Best Weight Loss Programs That Work

The 3 Week Diet

3 Week Diet is a program that covers the weight loss trifecta of dieting, exercise, and motivation and is intended to produce extremely quick fat loss results, guaranteeing to shed off 12 to 23 pounds in only 21 days. Expect this program to change your eating habits, teach you to follow a strict eating program that restricts carbohydrates while utilizing strategic protein consumption, go on an exercise habit, and keep a close eye on your progress. Brian Flatt who is health coach and nutritionist discovered these quick weight loss secrets after 12 years of research. Lots of people successfully burn fat with the help of these secrets. The main secret behind this program is signaling body to burn stored fat for energy and then creating starvation mode into the body. When body enters into starvation mode then body will burn stored fat for fueling liver, heart and other organs of the body. This is completely safe, natural and scientific proved weight loss technique. More here...

The 3 Week Diet Summary

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Author: Brian Flatt
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The 3 Week Diet Review

Highly Recommended

I usually find books written on this category hard to understand and full of jargon. But the writer was capable of presenting advanced techniques in an extremely easy to understand language.

All the modules inside this e-book are very detailed and explanatory, there is nothing as comprehensive as this guide.

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Toward A Science Of Obesity

The modern scientific tradition is the tradition of ''experimental'' science. That is, progress was made by designing ''experiments'' to test hypotheses and apply mathematical analysis to the results. The fruitfulness of this tradition is everywhere around us. Its application to obesity has come, as it has come to all other areas, but progress has been slow. From the beginning of the Scientific Era (AD 1500) to the beginning of Modern Medicine (AD 1800), only a few scholarly theses with obesity as the subject matter had been published (241-246). In general, these theses reflected the traditions of Hippocrates, Galen, or Avicenna, as interpreted in the more contemporary traditions provided by the iatrochemical and iatromechanical views of the words originating in the mechanical and chemical explanations of life. As interest in obesity increased, a much larger number of theses with obesity as the subject were published in the 18th century (247280), which also saw publication of the...

Weight Gain Prevention Trials

To date, there have only been a modest number of structured and evaluated interventions, which have had a primary objective of preventing or limiting weight gain. However, a broader range of projects have examined the most effective strategies for improving physical activity or encouraging specific dietary change or for combating allied chronic noncommunicable diseases such as CHD, hypertension, and diabetes. Examining the lessons learned from these programs allows a preliminary perspective on the potentially most suitable approaches to supporting and encouraging the prevention of weight gain in the community.

Deficiency Symptoms Are Produced When The Essential Fatty Acids Efa Are Absent From The Diet

Rats fed a purified nonlipid diet containing vitamins A and D exhibit a reduced growth rate and reproductive deficiency which may be cured by the addition of linoleic, a-linolenic, and arachidonic acids to the diet. These fatty acids are found in high concentrations in vegetable oils (Table 14-2) and in small amounts in animal carcasses. These essential fatty acids are required for prostaglandin, thromboxane, leukotriene, and lipoxin formation (see below), and they also have various other functions which are less well defined. Essential fatty acids are found in the structural lipids of the cell, often in the 2 position of phospholipids, and are concerned with the structural integrity of the mitochondrial membrane.

Definition Of Obesity And Bmi Cutoff Points

The WHO (30) defines obesity as a condition with excess body fat to the extent that health and well-being are adversely affected. The body mass index is used for the purpose of classification. The suggested cutoff points for overweight (BMI 25 kg m2) and obesity (BMI 30 kg m2) are based on observational studies on the relationship between morbidity and mortality and BMI primar In cross-country or cross-ethnic group comparisons on obesity, two factors should be kept in mind the body composition part, i.e., the level of body fatness and the health risks related to overweight obesity. Because of the differences in the BMI BF relationship among ethnic groups, it is clear that a general BMI cutoff point can be questioned. More specifically, a comparison between groups should be based on comparable levels of body fatness, which could be at different levels of BMI. Figure 4 shows calculated BMI cutoff points for obesity in different ethnic groups having the same body fat percent (40)....

Vclinical Management Of Adults With Established Obesity

Clinical treatment of obesity in childhood and adolescence is beyond the scope of this chapter. The Obesity Education Initiative (OEI) of the National Institutes of Health provides a reasonable approach to the management of adults with established obesity (1,2). Similar guidelines are available from other sources (2). The OEI report focuses primarily on weight reduction strategies although it indicated the need to evaluate coexisting risk factors, it did not directly recommend their management before instituting weight reduction. The ATP III report, on the other hand, placed priority on initiating therapies for risk factors before dealing with the problem of obesity. ATP III contends that risk factors typically impart a more immediate risk to patients than does obesity itself thus, risk factor control takes precedence in clinical management. The present chapter will attempt to integrate OEI and ATP III reports so as to facilitate both weight reduction and treatment of metabolic risk...

Dietary considerations and medications

Many medications used to treat mental disorders promote weight gain, including Dietary treatments for individuals taking these medications should focus on a balanced, low-fat diet coupled with an increase in physical activity to counter the side effects of these medications. Nutrient-rich foods such as fruits, vegetables, and whole grain products should be emphasized in the diet, whereas sweets, fats, and other foods high in energy but low in nutrients should be limited. Regular physical activity can help limit weight gain caused by these medications. Lithium is often used to treat individuals with mania. Lithium can cause nausea, vomiting, anorexia, diarrhea, and weight gain. Almost one-half of individuals taking lithium gain weight.

Obesity as a disease state or adiposity as a continuous variable

Obesity as a clinical condition is currently defined as an excess accumulation of adipose tissue resulting in a BMI greater than 30kg m2. While the diagnosis of obesity by this criterion has clinical relevance with regards to intervention, management, and treatment, from an epidemiological perspective, it may hamper the study of the genetics underlying variation in body fat mass and distribution. For example, BMI exhibits a normal distribution with no clear division between the ''clinically obese (BMI 30) and the non-obese. Such a pattern of continuous distribution is not restricted to merely BMI but is found in all obesity-related phenotypes, including anthropo-metric measures (e.g. skin folds, and waist circumference), measures of body composition (e.g. percentage body fat, fat mass), and associated biochemical markers (e.g. leptin). Therefore the division of individuals into ''obese'' versus ''non-obese'' categories has a certain degree of arbitrariness that does not appear to...

Germfree Animals And Dietary Requirements

Contrary to what is generally believed, germ-free animals require a higher dietary caloric intake than their conventional counterparts. The main reason is very simple. A normal microbiota will break down indigestible dietary substances to compounds that can be absorbed by the host. That is most prominent in ruminants, i.e., the microbiota digest cellulose into short chain fatty acids (SCFAs). In many germ-free macroorganisms, there might be a demand for an increased dietary intake of some vitamins. Broadly speaking, the gastrointestinal microbiota, placed between the ingesta and the host, may utilize dietary vitamins or produce vitamins themselves. Among the earliest evidence that the vitamin synthesis is connected to functions by the intestinal microbes was the demonstration that germ-free rats reared without a dietary source of vitamin K developed hemorrhages and hypoprotothrombinemia soon, whereas their conventional controls had normal prothrombin levels and no bleeding tendencies...

Obesity A Theoretical Overview

The behavioral approach to obesity grew out of Learning Theory (1,2) and was first applied to the treatment of obesity between 1960 and 1970 (3,4). The primary assumptions of the behavioral approach are that (1) eating and exercise behaviors affect body weight by changing eating and exercise behaviors it is possible to change body weight (2) eating and exercise patterns are learned behaviors and, like other learned behaviors, can be modified and (3) to modify these behaviors long term, it is necessary to change the environment that influences them. The essence of the behavioral approach to obesity is the functional analysis of behavior, delineating the association between eating and exercise behaviors and environmental events such as time of day, presence of other people, mood, and other activities (5,6). Patients are asked to monitor their eating and exercise behaviors to determine specific problem areas that should be targeted in treatment. The environment controlling these...

History Of Behavioral Approaches To Obesity

The earliest report of a behavioral treatment program for obesity was by Stuart, who successfully treated eight overweight women (4). These women experienced an average weight loss of 17 kg over a 12-month period, ranging from a weight loss of 12-21 kg. It should be noted that Stuart (an eminent behavior therapist) conducted the treatment program himself, selecting each patient individually and tailoring the program to fit the needs of the individual patient. At the start of therapy, the treatment sessions were scheduled frequently (several times per week), and then gradually less frequently. Eating and exercise behaviors were targeted, and patients weighed themselves four times each day. The program included cognitive interventions, as patients were taught to deal with their weight-related fears, and the patients were helped to develop new hobbies as alternative sources of reinforcement. Stuart's successful report led to a flood of behavioral research studies. These studies in the...

