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. Continue reading...

The 3 Week Diet Overview

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Therapeutic targets for reducing oxidant stress in overweight and obese patients

The findings of Block,9 Davi,10 and Keaney11 are not only important with respect to the study of basic mechanisms underlying oxidant stress associated with obesity, but they also have important public health implications in regard to the treatment of obesity-associated disease. The incidence of overweight and obesity is becoming more prevalent in the United States and weight loss programs are often ineffective.2 Thus, the number of persons with diseases associated with obesity is going to be a continuing burden to the medical community42 and novel strategies to prevent and treat these disorders based on the physiological perturbations associated with obesity need to be developed and tested. The findings of the studies discussed herein implicate decreasing in vivo levels of oxidant stress as one potential therapeutic target for obesity-associated disesase. Emerging evidence has implicated increased dietary intake of fish oil containing large amounts of polyunsaturated fatty...

Dietary control of conventional risk factors cholesterol blood pressure type diabetes and obesity

Cholesterol is a determinant of CHD mortality, and its blood level is at least partly regulated by diet. However, few epidemiological studies have prospec-tively included analyses of the dietary habits of the studied populations in the evaluation of their risk.119 In the Seven Countries Study, marked differences in CHD mortality, dietary habits and cholesterol distribution were observed in the different cohorts.119 Cholesterol levels were high in Northern Europe and in the USA (an average level of 7mmol L), and low in rural Japan (an average of 4mmol L), and population cholesterol levels were positively associated with CHD mortality. Secondary prevention trials with statins in Northern Europe120 and Australia121 confirmed the importance of cholesterol by demonstrating a A major (and often underestimated) finding of the Seven Countries Study was the large difference in absolute risk of CHD death at the same level of serum cholesterol in the different cohorts. At a cholesterol level of...

Dietary prevention of postangioplasty restenosis

Patients treated with percutaneous transluminal coronary angioplasty (PTCA) have a high (15 to 50 per cent, depending on studies) risk of developing restenosis within the first 6 months after the procedure. At present, with the exception of stents coated with antifibrotic substances113 and probucol (the later with many unacceptable side effects), there is no drug treatment to prevent that complication. On the other hand, a dietary approach with either n-3 fatty acid or folate supplementation has been proposed. It is noteworthy that in these negative trials, patients were treated with quite high doses of n-3 fatty acids, up to 8 g per day,115 and that no previous data did support the use of such doses in the prevention of CHD. In addition, these studies were all performed in patients having had conventional balloon PTCA, and there are no data on patients receiving any type of stent. One major limitation of the dietary approach of the prevention of restenosis is the theoretic...

Dietary strategies to prevent the development of heart disease

The oxidised LDL theory is not inconsistent with the well-established lipid-lowering treatment of CHD, as there is a positive correlation between plasma levels of LDL and markers of lipid peroxidation93,98 and a low absolute LDL level results in reduced amounts of LDL available for oxidative modification. LDL levels can be lowered by drugs or by reducing saturated fats in the diet. Reduction of the oxidative susceptibility of LDL was reported when replacing dietary fat with carbohydrates. Pharmacological quantitative (lowering of cholesterol) and nutritional qualitative (high antioxidant intake) approaches of the prevention of CHD are not mutually exclusive but additive and complementary. An alternative way to reduce LDL concentrations is to replace saturated fats with polyunsaturated fats in the diet. However, diets high in polyunsaturated fatty acids increase the polyunsaturated fatty acid content of LDL particles and render them more susceptible to oxidation28 which would argue...

Tips for Avoiding Dieting Pitfalls

Some of the best advice on how to avoid dieting pitfalls, or in other more positive words how to change your lifestyle to lose weight and keep it off, comes from Helen McGrane, one of the DPP participants. She called her piece (written in diary form), To Tell the Truth (How to Lose Weight and Keep It Off). October 1998 No pain, no loss. The Tufts Letter described research on people who had been successful with permanent weight loss. It found 60 percent had been stricter about their dietary approach, and 80 percent exercised more vigorously. The DPP gave me the guidelines about daily and weekly goals for diet and exercise. . . . I keep a food diary

Planning Meals for Your Weight Goal

Ou can eat wisely, get all the nutrients you need, and continue to eat great food, but you do have to limit your portions. In this chapter, we show you how to plan three different daily levels of kilocalories (the proper term for what most people call calories). You can lose weight rapidly, lose more slowly, or maintain your weight. We prefer the slower approach to losing weight. With this method, you'll probably feel less hungry, and cutting back a few hundred kilocalories a day doesn't cause a major upheaval in daily life. Also, maintaining a weight loss may be easier if you lose the weight slowly. Exercise can help speed up weight loss or permit you to eat more and still lose weight. Twenty minutes of walking burns up 100 kilocalories, and 30 minutes of walking burns up 150 kilocalories. Walk for 30 minutes a day, and you lose about > 3 of a pound per week (7 times 150 equals 1,050 kilocalories divided into 3,500) without reducing your calories. That activity amounts to an annual...

How to Change Your Eating Behavior

Chances are you've tried to change your diet in the past and have found it difficult. It is difficult, and we don't mean to suggest anything otherwise. But our experience with the DPP lifestyle-change program has been that lots of people can be successful. The diet and exercise program was developed by a lifestyleintervention committee, a multidisciplinary team of professionals including dietitians, behavioral psychologists, diabetes experts, and exercise physiologists who reviewed the evidence in nutrition, exercise, and behavioral research literature to identify the best ways to help people lose weight and keep it off. The DPP lifestyle program was then implemented in more than one thousand people from all over the country. The DPP volunteers represented a broad swath of the U.S. population, including women and men from all walks of life, and older and younger people from diverse racial and ethnic backgrounds. People can lose weight and keep it off. The National Weight Control...

Eating Well Nutrition Goals

To lose weight and prevent or slow the progression of diabetes, your nutrition goals should include targets for calorie and fat intake, based on your starting weight. Table 8.1 shows the calculated calorie and fat goals necessary to achieve weight loss. (We'll talk more about that in Chapter 12.) As part of this effort, you'll need to establish goals for changing your food shopping, prepa- ration, and eating habits and patterns. For instance, you may decide to go no more than four hours between meals and snacks to prevent getting overhungry, which leads to overeating. Once you have determined your weight loss, nutrition, and activity goals, self-monitoring helps you see how close you are to achieving them.

Losing Weight More Slowly at Kilocalories

The smaller the deficit of calories between what you need and what you eat, the more slowly you'll lose weight. If your daily needs are 1,700 kilocalories and you eat 1,500, you'll be missing 200 kilocalories each day. Because a pound of fat is 3,500 kilocalories, you'll lose a pound in about 17 days (3,500 divided by 200). You'll lose almost 2 pounds a month, or 24 pounds in a year. You can accomplish this loss by reducing your daily intake by only the equivalent of a piece of bread and two teaspoons of margarine. Put that way, losing the weight doesn't seem difficult at all.

General Dietary Recommendations For

A dogmatic approach to the dietary advice for GDM should be avoided as only four randomised trials of primary dietary management of GDM against no treatment were considered to be of sufficient standard to include in a recent Cochrane systematic review (57). This pooled data analysis of 612 women failed to show any benefit of dietary intervention on final birthweight, risk of LGA infants and or Caesarean deliveries (57). However, ignoring all clinical and observational nutritional studies that have no non-intervention arm is probably unwise, and until definitively controlled studies are done each available study should be considered on its own merit. The objectives in the dietary management of GDM include glycaemic control, balancing adequate nourishment for the mother and foetus, while limiting excessive weight gain, and establishing healthy eating habits that will continue beyond the pregnancy. Lifestyle changes encompassing diet and exercise should be started during the pregnancy...

Pathogenesis of Obesity Related Type Diabetes

The profound changes in eating habits, agricultural capabilities and pattern of physical activity has fuelled today's epidemic of obesity, bringing with it a host of long-term complications. However, obesity has not always been regarded as a disadvantage. Statues dating from the Stone Age period appear to provide the earliest depictions of obesity. These Stone Age sculptures demonstrate not only the social importance attached to it, but also the survival advantage conferred by the ability to store energy (Bray, 1990). The most famous of these, the Venus of Willendorf, a 12-cm limestone figurine, demonstrates a woman with excessive body fat stores (Figure 4.1) whose habitus has been ascribed to a diet rich in fat and marrow and a sedentary lifestyle secondary to confinement in caves during the glacial period. These early depictions, however, not only highlight obesity as a phenomenon but also draw attention to the importance of body fat distribution. Whilst the lower body fat...

Environmental causes of obesity

Simple obesity is caused by a long-standing imbalance between calories consumed and calories expended. This does not necessarily imply that an WHAT CAUSES OBESITY IN CHILDHOOD Table 12.1 Worldwide rate of increase in prevalence of childhood obesity (from Ebbeling et al, 2002) Measure of obesity Data regarding eating habits in children do suggest that patterns have changed considerably over the last twenty to thirty years. Some healthy eating advice has been accepted. The UK National Food Survey has collected information on household food consumption since the 1940s (National Food Survey, 2000). Table 12.2 Pathological causes of obesity in childhood Early onset severe obesity (< 2 years) Uncontrollable appetite Although it would be easy to blame the obesity epidemic on fast food outlets this is by no means the only reason. Children in recent years have become much less active. There are few objective measures of activity in childhood and there appear to be no studies which have...

