Secrets of Happy Eaters

For many of us, sumptuous meals translate to a guilt-ridden reach for the gym pass, a seven-day juice fast or panic about being able to zip up our jeans.

Fully 75 percent of women eat, think and behave abnormally around food, according to a one-of-a-kind survey of 4,000 women SELF conducted with Cynthia M. Bulik, Ph.D., director of the eating disorders program at the University of North Carolina at Chapel Hill. A minority has full-blown eating disorders such as anorexia or bulimia. But most are disordered eaters with less severe—but definitely unhealthy—hang-ups.

It's all an understandable reaction to our cult of thin and feast of fat. "Americans are bombarded by food cues. The profusion of cheap, high-calorie food is too often a prescription for weight gain," says Michael R. Lowe, Ph.D., professor of psychology at Drexel University in Philadelphia.

Yet if you look at our survey another way, 25 percent of women have a positive relationship to food. And plenty of these women—SELF calls them "happy eaters"—are not effortlessly slim. Many of them watch their weight; they judge themselves in the mirror. Yet they also keep food in perspective. Happy eaters manage the tricky balance of self-control without obsession.

Here's how to join them.

Happy eaters go on fewer diets

Of the disordered eaters in SELF's survey, 69 percent have spent at least a quarter of their adult life on a diet. But among women the survey classified as nondisordered eaters, 81 percent have spent little or no time dieting since age 18. "Losing weight and eating healthy are different things," Bulik notes. The survey's happy eaters are also much less likely to have started dieting before age 20. "If you start early, dieting can become a lifestyle," she says. Yet calorie-restricting diets aren't proven to lead to lasting weight loss or better health, an analysis by the University of California at Los Angeles notes.

The happy way to diet is for health, Lowe says—"not based on the idea that you can't be a worthwhile person unless you lose weight." Survey participant Julie Waldrop, 40, the owner of an eBay store in Crestwood, Kentucky, is 5 feet 6 inches and makes choices daily to maintain her 130 pounds. "I plan to have protein, veggies and fruit at meals. I avoid anything fried; I have irritable bowel syndrome, and junk food makes it worse," she says. "I don't know if it's a diet, or just healthy living."

"Weight loss should be the result of a goal, not the goal itself," adds Suzanne Farrell, R.D., of Cherry Creek Nutrition in Denver. Rather than a target weight, set a goal such as training for a race or eating a breakfast that gives you more energy at work. By redefining success, you'll stick with healthy habits even if you don't see immediate results on the scale.

Happy eaters have breakfast, lunch and dinner

Lisa Dolan, a 44-year-old mother of five from Cazenovia, New York, organizes three moderate meals a day for her entire brood. "I take a few extra steps: TV off, music on, the table set," says Dolan, who is 5 feet 2 inches and weighs 114 pounds. "We sit down instead of standing at the kitchen counter. I take my time—I've actually gone on yoga retreats where I wasn't allowed to talk while I was eating." The rest of the day, Dolan says, "I don't focus on food too much. I enjoy it, but I don't ritualize it."

Dolan is a happy eater who keeps food top of mind at meals and out of mind between them. And like 9 out of 10 happy eaters in the survey, she doesn't skip meals for weight loss—almost half of disordered eaters have. Regularly skipping meals makes you more prone to belly fat, heart disease and diabetes, reports a study from the Karolinska Institute in Stockholm, Sweden. Happy eaters are also much less likely to fast or smoke to lose weight. A mere 3 percent of them have eaten less than 1,000 calories a day, whereas 21 percent of disordered eaters have. "It's human to look for a quick fix," Bulik says. "But extreme dieting behavior backfires. Slow and steady wins the race."

Happy eaters can feel full all day by having a breakfast that's roughly 350 calories, lunch that's 500, dinner that's 600 and one or two 200-calorie treats, say SELF contributors Stephanie Clarke, R.D., and Willow Jarosh, R.D., of New York City. Plan menus and snack bags with a mix of dried fruit, nuts and whole-grain cereal. "Just as skipping meals is a habit, so is eating regular meals," Clarke says. "Stick with it, and soon skipping meals will feel strange."