Linkage studies in common obesity

The number of genome wide scans conducted in human populations has risen steadily over the last few years. Whilst many of these studies have yielded somewhat equivocal results, often due to limited sample size, there are now several studies showing evidence of linkage (LOD likelihood of odds ratio scores greater than 2.5) and these are discussed in this section. For a comprehensive list of all linkage studies performed see Human Obesity Gene Map (link to www.obesite.chaire.ulaval.ca genemap.html). To date, significant linkage results for obesity-related phenotypes have been published from a wide variety of human populations and importantly several studies have now replicated human obesity quantitative trait loci (QTLs) across different ethnic groups. To this extent there is now an emerging pattern with evidence that several major genes contribute to the variation in obesity related phenotypes in humans. Interestingly, not only are these linkage signals supported by significant LOD...

Longterm Effects Of Obesity Treatment

Numerous reviews have documented the effects of lifestyle interventions (2-5). Randomized trials conducted in the past decade show that lifestyle interventions, delivered in weekly group sessions over the course of 4-6 months, typically produce mean posttreatment weight reductions of 8.5 kg. Weight losses of this magnitude usually result in beneficial changes in blood pressure, blood glucose, lipid profiles, and psychological well-being (3,6). However, the clinical significance of 5-10 reductions in body weight is ultimately determined by long-term rather than short-term outcomes. If the weight reduction is not maintained, it is unlikely that the health benefits derived from that weight loss will be achieved or sustained. Table 1 summarizes the results of 10 behavioral weight loss intervention studies with follow-ups of 2 or more years (7-17). The initial weight changes in these studies ranged from 4.5 to 14.3 kg with a mean loss of 9.0 kg (unadjusted for study n). The magnitude of...

Prospective Study of Obesity and Risk of Coronary Heart Disease Among Diabetic Women

Summary This article reports on a study undertaken to examine the relationship of obesity, measured as BMI, and weight change to incidence of coronary heart disease (CHD) among women with diabetes. The authors followed 5,897 women with type 2 diabetes in the Nurses' Health Study for up to 20 years. Women were aged 40 to 74 years and had no history of cardiovascular disease or cancer at the beginning of the follow up period. During follow up, the authors document 418 incident cases of CHD (236 of nonfatal myocardial infarction and 182 of fatal CHD). After adjustment for age, smoking, and other coronary risk factors, current BMI (body mass index) was strongly associated with increased risk of CHD among women with diabetes. Increasing BMI values from age 18 years to 1976, before diagnosis of diabetes, were also positively associated with risk of CHD. Weight gain before the diagnosis of diabetes was related to increased risk of CHD. In contrast, weight change after diagnosis of diabetes...

Genetic Epidemiology Of Human Obesity

There are several considerations in genetic epidemio-logical studies of obesity (5). First, obesity is not a simple Mendelian trait. For example, expression of genetic propensities may depend on appropriate environmental stimulation (i.e., gene-by-environment interaction), or developmental stage (i.e., age dependency), or sex (i.e., sex limited). Second, obesity is not a homogeneous trait stemming from a unique gene or set of genes. Third, the trait measured may index other traits such as bone and muscle mass, which also may have separate genetic determinants. Genetic epidemiological methods are useful for addressing specific questions in human obesity, such as determining if there are genetic factors underlying an obesity phenotype, characterizing the sources of the genetic influence through maternal vs. paternal trans mission, and whether the trait is sex limited or age dependent, or if there is assortative mating, etc. Other strategies include documenting the presumptive causes of...

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. 2) and ''never overweight,'' using the NCHS data for prevalence of BMI 25 kg m2 as the solid line. Several surveys suggest that one-third of overweight adults become overweight before age 20, and two-thirds do so after that (2). Thus, 75-80 of adults will become overweight at some time. Between 20 and 25 of the population will display their overweight before age 20, and 50 will do so after age 20. Some of these overweight individuals will develop clinically significant

Medicine And Obesity From Recorded History To Ad 1500 Prescientific Medicine

Medical traditions have developed in all cultures. Several of these are described below, along with evidence that obesity was present. Evidence for obesity has been identified in all of these medical traditions and geographic regions, suggesting that independent of diet, the potential to store nutrients as fat was selected for by evolution at an early period in human development. tion achieved by these societies, including agricultural practices, development of writing and metallurgy, and the political climate. Several of the most sophisticated cultures have developed between two great river systems, and this has given rise to the two-rivers hypothesis of cultural development. These rivers are the Yellow River and the Yangtse River in China the Ganges and Indus Rivers in India the Amu Darya and Syr Darya Rivers in Central Asia and the Tigris and Euphrates Rivers in the fertile crescent of the Middle East. In all of these societies, whether in two rivers or otherwise, there have been...

Appetite Suppressant And Weightloss

Weight-loss products often contain guarana, in the belief that it suppresses appetite and may have thermogenic and diuretic activities. An animal study designed to evaluate the effects of guarana and decaffeinated guarana found that only the caffeinated herb was effective for weight loss (Lima et al 2005). To date, most clinical studies have investigated the effects of guarana in combination with other herbs. A double-blind, RCT testing a combination of yerbe mate (leaves of Ilex paraguayenls), guarana (seeds of Paulllnla cupana) and damiana (leaves of Turnera dlffusavar. aphrodlslaca) found that the preparation significantly delayed gastric emptying, reduced the time to perceived gastric fullness and induced significant weight loss over 45 days in overweight patients (Andersen & Fogh 2001). Another randomised double-blind placebo-controlled trial evaluated the effects of guarana in combination with Ma Huang (Ephedra spp.) and concluded that the formula was effective for weight-loss...

Social Economic and Cultural Determinants of the Prevalence of Obesity

Many factors affect energy balance and determine obesity. The major determinants can be grouped into three groups (25) With respect to the behavioural and sociocultural factors that affect energy balance and obesity, there are many that relate to eating habits and physical activity. Of the many gender-related social determinants of obesity, we briefly discuss the perception of overweight as a desirable or undesirable trait. The attitudes toward obesity vary greatly across social and ethnic groups, and are related to the economic position of individuals and groups. In many affluent countries women experience social pressures to be thin. Katzmarzyk and Davis (26) studied the body weight and shape of Playboy centerfolds in the period 1978 to 1998 as an example of culturally ideal women, and noted that 70 of them were underweight by WHO standards (BMI 18.5 kg m2). They speculate that this phenomenon helps to explain the high levels of body dissatisfaction and disordered eating among young...

Dietary Vitamin E Deficiency in Humans Is Unknown

In experimental animals, vitamin E deficiency results in resorption of fetuses and testicular atrophy. Dietary deficiency of vitamin E in humans is unknown, though patients with severe fat malabsorption, cystic fibrosis, and some forms of chronic liver disease suffer deficiency because they are unable to absorb the vitamin or transport it, exhibiting nerve and muscle membrane damage. Premature infants are born with inadequate reserves of the vitamin. Their erythrocyte membranes are abnormally fragile as a result of peroxidation, which leads to hemolytic anemia.

Gh Treatment Of Patients With Abdominal Obesity

Hormone Transition Photoshot

As GH promotes lipolysis low levels of GH has therefore been suggested to be of importance for the maintenance of the obese condition. The calorigenic effects of GH in obese subjects has also been known for many years (99). Some trials have therefore addressed the question of whether GH administration through its calorigenic and lipolytic action might enhance weight loss during dietary restriction in obese subjects. Both short-term (100) and several weeks of GH treatment (101,102) in combination with dietary restriction were unable to enhance the loss of body fat or body weight as compared with saline treatment. The GH administration may, however, decrease the loss of lean body mass during dietary restriction (100,102). These results, therefore, suggest that GH is not useful in the induction or enhancement of weight loss in obese subjects. We have learned that GH can improve several of the aberrations that occur both in GH deficiency and Syndrome X. Thus, in GH-deficient adults the...

