303-331. PubMed Abstract | Publisher Full Text OpenURL

  32. Everhart JE: Gallstones. In Gastrointestinal diseases: risk factors and prevention. Edited by Johanson JF. Philadelphia, PA: Lippincott-Raven Publishers; 1997:145-72. OpenURL

  33. Coggon D, Reading I, Croft P, McLaren M, Barrett D, Cooper C: Knee osteoarthritis and obesity.

    Int J Obes 2001, 25:622-627. Publisher Full Text OpenURL

  34. Andersen LB, Haraldsdottir J: Tracking of cardiovascular disease risk factors including maximal oxygen uptake and physical activity from late teenage to adulthood. An 8-year follow-up study.

    J Intern Med 1993, 24(3):209-215. OpenURL

  35. Slemenda CW, Reister TK, Hui SL, Miller JZ, Christian JC, Johnston CC Jr: Influences on skeletal mineralization in children and adolescents: evidence for varying effects of sexual maturation and physical activity.

    J Pediatr 1994, 125(2):201-207. PubMed Abstract | Publisher Full Text OpenURL

  36. Welten DC, Kemper HC, Post GB, Van Mechelen W, Twisk J, Lips P, Teule GJ: Weight-bearing activity during youth is a more important factor for peak bone mass than calcium intake.

    J Bone Miner Res 1994, 9(7):1089-1096. PubMed Abstract OpenURL

  37. Bass SL: The prepubertal years: a uniquely opportune stage of growth when the skeleton is most responsive to exercise?

    J Sports Med 2000, 30(2):73-78. Publisher Full Text OpenURL

  38. Brown JP, Josse RG: 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada.

    Can Med Assoc J 2002, 167(10 Suppl):S1-34. OpenURL

  39. Tremblay MS, Willms JD: Secular trends in the body mass index of Canadian children.

    Can Med Assoc J 2000, 136(11):1429-33.

    Erratum in Can Med Assoc J 2001, 164(7):970


  40. Hill JO, Trowbridge FL: Childhood obesity: future directions and research priorities.

    Pediatrics 1998, 101:570-574. PubMed Abstract | Publisher Full Text OpenURL

  41. Walsh-Pierce J, Wardle J: Cause and effect beliefs and self-esteem of overweight children.

    J Child Psychol Psychiatry 1997, 38:645-650. PubMed Abstract | Publisher Full Text OpenURL

  42. Corbin WR, Corbin CB, Pangrazi RP, Petersen G, Pangrazi D: Self-esteem profiles: a comparison of children above and below national criteria for body fatness.

    The Physical Educator 1997, 54:47-56. OpenURL

  43. Joint WHO/FAO Expert Consultation on Diet, Nutrition and the Prevention of Chronic Disease In Diet, nutrition and the prevention of chronic diseases: report of a joint WHO/FAO expert consultation. Geneva;

    28 January-1 February 2002


  44. Brownson RC, Eyler AA, King AC, Brown DR, Shyu YL, Sallis JF: Patterns and correlates of physical activity among US women 40 years and older.

    Am J Public Health 2000, 90(2):264-270. PubMed Abstract | Publisher Full Text | PubMed Central Full Text OpenURL

  45. Eyler A, Baker E, Cromer L, King A, Brownson R, Donatelle R: Physical activity and minority women: a qualitative study.

    Health Educ Behav 1998, 25:640-652. PubMed Abstract | Publisher Full Text OpenURL

  46. King A: Intervention strategies and determinants of physical activity and exercise behaviour in adult and older adult men and women.

    World Rev Nutr Diet 1997, 82:148-158. PubMed Abstract OpenURL

  47. Eyler AA, Vest JR, Sanderson B, Wilbur J, Matson-Koffman D, Evenson KR, Thompson JL, Wilcox S, Young DR: Environmental, policy, and cultural factors related to physical activity in a diverse sample of women: the Women's Cardiovascular Health Network Project – introduction and methodology.

    Women and Health 2002, 36(2):1-15. Publisher Full Text OpenURL

  48. Carter-Nolan PL, Adams-Campbell LL, Williams J: Recruitment strategies for black women at risk for noninsulin-dependent diabetes mellitus into exercise protocols: a qualitative assessment.

    JAMA 1996, 88(9):558-562. OpenURL

  49. Airhihenbuwa CO, Kumanyika S, Agurs TD, Lowe A: Perceptions and beliefs about exercise, rest, and health among African-Americans.