Happy eaters use a scale, but not daily

"Patients tell me, 'Getting on the scale tells me how my day will go,'" says Ellen Astrachan-Fletcher, Ph.D., director of the eating disorders clinic at the University of Illinois in Chicago. "That's a lot of power for one little number." Happy eaters, she says, know that weight fluctuates daily and that weighing each morning doesn't give you an accurate measure.

Normal- and underweight women often don't need a scale. For people who are prone to weight gain, checking in occasionally "makes them aware of when they need to cut back," Astrachan-Fletcher says. But happy eaters don't define themselves by the number they see or put off things they want to do because they haven't reached the right number. Nearly two thirds of disordered eaters say that a 5-pound weight gain would make them moderately or extremely upset, whereas about one third of nondisordered eaters feel that way.

Waldrop gained almost 10 pounds last year. "But I wasn't stressed about it," she says. She hit the scale a little more often, every few days, and asked herself what had led to the gain: being busy with two kids and a home business. She adjusted her calories and gradually dropped the weight. "I understand I'm going to gain a little, and I also know I can get it off," she says.

Happy eaters splurge with no regrets

In the SELF survey, 92 percent of disordered eaters said they categorize foods as "good" and "bad," defining bad foods as ones that are high in fat, calories and carbs. "We shouldn't look at foods as good or bad," Astrachan-Fletcher urges. "Foods don't carry judgment; they carry nutritional value. Think of food as just food—fuel for your body and something one can enjoy within reason."

We could all benefit from redefining what "good" food is, argues Kelly Brownell, Ph.D., director of the Rudd Center for Food Policy and Obesity at Yale University in New Haven, Connecticut. Food choices have consequences beyond ourselves, he says. "For example, food production is a huge contributor to global warming. Instead of eating something with 50 ingredients, eat one ingredient from a farmers' market." In his view, happy eating means valuing organic and local food, not just low-cal fare.

When happy eaters do splurge, they told SELF, they don't beat themselves up. "If I want a bag of chips, I'll have it. I don't deny myself," Dolan says. "Everyone needs Dairy Queen once in a while, right?" Waldrop reasons. Eve Metlis, a 33-year-old real estate agent from Orlando, Florida, builds splurges into her regular meal plans. Metlis is 5 foot 4 and weighs 140 pounds—a number she's proud of, as she lost 70 pounds to get there. At a party, she says, she'll choose a glass of wine over cake. "I might take a forkful of icing," she says. And she knows when going whole hog is the happy choice. "On holidays like Thanksgiving, I indulge. I can enjoy it because it's about being with my family," she says.

Farrell encourages her clients to have a weekly splurge. Six days a week, stick to low-calorie treats. One day, go for the full banana split. "Have a real-deal dessert without looking at the fat or sugar content," she says. "Savor and eat with pleasure."

Happy eaters know women come in all sizes

Danielle Trentacosti, 32, is 5 foot 7 and a size 0 and freely admits she has a blessed metabolism. "I thank my mother for that," says the stay-at-home mom in Toms River, New Jersey. Food and body image are not her issues—except to the extent that other women single her out. "I was at the beach with my friends, and someone hopped up to take a photo," Trentacosti recalls. "All the women scrambled to move away from me, saying they didn't want to be next to the 'skinny mom.' I was embarrassed and uncomfortable. I would never comment on what other women weigh or eat."

How can women who are not as effortlessly slender as Trentacosti be as nonjudgmental? For disordered eaters, it's a struggle: They are five times more likely than happy eaters to start a diet as a result of having slim friends. The difference is equally stark when it comes to feeling pressure from media images of slender women. And these unrealistic comparisons feed dangerous eating habits. "I hear women saying to each other, 'Oh, my God, you got so thin!'" says Sondra Kronberg, R.D., codirector of the Eating Disorder Treatment Collaborative in Westbury, New York. "It's normal in this culture to do that, but to me, it promotes something unhealthy. We can't all be 6 feet 2 inches and weigh 104 pounds."