Infant Feeding And Obesity

A recent study of 15,000 children aged 9-14 years found that in those who had been only or mostly fed breast milk, the odds ratio for being overweight was 0.78 (95 CI 0.66-0.91) compared with children who had been only or mostly fed infant formula (31). This apparent protective effect of breastfeeding against obesity persisted after adjustment for energy intake, physical activity, mother's body mass index, and other variables. The same association has not been found consistently in younger children, and there may be a latent period during childhood before it is manifest. A mechanistic explanation of the association is that breastfed babies have greater control of their intake than bottle-fed babies, and therefore develop better self-regulatory mechanisms. Another possibility is that hormones and

Treatment of Obesity

In America there are fewer cures for obesity undertaken than abroad because there are fewer obese people here. This statement was made in 1917, but time and the tides have now produced an epidemic of obesity in America (204). The clinical approach to treatment of obesity long antedates the Scientific Era. From the time of Hippocrates (205) and Galen (206) in the prescientific era, diet and exercise were an integral part of the therapeutic regimen for obese patients. Hippocrates, the ''Father of Medicine,'' suggested in the 5th century BC Obese people and those desiring to lose weight should perform hard work before food. Meals From this Greco-Roman beginning dietary treatment can be traced to the Arabic tradition in medicine. In the first book of his Cannon, Avicenna describes how to reduce the overweight individual The regimen which will reduce obesity. (1) Produce a rapid descent of the food from the stomach and intestines, in order to prevent completion of absorption by the...

Classification Of Obesity And Fat Distribution

The epidemiology of obesity has for many years been difficult to study because many countries had their own specific criteria for the classification of different degrees overweight. Gradually during the 1990s, however, the body mass index (BMI) (weight height2) became a universally accepted measure of the degree of overweight and now identical cutoff points are recommended. This most recent classification of overweight in adults by the World Health Organization is the following (1)

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 criteria for successful outcomes of treatment and goals of preventing progression from being at risk for overweight to becoming overweight, then developing the clinical sequelae of overweight (clinical overweight). Both clinical and laboratory information are needed for this evaluation. To make this evaluation effective, it must be done in the context of a sympathetic office practice concerned with the care and treatment of overweight patients. For additional insights into Care of the Obese Patient...

Nondietary Prostate Cancer Risk Factors

Although most attention has focused on possible dietary risk or protective factors for prostate cancer as the most likely environmental risk factor category to explain the racial ethnic variation in incidence and the impact of migration on risk modification, other factors have also been evaluated over the past few decades. Among these, cigarette smoking and a history of any type of sexually transmitted disease are among the most reproducible. As there are no highly suspected carcinogens to the prostate found in cigarette smoke or any direct evidence of an infectious etiology of prostate cancer, it has been proposed that both of these risk factors might be indices Obesity and indices of body size have also been of interest in terms of prostate cancer risk. Body mass index and height are of interest mechanistically in terms of both possible impact on steroid hormone levels and possible relationships with insulin-like growth factors (see below, Insulin-like Growth Factor Signaling...

Cultural Determinants Of Obesity

B The Obesity-Promoting Environment There is a general concern within the field of behavior change that the available methods are not sufficient to produce long-term improvements in lifestyle risk factors related to diet and physical activity, including obesity, as well as cigarette smoking (15). The need for effective long-term weight control strategies has become especially urgent in light of recent increases in obesity prevalence (16,17). At the ecological level, this upward trend in prevalence can be directly linked to cultural norms and social structural factors that encourage and maintain chronic overconsumption of calories and physically inactive lifestyles (17,18). The most obvious trends are those related to food portion sizes (e.g., supersizing of food packaging and restaurant portions), use of automobiles, television watching, use of computers, and sedentary forms of recreation (19,20). These trends are embedded in a synergism between cultural values (e.g., for individual...

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 Despite these concerns about the effectiveness of current obesity prevention approaches, there is indirect evidence from a range of sources that supports the view that prevention is not only feasible, but offers the only solution to controlling the worldwide epidemic of obesity. Bouchard (4) indicates that the heritability of obesity and body fat stores is only moderate and that recent increases in obesity rates have occurred at a rate too fast to be explained by changes in the frequency of obesity genes...

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, performs a limited physical examination, reviews and interprets pertinent laboratory and diagnostic tests, and provides recommendations that may include ordering further tests, writing prescriptions, and conducting counseling. Accordingly, care of the obese patient (and all patients) would be greatly facilitated by incorporating efficient and effective office-based systems. Put Prevention into Practice (PPIP), a national campaign by the Agency for Health Care Policy and Research (AHCPR) to improve the...

Obesity a major public health threat

Obesity is broadly defined as a condition in which body fat stores have increased to the extent that health may be adversely affected. Obesity is associated with substantially increased mortality from cardiovascular and cerebrovascular disease, diabetes and certain cancers (Kopelman, 2000) (Figure 22.1). It also results in morbidity from musculoskeletal, gastrointestinal, psychiatric and reproductive diseases and is associated with lowered quality of life, self-esteem and socioeconomic performance (Kopelman, 2000). The precise measurement of body fat is quite challenging and accurate methods are not applicable to large populations, therefore, surrogates such as the Body Mass Index (BMI) (weight in kilograms divided by the square of the height in metres) are most often used in population studies and in the clinic. The World Health Organization has defined obesity as a BMI exceeding 30 kg m2. Using this definition, currently at least 20 of the population of the USA and most Western...

Dietary Prostate Cancer Risk Factors

There are at least seven major dietary macro- or micronutrients that are under intense scrutiny currently as dietary risk or protective factors (Table 15.1). Prominent among these is dietary fat or some component of fat (e.g., saturated fat), which first received attention as a mechanism to possibly explain the low risk in native Asian populations and the apparent rapid shift in risk upon migration of Asian populations to the United States. There are suggestive data that increased fat consumption is associated with higher circulating testosterone levels, providing a possible mechanism for a fat-prostate cancer relation Antioxidant vitamins and minerals are of great current interest, not only as antiprostate cancer agents but also as anticarcinogenic agents in a broad sense. Antioxidants are potential anticancer agents because they bind free radicals, chemical entities that can damage DNA, create mutations, and lead to malignant transforma-tion.12 Two antioxidants are of special...

Body Composition Changes And Obesity

Most dramatically, not only is there an increase in the fat cell mass but also its distribution is changing, because this enhancement is due to an enrichment at the abdominal site (central distribution). This central redistribution of the fat cell mass has dramatic consequences for the metabolic environment and is a risk factor for several obesity and age-related metabolic abnormalities. Thus, the frontier between aging and obesity is very thin (Harris, 1999). Interestingly, the normal relationship between total body fat mass and circulating leptin levels appears to be disrupted in the elderly, suggesting that abnormal secretion of this adipostat may play a role in body fat changes with aging (Moller et al., 1998). The increase in visceral and central fat cell mass with or without reduction of peripheral fat mass has dramatic consequences for the metabolic environment and is a risk factor for several obesity and age-related metabolic abnormalities, such as hypertension and...

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 interventions to prevent obesity. Unfortunately, we have gained few insights into the most effective obesity prevention strategies from the limited number of programs that have attempted to address this issue in the past (see Sec. VII of this chapter). Thus it is necessary to speculate on what are the key behaviours to address that are most likely to support the attainment and maintenance of energy balance at both an individual and population level. The prevention of obesity does not necessarily...

Dietary Sources and Metabolism of Vitamin A 321 Food Sources of Vitamin A

Vitamin A is available in dietary sources as either preformed vitamin A or as provitamin A carotenoids. Rich dietary sources of preformed vitamin A include egg yolk, liver, butter, cheese, whole milk, and cod-liver oil. In animal foods, vitamin A is mostly in the form of retinyl esters, such as retinyl palmitate. In many developing countries, the consumption of foods containing preformed vitamin A is limited, and provitamin A carotenoids often comprise the major dietary source of vitamin A (134). The major provitamin A carotenoids consist of a-carotene and P-carotene, found in such foods as dark green leafy vegetables, carrots, sweet potatoes, mangoes, and papayas, and P-cryptoxanthin, found in foods such as oranges, tangerines, and kiwi fruit. Recent studies show that the bioavailability of provitamin A carotenoids is probably lower than previously believed (135,136). Many factors can affect the absorption and utilization of carotenoids, including the digestibility of the food...

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 outcome measures against which preventive programs can be evaluated, but they also guide the nature and the content of preventive efforts. Setting inappropriate goals, such as unattainable reductions in the prevalence of obesity in the community or reductions in the mean population BMI, are counterproductive and dangerous. Failure to achieve them will be taken as a measure of the weakness of an intervention and can often lead to the premature curtailment of potentially useful obesity prevention...

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). While this equation has served reasonably well as a model for understanding weight gain and obesity at an Figure 1 An ecological model of obesity. Figure 1 An ecological model of obesity.