Fit Your Favorite Foods into Your Diet with a Dietitian

Years ago when you got diabetes, it meant you had to make enormous changes in your diet. This was hard enough for people who ate the usual American diet, but much harder for people who came from another culture and had an entirely different diet. This situation has changed dramatically. The dietitian's job is to come up with a diabetic diet plan based upon your food choices, not those of the dietitian. ,f you have special dietary needs because of your culture, a dietitian must be able to accommodate those needs if they are reasonable.

Eating Habits in Restaurants

High or very high on quiz 2 but not quiz 1 (page 14) You are at risk for developing inflammatory diseases in the coming years. This would be a good time to bolster your long-term health. High or very high on both quiz 1 and quiz 2 You likely have a high level of inflammation. The reason is probably that you are eating too many pro-inflammatory foods.You would do well to go on the AntiInflammation Syndrome Diet Plan and take steps to improve your long-term health. High or very high on quiz 1 but not quiz 2 You have probably adopted a very good diet but may have to further fine-tune your diet and supplement program. In this chapter you will read about fifteen anti-inflammation dietary steps to follow while cooking at home or eating out. These steps form the foundation of the Anti-Inflammation Syndrome Diet Plan. Don't worry about trying to remember all fifteen of the steps. If you adhere strictly to step 1, you won't have to remember most of the remaining ones, and following just some...

Counting Alcohol as Part of Your Diet

Because alcohol has calories, if you drink some, you must account for it in your diet. The proof of the alcohol is the percentage of alcohol in an ounce of the drink multiplied by 2. Wine that is 12.5 percent alcohol is 25 proof. Beer is 12 proof most of the time. Liquor is often 80 proof. To determine the calories, use the following formula

Age Obesity And Glucose Counterregulation

Both the autonomic nervous system and the hypothalamic-pituitary-adrenal axis are activated in excess in the morbidly obese. Before and after bariatric surgery (average weight loss 40 kg over 12 months), severely obese non-diabetic subjects, underwent a hyperinsulinaemic hypoglycaemic clamp (blood glucose 3.4 mmol l). Before weight reduction, patients demonstrated brisk peak responses in glucagon, epinephrine, pancreatic polypeptide, and norepinephrine. After surgery and during hypoglycaemia, all these responses were attenuated and most markedly so for glucagon, which was totally abolished in association with a marked improvement in insulin sensitivity. In contrast, the growth hormone response was increased after weight reduction (Guldstrand et al., 2003).

Obesity and Nutritional Intake

Obesity, in general, is associated with decreased adiponectin expression in adipose tissue and plasma levels (7,13). In both men and women, overall obesity, assessed by parameters such as body mass index (BMI) and fat mass, is negatively correlated to adiponectin, although prolonged weight reduction leads to increased adiponectin levels (7,14-17). Nutritional intake does not seem to explain this relationship. Although fasting decreases adiponectin messenger ribonucleic acid (mRNA) levels in mice, serum levels remain unchanged (18). In humans, short-term fasting also does not change plasma levels of adiponectin, although prolonged caloric restriction does result in weight loss and increased adiponectin levels (14,19). Additionally, daily caloric intake, macronutrient intake, or a high-fat meal is not related to any immediate change in circulating adiponectin levels in humans except possibly in obese individuals (20-22).

Weight reduction by lifestyle modification

There is long-standing clinical evidence concerning the efficacy of weight reduction on clinical and endocrinological features of obese women presenting with PCOS. It has been reported that weight loss may improve menstrual abnormalities and both ovulation and fertility rate. Moreover, it was confirmed that hirsutism and acanthosis nigricans were significantly improved in most patients following weight loss. Reduction of hyperandrogenaemia appears to be the key factor responsible for these effects, since peripheral testosterone, androsten-dione and dehydroepiandrostendione sulphate values were significantly reduced after weight loss in obese PCOS women (Pasquali et al., 1989). These findings were subsequently confirmed by Kiddy et al. (1992) in women who obtained even moderate weight loss after long-term calorie restriction. They reported an improvement in menstrual pattern, endocrine profile and fertility in obese women (BMI > 25) with PCOS if they lost more than 5 per cent of...

Obesity And Glycemic Control

Management of Obesity in Subjects with Type 2 Diabetes The management of obesity represents a central component in the treatment strategy for type 2 diabetes, as obesity is not only a major predisposing factor of the disease and its accompanying disorders, but also aggravates the achievement of a good metabolic control. Moreover, it was repeatedly shown that reducing excessive body weight in individuals with type 2 diabetes improves metabolic control and prolongs life (30-33). However, currently available weight reduction programs for patients suffering from diabetes turned out to have only limited success, particularly in the long run. An essential prerequisite for successful treatment are realistic goals. This is particularly important for this group as treatment of obese subjects with type 2 diabetes is usually more difficult than treating obese subjects without diabetes for several reasons. Type 2 diabetic subjects are usually older than nondiabetic obese subjects, which means a...

Central Visceral Obesity

Central obesity (obesity localized to central visceral fat depots) is the most prevalent precursor of Type 2 diabetes mellitus (Ohlsson et al 1985). Insulin resistance, which is more prominent in visceral obesity than generalized obesity or that localized to peripheral gluteofemoral depots, is considered to be related to this pattern of obesity (Peiris et al 1986). Free fatty acids have been implicated in the pathogenesis of insulin resistance in muscle through their interface with critical steps in glycolysis. Muscle tissue is the main regulator of systemic insulin sensitivity (Bjorntrop and Rosmond 1999). Compared with subcutaneous fat, visceral fat has increased sensitivity to lipolytic stimuli and has decreased antilipolytic effects to insulin. This means that the potential per unit mass of visceral adipose tissue to mobilize free fatty acid is much larger than that of subcutaneous fat (Bjorntrop 1994). Acute reductions in caloric intake has been shown to improve insulin...

Dietary nutrient composition in type diabetes

Aetiological factor in susceptible individuals. Excess dietary fat is more easily converted to adipose tissue lipid stores than carbohydrate (Flatt, 1985) diet-induced thermogenesis is less with fat than carbohydrates or protein thus inducing lower metabolic rates with high fat diets (Lean and James, 1988 Lean et al., 1989) dietary fat has minimal effects on both appetite and satiety (Caterson and Broom, 2001) hyperinsulinaemia has been associated with high fat intakes possibly through components of the hormonal enteroinsular axis (Grey and Kip-nes, 1971). The associated hyperinsulinaemia will favour further fat deposition and aggravate the insulin resistance of type 2 diabetes, increasing the associated metabolic dysregulation, e.g. dyslipidaemia (Figure 6.3). In addition, in the obese individual dietary-induced thermogenesis is lower than in the non-obese, and hence further weight increase is more likely with energy-dense diets (Bruce et al., 1990). For the vast majority of type 2...

Epidemiology Of Obesity

Obesity has become a global epidemic that exists not only in the industrialized world but also in most developing countries. At present, the prevalence of obesity (BMI > 30kg m2) ranges between 15 and 30 in the adult populations of Europe and North America, with an unequivocal trend toward further increase. The most dramatic rise in these regions is currently observed in children and adolescents as well as young adults. In addition, there is a particularly alarming increase in the number of affected people in many developing countries (1). Obesity as a Risk Factor for Type 2 Diabetes There is a large body of clinical data demonstrating a close relationship between body fat mass and the risk of diabetes. In contrast to other obesity-associated metabolic disturbances, the risk of diabetes increases already in the upper normal range of BMI. In the Nurses' Health Study, women in the upper normal range with a BMI between 23.0 and 24.9 kg m2 had a four- to fivefold increased risk of...

Approaches To Weight Management

In theory, the management of the obese diabetic patient should not differ from that of the obese non-diabetic patient. However, it has been reported that weight loss is much more difficult for Type 2 diabetic subjects than obese non-diabetic subjects. For example, 12 overweight diabetic patients treated in a behavioural weight loss programme for 20 weeks lost significantly less weight than their non-diabetic spouses on the same programme (29). Although it appears that dietary adherence alone may account for the difference, a small sample size and family dynamics may be confounding factors in these results. Indeed a more recent study using larger numbers and unrelated subjects showed that, on the contrary, Type 2 diabetic subjects can lose as much weight as their non-diabetic peers during active treatment but that the diabetic subjects regain significantly more weight at 1 year follow-up (37). This suggests that weight loss maintenance rather than initial weight loss is the main...