Simply being aware of the body assessments you make throughout the day can help end the negative ones, notes Mary E. Connors, Ph.D., a clinical psychologist in Chicago, who specializes in mindful eating. Take a day to track how much you are body checking—looking in mirrors, fussing with the fit of your clothes, touching areas such as your tummy or collarbone. "If your first thought is something like, Compared to that model's, my thighs are gross," Connors says, then try to shift your thinking to a happier frame of mind. "Focus on what your legs do for you and all that they add to your life."

Happy eaters exercise without anxiety

Among the women we surveyed, one group was most likely to work out more than once a week: nondisordered eaters who are watching their weight. Many disordered eaters exercise frequently, too. But for happy eaters, "exercise is a means to have a healthy body and cope with stress. It doesn't define them," says Graham Thomas, Ph.D., assistant professor of behavioral medicine at Brown University Medical School in Providence, Rhode Island, and coinvestigator for the National Weight Control Registry. "For some eating-disordered women, exercise does define them. They might decide how they feel about themselves based on how much they work out."

Gregory Florez, CEO of FitAdvisor.com, a corporate health-coaching service in Salt Lake City and spokesman for the American Council on Exercise, says two thirds of his clients are exercise addicts. "Some women have low self-esteem or anxiety that they are pouring into body image. Because they exercise from a place of fear, they can feel frantic if they miss a workout and stick to their routine even when ill or injured." Happy eaters, in contrast, "listen to their body and rest when they need to," Florez says. "Give your body time to recover and your next workout will be of a higher quality."

For happy eater April Grimm, a 36-year-old day care center owner from Little Cedar, Iowa, making a mix of activities part of her daily play has helped her decouple exercise from weight loss worries. And by testing her muscles in new ways, she gets better results than she would with a set routine. Grimm, 5 foot 9 and about 135 pounds, lifts weights and gets creative to stay active with her kids. "I do sit-ups while my youngest crawls around me," she says. "We take bike rides or run in circles in the yard." Learning to feel satisfied with this kind of "unworkout" is a happy approach. "The worst thing you can do is say, It's not going to count if I don't do 60 minutes at the gym," Florez says. "Any movement counts, even if it's only for 10 minutes."

No-Diet Ways to Lose Weight

If you shudder at any mention of the “D” word but still need to drop a few pounds, use these tricks to help you slim down sans calorie counters and detox drinks

If sifting through the Google results for “diets that work” makes your head spin, try this trick: Don’t call it a diet. “For most Americans, diet is a dirty word that evokes pain, frustration, and bad memories of diets that went belly up,” says Connie Bennett, a life and health coach and author of Sugar Shock: How Sweets and Simple Carbs Can Derail Your Life—and How You Can Get Back on Track. So forget trying to overhaul your eating with detox cleanses and flavorless microwave meals. Instead, focus on making small, manageable changes that fit into your life. The following 11 simple strategies will help you slim down without giving up what you love.

The do-it-yourself diet

1) Schedule Sweat Sessions. It’s obvious advice, but it works. Exercise can help you lose weight by burning calories, increasing metabolism, and warding off cravings. Italian researchers found that overweight, sedentary women who made no changes to their eating habits but participated in a 12-week indoor cycling program of three 1-hour sessions per week reported weight loss, fat loss, smaller waist sizes, and increased muscle mass after 24 and 36 sessions. The women also lowered their resting and training heart rates and improved cardio-respiratory fitness, according to a study published in the Journal of Sports Medicine and Physical Fitness.

Don't give exercise the cold shoulder. Rally with these 40 winter-inspired tips.