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 intervention, combined with weekly group treatment sessions, produces an average loss of 8-10 of initial weight in 16-26 weeks (48). Mean losses may be Numerous studies have examined the effects on weight loss of adding exercise to caloric restriction. Perri and colleagues (50), for example, compared the combination of diet plus group behavior modification with the same intervention combined with a walking program designed to expend 800 kcal (3350 kJ) a week. After 20 weeks, participants in the first...

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 while watching TV is common at this time. Surfing the Internet and playing video games commonly takes time away from outside activities (11). The availability of cheap food enhances caloric intake. When busy parents return home at night, they often prefer eating out to preparing healthy meals at home. A trip for hamburgers or pizza typically provides both diversion and unneeded calories. All ofthese factors combine to promote weight gain in children and adolescents. To reverse these trends, it will...

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 triad, which has been successfully applied in other epidemics. individual level, it is not helpful in incorporating the broader influences on weight gain and obesity, especially the environmental influences. We have expanded the energy fat balance equation into an ecological model to help visualize the interplay between the broad influences on energy balance (Fig. 1) (19). Ecological models help to conceptualize the interdependence of people, their health, and their environments in the broadest...

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 consistently related to a greater risk of adult obesity. The issue of birth weights has already been addressed, but the causes of earlier pubertal maturation are more difficult to establish. Rapid early growth induced by high-protein and high energy-dense diets rich in fats and sugars may promote earlier maturation, but individual genetically related susceptibility to early puberty may also be involved. The review did not find a consistent relationship between physical activity or diet and childhood or...

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.

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 general definition leads to a plethora of issues because in affluent Western societies women, in particular, are striving to prevent even modest weight increases often when they are within the normal BMI range. The concept of well-being, therefore, involves recognition that the quality of life of children and adults is in part determined by their cultural setting and not just by whether or not they have symptoms relating to physical comorbidities. Prevention strategies could be defined for simplicity...

Evaluating Antiobesity Drugs

A number of criteria have been proposed for evaluating the response to treatment for obesity. Table 1 lists several criteria for evaluating success in treating obesity, and readers are referred to other publications for a discussion of these approaches. Both the U.S. Food and Drug Administration (FDA) and the Committee for Proprietary Medicinal Products (CPMP) of the European Agency for the Evaluation of Medicinal Products (EMEA) have proposed criteria to be met by drugs approved for the treatment of obesity (7,8). These are summarized in Table 2. The FDA has suggested as evidence for efficacy that weight loss be more than 5 and significantly more than placebo at 12 months. The CPMP has suggested a 10 loss from baseline weight, which is significantly greater than placebo. A number of secondary criteria are also listed along with inclusion criteria and dose-ranging studies. For efficacy trials, both obese men and women should be included who are otherwise healthy with a BMI 30 kg m2 or...

Blurring the Distinctions Between Prebiotics Dietary Fibers and Other Fermentable Dietary Carbohydrates in the Colon

The greatest volume of research and evidence for prebiotic effects has been accrued for fructo-oligosaccharides and inulin, but there is accumulating evidence of prebiotic actions by a number of non-digestible carbohydrates. Lactulose and galacto-oligosaccharides have strong claims to be classified as prebiotics, while there is promising evidence for prebiotic activity by isomalto-, xylo-, and soybean-oligosaccharides. There is growing interest in the impact of dietary fibers on the composition as well as the activity of the intestinal microbiota, and resistant starches and arabinoxylans in particular warrant further study for bifidogenic and other prebiotic effects.

Health Functional and Therapeutic Implications of Obesity in Aging

Body weight generally increases from puberty through middle life. Some of this is due to muscle gain in the early years, but mostly it is fat. When weight gain is excessive, there is increased morbidity and mortality from diabetes, vascular disease, other chronic diseases, and malignancy. Although the prevalence of obesity is increasing, prognosis from associated chronic diseases is also improving. The consequence is that increasing proportions of the population reach old age and are either overweight or obese, or they become so in later life. The relationship between obesity and risk of death in later years of life is less clearcut than in younger subjects. There are no evidence-based guidelines for desirable body weight or managing obesity in the elderly. We do not really know how to measure obesity meaningfully in this age group. In fact, low body weight or weight loss appears to be a much more significant determinant of health in older subjects. However, obesity is associated with...

Biomarkers of Healthy Eating

Although some researchers think of biomarkers as potential gold standards of dietary intake, there are good reasons to accept such a view only with thoughtful reservations (Weinstein et al., 2004). Subjects are well known to vary in metabolic pathways for reasons of sex, genetics, and previous nutrient exposures (Arab et al., 2003). These differences include age-related variations in absorption, the impact of coingestion of foods that may inhibit the absorption of others (e.g., green vegetables contain oxalic acid, which impairs the absorption of calcium). Likewise, renal excretion is subject to tight controls designed to remove unwanted metabolic products and excess nutrients but to retain needed nutrients. Urinary analyses, for these reasons, can be misleading as they indicate the net outcome of these diverse processes (including saturation) and are not directly correlated with intakes. In nutritional gerontology, the issue of differences in cognitive ability in the assessment of...

Epidemiology of Obesity and Aging

The prevalence of obesity in human populations increased markedly in the last four decades of the second millennium. On average, body weight increases throughout adult life up to the age of about 60 years. Most of the increase in weight with aging is due to fat accumulation in several depots in the body. After the age of 60, average body weight begins to decline and by the age of 80 the prevalence of obesity is only about a third of that at age 60. The factors responsible for the decline in body weight with age are complex and incompletely understood. They include loss of muscle (sarcopenia), due in part to decreased activity and the endocrine changes that accompany aging. There is also an element of selection since obesity increases risk of conditions, including cardiovascular diseases and cancer, which shorten life. Furthermore, there is a well-established association between calorie restriction and longevity. Influences on the body weight of aging cohorts are multiple and need to...

Gh Secretion In Abdominal Obesity

With increased adiposity, GH secretion is blunted with a decrease in the mass of GH secreted per burst but without any major impact on GH secretory burst frequency (46). Moreover, the metabolic clearance rate of GH is accelerated (32). The serum insulin-like growth factor (IGF)-1 concentration is primarily GH dependent and influences GH secretion though a negative feed-back system (47). The serum levels of IGF-1 are inversely related to the percentage of body fat (46). In addition, the low serum IGF-1 concentration in obesity is predominantly related to the amount of visceral adipose tissue and not to the amount of subcutaneous fat mass (48). The relationship between regional fat distribution and GH secretion has only recently been considered. No significant correlation was found between the waist-to-hip ratio and 24-h GH secretion rates in a study of 21 healthy men (49). However, measured by computed tomography, the amount of visceral adiposity was a major determinant of stimulated...

Novel human monogenic obesity syndromes

In the past eight years several human disorders of energy balance that arise from genetic defects have been described. All of these are in molecules identical or similar to those known to cause obesity in genetic and experimental syndromes of obesity in rodents (Leibel et al., 1997) and all have been identified using a candidate gene approach (Figure 22.2). These mutations all result in morbid obesity in childhood without the developmental pleiotropic features characteristic of the recognized syndromes of childhood obesity.

Association studies in common obesity

To date, association studies have largely been restricted to candidate genes whose dysfunction might reasonably be expected to result in obesity by virtue of their having putative effects on energy intake, energy expenditure or nutrient partitioning. Genome-wide association studies are still in the future. The interpretation of association studies always requires caution because of the possibilities of problems such as population stratification, small sample size and publication bias. Some of these problems are exemplified by a common polymorphism in the b3-adrenergic receptor, where despite over 40 association studies, involving more than 7000 subjects, the findings have been markedly inconsistent (Barsh et al., 2000). While significant and consistent associations have been obtained in large case-control studies for some variants including the insulin VNTR (Le Stunff et al., 2001) and IGF-1 SNPs (Hart et al., 2004), it is true to say that as of now, no single common variant is widely...

Methodological issues in the hunt for human obesity genes

Obesity is defined as an excess of body fat, which can be measured directly using dual energy X-ray absorptiometry and isotopic dilution techniques. However, these are costly and their limited availability makes it difficult to perform such measurements in large numbers of subjects. In some studies fat mass has been measured indirectly using bioelectrical impedance or skin-fold thickness both of which correlate reasonably well within the normal range but less so in the very lean or the obese. The most commonly used marker of adiposity is BMI (weight in kg height in m2) which is a measure of heaviness that can be performed in large epidemiological studies and correlates reasonably well with body fat content. Body fat distribution provides an additional risk that is not given by simply the amount of body fat. Abdominal fat mass, for example, can vary significantly within a narrow range of total body fat or BMI. Furthermore, within a given BMI, men have on average twice the amount of...