The role of antiobesity drugs in diabetic management

Given the overwhelming evidence that obesity is of fundamental importance in the aetiology of type 2 diabetes, as well as many of its co-morbid conditions such as hypertension, dyslipidaemia and other aspects of the metabolic syndrome, it is surprising how little attention has been given to weight management, compared to the extensive studies that have been conducted with drugs to control hyperglycaemia, hypertension and dyslipidaemia. There is little doubt that reduction of excess body weight can be very effective treatment. Dietary intervention studies suggest that a weight loss of approximately 10 per cent is required to significantly improve HbA1c in subjects with established type 2 diabetes, although some subjects may respond dramatically to lesser degrees of weight loss (Wing et al., 1987). Modest weight loss early in the course of the disease, combined with other changes to diet and lifestyle can also be extremely effective, as was shown during the first 3 months of dietary...

Considerations In Managing Obesity Within Diabetes Care

Significant benefit, i.e. 5-10 of current body weight. Although the results of obesity surgery provide compelling evidence that an even greater amount of weight loss can significantly reduce the need for medication and in some cases eliminate the need for any further treatment, obesity surgery will not be appropriate for or accessible to many people with diabetes. It is important therefore that an achievable degree of weight loss is promoted and that a greater understanding of the benefits of a more modest amount of weight loss in the treatment of those with Type 2 diabetes is gained. In addition, with many studies demonstrating weight regain following a period of weight loss, the importance of weight maintenance needs to be more strongly emphasised. Also in advising patients to 'lose some weight' it is to be questioned whether current services are designed to help patients to achieve this. Obesity, like no other condition, is considered to be solely under the control of the...

Prevention Of Obesity

Studies that aim to reduce obesity or prevent it from developing are relevant to the prevention of type 2 diabetes, since obesity is one of the major modifiable risk factors. Like diabetes, overweight and obesity have been the outcomes for a large number of clinical trials and observational studies exploring risk factors for their development and reduction. Comprehensive reviews of obesity prevention issues and approaches have been published13,163,262-264 and it is not possible to review them here. The interventions studied have been similar to those for type 2 diabetes, and have focused on lifestyle modification as well the use of selected pharmacological agents that may reduce weight. No large RCTs have investigated the prevention of obesity (in contrast to obesity reduction) as it relates to type 2 diabetes. Several community-based cardiovascular prevention studies have included obesity as one of several outcomes, often with limited success265-267. However, hypertension prevention...

Does Exercise Correct Overweight Obesity

In the metabolic syndrome diabetes type 2 overweight and physical inactivity are the most conspicuous problems (Fig. 4). Theoretically, overweight could be corrected by an increase of physical activity in order to burn 0.1 kg of fat 700kcal need to be expended, i.e., 90min of bicycle exercise at an intensity of 100 Watts. Requirements to loose significant amounts of weight (> 10 kg) and maintain it by exercise only are impressive 2500 to 2800 kcal need to be expended per week requiring a minimum of 5 to 6 h of exercise at moderate levels (500 kcal h) (30-35). It is quite obvious that only exceptionally motivated patients are willing to invest the time and the effort to achieve this goal. Moreover, as a result of excessive overweight many patients have lost the capability to undergo such demanding exercise programs. After having been inactive for the better part of their life it would be quite unrealistic to expect radical changes from patients after the age of 50. Thus, most studies...

The Anti Inflammation Syndrome Food Pyramid

Because of the widespread use of the U.S. Department of Agriculture's food pyramid, this drawing might help some people visualize the Anti-Inflammation Syndrome Food Pyramid. Foods toward the top are those you would eat the least of, whereas those toward the bottom are those you would eat the most of.

The Optimal Mix Of Dietary Carbohydrate And Fat For

The diet for the diabetic mother needs to limit excess maternal-foetal transfer of glucose. As post-prandial hyperglycaemia is the time of maximal maternal-foetal glucose transfer, treatment interventions need to target this period (6). Controversy exists on how best to achieve this. Some authorities recommend limiting carbohydrate at the expense of increasing dietary fat, while others The American Diabetic Association (62) recommend limiting carbohydrate to 40 of the total energy content by increasing dietary fat to 40 . This advice is based on clinical studies showing women with GDM have better glycaemic control when consuming less than 45 , rather than more than 45 , of their calorie intake as carbohydrate (72,73). The American approach gives no acknowledgement to the fact that different ingested carbohydrates have different glycaemic responses as measured by their glycaemic index (74). British advice on the diabetic diet in pregnancy does not recommend limiting carbohydrate to 40...

Modification of dietary intake

Although this evidence provides a cogent argument for the role of reduced calorie intake mediating improved diabetes control, other observations indicate that this can not be the sole explanation. Whilst energy intake is drastically reduced immediately after surgery, over the ensuing months it progressively increases

Dietary treatment of diabetes

Dietary advice will form the backbone of a diabetic's future management and it is therefore crucial to get the right message across from the outset. Poor information delivered early in management can have adverse short, and long-term effects, and should be avoided. The aims of dietary advice should be to minimize symptoms of hyperglycaemia, minimize the risk of hypoglycaemia, and to promote weight loss, while ensuring that any proposed changes are tolerable and sustainable (Frost et al., 1991). Remember that in encouraging the patient to make (possibly) substantial changes to their dietary intake you will be asking them to change life-long habits, to stop doing things they enjoy (and perhaps replace with less-well-received alternatives) and will at first appear to be asking them to make changes that will diminish their ability to socialize with family and friends at the dinner table and on special occasions. For most new diabetics, but depending on the severity of their glycaemia, it...

Economic Impact Of Obesity

The increasing prevalence of obesity is associated with rising health care costs. The cost of treating obesity-related illnesses to the economy of the U.S. business sector has escalated in recent years. It has been estimated that over 9.0 of annual medical expenditures are related to obesity (142). Health insurance expenditures for treating obesity-related illnesses such as hypertension, Type 2 diabetes, and coronary artery disease amounted to 43 of the total amount. Additional costs include increased sick leave, and life and disability insurance payments. In 2003, annual U.S. obesity-attributable medical expenditures were estimated at 75 billion in 2003 dollars, and approximately one-half of these expenditures were financed by Medicare and Medicaid (143). Other countries have seen similar obesity-related increases in health care costs (144), and spend a considerable amount of available health care dollars for treating obesity-related comorbidities. Most obesity-related expenditures...

Obesity and mortality

The association between excess body weight and death is confirmed by the Nurses' Health Study, with mortality rising progressively in woman with BMI > 29 kg m2 (Manson et al. 1995). The increased mortality was also noted in the American Cancer Society's Cancer Prevention Study I and II. Cancer Prevention Study II involved 457 785 men and 588 369 women followed for 14 years. The lowest mortality for men was within BMI 23.5-24.9 kg m2 and for women 22.0-23.4 kg m2. For BMI > 40kg m2, the relative risk of death was 2.6 times higher for men and 2 times higher for women compared with BMI between 23.5 and 24.9. There was an ethnic difference with the relative risk of death - 1.4 for black men and 1.2 black women with a BMI > 40 kg m2 (Calle et al., 1999).

Lipid Changes in Obesity

Obese women demonstrated similar increases in fat oxidation, in the absence of changes to carbohydrate metabolism, to those observed in lean individuals (11). In obese NGT and GDM women there was an inverse correlation between endogenous glucose production and fat oxidation from prepregnancy to early gestation (11). Triglyceride oxidation, as assessed by recovery of exogenous 13C Hiolein (a biosynthetic triglyceride) as exhaled 13CO2 (19), was significantly lower in GDM independent of obesity. The authors proposed that this could be due to decreased plasma triglyceride lipolysis, reduced nonesterified free fatty acid uptake and oxidation, or increased hepatic oxidation and esterification of nonesterified fatty acids to provide for increased gluconeogenesis and VLDL synthesis. Maternal obesity is associated with increased total and VLDL triglycerides (59, 71). Reduced levels of plasma HDL but similar levels of LDL were also observed (59). A correlation between maternal BMI and...

Nutrition and meal planning in gestational diabetes

MNT is the cornerstone of treatment for gestational diabetes (GDM). Within 48 h of diagnosis, a woman should see a diabetes educator, preferably a registered dietitian for meal planning to assist with blood glucose control (31). Education can be conducted in a class or an individual counseling session. The ideal amount of carbohydrate is unknown but is generally limited to 40-45 of the total calories needed for the day (32). For obese women one can reduce the amount of carbohydrate to 35-40 (23). The meal plan needs to be individualized to a woman's eating style and food preferences. Forty percent of an average 2,000 calorie meal plan would yield 200 g of carbohydrate per day, which is well above the recommended 175 g. Focusing on one nutrient, carbohydrate helps control postprandial blood glucose and aids in making the meal plan. Basic carbohydrate counting is used to achieve a consistent carbohydrate meal plan with three meals and four to five snacks per day.

