Prognosis A Anorexia Nervosa

Anorexia nervosa is a condition with severe morbidity and a high mortality, estimated at up to 20 over 20 years, although most studies show considerably lower rates, closer to 5 (143-145). The major reasons for death include starvation, suicide, and cardiac arrhythmias due to fluid and electrolyte imbalance (144,145). A 10-year follow-up study of 76 severely ill anorexics found high rates of chronicity, with 41 experiencing bulimic episodes 10 years after initial treatment, and a 13-fold...

Moving Beyond Behavior Change Strategies In The Prevention Of Obesity

Changing eating and physical activity patterns that predispose to weight gain remains the key concern of obesity prevention strategies, as the prevention of weight gain is dependent upon balancing energy intake and expenditure. Until recently, interventions aimed at the population control of obesity have focused on improving the knowledge and skills of individuals within the community in the belief that large-scale individual change will have an impact on the population weight status. However,...

Conclusions

Amount of energy is expended in a safe exercise bout that is within the framework of the patient's lifestyle. As exercise becomes a sustained behavior, the intensity and or duration of exercise can be increased in order to gain more pronounced fitness benefits. Exercise can be a valuable tool in the treatment of obesity. Exercise increases energy expenditure and may slow the rate of lean tissue loss that occurs with severe dieting. The effects of exercise training on RMR may vary among...

Keeping Obesity Prevention Firmly Environment Based

One of the risks to developing a momentum for environment-led obesity prevention is that obesity as an issue gets combined with diabetes and cardiovascular diseases, and then most of the funding and efforts are channeled into clinical interventions and or mass-media strategies. While the rationale for such clumping is readily defendable and these strategies are important, a primary focus on improving the environments for healthy food and physical activity choices is needed if population-based...

Weight Loss Surgery

Surgery is one option for weight reduction for some patients with severe and resistant obesity. The aim of surgery is to reduce net food intake. Generally weight loss surgery should be reserved for patients with severe obesity, in whom other therapies have failed, and who are suffering from the complications of obesity. Surgical interventions commonly used include gastroplasty, gastric partitioning, and gastric bypass. Treatment of clinically severe obesity involves an effort to create a...

Treatment Providers

Obesity treatment is ultimately a social exchange between one or more clients and one or more providers who are usually health care professionals. From the foregoing discussion, it is clear that cultural variables and related contextual factors are highly relevant to lifestyle change from the client's perspective. This section addresses cultural influences from the provider perspective. For example, what factors support or limit the receptivity of those who provide obesity treatment to...

Health Benefits of Exercise Training with or Without Substantial Weight Loss

Normalization of body weight or body fat content through exercise is not necessary to improve health of obese individuals with metabolic disorders that are thought to be weight related. For example, Lamarche and associates (30) have shown that a 6-month exercise program consisting of four to five weekly 90-min exercise sessions at 55 of VO2max improved metabolic profile of obese women in spite of the fact that these women gained 2.3 kg body weight and 2.8 kg body fat during the same time...

Assessment of Risk Factors

Overall, the greatest danger of overweight obesity is the development of cardiovascular disease. Moreover, in the long term obesity predisposes to type 2 diabetes, which is itself a risk factor for cardiovascular disease. ATP III provides useful classifications for lipid and nonlipid risk factors. These classifications are shown in Tables 1 and 2, respectively. In ATP III, estimates are made of a person's absolute risk using Framingham risk scoring, which is available through the NHLBI (http...

Prevention of Obesity in Adults

Many people make it through adolescence without developing obesity. In fact, in our society, a great deal of weight gain typically occurs between ages 20 and 50 years. This gain is the result of several factors decreasing physical activity, ''stress'' eating at both home and work, and for women, weight gain with pregnancy (1315). The increase of body weight during young adulthood lays the foundation for the medical consequences of obesity. Prevention of adult-onset obesity again must focus on...

Tailoring Treatment Programs

''Tailoring'' refers to deliberate attempts to account for important individual or subgroup variables when developing program messages or intervention strategies (91). The concept of tailoring has particular relevance to theories that incorporate contextual factors as primary intervention variables as opposed to those that tend to subordinate the importance of contextual issues in favor of greater emphasis on self-control. As reviewed by Rakowski (91), the concept of tailoring has evolved to a...