Is genetics important in determining susceptibility to human obesity

The recent and relatively rapid rise in the prevalence of obesity occurring over a timescale which would make conventional evolutionary explanations implausible has, understandably, led some to question the importance of genetics in the etiology of obesity. There are some obvious candidates for the causation of secular changes in obesity prevalence including the increased availability of palatable energy dense foods and the reduced requirement for physical exertion during working and domestic life. It is therefore timely to review the evidence for inherited determinants of obesity and related intermediate traits. We will focus on data from twin and adoption studies as these are the most powerful tools to address this question.

Monogenic disorders leading to human obesity

It is well established that obesity runs in families, although the vast majority of cases do not segregate with a clear Mendelian pattern of inheritance. There are about 30 Mendelian disorders with obesity as a clinical feature but often associated with mental retardation, dysmorphic features and organ-specific developmental abnormalities (i.e. pleiotropic syndromes). A number of families with these rare pleiotropic obesity syndromes have been studied by linkage analysis and the chromosomal loci for obesity syndromes are known. For a comprehensive list of syndromes in which obesity is a recognized part of the phenotype, see Online Mendelian Inheritance in Man (OMIM), www.ncbi.nlm.nih.gov omim .

Menopause and Obesity in Women

There are relatively few data on changes in adiposity and fat distribution associated with menopause in women. This is an important issue because of the relationships that have been noted between obesity and cardiovascular disease (5), and obesity and certain cancers (56,57) in postmenopausal women. As noted above, body weight reaches its maximum in women very near the time of menopause, and there is an increase in relative adiposity for any given weight or BMI. While some studies find that the increase in weight accompanying menopause is more related to age than menopause itself (58,59), others have noted specific menopause-related increases in BMI, overall adiposity, central adiposity and intra-abdominal adiposity (60-64). A recently published longitudinal study that followed 35 women aged 44-48 for 6 years (65) found that those women who experienced menopause during the period of follow-up lost significantly more FFM ( 3 vs. 0.5 kg), and had greater increases in fat mass (FM 2.5...

Dietary Requirements for Vitamin A

The Food and Nutrition Board of the Institute of Medicine has made new recommendations of vitamin A intake by life stage and gender group (Table 2) (246). These Dietary Reference Intakes (DRIs) are reference values that are quantitative estimates of nutrient intakes to be used for planning and assessing diets in apparently healthy people and include Recommended Dietary Allowances (RDAs), Estimated Average Requirement (EAR), and Adequate Intake (AI) (246). The RDA is defined as the dietary intake level that is sufficient to meet the nutrient requirement of nearly all (97 to 98 percent) healthy individuals in a particular life stage and gender group. The EAR is defined as a nutrient intake that is estimated to meet the requirement of half of the healthy individuals in a life stage and gender group. AI is defined as a recommended intake value based on observed or experimentally determined approximations or estimates of nutrient intake by a group (or groups) of healthy people that are...

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 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 obesity, particularly to control comorbidities. Theoretically, they could be considered for patients with type 2 diabetes, although they have not been thoroughly evaluated in such patients. The following approach to weight loss in overweight obese persons at risk for cardiovascular disease or type 2 diabetes is taken in large part from recommendations of the OEI report (1,2).

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 weight gain. At this time too, medical intervention must aim to prevent the complications of obesity, particularly cardiovascular disease and type 2 diabetes. This chapter will briefly address prevention of obesity in the general population and will then focus on the clinical management of overweight obese patients with particular attention to preventing medical complications. In the approach to the problem of obesity a clear distinction cannot be drawn between ''prevention'' and ''treatment.''...

Obesityrelated Disease Interactions Between Fetal Growth And Childhood Body Mass

Studies of the fetal and infant origins of obesity are part of a wider field of research on the early origins of adult diseases (33) It is now known that people who had low birth weight, or who were thin or stunted at birth, are at increased risk of type 2 diabetes, coronary heart disease, and hypertension (34-40). These diseases, especially type 2 diabetes, are associated with obesity (41). Their association with small body size at birth has led to the conclusion that they originate in persisting changes in the body's structure, physiology, and metabolism that result from fetal undernutrition and are associated with slow growth in utero (15,33). a cohort of 4630 boys born in Helsinki (40). Their body size is expressed as mean standard deviation or Z scores. The Z score for the cohort is set at zero, and a boy maintaining a steady position as large or small in relation to other boys would follow a horizontal path on the figure. Boys who later developed coronary heart disease, however,...

Why look for human obesity genes

The discovery of human obesity genes will undoubtedly lead to health benefits. Firstly some obesity syndromes are very severe, occur at a young age and are associated with other developmental and clinical manifestations. It is clear that knowledge of the underlying genetic defect in these syndromes will be of considerable clinical benefit in terms of recognising other treatable aspects of the particular syndrome and providing more informed genetic counseling. As illustrated by congenital leptin deficiency (see below) the precise identification of some of these syndromes may turn out to have therapeutic relevance. Thirdly, and most speculatively, it is possible that by recognizing common genetic variants which predispose to obesity through different mechanisms, we can classify obese subjects into subgroups

Dietary Restriction and Oxidative Stress in Annual Fish Mutants

Once the mutagenesis is achieved, dietary resistant mutants and oxidative stress resistant mutants could be selected which might suggest genes involved in such a mechanism. For example a paraquat resistance mutant could be selected and then tested for lifespan extension. Similarly, mutants could be fed with a high fat and high nutrient diet which, in contrast to dietary restriction, should shorten the lifespan and the mutants that live under these conditions could be selected. However, these require careful feeding experiments. Likewise, by feeding -3 fatty acids, the mutants that do not prolong the lifespan in the presence of -3 fatty acids could be selected. All these imaginative screens will be feasible once the Nothobranchius model is available as a genetic model.

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 social factors. Here, public education and enhanced awareness of the dangers of weight gain are needed. g Many young adults are not yet tuned into the health drawbacks of obesity, and they fail to take precautions to avoid it at this stage. Consequently, a more intensive educational effort for this age range is required. Adults must restructure their lives to allow more time for exercise, to minimize use of''labor-saving devices,'' and to limit portion sizes of their food choices. Whether large-...

Requirements For Cost Of Obesity Studies

From the above discussion it can be seen that there are a number of prerequisites before a meaningful cost of obesity study can be performed. There needs to be a good study of the prevalence of obesity (defined using the WHO's suggested BMI cut points). In addition, a standard group of obesity-associated disorders should be included and it is optimal if there are known local RRs of these disorders from previous studies. Such estimates of RR will account for details of ethnic variation that may otherwise not be fully detailed in an analysis. If there are no local RRs, then it would be appropriate to use published values from other countries, trying as best as possible to match ethnic groupings and perhaps using a conservative risk factor as well as a high value. This approach assumes that the physiological and pathologic consequences of obesity are consistent across communities, which is not unreasonable. There also needs to be a standard approach to cost centers used for direct costs....

Testing Dietary Interventions in Autoimmune Prone Mice to Delay Aging and Age Associated Diseases

Research because CR is the only known experimental regimen to increase life span in all experimental models tested including yeast, nematodes, flies, and rodents (Jolly, 2004). The models examined are not malnourished because the CR diets have enriched vitamin and mineral content to compensate for the decreased food intake. CR is also potent at delaying the onset of diseases like autoimmune disease and certain types of cancer. Therefore, it appears that CR may be a dietary regimen that not only increases life span by altering the biological process of aging, but also improves the quality of life by decreasing the severity of age-related diseases. The primary immune cell studied examining the impact of CR feeding on immune function in aging and age-associated disease has focused on the T cell. The main reason for this is that the T cell is critical in determining both the type and extent of an immune response. Two of the most consistent effects of CR on aged T cell function in rodents...

Dietary Fat and Fiber

Much attention has been focused on dietary differences, particularly in fat consumption, to ex plain both the international pattern of breast cancer occurrence and changes in rates of breast cancer following migration to high-risk countries from low-risk countries.66,67 International breast cancer mortality rates correlate highly with per capita consumption of fat in the diet (correlation coefficient r 0.93).67 When international breast cancer incidence rates rather than mortality rates are considered, the magnitude of the correlation is still quite high (r 0.84). The correlation of fat consumption with international breast cancer mortality remains highly significant even after statistical adjustment for body weight and age at menarche. However, such ecological studies suffer from many well-known limitations, including the ecological fallacy, which results from attempting to make inappropriate conclusions at the individual level from summary data applied to a large geographic area....