    Am J Health Promotion 1995, 9(6):426-429. OpenURL

  50. Broman CL: Leisure-time physical activity in an African-American population.

    J Behav Med 1995, 18(4):341-53. PubMed Abstract | Publisher Full Text OpenURL

  51. Flynn KJ, Fitzgibbon M: Body image and obesity risk among black females: a review of the literature.

    Ann Behav Med 1998, 20(1):13-24. PubMed Abstract OpenURL

  52. Thompson JL, Allen P, Cunningham-Sabo L, Yazzie DA, Curtis M, Davis SM: Environmental, policy, and cultural factors related to physical activity in sedentary American Indian women.

    Women and Health 2002, 36(2):59-74. Publisher Full Text OpenURL

  53. Humbert ML: On the sidelines: the experiences of young women in physical education classes.

    Avante 1995, 1(2):58-77. OpenURL

  54. Thompson RA: Management of the athlete with an eating disorder. Implications for the sport management team.

    Sport Psychol 1987, 1:114-126. OpenURL

  55. Vertinsky P: Reclaiming space, revisiting the body: the quest for gender sensitive physical education.

    Quest 1992, 44:373-396. OpenURL

  56. McLear K: The myth of the model minority. Re-thinking the education of Asian-Canadians.

    Our Schools, Our Selves 1994, 54-76. OpenURL

  57. O'Brien S, Vertinsky P: Unfit survivors: exercise as a resource for aging women.

    Gerontologist 1991, 31(3):347-357. PubMed Abstract OpenURL

  58. Health Canada: [] webcite

    Canada's physical activity guide to healthy active living. Ottawa: Health Canada,. 1998. OpenURL

  59. Sallis JF, Saelens BE: Assessment of physical activity by self-report: status, limitations, and future directions.

    Res Q Exerc Sport 2000., 71(2) OpenURL

  60. Barbanowski T: Validity and reliability of self-report of physical activity: an information processing perspective.

    Res Q Exerc Sport 1988, 59:314-327. OpenURL

  61. Warnecke RB, Johnson TP, Chavez N, Sudman S, O'Rourke DP, Lacey L, Horm J: Improving question wording in surveys of culturally diverse populations.

    Ann Epidemiol 1997, 7:334-342. PubMed Abstract | Publisher Full Text OpenURL

  62. McCabe RE, McFarlane T, Polivy J, Olmsted MP: Eating disorders, dieting and the accuracy of self-reported weight.

    Int J Eating Dis 2001, 29:59-64. Publisher Full Text OpenURL

  63. Strauss RS: Comparison of measured and self-reported weight and height in a cross-sectional sample of young adolescents.

    Int J Obes 1999, 23:904-908. Publisher Full Text OpenURL

  64. Bostrom G, Diderichsen F: Socioeconomic differentials in misclassification of height, weight and body mass index based on questionnare data.

    Int J Epidemiol 1997, 126(4):860-866. Publisher Full Text OpenURL

  65. Plankey MW, Stevens J, Flegal KM, Rust PF: Prediction equations do not eliminate systematic error in self-reported body mass index.

    Obes Res 1997, 5(4):308-314. PubMed Abstract OpenURL

  66. Hill A, Roberts J: Body mass index: a comparison between self-reported and measured height and weight.

    J Public Health Med 1998, 20(2):206-210. PubMed Abstract OpenURL

  67. Roberts RJ: Can self-reported data accurately describe the prevalence of overweight?

    Public Health 1995, 109(4):275-284. PubMed Abstract | Publisher Full Text OpenURL

  68. Jebb SA, Moore MS: Contribution of a sedentary lifestyle and inactivity to the etiology of overweight and obesity: current evidence and research issues.

    Med Sci Sports Exerc 1999, 31(Suppl 11):S534-S541. Publisher Full Text OpenURL

  69. Shannon B, Smiciklas-Wright H, Wang MQ: Inaccuracies in self-reported weights and heights of a sample of sixth-grade children.

    J Am Diet Assoc 1991, 91(6):675-678. PubMed Abstract OpenURL

  70. Vailas LI, Nitzke SA: Self-reported versus measured weight and height in an older adult meal program population.

    J Gerontol A Biol Sci Med Sci 1998, 53(6):M481-3. PubMed Abstract OpenURL

  71. Kuczmarski MF, Kuczmarski RJ, Najjar M: Effects of age on validity of self-reported height, weight, and body mass index: findings from the Third National Health and Nutrition Examination Survey, 1988–1994.

    J Am Diet Assoc 2001, 101(1):28-34. PubMed Abstract | Publisher Full Text OpenURL

  72. Expert Panel of the National Institutes of Health. Clinical guidelines on the identification, evaluation and treatment of overweight and obesity in adults: executive summary

    Am J Clin Nutr 1998, 68(4):899-917. PubMed Abstract | Publisher Full Text OpenURL