2) Pick Petite Plates. “If you can decrease the amount of food you currently eat by 25 percent, you would quickly see the pounds come off,” says Adam Shafran, cohost of the Atlanta-based radio show Dr. Fitness and the Fat Guy and coauthor of 35 Things to Know to Raise Active Kids. “Try using smaller plates and taller glasses in order to give the appearance of bigger portions.” When you’ve finished eating, leave your dainty dinnerware where you can see it. Sitting among heaps of dirty dishes helped Cornell University graduate students eat 28 percent less than those whose tables were cleared at a free Super Bowl Sunday chicken wing buffet, according to a study published in the journal Perceptual and Motor Skills.

3) Take Time-outs. To keep your body moving—and burning calories—throughout the day, Bennett suggests taking a mini break every 15 minutes. “It reminds me to stretch, take care of my back, do some exercise bursts, be present, and have fun,” says Bennett. “You can take as little as 30 seconds or as long as 5 minutes. Just get up off your rear end, stretch, go get some water, pull in your stomach, rearrange something on your desk or in your home, and stand on your tippy toes.” To schedule your breaks, try setting a timer. This free tool from online-stopwatch.com lets you pick your own sound—like a round of applause—to signal that it’s time to get up and move.

4) Don’t Skimp on Sleep. “Sleep deprivation causes fatigue, clumsiness, and weight gain,” says Carrie Wiatt, owner of Diet Designs, a Los Angeles–based nutritional counseling firm. “Getting enough sleep is crucial to proper cognitive function as well as controlling hunger.” Sleep deprivation has the power to slow down your metabolism, increase your appetite, and throw your body’s hunger and satiety hormones out of whack. Of more than 68,000 middle–age women who participated in a Case Western Reserve University study, those who slept for less than 5 hours each night were 32 percent more likely to gain 33 pounds or more over the course of the 16-year study, compared with those who got 7 to 9 hours of shut-eye.

5) When in Doubt, Delay. Here’s one way procrastination can work in your favor. “If carb cravings are haunting you, just delay,” Bennett suggests. “In other words, look at your watch and promise yourself that for the next 10 to 15 minutes, you won’t give in to your cravings. During that time, you could go to the restroom, wash the dishes, or call a friend.” You’ll give yourself a chance to figure out what your body really wants or needs—maybe a glass or water, a protein-rich snack, an energizing walk, or even a laugh.

source: msn health

Top 5 Habits That Harm Your Heart

cording to a centuries-old story, the Four Horsemen of the Apocalypse will announce the end of the world. According to hard data, five harmful habits herald the coming of heart disease. These five are:

1. smoking
2. being inactive
3. carrying too many pounds
4. eating poorly
5. drinking too much alcohol

Alone and together, they set the stage for artery-damaging atherosclerosis and spur it onward. They do this by deranging metabolism and changing how cells and tissues work. They also disturb the markers of health we worry about so much: blood pressure, cholesterol, and blood sugar. All too often, the end result of these five habits is a heart attack, stroke, peripheral artery disease, valve problem, aortic aneurysm, or heart failure. And the damage they cause isn't limited to the cardiovascular system, but extends to the kidneys, bones, and brain.

Premature aging and death

How much do these five habits contribute to a personal health apocalypse? A lot. In a study of 4,900 men and women in England, Wales, and Scotland, researchers tallied up the occurrence of four unhealthy habits — smoking, low intake of fruits and vegetables, little physical activity, and having more than 21 alcoholic drinks a week for men or 14 for women. Compared to participants with none of the habits, those with just one of them were 85 percent more likely to have died during the 20-year study, while the increase among those with all four was 349 percent, or more than threefold higher (Archives of Internal Medicine, April 26, 2010). By the researchers' reckoning, people with all four unhealthy behaviors were physically 12 years older than their chronological ages.

What can making better choices do for health and longevity? Read on for five strategies for change.

Strategies for change: Avoid tobacco

Smoke from cigarettes, cigars, and pipes is as bad for the heart and arteries as it is for the lungs. If you smoke, quitting is the biggest gift of health you can give yourself. Secondhand smoke is also toxic, so avoid it whenever possible.