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 prevention is to be a priority. The vastness of the task of preventing obesity is a classic barrier to action. To build the political and community case for action, the interventions need to be doable. Expanding existing programs that have shown some success (43,63-65), limiting the geographical reach of interventions in the first instance (i.e., establishing demonstration or sentinel sites) or focusing on a small number of settings are all strategies that can overcome the ''inertia of...

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, such programs have had only limited success because they have not engaged all sections of the community and because the environment in which eating and exercise behaviors are made is now so antagonistic to healthy lifestyle choices that even the most motivated individuals find it difficult to make and sustain appropriate changes (101). Recent analyses of the obesity problem have focused discussion on moving beyond strategies that focus solely on changing personal or community behaviors to...

Reported Costs Of Obesity

There are a large number of obesity cost or burden of illness studies. Table 1 gives a summary of those recently published from a variety of different countries and continents. The range of direct costs reported is between US 77 million for New Zealand (14), a country in which the prevalence of obesity is now 19 , and US 70 billion in the United States (15), where the prevalence of obesity is some 25 of the adult population. Recently it has been suggested that the direct cost of obesity in Australia is now US 630 million (S. Crowley, personal communication). The differences in costs reported may reflect different obesity prevalence in the various countries or different absolute health costs in the treatment of obesity and its related diseases. More likely, however, are differences in the methodology of performing the study. Some of these differences (e.g., the body mass index BMI cut point used, the diseases included in the costs) will be discussed in the following section. As a...

Obesity

As chromium has a role in maintaining carbohydrate and lipid metabolism, and potentiating insulin action, it has been suggested that chromium supplementation may have effects on body composition, including reducing fat mass and increasing lean body mass (Vincent 2003). A meta-analysis of RCT concluded that chromium picolinate elicited a relatively small effect compared with placebo for reducing body weight (Pittler et al 2003). One study, however, did show promising results using 200 g chromium bound to niacin three times daily (total 600 g day) with moderate exercise. At these high doses, while overall reduction in body weight was similar for both the chromium and placebo groups, total fat loss was more significant in the chromium group, suggesting a muscle sparing effect (Crawford et al 1999).

Dietary Patterns

People eat mixes of foods, not isolated nutrients. Within individuals there are strong correlations between the consumption of individual nutrients so that it is often very difficult to separate the contribution to health or disease of one nutrient from a group of nutrients. Therefore, interest has grown in the identification of patterns of food consumption and the extent to which particular patterns can be linked to health outcomes (dietary pattern analysis). This interest represents an understandable expansion of awareness of the importance of particular food combinations and the role of nutrient-nutrient interactions (Hu et al., 1999 Millen et al., 2004). In large part, the interest is based on ecological comparisons between communities who differ in risk of specific diseases that can be plausibly linked to dietary habits. Where the aim is to understand an overall picture of the relationships between diet and disease, dietary patterns may be more informative than study of single...

Appetite Suppressant

Synephrine produces effects on human metabolism, which could be useful for reducing fat mass in obese humans because it stimulates lipolysis, raises metabolic rate and fat oxidation through increased thermogenesis (Pellati et al 2002). A controlled in vivo study of C. aurantium fruit hydro-alcoholic extracts standardised to synephrine 4 (Ci.au. 4 ) and 6 (Ci.au. 6 ) found repeated administration of the extract significantly and dose-dependently reduced food intake and body weight gain (Calapai et al 1999).

Stone Age Obesity

Table 1 is a list of several artifacts from the paleolithic stone age that depict obesity. These artifacts were found across Europe from southwestern France to Russia north of the Black Sea. The location in which they were found and their appearance is shown in Figure 1. They were produced during a fairly narrow time frame in the early Upper Paleolithic period (Upper Perigordian or Gravettian) some 23,000-25,000 years ago (40). They Table 1 Paleolithic Venus Figurines with Prominent Obesity Table 1 Paleolithic Venus Figurines with Prominent Obesity

Caloric Restriction

Beginning with the early work of McCay and Maynard (1935) who reported a life-prolonging effect of caloric restriction in rats, numerous attempts have been made to study the underlying causes of this obviously general mechanism. It could be shown that a reduction of caloric intake of 30 to 50 prolonged the life of rodents up to 60 . The same results were obtained in young animals and in older adults which received the reduced diet later in life. The results of the studies on rodents could be confirmed in numerous studies on other vertebrates, nematodes and even protozoa (see Masoro, 2000). Evidence for enhanced survival under dietary restriction in insects was provided by studies on waterstriders (Kaitala, 1991), carabid beetles (Ernsting and Isaaks, 1991), and Drosophila (see chapters in this book). Longtime studies using primates started in the eighties and continue up to now, revealing exciting results (Mattison et al., 2003). The influence of dietary restriction on the organism is...

Dietary Restriction

Dietary restriction is the only environmental manipulation that can bring robust extension of lifespan in a variety of model organisms, and is one of the most important themes in aging studies. Despite a great deal of effort, the precise mechanisms by which it works are not clear. Exploration of its mechanism has also been Using demographic analyses, it has been shown that dietary restriction extends lifespan in flies by altering baseline mortality rate without altering the rate of aging (Mair et al., 2003). (Figure 22.1).

Preface To The Series

The business of dietary supplement in the Western World has expanded from the Health Store to the pharmacy. Alternative medicine includes plant based products. Appropriate measures to ensure the quality, safety and efficacy of these either already exist or are being answered by greater legislative control by such bodies as the Food and Drug Administration of the USA and the recently created European Agency for the Evaluation of Medicinal Products, based in London. In the USA, the Dietary Supplement and Health Education Act of 1994 recognised the class of phytotherapeutic agents derived from medicinal and aromatic plants. Furthermore, under public pressure, the US Congress set up an Office of Alternative Medicine and this office in 1994 assisted the filing of several Investigational New Drug (IND) applications, required for clinical trials of some Chinese herbal preparations. The significance of these applications was that each Chinese preparation involved several plants and yet was...

Feeding ecology and diet

Primate species exhibit a wide range of diets, although most of them include at least some fruits in their food intake. If there is a typical dietary category for primates generally, it is surely fruit consumption, as this is found from the smallest to the largest species. Although most primates eat at least some fruits, primates can be classified into three main dietary categories representing at least 50 of food intake (1) insectivores, feeding mainly on arthropods (e.g., tarsiers) (2) frugivores, feeding mainly on fruits (e.g., most forest-living monkeys) (3) folivores, feeding mainly on leaves (e.g., leaf-monkeys). There is a general trend among primates for the diet to shift progressively from insectivory through frugivory to folivory as body size increases. This is understandable because small-bodied mammals have relatively high-energy requirements per unit body weight and must eat foods with a rich, easily available energy content. Large-bodied mammals have relatively low...

Recommended dosage

The typical dose for amphetamines in the treatment of narcolepsy in adults ranges from 5 mg to 60 mg per day. These daily doses are usually divided into at least two small doses taken during the day. Doses usually start on the low end of the range and are increased until the desired effects occur. Children over the age of 12 years with narcolepsy receive 10 mg per day initially. Children between the ages of six and 12 years start with 5 mg per day. The typical dose for adults with obesity ranges from 5 mg to 30 mg per day given in divided doses. The medication is usually given about one-half hour to one hour before meals.

Diagnosis of deepvein thrombosis Introduction

A proper clinical evaluation involves a careful assessment of the patient's symptoms, signs, and risk factors for venous thrombosis. Patients with symptomatic DVT can present with painful swelling, tenderness along the distribution of the deep leg veins, and localised erythema consequent to venous obstruction or perivascular inflammation. These signs can also be found in patients with cellulitis, ruptured Baker's cyst, superficial thrombophlebitis, and other muscu-loskeletal conditions. Therefore, the most important objective of the clinical evaluation is to determine whether the presenting features are more or less likely to be caused by one of these alternative diagnoses. If the patient has no known risk factors for venous thrombosis an alternative diagnosis is considered more likely and, therefore, the likelihood of DVT is significantly reduced. In contrast, if the patient has one or more known risk factors for thrombosis, the likelihood of DVT is increased. Well-established risk...