Fisoprostanes and overweight and obesity

Quantification of F2-IsoPs has been used to implicate a role for oxidative stress in the pathophysiology of a number of human conditions and diseases. Notably, F2-IsoP levels were shown to be increased in neurodegenerative conditions such as Alzheimer's disease, Huntington's disease, aging, certain types of cancers, and, of notable importance to consequences of overweight and obesity, atherosclerotic cardiovascular disease.1422-26 In the first of these studies, Block and colleagues at the University of California at Berkeley and Kaiser Permanente in Oakland sought for the first time to gather large-scale epidemiological data describing oxidative damage that occurs in normal, healthy populations and the demographic, physical, and nutritional factors associated with it.9 More than 300 volunteers (55 women, 45 men) between the ages of 19 and 80 were recruited, and their complete dietary information and medical histories were known. Plasma F2-IsoPs were measured in all volunteers and...

Your Diet for Type Diabetes

People with type 2 diabetes are frequently overweight, so advice about nutrition is directed not only at controlling carbohydrate intake, but also at limiting calories. (I discuss caloric restriction and weight loss in Chapter 10.) If you have type 2 diabetes, there are several reasons why you still need to estimate the carbohydrate content of your food

Does obesity in childhood matter

Obese children appear to be at risk of the same complications of obesity as are obese adults (Table 12.3). However, no data exist which correlate definitions of childhood obesity based on BMI cut-offs with the risk of adverse health outcomes in childhood. Instead BMI criteria are used to highlight those who may be at greater risk and who would benefit from assessment and intervention. Currently the greatest concern is the development of type 2 diabetes, the emergence of which has changed the face of paediatric diabetes practice over the last 5-10 years.

Prevalence of obesity

The prevalence of obesity is increasing throughout the world at an unprecedented rate. To be a healthy BMI, as defined by the World Health Organization (WHO), is now to be in a minority in much of western Europe as well as the United States. Indeed, in many developing countries overweight and obesity are now so common that they are replacing more traditional problems such as undernutrition and infectious diseases as the most significant causes of ill-health (World Health Organization, 2000). In 1995, there were an estimated 200 million obese adults worldwide and another 18 million under-5 children classified as overweight. As of 2000, the number of obese adults has increased to over 300 million. This obesity epidemic is not restricted to industrialized societies in developing countries, it is estimated that over 115 million people suffer from obesity-related problems (World Health Organization, 2000). As the proportion of the population with a low BMI decreases, there is an almost...

Healthy eating and weight control

Recommendations for healthy eating and weight control Eat smaller portions and never skip meals Consult with a diabetes educator and or registered dietitian for assistance in preparing an individualized meal plan. Carbohydrate counting, as a meal-planning alternative, can be discussed at this meeting, if desired. Studies suggest that approximately 80 of people with type 2 diabetes are overweight or obese 14 . Experts agree that people with type 2 diabetes should be encouraged to achieve and maintain a desirable body weight. A majority of these experts agree with the following recommendations a body mass index (BMI) of < 25 kg m2 limiting fat to 25-30 of calorie intake nutritional counseling to improve meal planning and food choices as well as information on portion sizes Figure 2.5 The Food Pyramid Nutrition recommendations should be based on the Food Pyramid (see Figure 2.5) which allows for variations in the appropriate number of servings as determined by individual evaluations...

Diets For Weight Control Is The Amount And Type Of Carbohydrate Important

Weight loss is usually a major treatment goal in Type 2 diabetes, but the ideal dietary composition for weight control is still the subject of debate. Many health professionals are concerned that high-fat diets, irrespective of the type of fat, might promote weight gain. The prevalence of obesity is often lower in people with high carbohydrate consumption (expressed as a percentage of energy) than in those with high fat intakes (but this is not always true). In animal studies, high-fat diets induce faster weight gain and greater insulin resistance compared with high-carbohydrate diets, whether fed ad libitum or isocalorically (50). In humans, several studies have shown that ad libitum

Current Dietary Recommendations As Applicable To The Older Person With Diabetes

Current European recommendations are based on studies in younger age groups, which have then been extrapolated to the elderly. The quality of evidence for the specific effects of dietary intervention in older age groups is poor. The most recent European recommendations for adults with diabetes are shown in Table 10.1 (15). They emphasise energy balance and weight control, and recognise a wide variation in carbohydrate intake as being compatible with good diabetic control. The target of nutritional management is to help optimise glycaemic control and reduce the risk of cardiovascular disease and nephropathy. However, the quality of life of the individual person must be considered when defining nutritional objectives and health care providers must achieve a balance between the demands of metabolic control, risk factor management, patient well-being and safety. Compliance with all treatment modalities is likely to be compromised by increasing physical and mental disabilities, which occur...

Risk Factors The Epidemiology Of Obesity And Hyperinsulinemia In Children

It is well accepted that overweight as a child is a risk factor for obesity in adulthood. Using data from the Fels Longitudinal Study, Guo et al. (76) correlated girls' percent ideal body weight aged 10-18 with their percent ideal weight at age 35 all coefficients exceeded 0.6. We know that obesity, impaired glucose tolerance and insulin resistance are important metabolic risk factors for Type 2 diabetes mellitus (77, 78), and they are also suspected to be important etiologic components of youth-onset disease. Defining obesity in growing children and adolescents is more problematic than in adults, and various investigators have relied on skinfolds, body mass index (BMI defined as weight height2), ponderosity (weight height3), and other methods (79). Irrespective of which of these measures is used, most secular analyses indicate that adiposity has increased among US youth since 1960. Comparing data from four US national surveys collected between 1963 and 1980, Gortmaker et al. (80)...

Dietary Treatment For Type Diabetes Mellitus

Diet is the cornerstone of treatment of type 2 DM. Simple initial advice for calorie restriction and avoidance of sweet foods and drinks can lead to symptomatic improvement and a fall in blood glucose levels before any reductions in body weight are detectable. More detailed advice is then required to formulate a long-term strategy. The main goal is to correct obesity as weight loss will improve blood glucose control, lower blood pressure and lower blood lipid concentrations, all of which may be expected to improve the prognosis for patients with type 2 DM. A diet similar to that advised for patients with type 1 DM is recommended with special emphasis on lowered fat intake and reduced energy intake. Dietary failure is common in the treatment of overweight associated with type 2 DM. At the outset, avoidance of fat in the diet must be stressed and it is important to define realistic body-weight targets and rates of weight loss. Discussion of ideal body weight from actuarial tables is...

Obesity And Insulin Resistance

Obesity is the most common condition associated with insulin resistance (13). Obesity is a health problem reaching epidemic proportions in Western countries. In the UK alone some 16 of men and 18 of women are obese (14). Obesity can be defined as a body mass index (BMI) greater than 30kg m2. Insulin resistance is frequently observed in obese subjects and constitutes an independent risk factor for the development of Type 2 diabetes and atherosclerosis. The importance of increasing visceral fat (measured by waist hip ratio) as a risk factor for insulin resistance and cardiovascular disease has also been demonstrated (15). Weight loss improves insulin sensitivity and any type of therapy, whether it is dietary or pharmacological, that can aid effective weight loss and or weight maintenance will help prevent some of the deleterious metabolic changes associated with insulin resistance.

Dietary strategies for preventing the onset of diabetes

The different natures of the two types of diabetes requires diverse dietary strategies in order to prevent their onset. For type 1 diabetes, while the exact causes are still being investigated, it is acknowledged that various environmental factors increase the risk of diabetes in genetically susceptible subjects. If these factors can be identified, there could be a good chance of decreasing the incidence of the disease. Other dietary factors being investigated include the active form of vitamin D,5 which is thought to help prevent the development of autoimmune diabetes and gluten since studies have shown that islet cell antibodies may disappear after a gluten-free diet in celiac patients.6'7 However, time is needed before an answer on the efficacy of these dietary intervention trials is known. There are various risk factors for developing type 2 diabetes. One of the primary ones being obesity as defined by a body mass index of over 30 (Table 7.1). Other risk factors include increased...

Why has the genetics of obesity been difficult to study Defining the phenotype

One of the first problems faced in attempting to define a genetic basis for obesity is deciding what kind of effect (phenotype) we seek to examine. Obesity is a heterogeneous clinical disorder. Whilst it can be conveniently defined and clinically measured in terms of elevated body mass index (BMI), this is a definition chosen to define people or populations thought to be most at risk from its complications. It is a composite measure of body mass in relation to height, and Obesity and Diabetes. Edited by Anthony H. Barnett and Sudhesh Kumar 2004 John Wiley & Sons, Ltd ISBN 0-470-84898-7 For this reason, some studies have investigated genetic influence on more specific measures of body composition such as percentage body fat, total fat mass, visceral fat mass, subcutaneous fat mass or waist-hip ratio. These variables can be measured by bioelectrical impedance, computed tomography, magnetic resonance imaging, dual-energy X-ray absorbimetry scanning or underwater weighing. Whilst there...