Introduction

Its prevalence is increasing in almost all countries developed and developing (1). To curtail and eventually reverse the rise in obesity prevalence rates, a broad, population-based approach will be needed (1,2). The majority of the current global effort on obesity, however, is centered around establishing biological mechanisms related to energy imbalance and finding appropriate methods of treatment for individuals with obesity. The move to tackling whole...

Prevention Of Obesity The Ultimate Goal

A high priority for health care in our society is to prevent the development of mass population obesity. Prevention strategy is directed first to factors leading to obesity in childhood, adolescence, and young adulthood. Nonetheless, prevention must extend into middle age and the later years, where changes in body composition accentuate the adverse effects of excess body fat. Once obesity becomes established, attention must turn to reducing excess both weight as well as to preventing further...

Syndrome

Elevations of triglycerides and low levels of high-density < lipoprotein (HDL) are common in overweight obese patients. They are especially common when patients have other risk factors of the metabolic syndrome (4-6). 5 ATP III classification of serum triglycerides is shown in Table 8. In patients with atherogenic dyslipidemia (triglyceride > 150 mg dL, small LDL particles, and low HDL cholesterol (< 40 mg dL) , a three-part ther- I Table 8 ATP III Classification of Serum Triglycerides...

Underlying Risk Factors Overweightobesity And Physical Inactivity

These risk factors will be considered together because they are closely intertwined. In particular, management of physical inactivity is one therapy for obesity. Approaches to management of overweight obesity including the following Energy-restricted diets Increased physical activity Behavior modification Pharmacotherapy Surgical therapy The first three are standard therapies. Pharmaco-therapy and surgical therapy are reserved for special cases. They are used mainly for more severe forms of...

Strengthening the Exercise Component

As noted above, exercise is a key component of behavioral weight loss program, and has been strongly associated with the long-term maintenance of weight loss. Previous to 1990, there were a number of behavioral treatment studies showing that the combination of diet plus exercise was more effective for long-term weight control than diet or exercise alone (35,36,61). Foreyt and colleagues (27) recently replicated this finding in a study of 165 mildly overweight adults who were randomly assigned...

Role of Exercise in Maintaining Weight Loss

Improving the maintenance of weight loss remains a central goal of obesity research. A new generation of weight loss medications holds promise of facilitating this goal (54), but, for now, exercise appears to be the best bet for long-term weight control. This conclusion is based on case studies, correlational investigations, and randomized controlled trials. Several studies have identified groups of individuals who by their own reports, or as documented by medical records, lost substantial...

Assessment for Underlying Risk Factors

Body Mass Index According to the OEI report (1,2), overweight is defined as a body mass index (BMI) of 25-29.9 kg m2 and obesity by a BMI of 30 kg m2. Several methods can be used to calculate total body fat total body water, total body potassium, bioelectrical impedance, and dual-energy x-ray absorptiometry. However, in the clinical setting, BMI is the best indicator of body fat, importantly, the BMI provides a more accurate measure of total body fat than does weight...

Treatment A Anorexia Nervosa

Anorexia nervosa is treated through a combination of nutritional rehabilitation and psychotherapy, with the goals of weight restoration, development of healthy eating habits, improvement in moods behaviors, reduction in obsessions with thinness, and amelioration of concomitant physical and psychiatric symptoms (8). Nutritional rehabilitation is crucial and should be accomplished either prior to or concomitant with psychotherapy. The involvement of a dietician for meal planning is helpful....

Evaluating Antiobesity Drugs

Following World War II, pharmaceutical companies began to evaluate potential agents for weight loss, measuring the amount of weight loss either in absolute terms or relative to initial weight, but always in comparison to the weight loss of a placebo. Weight loss in placebo-treated groups is highly variable from one study to another since the placebo effect is augmented by variations in diet, physical activity and behavioral therapy. A number of criteria have been proposed for evaluating the...