Greco Roman Medicine

From the vantage point of Western civilization, Greco-Roman medicine has been the major source of our medical tradition. The health hazards associated with obesity were clearly noted in the medical writings of Hippocrates, where he states, ''Sudden death is more common in those who are naturally fat than in the lean'' (58). These traditions also note that obesity was a cause of infertility in women and that the frequency of menses was reduced in the obese. Galen was the leading physician of Roman times. His influence on medicine and medical teaching lasted more than 1000 years. He identified two types of obesity, one he called ''moderate'' and the other ''immoderate. The former is regarded as natural and the other as morbid. Descriptions of sleep apnea associated with obesity also date from Roman times. Dionysius, the tyrant of Heracleia of Pontius, who reigned ca 360 BC, is one of the first historical figures afflicted with obesity and somnolence. This enormously fat man frequently...

Scientific Medicine 1500 To Present

In the following sections, I will review each of the major areas that affect the development of the ''science of obesity.'' To put this in the broader context, the reader is referred to the timeline in Figures 3-7. The first anatomical dissections of obese individuals are attributed to Bonetus (65). Other descriptions appear in the publications by Morgagni (66), by Haller (67,68), and most particularly by Wadd (69). Of the 12 cases presented in Wadd's book, Comments on Corpulency, Lineaments of Leanness, two had been examined at postmortem and had been found to have enormous accumulations of fat. This was the first instance of a monograph devoted to obesity that contained anatomical dissections.

Role Of The Gastrointestinal Microbiota In Humans

Traditionally, the colon has been considered to largely be the human sewage system which, as well as storing and removing waste material from the GI tract, was capable of recycling water (i.e., absorption). However, we now recognize that the GI tract is one of the most metabolically and immunologically active organs of the human body. Indeed, the primary function of the microbiota is generally considered to be salvage of energy via fermentation of carbohydrates, such as indigestible dietary residues (plant cell walls, non-digestible fibers and oligosaccharides), mucin side-chains and sloughed-off epithelial cells (5,6,8,13,17). It has been estimated that between 20 and 60 grams of carbohydrate are available in the colon of healthy human adults per day, as well as 5-20 grams of protein. In addition to salvaging energy, principally through production of short-chain fatty acids (SCFAs) and their subsequent absorption and use by the host, microbial fermentation produces gases (principally...

Chinese stripenecked turtle

The only detailed study of this turtle's diet is from Taiwan this study suggests that significant dietary differences exist between the sexes. Juveniles of both sexes tend to be carnivorous, eating primarily insects along with plant roots, shoots, and leaves. The males remain primarily carnivorous into adulthood, consuming mainly dipteran (mosquito) larvae and other insects, as well as some plant leaves, seeds, and roots. The females become increasingly herbivorous as they mature, feeding primarily on the leaves of terrestrial plants that grow along riverbanks, but also occasionally eating insects (especially dipteran larvae).

Composition Of The Adult Fecal Microbiota Assessed By Culturing

Much of the early information on the composition of the human colonic microbiota was elucidated using traditional cultivation techniques. The majority of such work was driven by the quest to determine the relationship between diet and colonic cancer (16,36-38). Epidemiological studies had identified that risk of colon cancer correlated with dietary habit, with higher colorectal cancer incidence in populations consuming a high-fat, low-fiber diet. In 1969, Aries and coworkers (39) postulated that this correlation between diet and cancer should be reflected in the composition of the colonic microbiota. Thus, interest in the effect of diet on the GI microbiota began in earnest. The majority of these early studies compared the fecal microbiota of individuals from different populations which had significantly different incidences of colon cancer. For example, Aries and coworkers (39) compared the fecal microbiota of English subjects (relatively high incidence) to that of Ugandans (low...

What is gene mapping and why is it useful

One of the goals of human genetics research is to understand genetic variation between people in their susceptibility to disease. From twin and family studies, and the study of Mendelian disease, it is clear that some traits and diseases ''run in families'' and that the reason for the increased disease risk of relatives of affected individuals is, at least in part, because of their genetic predisposition. Genetic variation in populations is caused by mutations that cause differences in DNA sequence and by other genome events in the germline, for example insertions, deletions, duplications and translocations of stretches of DNA. If these mutation events have an effect on a phenotype of the carrier, for example an increased risk of disease or an effect on a continuously varying phenotype (such as blood pressure or body mass index), then there will be an association between the genotype and the phenotype. Gene mapping aims to identify locations on the genome that are responsible for...

Statistical Issues for Longevity Studies in Animal Models

In this chapter we provide an overview of basic statistical concepts and procedures that are germane to researchers interested in aging. We include discussions of hypothesis testing, research design, statistical power, data collection, statistical significance, parametric and nonpara-metric statistical methods, and choosing an appropriate statistical test. We also provide brief introductions to the different types of data (categorical versus continuous), summary statistics, and a selection of parametric and nonparametric statistical tests including t-tests, analysis of variance, ordinary least squares regression, logistic regression, and survival analysis. We place special emphasis on statistics for maximum lifespan using the example of animal research on caloric restriction. We also include discussions of the major methods of significance testing for statistics of maximum lifespan. We conclude the chapter by offering a series of recommendations that will greatly increase the chances...

Health Issues Affecting Lgbt Populations

Some preliminary studies have suggested that gay men and lesbians may be at increased risk for certain types of cancer (Dean, et al., 2000), though the reasons for these elevated risks are generally due to variables other than sexual behavior. For instance, the higher incidence of breast cancer among lesbians is likely attributable to increased rates of obesity, alcohol consumption, nulliparity and smoking and lower rates of breast cancer screening, gynecological care, and hormone exposure through oral contraceptives (Dean, et al., 2000 Office on Women's Health, 2000). Lesbians are also less likely than heterosexual women to have a Pap test (Aaron, et al., 2001), although no studies have documented higher rates of cervical cancer. Studies have found higher rates of Kaposi's sarcoma, non-Hodgkins lymphoma, Hodgkin's disease, and anal cancer among gay men, but all of these, except anal cancer, have been attributed to increased incidence of HIV AIDS (Dean, et al., 2000 Hessol, et al.,...

Clinical manifestations

Pulmonary decreased lung volumes and capacities (suggestive of restrictive lung disease secondary to decreased chest wall compliance), arterial hypoxemia (decreased FRC predisposes the obese patient to a rapid decrease in PaO2 if FRC below closing volume may lead to airway closure, ventilation perfusion mismatch, and hypoxemia), obesity-hypoventilation syndrome.

Obstructive sleep apnea syndrome OSAS

Obesity and sleep-induced relaxation of the pharyngeal musculature are thought to cause intermittent upper airway obstruction. Obstruction leads to hypoxemia and hypercarpnia, which results in arousal and the return of normal respiration. Repeated awakenings result to daytime somnolence.

Nutritional Genetic Disorders Can Impair Collagen Maturation

The complex series of events in collagen maturation provide a model that illustrates the biologic consequences of incomplete polypeptide maturation. The best-known defect in collagen biosynthesis is scurvy, a result of a dietary deficiency of vitamin C required by prolyl and lysyl hydroxylases. The resulting deficit in the number of hydroxyproline and hydroxylysine residues undermines the conformational stability of collagen fibers, leading to bleeding gums, swelling joints, poor wound healing, and ultimately to death. Menkes' syndrome, characterized by kinky hair and growth retardation, reflects a dietary deficiency of the copper required by lysyl oxidase, which catalyzes a key step in formation of the covalent cross-links that strengthen collagen fibers.

Background And Relevant Pharmacokinetics

Absorption of chromium occurs by passive diffusion and is inversely related to dietary intake (e.g. from a dose of 10 fjg, 2 is absorbed from a dose of 40 fjg, 0.5 is absorbed) (Anderson & Kozlovsky 1985). Absorption may be inhibited by zinc (Hahn & Evans 1975) and phytates, and enhanced by oxalate (Bryson & Goodall 1983) and ascorbic acid (Offenbacher 1994). In regard to supplements, chromium picolinate appears to be the most absorbable form as the complexation of picolinic acid with chromium increases its bioavailability (Edmonson 2002, Press et al 1990).

Cultural Adaptation Strategies A Overview

Social pressure to lose weight Weight-related health concern Perceived appeal of program Reactions to treatment setting Interactions with provider Interactions with other participants Preferred language Adoption of weight management behaviors Achievement of short-term weight reduction (vs. no loss, or gain) Source Ref. 44. Adapted with permission from Dalton, S. ed. Overweight and Weight Management. Chapter 3 Cultural appropriateness of weight management programs. Gaithersburg, MD Aspen Publishers 1997 69-106. lifestyle choices, and the structural constraints would be most relevant at the level of maintaining long-term change. Ultimately then, the rewards of having lost weight must be sufficiently reinforcing (positively) within the applicable context to motivate continued practice of the altered eating and activity patterns or, rather, according to Bouton, to drown out the inherently strong reinforcement for the prior, original, and culturally embedded behavior pattern. Clinical...