Assessment of obesity in epidemiological studies

Most current epidemiological studies of body weight use body mass index (BMI) to define degrees of obesity. BMI is calculated as the subject's weight in kilograms divided by the square of their height in metres (kgm-2). Cut-offs for underweight, normal weight, overweight and obesity are shown in Table 1.1. Obesity and Diabetes. Edited by Anthony H. Barnett and Sudhesh Kumar 2004 John Wiley & Sons, Ltd ISBN 0-470-84898-7 Table 1.1 World Health Organization classification of obesity Healthy weight 18.5-24.9 Overweight (grade 1 obesity) 25-29.9 Obese (grade 2 obesity) 30-39.9 Morbid severe obesity (grade 3 obesity) > 40

The Impact of Maternal Obesity on the Energy Cost of Pregnancy

Butte et al. (13) compared energy metabolism in women with a low, normal, and high body mass index (BMI). The increase in BMR during pregnancy was highest in a high BMI (> 26 kg m2) group at 16.3 (5.4) kcal week compared with a normal BMI (19.8-26.0 kg m2) group at 9.5 (4.6) kcal week and a low BMI ( 19.8 kg m2) group at 8.8 (4.5) kcal week (13). Increments in BMR and 24-h energy expenditure were correlated with change in weight and fat-free mass but also with prepregnancy BMI or percentage fat (13). The change in BMR at 24 weeks gestation was significantly correlated with maternal obesity prior to pregnancy. Women who were lean prepregnancy were more likely to attenuate the increase in BMR in order to spare energy, whereas obese women had larger increases in BMR in response to energy excess (8).

Dietary Needs of Diabetic Residents

Residents are likely to have several reasons for being nutritionally at risk. These include a lack of nutritional knowledge and outdated ideas about diabetic diets held by some staff. It is vital that up-to-date information about diabetes and healthy eating be given to care home staff, especially those who have responsibility for menu planning, food purchasing and cooking. The local community dietitian (where available) will usually be a good source of help and advice in implementing healthy eating policies. They may often be able to help in staff training on the dietary aspects of diabetes care.

Management of childhood obesity Prevention

A recent Cochrane review has examined the efficacy of obesity prevention strategies in childhood (Campbell et al., 2002). The authors commented that 'the mismatch between the prevalence and significance of the condition and the knowledge base from which to inform preventive activity, is remarkable and an outstanding feature of this review'. Only seven 'long-term' randomized controlled studies, lasting 12 months, were identified and three short-term studies of 3 months' duration were therefore included. The studies used a number of interventions and it was difficult to generalize the findings. One study examined the effect of dietary education aimed at young children, 3-9 years old. A significant reduction in prevalence of overweight and obesity was reported in the group of children who were given 'multimedia' information regarding healthy eating which included the use of qualified staff to underline health messages (Simonettei et al., 1986). No significant changes were seen in the...

What Are Overweight and Obesity

By clinical definition, a person is obese when he or she is thirty or more pounds over his or her ideal weight. Simply being overweight is characterized by being a few pounds to up to thirty pounds over his or her ideal weight. Of course, a well-trained muscular person might be incorrectly considered overweight because muscle tissue is more dense and heavy than fat tissue. Therefore, accurate assessments should calculate fat-to-muscle or hip-to-waist ratios. From a practical standpoint, a look in the mirror can make much of the testing unnecessary. Most people who are overweight or obese know that they are, though they might want to deny the obvious. Overweight and obesity usually are diseases of overeating, although metabolic factors affect some people. The traditional view is that people Several animal studies have found that some dietary fats are more likely than others to become body fat. For example, some research shows that consumption of monounsaturated fat results in less body...

Conclusion using the Mediterranean diet to prevent coronary heart disease

Despite the increased evidence that dietary prevention is critical in the post-AMI patient, many physicians (and their patients) remain rather poorly informed about the potential of diet to reduce cardiac mortality, the risk of new CHD complications and the need for recurrent hospitalisation and investigation. There are many reasons for that, the main one probably being an insufficient knowledge of nutrition.156 For that reason (and knowing the resistance of many physicians to accept the idea that diet is important in CHD), we propose a minimum dietary programme that every CHD patient, whatever his or her medical and familial environment, should know and follow. This minimum 'Mediterranean' dietary programme has been recently described,157 and should include the following Reduced consumption of animal saturated fat (for instance, by totally excluding butter and cream from the daily diet and drastic reduction of fatty meat) and increased consumption of n-3 fatty acids through increased...

What Is Dietary Fiber

Dietary fiber comes from the portion of plants that is not digested by enzymes in the intestinal tract. Bacteria in the lower gut, however, may metabolize part of it. (Dietary fiber is only found in plants, Meat and other animal products do not contain fiber.) In contrast, fibers in cell walls are water insoluble. These include cellulose, hemicellulose and lignin. Such fibers increase fecal bulk and speed up the passage of food through the digestive tract. Wheat bran and whole grains contain the most insoluble fiber, but vegetables and beans also are good sources. Recently psyllium has become a popular high fiber source. Psyllium is higher in dietary fiber than most other sources. Sometimes there is confusion as to the difference between crude fiber and dietary fiber. Both are determined by a laboratory analysis, but crude fiber is only one-seventh to one-half of total dietary fiber.

Dietary sources and intake levels of flavonoids

Only a few of the thousands of different flavonoids identified in plants are present in considerable amounts in the human diet, and the intake of these dietary flavonoids varies among countries and cultures (Table 9.1) The dihydrochalcone phloretin and its glycoside phloridzin are found in large amounts in apple, but no estimates of intake levels have been reported. The flavanones are present mainly in citrus fruits, predominated by naringin (the glycoside of naringenin), responsible for the bitter taste of grapefruit, and hesperidin (the glycoside of hesperetin) found in oranges. Since the intake of orange juice is extensive in many Western countries, e.g. Denmark and Finland, the intake of in particular the citrus flavanone hesperetin is very high (Kumpulainen et al., 1999 Justesen et al., 2000). Table 9.1 Dietary sources and intake of flavonoids Major dietary

Behavioural modification strategies in obesity treatment

There are multiple published articles describing the commonly employed behavioural modification strategies for dietary change, exercise adoption, and relapse prevention (Brownell, 2000 Foreyt and Poston, 1998 Poston and Foreyt 2000 Wing, 1998). Establishing reasonable, specific short-and long-term goals, daily self-monitoring of dietary intake and exercise behaviours, using stimulus control techniques to modify environmental and intrapersonal factors that precede and cue food intake, cognitive restructuring to address maladaptive thoughts impacting behaviour change, problem-solving environmental, emotional, or motivational challenges to change efforts, enlisting social support resources, and relapse prevention training are useful techniques in modifying behaviours associated with weight loss. Several examples of how the primary behavioural modification strategies might be incorporated throughout the weight loss process are provided in Table 7.1.

The Need And Feasibility Of Future Dietary Studies In Pregnancy

There remains a lack of good randomised studies on the dietary management of diabetic pregnancies. Such studies are required for both short-term pregnancy outcomes and long-term outcomes for the mother and her child. One of the main difficulties in conducting such studies is the control arm even when no dietary advice is given, women once diagnosed with GDM make lifestyle changes based on family beliefs or information gathered from a variety of sources. Also if the health care providers are aware of the diagnosis they too unintentionally are likely to influence lifestyle factors. The need to blind both the women and the health care staff to the diagnosis is difficult and often considered unethical, as GDM if ignored can carry a risk to the pregnancy (99). It is hoped that the HAPO Study (Hyperglycaemia Adverse Pregnancy Outcome Study) currently underway, looking at pregnancy outcomes in 25 000 pregnant women in whom lesser degrees of glucose intolerance will go untreated, will help to...

Dietary Salt Intake And Diabetic Nephropathy

Systemic blood pressure elevation accelerates the progression of diabetic nephropathy in both type 1 and type 2 diabetic patients 93 , and effective antihypertensive treatment reduces albuminuria and the rate of decline in GFR in these patients. Extracellular fluid volume expansion due to impaired renal sodium excretion is the most clinically important mechanism that leads to the development of secondary hypertension in diabetic and non-diabetic patients with chronic renal disease 94 95 . Regardless of which specific antihypertensive agent is used, sodium restriction and treatment with loop diuretics is of major importance for the management of hypertension in these patients 95 . Recent short-term studies have demonstrated that the antiproteinuric effect of blockers of the renin-angiotensin-system RAS and nondihydropyridine calcium channel blockers is enhanced during dietary salt restriction independently of the blood pressure reduction in both diabetic and non-diabetic renal diseases...

What are the recommendations concerning the intake of dietary fibre vitamins salt and alcohol

The intake of an adequate amount of dietary fibre is considered very important. Soluble dietary fibre (pectins, comea, etc.) found in fruits and vegetables is more beneficial than insoluble fibre (cellulose, hemicellu-loses) found in cereals, because it decreases the post-prandial glycaemia and acts favourably on blood lipids. It is recommended that the diet of a diabetic person contains at least 20-30g of dietary fibre daily. As regards the consumption of special foods for diabetics, their use is not necessary and should not be encouraged. This is especially valid nowadays, when the strict restriction of carbohydrates and the complete avoidance of sugar are no longer recommended. Usually, special diabetic foods contain either fructose or sorbitol, substances that do not present, as already mentioned, any particular advantages. Moreover, many of these products contain a lot of fat, in particular saturated fat. In fact, their use often leads to over-consumption of food, because of the...

