Anorexia Nervosa

In patients with anorexia nervosa, emaciation will be obvious. Often, the patient is brought to the clinician's attention by the family, who are concerned about weight loss. The patient frequently tries to minimize concerns about her intake and low body weight, and may resort to subterfuge, such as wearing heavy clothing while being weighed. Although physical complaints are remarkably few given the degree of emaciation (73), patients present with a variety of signs and symptoms referable to low...

Info

Figure 2 Natural history of overweight. Because many nonoverweight babies become overweight, this group is labeled pre-overweight. About one-third of those who become overweight do so before age 20, and two-thirds do so after. The remainder are not overweight. Parental overweight Lower socioeconomic status Smoking cessation Low level of physical activity Low metabolic rate Childhood overweight Heavy babies Lack of maternal knowledge of child's sweet-eating habits Recent marriage Multiple birth...

Conclusions

This chapter has shown the difficulties that past obesity prevention programs have faced, given the very disadvantageous environment which is so conducive to the inappropriate dietary and physical activity behaviors that underlie the emerging epidemic of obesity throughout the world. Current obesity prevention efforts may have been inhibited by a number of factors, including a lack of acceptance of the importance of obesity as a serious health problem the setting of inappropriate or...

References

Cultural and psychosocial determinants of weight concerns. Ann Intern Med 1993 119 643-645. 9. 2. Sobal J, Maurer D. Weighty Issues. Fatness and Thinness as Social Problems. Hawthorne, NY Gruyter, 1999. 3. Brown PJ, Konner M. An anthropological perspec- 10. tive on obesity. Annals of the New York Academy of Sciences 1987 499 29-46. 4. Ritenbaugh C. Obesity as a culture-bound syndrome. 11. Culture Med Psychiatry 1982 6 347-361. 5. Thomas PR, ed. Weighing the Options. Criteria for...

Introduction

With nearly 60 of U.S. adults currently categorized as overweight or obese, this condition represents one of the most common chronic medical problems seen by the primary care physician. Since obesity is associated with an increased risk of multiple health problems, these patients are also more likely to present with silent diseases, e.g., hypertension, dyslipidemia, type 2 diabetes, or with a variety of complaints requiring further medical attention. For this reason, the U.S. Preventive...

Long Term Prevention of Weight Regain

Recent studies with a liquid diet and meal replacement scheme have produced a better initial weight loss in obese patients than a standard, energy-restricted regimen. In addition, persisting with the replacement of a single meal together with an energy-restricted diet after a 3-month weight loss period allowed patients to both amplify their weight loss for a time and then maintain the reduced weight at 3 months for a further 4 years (144). Although this trial involved supervision, another...

Of Overweight Patients

Overweight is now recognized as a risk factor for cardiovascular disease and as a contributing factor in the development of other diseases, most notably diabetes and gallbladder disease. In this context, it is important to evaluate and treat the obesity and other risk factors so as to reduce the overall likelihood for developing disease and to reduce the social consequence of being obese. The section addresses the clinical evaluation of the overweight patients (1,100,101). It then reviews...

Night Eating Syndrome

A characteristic circadian neuroendocrine pattern has been observed in a study of the night eating syndrome (7). The presence of elevated 24-hr levels of cortisol provides a biological marker of the stress under which patients are laboring. Blunting of the expected nighttime rise in melatonin and leptin was also found, in intriguing association with the impaired sleep and nighttime snacking of the night eating syndrome. In patients undergoing inpatient or partial hospital-ization, the...

Conceptualization Of The Problem Of Weight Regain

A complex interaction of physiological, environmental, and psychological factors makes the maintenance of lost weight difficult to achieve. Following a period of restrictive dieting, people often experience a heightened sensitivity to palatable food (22). Consequently, exposure to an environment rich in tasty high-fat, high-calorie foods virtually guarantees occasional lapses in dietary control (23,24). Moreover, increased caloric intake during the postdieting period may easily translate into...

Medical And Health Care Discrimination

Health care is an additional arena where weight discrimination appears to occur. Negative antifat attitudes have been reported among physicians, nurses, and medical students. Perceptions of obese patients include beliefs that they are unsuccessful, unpleasant, unintelligent, overindulgent, weak-willed, and lazy (19-23). Attributions about the cause of obesity may be partially responsible, and include assumptions that obesity can be prevented by self-control (22), that patient noncompliance...

Increased Physical Activity

An increase in physical activity promotes weight loss through increased expenditure of energy and possibly through inhibition of food intake. Physical activity also helps to maintain a desirable weight and to reduce CHD risk beyond that produced by weight reduction alone. Several experts contend that a decrease in the amount of energy expended for work, transportation, and personal chores is a major cause of obesity in the United States. They note that total caloric intake has not increased...

Exercise and Metabolism

The 24-h energy expenditure can be broken down into several components, including resting metabolic rate (RMR), the thermic effect of feeding, and the energy cost of physical activity. Less than 20 of the RMR is attributed to skeletal muscle (1). Nonetheless, the factor that can cause the most dramatic effect on metabolic rate is strenuous exercise. During strenuous exercise, the total energy expenditure of the body may increase 15-25 times above resting levels (1). This enormous elevation in...

Dissecting Obesogenic Environments The Angelo Framework

The development and execution of health promotion programs, including environmental interventions requires the following steps (1) needs analysis, (2) problem identification, (3) strategy development, (4) intervention, and (5) evaluation (34). Major barriers to progressing through these steps for environmental programs include the lack of suitable paradigms and tools for understanding and measuring the environment (35). We have previously described the development and use of the ANGELO...

Clinical Classification

Liposarcoma Lump

A Anatomic Characteristics of Adipose Tissue and Fat Distribution Obesity is a disease whose pathology lies in the increased size and number of fat cells. An anatomic classification of obesity from which a pathologic classification arises is based on the number of adipocytes, on the regional distribution of body fat, or on the characteristics of localized fat deposits (1,2). The number of fat cells can be estimated from the total amount of body fat and the average size of a fat cell (3)....

Sociocultural Factors

It has been proposed that''dieting disorders'' is a more proper term than ''eating disorder'' because the underlying essential feature of anorexia nervosa, bulimia nervosa, and associated conditions is the ''inappropriate and excessive pursuit of thinness'' (32). For individuals with either anorexia nervosa or bulimia nervosa, attempts at weight loss and dietary restriction (often severe) almost invariably precede the development of the significant symptoms of disordered eating. The current...

Natural History Of Obesity

Individuals can become overweight at any age, but this is more common at certain ages. At birth, those who will and those who will not become obese later in life can rarely be distinguished by weight (87), except for the infants of diabetic mothers, for whom the likelihood of obesity later in life is increased (88). Thus, at birth, a large pool of individuals will eventually become overweight, and a smaller group will never become overweight. I have labeled these pools ''preoverweight'' (Fig....

Iiiobesogenic And Leptogenic Environments

A central concept to emerge from considering these models is that, while environments are external to the person, they have a powerful influence on the person's behaviors and thus energy balance and obesity. The term obesogenic environments can be defined as ''the sum of influences that the surroundings, opportunities or conditions of life have on promoting obesity in individuals or populations'' (19). By contrast, leptogenic environments would promote healthy food choices and encourage regular...