Weight Gain Prevention in Individuals

The prevention of weight gain rather than a reduction in obesity prevalence is a goal that should apply equally to both populations and individuals and is appropriate to nearly all members of society regardless of their initial weight. Criteria have not been specifically set for obesity prevention, but it would seem appropriate to ensure that individuals avoid weight gain which has the potential to impact appreciably on their ''well-being'' and capacity to live a full life. However, this...

Pathophysiology A Individual and Familial Factors

A number of psychological factors have been described in patients with eating disorders, including difficulties in self-esteem and self-regulation, along with a sense of ineffectiveness and helplessness. Eating disorders, in this view, represent the attempt of the patient to gain control in the arena of eating and weight. Girls who are conflicted about maturation and sexuality are felt to be particularly prone to the development of anorexia nervosa. There are limitations in determining the...

Weight Reduction Pharmacotherapy

The purpose of weight loss and weight maintenance is to reduce health risks. If weight is regained, health risks increase once more. The majority of persons who lose weight regain it, so the challenge to the patient and the practitioner is to maintain the weight loss. Because of the tendency to regain weight after weight loss, the use of long-term medication to aid in the treatment of obesity may be indicated in some carefully selected patients. One weight loss drug is sibutramine. It has...

Preventing Childhood Overweight and Obesity

The longer-term benefits of limiting obesity rates in children are likely to be particularly important if the obesity persists into adult life. The persistence of excess weight in childhood into adult obesity appears to increase linearly with age from around 6 years and is particularly strong in adolescents (39). Parsons et al. (105) in their systematic review of childhood predictors of adult obesity found a range of factors including higher birth weight and earlier pubertal maturation...

Models Of Obesity Incorporating The Individual And Population Perspectives

There are a large number of models in common usage in health promotion and clinical care (14). The value of any particular model is that it helps to explain the problem and to provide a framework for action, and in the obesity area, it should ideally incorporate both treatment and prevention aspects as these should be considered on a continuum. We have found two models of particular value one is an ''ecological model'' based on the energy balance equation. The other is the epi-demiological...

Beliefs Underlying Stigma

People get what they deserve, and to the tendency to attribute the fates of others to internal and controllable factors (50). Thus, if an individual believes that obese people are responsible for their weight (e.g., through laziness, overeating, or low self-discipline), stigma is more likely to occur (47). In addition to attributions of responsibility, research suggests that perceptions of causality and stability of obesity are also important factors contributing to stigmatizing attitudes....

Select a Low Fat Low Energy Dense Diet

1 The Importance of Low-Fat Diets in Preventing Weight Gain The role of a high-fat diet in inducing weight gain was highlighted by the WHO Consultation on Obesity (9) and gained general acceptance as an appropriate strategy for the prevention of obesity until questioned by some authors who expressed doubts about the efficacy and safety of this approach (48-50). Their skepticism was based on the association of increasing levels of obesity with decreasing proportion of dietary energy from fat in...

Prevention of Childhood and Adolescent Obesity

Obesity in childhood and adolescence is increasing at an alarming rate (10). This increase appears to be largely due to societal changes. Nowadays children generally do not to walk to school. Compared to the past, less time is devoted to physical activity in school. After school, children have fewer opportunities for playing outside. Many go straight home and lock themselves in, waiting for parents to come home from work. At home, they settle down into chairs and watch television. Snacking...

Exercise Plus Caloric Restriction for Inducing Weight Loss

Caloric restriction (i.e., dieting) remains the cornerstone of most weight loss interventions, principally because overweight and obese individuals find it easier to achieve negative energy balance by reducing their energy intake than by increasing their energy expenditure (48). In behavioral weight loss programs, women typically are instructed to consume a 1200-to-1500-kcal d (5.0-6.3 MJ) diet composed of conventional foods and men a similar diet of 1500-1800 kcal d (6.3-7.5 MJ). This...

The Exercise Prescription

Physical fitness is evaluated in terms of body composition ( body fat), cardiovascular capacity (VO2 max), muscular strength and endurance, and flexibility. The ideal would be for all persons to participate in an exercise training program to improve or maintain fitness in each of these categories. However, the majority of Americans do not participate in any type of regular 1. Maintenance of reduced body weight and body fat content 2. Prevention of weight fat regain 3. Reduced systolic and...