Dietary iron intake absorption and metabolism

Although there is no physiological means of iron excretion, a well-balanced diet containing sufficient iron is needed. Only about 10 per cent of ingested iron is absorbed in the gut. Therefore, around 10-20 mg of dietary iron intake is needed to balance the 1 or 2mg of daily losses. The normal amount of total body iron is about 40-50 mg kg body weight. In the body, iron is mainly needed to form the porphyrin complex of haemoglobin (30 mg kg), myoglobin in muscle cells (48 mg kg) and also iron-containing enzymes, such as cytochromes, oxidases and peroxidases. Up to 30 per cent of body iron (12mg kg) may be stored as ferritin and hemosiderin in the bone marrow, spleen and liver. The efficiency of iron absorption is mainly regulated by body requirements to maintain iron homeostasis. Iron deficiency causes an increase in iron absorption, while iron overload reduces but does not eliminate absorption. Fertile women, for example, need to absorb up to 2-5 mg of iron each day to compensate for...

Dietary prevention of chronic heart failure CHF the role of micronutrients dietary fatty acids and reduced sodium intake

The vital importance of micronutrients for health and the fact that several micronutrients have antioxidant properties are now fully recognised. These may be as direct antioxidants, such as vitamins C and E, or as components of antioxidant enzymes superoxide dismutase or glutathione peroxidase.56 It is now widely believed (but still not causally demonstrated) that diet-derived antioxidants may play a role in the development (and thus in the prevention) of CHF. For instance, clinical and experimental studies have suggested that CHF may be associated with increased free radical formation57 and reduced antioxidant defences58 and that vitamin C may improve endothelial function in patients with CHF.59 In the secondary prevention of CHD, in dietary trials in which the tested diet included high intakes of natural antioxidants, the incidence of new episodes of CHF was reduced in the experimental groups.18,60 Taken altogether, these data suggest (but do not demonstrate) that antioxidant...

The use of functional foods to meet dietary guidelines

Many consumers struggle to meet dietary recommendations. The United States Department of Agriculture (USDA) reported in 1998 that the average intake of added fats and sugars was too high and the intake of fruits, vegetables, dairy products, lean meats and foods made from unrefined grains was too low compared with serving recommendations.9 Comparable findings in The Netherlands10 and the rest of Europe (supplement 2 to the British Journal of Nutrition 1999, vol. 81) have been reported. Functional foods enriched with vitamins, dietary fibres or specific fatty acids, or foods that are designed to be low in sodium or saturated fat, can therefore make a valuable contribution to our diet, as will be discussed in the following paragraphs. The evidence-based strategies for a reduction in CVD risk have been used as a guide. In the US, vegetable consumption is close to the recommended daily intake but fruit consumption is less than half of the recommended amount.9 In Europe, fruit and vegetable...

Shortterm Renal Effects Of Dietary Protein Intake Healthy subjects

For more than half a century it has been recognised that short-term changes in dietary protein intake is followed by significant alterations in GFR and renal plasma flow (RPF) in healthy subjects. Originally, Nielsen et al. 18 in 1948 demonstrated a decline in GFR of 7 in 8 healthy women during a low-protein, low caloric diet of two weeks. Subsequently, Pullman et al. 19 in 1954 extended this observation and documented a decline in GFR of 9 and RPF of 6 in 20 healthy subjects after two weeks treatment with a low protein diet (average 0.3 g kg day), compared to a usual-protein diet (average 1.0 g kg day). It was further demonstrated that a short-term high-protein diet (average 2.6 g kg day) increased GFR and RPF, 13 and 12 , respectively, compared to a usual protein diet. Several investigators have since verified these findings 20-25 .

Letting Legumes into Your Diet

It's tough to find a more perfect all-round food than legumes. They're rich in protein, low in fat (what fat they do have is the good fat), high in dietary fiber, and rich in complex carbohydrates and vitamins. Besides being healthy, they're inexpensive, very versatile, and easy to use. They store well when dried, and have a shelf life of a full year.

Components of obesity treatment Behavioural lifestyle modification

Persons with BMI of 25.0-29.9 kg m2 who have two or more health risk factors are encouraged to consume a low-calorie diet and increase physical activity consistent with the US Surgeon General's recommendation for 30min or more per day most days of the week (NHLBI and NAASO, 2000 US Department of Health and Human Services, 1996). Behavioural lifestyle modification has comprised the cornerstone of weight loss treatment for decades, and typically involves group-led weekly meetings focusing on dietary change, activity increase and instruction in behaviour change techniques. Programme lengths have doubled from an average of 20 weeks in the 1980s to 40 or more weeks at present (Perri et al., 1989 Wing, 2002), with the active instructional phases most commonly lasting 16-26 weeks, and follow-ups typically extended to one or more years. Dietary recommendations include limiting calories to 1000-1800 kcal day, with no more than 20-30 per cent of calories from fat. Behaviour change strategies...

Dietary antioxidants and the prevention of CHD epidemiological evidence

A large number of epidemiological studies have evaluated potential relationships between dietary intake of antioxidants and coronary heart disease (CHD). These are summarised in Table 5.1. Among these, the Nurses' Health study,36 included over 87 000 female nurses 34 to 59 years of age, who completed dietary questionnaires that assessed their consumption of a wide range of nutrients, including vitamin E. During follow-up of up to 8 years 552 cases of major coronary disease were documented. As compared with women in the lowest fifth of the cohort with respect to vitamin E intake, those in the top fifth had a relative risk of major coronary disease of 0.66 after adjustment for age and smoking. Further adjustment for a variety of other coronary risk factors and nutrients, including other antioxidants, had little effect on the results. Similarly, the Health Professionals' Follow-up study, among almost 40 000 males of 40-75 years, followed up for four years, showed a lower risk of coronary...

Correlation of altered nutritional experience in early life to subsequent high incidence of obesity and metabolic

Studies of the long-term consequences of an altered nutritional experience in early post-natal life indicate the importance of this phase of life for metabolic programming effects. Dietary habits for all ages have undergone tremendous changes over the past several decades. The present obesity epidemic, to a large measure, may be the result of such changes. Extrapolation of data obtained from HC rat models suggests that post-natal increased consumption of carbohydrates by infants (formula feeding with early introduction of carbohydrate-rich supplements such as cereals, fruits juices, etc.) in Western societies may be partly responsible for the increase in the incidence of obesity. This effect is exacerbated by the mode of feeding (bottle, spoon, etc., resulting in overfeeding). Supplementation of milk (breast or formula) with early introduction of carbohydrate-enriched baby foods and overfeeding may result in malprogramming effects in these babies, leading to adult onset obesity and...

Integrating obesity management with diabetes

Within primary care there has been a lot of interest in developing distinctive practice-based obesity clinics, often led by one or two enthusiastic members of the practice team and some achieving excellent results. Many others, however, find the prospects of developing such a stand-alone clinic daunting, citing the lack of time, staff, resources or skill-base as their main concerns. When considering the management of diabetes in primary care, however, the need for medical management of overweight is inescapably integral to any serious diabetes treatment plan. It must therefore be within the scope and remit of primary care diabetic clinics to provide for the management of overweight. To do otherwise is to fail to recognize and address the root cause of the disease we are trying to control, and thereby miss the perfect opportunity to develop life-long lifestyle change with all the medical benefits that would confer. This approach does however require an informed and motivated practice...

Pathophysiology of Adipose Tissues Obesity and Insulin Resistance

Lipid storage in adipose tissue represents excess energy consumption relative to energy expenditure, which in its pathological form has been coined 'obesity'. In recent years, overnutrition has reached epidemic proportions in developed as well as developing countries. This reflects recent lifestyle changes, however there is also a strong genetic component as well. While the biochemical mechanism(s) for this genetic predisposition are still under investigation, the genes that control appetite and regulate energy homeostasis are now better known. For example, adipocytes produce leptin (see above) that suppresses appetite and was initially considered a promising target for drug therapy. However, most overweight individuals overproduce leptin, and no more than 2-4 of the overweight population has defects in the leptin appetite suppression pathway 14 . In contrast, genetic predisposition to obesity and or T2D when excess calories are consumed is common in the population for instance,...

Dietary antioxidants and the prevention of CHD evidence from clinical trials

While most epidemiological studies have demonstrated that dietary intake of vitamin E is inversely related to coronary heart complications, supplementation studies gave conflicting results. Clinical trials with antioxidants have been done in patients with or without previous history of cardiovascular disease (Table 5.2). Surrogate endpoints, such as analysis of atherosclerosis progression, or 'hard' endpoints, such as vascular death and MI, have been used to evaluate the clinical benefits of antioxidant vitamins. The Alpha-Tocopherol-Beta-Carotene-Cancer (ATBC)52 prevention study was a randomized, double-blind, placebo-controlled primary-prevention trial to determine whether daily supplementation with alpha-tocopherol, beta-carotene or both reduced the incidence of lung cancer and other cancers. A total of 29 133 male smokers, 50-69 years of age, were randomly assigned to one of four regimens alpha-tocopherol (50 mg per day) alone, beta-carotene (20 mg per day) alone, both...