Strategies for change: Drink alcohol in moderation (if at all)

If you drink alcohol, limit your intake — one to two drinks a day for men, no more than one a day for women.

Strategies for change: Aim for a healthy weight

Carrying extra pounds, especially around the belly, strains the heart and tips you toward diabetes. If you are overweight, losing just 5 percent to 10 percent of your starting weight can make a big difference in your blood pressure and blood sugar.

Strategies for change: Enliven your diet

Add fruits and vegetables, whole grains, unsaturated fat, good protein (from beans, nuts, fish, and poultry), and herbs and spices. Subtract processed foods, salt, rapidly digested carbohydrates (from white bread, white rice, potatoes, and the like), red meat, and soda or other sugar-sweetened beverages.

How change can help your heart

Consider this provocative finding from the Nurses' Health Study. Nonsmoking women with a healthy weight who exercised regularly, consumed a healthy diet, and had an alcoholic drink every other day were 83 percent less likely to have had a heart attack or to have died of heart disease over a 14-year period, compared with all the other women in the study (New England Journal of Medicine, July 6, 2000). The results were almost identical in a similar study in men. In these two studies, more than two-thirds of all cardiovascular events could be chalked up to smoking, excess weight, poor diet, and drinking too much.

Set goals and track progress

Give yourself a gold star if you are in the small minority of Americans who follow all five healthy behaviors. You have built yourself a solid foundation for good health.

If you have one or more habits that are working against you, now is as good a time as any to set a course for better health. How? "Just do it" may be catchy advice, but it doesn't often work. Most of us need concrete help to make and sustain lifestyle changes. The American Heart Association recommends "cognitive behavioral strategies for promoting behavior change" (Circulation, July 27, 2010). They aim to help you think more positively about yourself as you make healthy changes. Here are some of those strategies:

Set goals. Having specific, achievable goals is a key strategy for successful change. Goals that involve behaviors ("I will eat three servings of whole grains a day") tend to work better than physiological goals ("I will lower my cholesterol").

Track your progress. With all the things you have to remember each day, it's hard to know whether you are meeting your daily goals. Keeping track of steps taken each day (if you use a pedometer) or pounds lost each week gives important feedback about your progress. Data from dozens of studies show that self-monitoring is an important attribute of successful changers. You can do this with a notebook, a computer, a smartphone, or an invention of your own.

Find your motivation and seek support

Motivation. Changing a habit or behavior is easier if you have a good reason for doing it. Hearing your doctor say "You need to quit smoking" isn't nearly as compelling a reason to stop as having a family member or friend diagnosed with lung cancer. Motivation can be something big, like getting in shape for a walking trip with a grandchild, or small, like fitting into a slimmer suit for a wedding. The more personal the motivator, the better.

Get support. Starting a change isn't nearly as challenging as sticking with it. Support from family, friends, a doctor, or someone else — even from an online community — can provide feedback and encouragement, especially when you are feeling low. Sharing a daily walk or a weight-loss program with an exercise or diet "buddy" makes it more fun and harder to slack off.

Reward yourself and realize you're not perfect

Reward yourself. Change is hard work. So give yourself pats on the back along the way. These can be small things, like a new CD or a vase of flowers, or something bigger, like tickets to a play or a special trip. The pleasure you get from rewards loops back to reinforce the positive changes you are making.

Get back on track. To paraphrase poet Robert Burns, the best laid plans of cigarette quitters or new exercisers often go awry. It's to be expected — no one is perfect, and life can get in the way of even the most meticulous plans. Take a derailment in stride. Instead of berating yourself, summon the motivation and goals that got you started and use them to keep moving forward. It is during these so-called relapses that support is most helpful.

You don't need to aim for a complete transformation all at once. Small changes in diet, exercise, or weight can make a big difference in your health. Setting goals you can realistically achieve, and then meeting them, can snowball into even bigger improveme

from: Harvard Health Publications

Tiny breaks from sitting can whittle a tinier waist

Taking short breaks from sitting, even for only one minute, might whittle your waistline and improve your heart health, according to a new study.