Summary And Conclusion

Cultural issues arise in conjunction with health programs in general, including weight management programs, because of the belief that attending to cultural factors will allow for services that are better aligned with the client's needs and circumstances and thus more sensitive and effective. In addition, cultural influences on obesity treatment are of particular interest because of the disproportionate prevalence of obesity in U.S. ethnic minority populations. Culture influences obesity and weight change through several attitudinal and behavioral pathways that converge in food intake and energy output. Differences in weight related attitudes and practices can be readily documented among U.S. ethnic groups. In particular, compared to middle-class whites, some population groups with a higher prevalence of obesity have more tolerant views about obesity. Cultural perspectives on obesity treatment should be viewed along all relevant dimensions, such as age, gender, and socioeconomic...

Employment Discrimination

Both laboratory and field studies show widespread weight bias in all aspects of the employment process (3-7). Research addressing employer attitudes and hiring decisions suggests that overweight people face prejudice even prior to initial job interviews. Studies have manipulated participant perception of employee weight (through written vignettes, videos, or photographs), where subjects are randomly assigned to a condition in which they are asked to evaluate a fictional applicant's qualifications. Overweight employees are evaluated more negatively and are rated as less likely to be hired than average-weight employees, despite identical qualifications. Though this bias has been demonstrated within a variety of employment positions, it appears that overweight applicants are especially denigrated in sales positions and are perceived to be unfit for jobs involving face-to-face interactions (3,8,9). Several recent reviews indicate that discrimination may continue once an overweight person...

Glycocholate Breath Test

14C-glycocholate breath test or bile acid test is based on the bile salt deconjugating capacity of bacteria in the proximal small bowel. Conjugated bile acids are excreted through the bile in the duodenum, and they are reabsorbed in the terminal ileum. Conjugated bile acids are in the enterohepatic circulation. Physiologically, less than 5 of the conjugated bile acids reach the colon. After excretion in the duodenum, bile acids stimulate micellization of dietary lipids. After oral administration of glycocholic bile

Educational Discrimination

Multiple forms of weight discrimination occur in educational settings. Antifat attitudes have been demonstrated in preschool children (35), which likely sets the stage for later peer rejection and teasing. These types of negative attitudes are shown in studies in which obese children are rated as the least desirable friends by their peers when compared to photos of children varying in weight and physical disabilities (36). Indeed, peers appear to be the primary proponents of weight-related teasing, and the school seems to be the most frequent location where overweight children are harassed (37). Unfortunately, the shame surrounding obesity is also evident in overweight children themselves, who blame their weight as the reason for why they have few friends and are excluded by peers, and who believe that they would stop being teased and humiliated if they could lose weight (38). Any professional who asks obese patients about these experiences will hear wrenching stories of ridicule and...

The Legal System And Weight Discrimination

Given the apparent pervasiveness of weight prejudice, it is surprising that no federal laws prohibit this form of discrimination and that only a handful of states include body weight in their definitions of unlawful discrimination (16,43,44). Weight discrimination has most often been fought using the Rehabilitation Act and American Disabilities Act (45), though the success of this legislation for obese people has been inconsistent. Unreliable rulings result from differing court views of when or if obesity meets disability criteria, common assumptions that obesity is a voluntary and changeable condition, and ambiguities surrounding definitions of obesity and impairment (43,46). If these trends persist in the courts, rulings will likely produce mixed and unpredictable results.

Physiological Stimuli For Gh Release In Search Of An Endogenous Ligand For Gh Secretagogues

Food deprivation induces a dramatic alteration in GH secretion in all species studied. In rats, food deprivation inhibits pulsatile GH secretion, and refeeding results initially in low-amplitude pulses (at a higher frequency than the endogenous rhythm) giving way to normal 3 h high-amplitude pulses within 6-8 h (31). A variety of nutrients modulate GH secretion including free fatty acids and amino acids (32). The effects of refeeding are mimicked by iv injection of amino acids, but not by iv glucose, whereas iv injection of lipid abolishes pulsatile GH secretion (31). Food deprivation results in a dramatic reduction in GHRH gene transcription in rats, an effect that can be reversed with refeeding of dietary protein (33) in humans, by contrast, fasting stimulates GH secretion. Thus, exercise and diet have a major physiological influence on the hypothalamic regulation of GH secretion, but the pathways involved in these influences are poorly understood.

Stigma Reduction Strategies

A central priority for research is to develop and test stigma reduction strategies. Very few studies have attempted this, but of those that have, there are promising findings. One randomized study attempted to reduce stigma toward obese patients among medical students. An educational course improved attitudes and beliefs about obesity in students compared to a control group (53). Another study reduced antifat attitudes among participants through education about the biological and genetic causes of obesity (47), and a third study improved attitudes and reduced weight-related teasing among children through a curriculum to promote size acceptance (54). Further studies examining the development of stigma reduction interventions will make important contributions to this area of research.

Retinoic Acid Receptors

All members of the RAR family are capable of binding to both all-trans RA and 9-cis RA, the two isomers produced by the metabolism of the active derivative of dietary vitamin A, retinol.217 The abundance and tissue distribution of these compounds are regulated partially by the RARs themselves as RXR heterodimers and by RXR homodimers.52 These various receptor dimers participate in complex tissue-specific transcrip-tional regulation of the cellular retinol and RA binding proteins (CRBPs and CRABPs) and metabolic enzymes that catabolize retinoids, ensuring appropriate distribution of and protection from the teratogenic effects of retinol esters in development. Developmental studies suggest that a morphogen gradient of RA activity throughout the developing embryo is critical for proper limb formation, axial patterning, neural crest cell migration, and specification of cognitive, sensory, and motor neurons.340 Also, RARs are involved in specialized functions in the differentiation of...

Future Directions For Research

Increased use of randomized designs and ecologically valid settings. Evaluation of reliability and validity of measures assessing weight discrimination. Development of assessment methods to examine discriminatory practices. Evaluation of predictive power among obesity stigma models. Further exploration of why negative attitudes arise. Examination of psychological and social origins of weight prejudice. Experimental manipulation of proposed components of stigmatizing attributions. Assessment of attitudinal and behavioral expressions of weight bias. Cross-cultural examinations of antifat attitudes and weight-related attributions. Clarification of definitions of disability and impairment relevant to obesity. Examination of legislative approaches used to counter discriminatory practices. Increased attention to hiring, promotion and benefits discrimination against obese employees. Closer examination of which occupations are most vulnerable to weight bias. Experimental assessment of...

Significance to humans

Sloths are infrequently used by humans as a food source because they have a small muscle mass and are reputed to be tough chewing. They are renowned as the namesake of the vice slothfulness because of their slow-moving habits, although the general public is not very familiar with their appearance or the details of their habits. Choloepus does well in zoological parks, and can be tamed and kept as a pet, but the more docile Bradypus, although hardly in need of taming, does not survive in captivity away from its home rainforests, probably because of specialized dietary preferences. Three-toed sloths are referred to as ai's, named after one of the soft calls they make. The common name for two-toed sloths is unau, although both genera may be referred to as peresozo, or lazy man, because of the slowness of their movement.

Selective Serotonin Reuptake Inhibitors

The SSRIs are relatively well tolerated, although acute, treatment-emergent side effects such as agitation, diarrhea loose stools, insomnia, nausea, and sedation may occur. Occasionally, SSRIs may worsen tremor, and chronic use is associated with an increased risk of developing endocrinologic and metabolic adverse effects, such as hyponatremia, sexual dysfunction, and weight gain (Table 1) (50-52). The concomitant use of amantadine has been reported to reduce the risk of SSRI-induced sexual dysfunction (53). Reversible SSRI-induced worsening of parkinsonism has also been reported, but data are conflicting regarding the magnitude of this risk (54-56). Pharmacodynamic studies have not detected any significant reduction of motor function in patients with PD treated with SSRIs (57-58). Patients on a concomitant monoamine oxidase-B (MAO-B) inhibitor (e.g., rasagiline, selegiline) may be at increased risk of developing 5-HT syndrome however, the overall risk appears to be minimal. In one...

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