Dietary and lifestyle alterations

It is important to understand, however, dietary intake cannot be reliably estimated in the overweight patient as they consistently understate their food Figure 6.2 Weight loss and maintenance including the influence of hypothalamic control. Weight loss programmes should be carried out in 6-monthly stages with periods of weight stabilization. Figure 6.2 Weight loss and maintenance including the influence of hypothalamic control. Weight loss programmes should be carried out in 6-monthly stages with periods of weight stabilization.

Factors modifying the relationship between obesity and diabetes

A large number of factors influence the relationship between obesity and diabetes and many of them are closely inter-related. That obesity on its own is not sufficient to cause diabetes is apparent from the observation that 20 per cent of patients with type 2 diabetes are not obese and even in the highest risk group with high BMI and high waist-hip ratio over 80 per cent will escape type 2 diabetes (Colditz et al., 1995). Other factors include body fat distribution, duration of obesity, weight gain, age, physical activity, diet, the in utero environment, childhood stunting and genetic factors. Methodological issues are also important in examining the relationship between obesity and diabetes. Some of the observed increase in diabetes prevalence attributed to obesity could be related to more awareness and detection of type 2 diabetes, rather than a true increase in numbers (previous Diabetes UK estimates are that 50 per cent of patients do not know they have type 2 diabetes). The...

Finding your ideal weight range

The ideal weight for your height is a range and not a single weight at each height, but we use numbers that give a weight in the middle of that range. Because people have different amounts of muscle and different size frames, you're considered normal if your weight is plus or minus 10 percent of this number. For example, a person who is calculated to have an ideal weight of 150 pounds is considered normal at a weight of 135 (150 minus 10 percent) to 165 (150 plus 10 percent) pounds. Because no two people, even twins, are totally alike in all aspects of their lives, we can only approximate your ideal weight and the number of calories you ( ll need to maintain that weight. You'll test the correctness of the approximation by adding or subtracting calories. If your daily caloric needs are 2,000 kilocalo-ries and you find yourself putting on weight, try reducing your intake by 100 kilocalories and see whether you maintain your weight on fewer kilocalories. If you're a male, your...

Self Monitoring Recording Your Weight Loss Progress

The first step to self-monitoring is to put your weight loss goals on paper. Identify your current weight and 5 percent, 7 percent, and 10 percent weight loss targets and record them on your weight loss graph. Weigh yourself on a reliable scale at the same time of day and in the same clothing (either naked or in your underwear, if you're self-conscious) because your weight can fluctuate by several pounds over the course of the day. Ideally, you should weigh yourself in the morning before eating to minimize fluctuations in your measurements. How often should you weigh yourself You may start by weighing yourself daily to keep focused and get into a habit of monitoring your weight. However, if you find this discouraging and counterproductive, weigh yourself a little less often, either every other day or twice a week. Research shows that people who weigh themselves regularly do best at keeping weight off over the long term, so it is critical that you establish a habit of weighing yourself...

Risk Factors For Obesity

The patient's age is important in determining risk from obesity and generally there is greater risk from obesity in those under 40 years of age. Taking a weight history can ascertain the onset and duration of obesity as well as the pattern of weight gain and weight loss throughout the individual's life. Longitudinal studies have shown that weight gain confers a greater risk of cardiovascular disease than an unchanging level of obesity (40). In addition, the longer the duration of obesity the more difficult treatment may be. Gender is another variable that impacts on the development of obesity, with women generally having a higher prevalence of obesity compared to men, especially in middle age (41). Reproductive function can be affected in younger women, with menstrual disorders including irregular bleeding and amenorrhea being more common among obese females. Various medical genetic causes of obesity must also be considered. Endocrine conditions associated with weight gain include...

Dietary strategies for the control of diabetes carbohydrates and lipids

According to the American Diabetes Association, the goals of medical nutritional therapy for diabetes are to prevent and treat complications such as cardiovascular disease, hypertension, nephropathy, obesity and dislipidaemia, and include Attention should be paid to the daily energy requirement of children with type 1 diabetes, as they might lose weight at the onset of the disease. The weight-height charts used by paediatricians are useful to measure the adequacy of the energy intake. For adult type 1 diabetic patients, the daily energy requirement is not different from that of a normal individual. In this case it is also advisable to keep a desirable lean weight throughout life. However, for type 2 diabetes, since it usually occurs in overweight people, weight loss and behavioural changes are to be stressed.

Obesity and type diabetes

Obesity is the most significant risk factor for type 2 diabetes, which is three times more common in overweight individuals (BMI > 25 kg m-2) than in those of normal body weight (Pi-Sunyer, 1993 Perry et al, 1995 Colditz et al, 1995). In the morbidly obese, the relative risk of type 2 diabetes is at least 5 per cent Obesity and Diabetes. Edited by Anthony H. Barnett and Sudhesh Kumar 2004 John Wiley & Sons, Ltd ISBN 0-470-84898-7 for men and 8-20 per cent in women (Mason et al., 1992 Sjostrom et al., 1999 Kral, 2001). Approximately 30 per cent of those considered for weight reduction surgery have type 2 diabetes (Gleysteen et al., 1990 Pories et al., 1995 Wittgrove et al., 1996 Cowan and Buffington, 1998 Noya et al., 1998), and a further 5-27 per cent have impaired glucose tolerance (Pories et al., 1995 Wittgrove et al., 1996 Cowan et al., 1998). Even allowing for a degree of selection bias in these surgical reports, obesity is clearly a major problem for a significant proportion...

How Common Are Overweight and Obesity

The prevalence of obesity and overweight have, without exaggeration, skyrocketed in recent years. In 2001 David Satcher, M.D., then surgeon general of the United States, described it as an epidemic. He predicted that the health consequences of overweight and obesity would soon overtake the effects of tobacco. Thirty-one percent, or almost one-third, of North Americans are now obese. They are part of the 65 percent two-thirds of North Americans who are now overweight. The number of overweight children also is disturbing. Estimates of overweight children range from 13 to 20 percent. These increases in weight result largely from the increased consumption of junk foods consisting chiefly of refined sugars, carbohydrates, and fats. A major source of dietary sugar is soft drinks, which the consumer-oriented Center for Science in the Public Interest has described as liquid candy. A 64-ounce bottle of any calorically sweetened (in contrast to artificially sweetened) soft drink contains...

Physical activity and the behavioural treatment of obesity

The behavioural treatment of obesity refers to a set of principles and techniques designed to help overweight and obese individuals reverse their maladaptive eating, activity and thinking habits (Wadden and Foster, 2000). Safety and the environment Sallis and Owen (1997) have suggested that time spent outdoors was the single best correlate of physical activity for children. However, many parents keep their children indoors because of concern about safety and lack of space and facilities near homes. A consideration for children is not only their physical safety, but their psychological safety is also of paramount importance. The evidence on the psychological co-morbidities associated with obesity is high (Gortmaker et al., 1993 Sullivan et al., 1993). For a thorough consideration of the role of behavioural approaches in the treatment of obesity the reader is referred to the preceding chapter and a number of reviews of this subject (Wadden et al., 1999 Faith et al., 2000 Wadden and...

The Association Between Obesity And Type Diabetes

The link between obesity and Type 2 diabetes has long been established and a visit to any diabetes clinic will confirm the alarming statistic that 90 of those with Type 2 diabetes are also estimated to be obese (18). It is not currently known whether insulin resistance is the cause of obesity, the result of obesity, or whether the two conditions arise independently from each other (19). It is known that the prevalence of insulin resistance is greater among the obese, however, there are normal weight individuals who are equally insulin resistant Several mechanisms have been proposed to explain how excessive body weight is associated with Type 2 diabetes. In general, the accumulation of fat mass is associated with a decline in whole body insulin sensitivity. The distribution of obesity is important, with resistance to the action of insulin and glucose intolerance most closely associated with excess abdominal adipose tissue. As visceral adipose tissue increases plasma triglyceride (TG)...

Obesity Body Composition

Obesity is clearly associated with chronic diseases such as type 2 diabetes, coronary heart disease, and dyslipidemia, yet the underlying mechanisms are not well defined. However, the evidence is strong that insulin resistance contributes greatly to the pathophysiology of these observed metabolic abnormalities and their associated morbidity (72). Insulin resistance is observed frequently in obese subjects and is considered an independent risk factor for the development of both type 2 diabetes and coronary artery disease (72-75). Although it is established that hyperinsulinemia, insulin resistance, and other obesity-related metabolic abnormalities are significantly associated with overall accumulation of fat in the body, there is considerable evidence that the specific fat distribution is important. Excessive accumulation of fat in the upper body's abdominal area is referred to as ''truncal'' or ''central'' obesity. Central obesity appears to be a better predictor of morbidity than...