People in the study who took the most breaks from sitting — up to 1,258 short breaks in one week — were about two pant sizes smaller than those who took the fewest, as few as 99 breaks in one week, said study researcher Genevieve Healy, who studies population health at the University of Queensland in Australia.

And a smaller waistline means less abdominal fat and better heart health, Healy said.

"A high waist circumference is associated with an increased risk for type 2 diabetes, high blood pressure and cardiovascular disease," she told MyHealthNewsDaily.

When we stand, the large muscles in our legs and the back are continually contracting to maintain our posture, but when we sit or recline, these muscle groups are basically inactive, Healy said.

"So even short breaks from sitting get these large muscle groups contracting," she said.
The study will be published tomorrow (Jan. 12) in the European Heart Journal.

Swine flu could mix with bird flu, expert warns

Bird flu kills more than 60 percent of its human victims, but doesn't easily pass from person to person. Swine flu can be spread with a sneeze or handshake, but kills only a small fraction of the people it infects.

So what happens if they mix?

This is the scenario that has some scientists worried: The two viruses meet — possibly in Asia, where bird flu is endemic — and combine into a new bug that is both highly contagious and lethal and can spread around the world.

Scientists are unsure how likely this possibility is, but note that the new swine flu strain — a never-before-seen mixture of pig, human and bird viruses — has shown itself to be especially adept at snatching evolutionarily advantageous genetic material from other flu viruses.

"This particular virus seems to have this unique ability to pick up other genes," said leading virologist Dr. Robert Webster, whose team discovered an ancestor of the current flu virus at a North Carolina pig farm in 1998.

The current swine flu strain — known as H1N1 — has sickened more than 2,300 people in 24 countries. While people can catch bird flu from birds, the bird flu virus — H5N1 — does not easily jump from person to person. It has killed at least 258 people worldwide since it began to ravage poultry stocks in Asia in late 2003.

‘Do not drop the ball’

The World Health Organization reported two new human cases of bird flu on Wednesday. One patient is recovering in Egypt, while another died in Vietnam — a reminder that the H5N1 virus is far from gone.

"Do not drop the ball in monitoring H5N1," WHO Director-General Margaret Chan told a meeting of Asia's top health officials in Bangkok on Friday by video link. "We have no idea how H5N1 will behave under the pressure of a pandemic."

Experts have long feared that bird flu could mutate into a form that spreads easily among people. The past three flu pandemics — the 1918 Spanish flu, the 1957-58 Asian flu and the Hong Kong flu of 1968-69 — were all linked to birds, though some scientists believe pigs also played a role in 1918.

Webster, who works at St. Jude's Children's Research Hospital in Memphis, Tenn., said bird flu should be a worry now. Bird flu is endemic in parts of Asia and Africa, and cases of swine flu have already been confirmed in South Korea and Hong Kong.

"My great worry is that when this H1N1 virus gets into the epicenters for H5N1 in Indonesia, Egypt and China, we may have real problems," he told The Associated Press. "We have to watch what's going on very diligently now."

Spokesman Dave Daigle said he could not comment specifically on how concerned the U.S. Centers for Disease Control and Prevention is about the scenario Webster describes, or what it is doing to study such a possibility.

Malik Peiris, a flu expert at Hong Kong University, said the more immediate worry is that swine flu will mix with regular flu viruses, as flu season begins in the Southern Hemisphere. It is unclear what such a combination would produce.

But he said there are indications that scenario is possible. Peiris noted that the swine flu virus jumped from a farmworker in Canada and infected about 220 pigs. The worker and the pigs recovered, but the incident showed how easily the virus can leap to a different species.

"It will get passed back to pigs and then probably go from pigs to humans," Peiris said. "So there would be opportunities for further reassortments to occur with viruses in pigs."

He said so far bird flu hasn't established itself in pigs — but that could change.