Ecological Model of Obesity

The energy balance equation is a logical place to start trying to understand obesity at the individual and population level. The most accurate version of the energy balance equation is the ''dynamic, physiological'' version (15) which incorporates rates of change (16) and an interconversion between energy balance and fat balance (17,18). Rate of change of energy(fat) stores rate of energy (fat) intake While this equation has served reasonably well as a model for understanding weight gain and...

Appropriate Goals For Obesity Prevention

Setting appropriate and achievable goals is an important component of the planning of any health promotion intervention. Past obesity prevention programs have been criticised for failing to adequately define a successful outcome (10). Jeffrey (45) believes that a failure to set specific weight-related goals was a contributing factor to the ineffectiveness of community CHD programs to prevent increases in the mean BMI of participants over time. Clear goals for obesity prevention not only provide...

Strengthening the Dietary Component

1 Combining Behavior Modification and Very Low Calorie Diet One approach to improving weight loss in behavioral treatment programs is to improve initial weight loss by using stricter dietary approaches, such as very low calorie diets (VLCDs). VLCDs are diets of < 800 kcal d, usually consumed as liquid formula or as lean meat, fish, and fowl (45). These diets have been shown to produce excellent weight losses (9 kg in 12 weeks) (45, 46) and appear to be safe when used with carefully selected...

In Obesity Prevention Programs

Many other chapters in this handbook have highlighted the complex, multifactorial nature of the etiology of obesity. Some of these factors are nonchangeable such as genetics, gender, and age, and others, such as physiological disturbances in hormonal regulatory systems, can only be dealt with at an individual level (if at all). However, this still leaves a large number of potential influences over energy intake or energy expenditure and thus body weight regulation which could be the focus of...

Affective Disorders

Affective disorders are common among patients with eating disorders, leading some researchers to postulate that eating disorders are a variant of affective disorders. Comorbid major depression is frequent among patients with eating disorders (42,43), occurring in over half of all patients in some series. In addition, family history of affective disorders is often more frequent among patients than controls. The response of symptoms to antidepressant treatment, in both bulimia nervosa and binge...

Binge Eating Disorder

Binge eating disorder is generally treated with similar therapies to bulimia nervosa, including cognitive behavioral and interpersonal psychotherapy and antidepres-sant medications. Any consideration of the treatment of binge eating disorder must begin with recognition of the unusual instability of the disorder. As Fairburn et al. (120) have noted, ''unlike bulimia nervosa, binge eating disorder is an unstable state with a strong tendency toward spontaneous remission.'' In one study, a 4-week...

Individuals or Populations

Levels Prevention

The criteria chosen for the targeting of preventive strategies raise many issues. It might seem logical to consider identifying those who are on the borderline for becoming obese (i.e., adults with BMIs of perhaps 2829) and attempting to prevent them from gaining further weight and thus entering the obese category (i.e. a BMI > 30 kg m2). Success would relate to maintaining a maximum BMI of 29 for individual adults, with equivalent cutoff points being chosen on a sex- and age-specific basis...

Officebased Obesity Care

One of the most significant obstacles to patient counseling during a routine office visit is availability of time. Two 1998 national surveys found that the average office patient visit length was 21.5 min and 18.3 min, respectively (5). The Direct Observation of Primary Care (DOPC) study found that the average duration of direct physician-patient contact during an office visit was actually only 10 min (6). Within the confines of this time, the physician typically elicits a brief history,...

Behavior Change Paradigms

All paradigms reflect and are grounded in culture. However, the currently dominant biomedical paradigm in the United States is allopathic, technology centered, and clinical (25,82). As such, it does not readily incorporate cultural considerations in its explanatory framework, at least not directly, even for conditions such as obesity that are clearly culture bound in many respects (4). However, the awareness of cultural issues in U.S. health care generally has increased with ongoing...

Iiis Obesity Preventable

A number of chapters in this handbook have indicated that the rates of obesity throughout both the developed and the developing world are increasing at a dramatic rate. Indeed, the pandemic of overweight and obesity is now so advanced and so widespread that few regions of the world (with the possible exception of parts of sub-Saharan Africa) appear to have escaped the effects of this major public health problem. Previous chapters have highlighted the strong biological influences that contribute...