"H5N1 itself has not got established in pigs," he said. "If that were to happen and then these two viruses were both established in pigs in Asia, that would be quite a worrying scenario."

No evidence of mixing yet

Michael Osterholm, an infectious disease specialist at the University of Minnesota who has advised the U.S. government on flu preparations, said while flu experts are discussing the scenario, he has yet to see specific evidence causing him to think it will happen.

"Everything with influenza is a huge guessing game because Mother Nature holds all the rules, and we don't even know what they are, so anything's possible," he said. "We don't have any evidence that this particular reassortment is that much more likely to pick up H5N1 than any other reassortment out there."

"We don't have to put these things together," he added. "This is not chocolate and peanut butter running into each other in the dark hallway."

But there is in fact discussion of putting them together — in a high-security laboratory — to see what a combination would look like, according to Webster. Similar tests have been done at the CDC mixing bird flu and seasonal human flu, resulting in a weak product, he said.

Daigle, the CDC spokesman, refused to comment on the prospect of any such experiment.

Infections around the world

Webster has done groundbreaking work on both swine and bird flus in his 40-year career, and has followed the evolution of the current swine flu strain from a virus that sickened a handful of people who worked with North Carolina hogs into a bug that has spread from person to person around the world.

He is closely involved in the global effort to analyze what the virus might do next. It has killed 42 people in Mexico and two in Texas, but so far has not proven very deadly elsewhere, leading to some criticism that the World Health Organization's warnings of a potential pandemic have been overblown.

Webster said underestimating the swine flu virus would be a huge mistake.

"This H1N1 hasn't been overblown. It's a puppy, it's an infant, and it's growing," he said. "This virus has got the whole human population in the world to breed in — it's just happened. What we have to do is to watch it, and it may become a wimp and disappear, or it may become nasty."

source: msn health

Pregnant women often deny smoking

Overall, about one in four women who smoke while pregnant deny it, a new study hints. The numbers could be even higher in certain groups of women, like those in their early 20s.

In the United States, smoking by moms-to-be is one of the most common preventable causes of illness and death among infants, Dr. Patricia Dietz from the division of reproductive health at the Centers for Disease Control and Prevention in Atlanta, and colleagues note in their report.

In their study, they estimated how many pregnant and nonpregnant smokers aged 20 to 44 years did not disclose their habit on a health questionnaire.

How did they catch the deception? They took blood samples from the women to measure levels of cotinine -- a byproduct of nicotine that serves as a marker of exposure to tobacco smoke. Their analysis included 994 pregnant women and 3,203 nonpregnant women.

Overall, 13 percent of pregnant women and 30 percent of nonpregnant women were active cigarette smokers. The pregnant smokers smoked an average of 11 cigarettes a day, while the nonpregnant smokers averaged close to 14 cigarettes a day.

According to the investigators, far more pregnant than nonpregnant smokers failed to disclose their habit - 23 percent versus nine percent - and were identified by their cotinine concentrations.

For a variety of reasons, such as the fact that pregnant women's bodies break down cotinine faster, the researchers think the results "likely underestimate" the true number of pregnant women who smoke and don't say so.

Among both pregnant and nonpregnant smokers, those most likely to keep this information to themselves were women aged 20 to 24, as well as those with Medicaid or other source of government-funded health insurance and those with less than a high school education.

Race also factored in. Pregnant smokers who failed to report their habit were most likely to be non-Hispanic black. In women who weren't pregnant, nondisclosure was most common among Mexican-American women and non-Hispanic blacks.

Writing in the American Journal of Epidemiology, Dietz and her colleagues say their findings may have important implications for researchers studying how smoking during pregnancy affects the developing baby, as roughly one in four pregnant smokers, and one in 10 nonpregnant smokers, deny smoking.

Studies and surveillance systems that rely on people to accurately state their smoking status may get inaccurate information, "especially among pregnant women," they warn.

SOURCE: http://link.reuters.com/tux34r American Journal of Epidemiology