The Realities Of Overweight

Overweight is a chronic, stigmatized disease that is increasing in prevalence with more than 60 of the American population who are now overweight (BMI > 25 kg m2). This represents more than 100 million people. The prevalence of obesity (BMI > 30 kg m2) has risen > 50 in the past 15 years and continues to increase. The social disapproval of obesity and the lengths people go to prevent or reverse it fuel a 70 billion a year set of industries. Nearly 65 of American women consider themselves...

Other Comorbid Psychiatric Conditions

Obsessive-compulsive disorder is reportedly more frequent in both anorexia nervosa and bulimia nervosa (46,47), and some researchers have speculated that disturbances in neurally active substances, such as 5HIAA, brought about by starvation, binge eating, or purging, may contribute to the perpetuation of compulsive behaviors in patients with these disorders (46-49). Among individuals with binge eating disorder, no increase in either obsessive-compulsive disorder or obsessive-compulsive...

Addiction

Addiction has been postulated to play a role in disordered eating, with some individuals addicted to certain foods or combinations of foods. Although substance abuse and other impulse control disorders are associated with binge eating in some studies, there is no evidence that ''addiction'' to foods such as refined flour, simple sugars, or carbohydrates occurs or triggers binge episodes (71). An interesting finding, however, is that both lean and obese female binge eaters, women with binge...

Sexual Abuse

The contribution of sexual abuse to the development of eating disorders remains controversial. While some authors have cited sexual abuse as a major causal factor in eating disorders (66), others have found that the prevalence of sexual abuse is no greater in eating disordered patients than in patients being treated for other psychiatric disorders (67). It has been suggested that some types of sexual abuse, such as earlier and more persistent abuse, may predispose to eating disorders (68), and...

Cognitive Restructuring

The cues for overeating and underexercising include not only physical cues such as the sight and smell of food, but also cognitive cues. A person's thoughts, such as the thought ''I've had a bad day. I deserve a treat. I'll go for some ice cream'' can lead to inappropriate behavior. Dividing the world into good and bad foods, developing excuses or rationalizations for inappropriate behavior, and making comparisons with others can all serve as negative thoughts. Behavioral programs teach...

Diagnostic Characteristics

Anorexia nervosa is characterized by refusal to maintain a normal body weight, along with a fear of gaining weight. Diagnostic criteria for anorexia nervosa are shown in Table 1. The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) (1) criteria divide anorexia into the restricting and binge-eating purging subtypes. Approximately 50 of patients with anorexia nervosa experience binge eating and or purging at some point in their illness (3). Bulimia nervosa is...

Cultural Determinants Of Obesity

A A Culture and Cultural Differences Culture influences all human behavior and dialectically shapes social institutions and social interactions among populations groups and individuals. Culture has many definitions, but all embody the underlying concept of implicit and explicit guidelines that are inherited and shared by members of a particular society or societal subgroup (6,7). These guidelines define''how to view the world, how to experience it emotionally, and how to behave in it in...

Epidemiology

Anorexia nervosa, as categorized by the DSM-IV, is relatively uncommon, affecting 0.5-1 of adolescent and young adult women (8,9), although a much larger percentage experience subthreshold symptoms. Approximately 10 of patients with anorexia nervosa are male (9). There is some evidence that the incidence of anorexia nervosa is increasing among adolescents, but not among adults (10,11). Although most individuals with anorexia nervosa are adolescents or young adults, onset has been reported in...

Clinical Trials With Sympathomimetic And Serotonergic Drugs That Reduce Food Intake

Both short-term and long-term clinical trials have established the effectiveness of sympathomimetic and serotinergic drugs. Weight loss was significantly greater than placebo in most trials, but the magnitude of the weight loss has been variable. We review below the short-term, then long-term studies that meet our criteria for efficacy outlined earlier in Section II. A Short-Term Clinical Studies of 3 Months' Duration with Single Drugs In 1976 Scoville (4) summarized studies submitted to the...

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...

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...

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...