How much of obesity is genetic

Given that the explosion in obesity prevalence over the past 20 years is likely to have taken place against a background of relatively constant population genetic structure, the question of to what extent obesity is subject to genetic influence is one that merits careful consideration. Many studies have attempted to resolve the population variance of a specific obesity phenotype into genetic, environmental and unknown (or residual) effects. In principle, the total observed phenotypic variance, Vp may be considered to be due to the sum of genetic variance (Vg), shared environmental variance (Vc) and an unknown residual (unshared environmental) variance (Ve) such that Vp Vg + Vc + Ve. The percentage genetic inheritability of the trait in question is represented by the term Vg Vp. Modifications of this simple model to attempt detection of gene-gene and gene-environment interactions and the application of complex multivariate computational modelling in different study populations are...

Metabolic Consequences Of Obesity Why Does It Predispose To

Much work has been done in recent years to understand the links between physical inactivity, obesity, and the development of T2DM. Still no clear, unifying hypothesis has been able to encompass the complex web of metabolic and molecular defects that accompany T2DM. However, much has been learned on how dysfunctional adipose tissue in obesity impairs glucose homeostasis in humans, which can be separated conceptually in two major mechanisms (a) dysfunctional fat viewed as an endocrine organ, actively involved in releasing a number of cytokines that promote systemic inflammation that cause promote muscle liver insulin resistance, and (b) abnormal dysfunctional fat causing lipo-toxicity, where sick insulin-resistant adipocytes cause ectopic fat deposition in skeletal muscle, liver, and pancreatic P-cells, with devastating effects for glucose homeostasis.

Implications of obesityassociated diabetes

The consequences of obesity are serious. Obese individuals are predisposed to a cluster of metabolic disturbances known as 'syndrome X' or the metabolic syndrome, which comprises glucose intolerance (the inability to metabolize glucose adequately), type 2 diabetes mellitus, hypertension, dyslipidaemia (high triglyceride levels accompanied by a raised concentration of low-density lipopro-teins and diminished high-density lipoproteins), leading to an increased risk of stroke and cardiovascular disease (Ramirez, 1997 Reaven 1988, 1995 Walker 2001). In addition, obesity is also a risk factor for some malignancies such as endometrial cancer (Iemura et al., 2000). The more life-threatening, chronic health problems have been categorized into four main areas by WHO. These include cardiovascular problems including hypertension, stroke and coronary heart disease conditions associated with insulin resistance, namely type 2 diabetes certain types of cancer as well as gall bladder disease.

Assessing Motivation To Lose Weight

When conducting an assessment of obesity, it is important to establish the ability and motivation of the individual to make lifestyle changes at that time. The style of the therapist can be crucial in facilitating behaviour change (48) and enhancing the confidence of the individual to be able to sustain changes. Key skills include the core counselling skills of listening and reflecting,

Obesity type diabetes and insulin resistance

Insulin resistance is a common feature of obesity and its incidence rises with increasing BMI. Visceral obesity is an even better predictor than BMI of hyperin-sulinaemia, insulin resistance and type 2 diabetes (Despres, 1998 Ferrannini and Camastra, 1998). The clustering of cardiovascular risk factors with insulin resistance was first described as syndrome X by Reaven in 1988 and included central obesity, hypertension, glucose intolerance and dyslipidaemia (the 'deadly quartet') (De Fronzo and Ferrannini, 1991 Reaven, 1993 Williams, 1994). Other features of the syndrome have since been added to include a pro-coagulant state and accelerated atherosclerosis, appropriately called the 'cardiometabolic syndrome'. Recent guidelines from the National Cholesterol Education Programme (Adult Treatment Panel III, ATP III) suggests that clinical criteria for definition of insulin resistance or metabolic syndrome should be based upon any three of the following (Executive Summary, 2002 Figure...

Inflammation A Process Associated with Obesity Induced Insulin Resistance

Adipose tissue modulates metabolism by releasing NEFAs and glycerol, hormones -including leptin and adiponectin - and proinflammatory cytokines 19 . There is now clear evidence that obesity associated with or without T2D is an inflammatory state, consistent with the production of TNF-a and other cytokines by adipose tissue. Chronic inflammation of white adipose tissue characterized by macrophage infiltration is thought to contribute to insulin resistance associated with obesity, and in obesity, the production of many of these adipokines is increased. RBP4 induces insulin resistance through reduced phosphatidylinositol-3-OH kinase (PI3K) signaling in muscle and enhanced expression of the gluconeogenic enzyme phosphoenolpyruvate carboxykinase in the liver through a retinol-dependent mechanism. By contrast,

Obesity and hypertension

A rise in blood pressure is associated with increased body weight. Epidemi-ological studies indicate that obesity is a strong independent risk factor for hypertension (Modan et al., 1985 Stamler et al., 1993). In the Framingham Study, for example, the prevalence of hypertension among obese individuals was twice that of those individuals with normal weight irrespective of sex and age (Hubert et al, 1983). The INTERSALT Study involving 10000 men and women showed that a 10-kg increase in weight was associated with 3-mmHg rise in systolic and 2.3-mmHg rise in diastolic blood pressure (Dyer and Elliott, 1989). This level of blood pressure elevation is associated with a 12 per cent increase risk for CHD and 24 per cent increase for stroke. In the Nurses' Health Study, the relative risk of hypertension in those women who gained 5.0 to 9.9 kg and greater than 25.0 kg was 1.7 and 5.2, respectively (Huang et al., 1998). The risk of hypertension was even higher with abdominal obesity (WHR >...

Evaluating obesityrelated hypotheses for progression of type diabetes

Although the portal hypothesis is associated with obesity, insulin resistance and the pathogenesis of type 2 diabetes associations between subcutaneous fat on the trunk and insulin resistance have been shown in obese non-diabetic men (Abate et al., 1995 Goodpaster et al., 1997) and in men with type 2 diabetes Abate et al., 1996 Kelley and Mandarino, 2000 Smith et al., 2001. As the present data suggests that subcutaneous fat, which accounts for 80 per cent of total adipose tissue, is a cause of insulin resistance this must occur via a non-portal mechanism as this fat depot does not drain into the portal vein. Furthermore, insulin resistance appears independently by an increased truncal subcutaneous adipose tissue and an increased visceral fat store (Albu et al., 2000 Marcus et al., 1999 Bavenholm et al., 2003). Because of growing evidence that subcutaneous fat may play an important role in obesity-related type 2 diabetes with conflicting evidence for the role of the portal fat, changes...

Physical activity and the treatment of overweight and obesity

There have been a number of review articles that have demonstrated greater success with the inclusion of physical activity in the treatment of overweight and obesity (Miller et al. 1997, 1995 Ballor and Poehlman, 1995 Epstein and Myers, 1998). It is clear from a variety of intervention studies that acute treatments lead to significant weight loss (Ballor and Poehlman, 1995 Miller et al., 1997 Epstein and Myers, 1998) but weight loss maintenance tends to be limited (Garner and Wooley, 1991 Miller, 1999). Studies comparing the outcomes of diet only versus exercise only interventions, show that the ability of exercise only interventions to achieve weight loss is very limited (Garrow and Summerbell, 1995 Miller et al., 1997). Miller et al. (1997) compared diet only, exercise only and diet plus exercise interventions, the outcomes of which were average weight losses of 10.7 0.5 kg, 2.9 0.4 kg and 11.0 0.6 kg respectively for short duration interventions lasting 15.6 06 weeks. Miller et al....

Role of metabolic programming in etiology of obesity epidemic

Population-based evidence and studies of early nutritional experiences in animals suggest that different nutritional insults during fetal or neonatal life may result in increased risks of developing metabolic diseases such as obesity and metabolic syndrome later in life.10 Metabolic programming is a phenomenon in which a stimulus or insult that occurs during a critical period of organogenesis in early life results in permanent alterations in the structures and functions of affected organs and increased susceptibility to adult disease (Figure 4.1).17,18

Other Dietary Factors And Smoking

In 1972 Bjorntorp and colleagues suggested that physical training resulted in lower plasma insulin levels and improved insulin sensitivity (53). This has been convincingly confirmed in many subsequent experiments. In cross-sectional epidemio-logical studies Type 2 diabetes rates have been shown to be lower amongst physically active individuals than amongst those not having regular physical activity (54). The protective effect of physical activity against Type 2 diabetes has been confirmed in several prospective studies. For example, in the Nurses' Health Study women who engaged in vigorous exercise at least once a week had an age-adjusted relative risk of Type 2 diabetes of 0.67 compared with women who exercised less frequently than weekly (55). The relative risk was reduced after adjustments for BMI, but remained highly statistically significant. A similar graded reduction in risk of subsequently developing Type 2 diabetes associated with a graded increase in physical activity was...

Obesity and dyslipidaemia

Obesity is associated with alteration in lipoprotein metabolism resulting in increase in total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDLc), very-low-density lipoprotein cholesterol (VLDL) and reduced level of high-density cholesterol (HDLc) (Hubert et al., 1983 Grundy and Barnett, 1990). Epidemiological studies such as the Framingham Heart

Dieting Body Image Problem

There is a culture of body image in our society, thus it is important to pay close attention to the behavioral and mental health concerns for children and adolescents. The American Academy of Pediatrics Diagnostic and Statistical Manual for Primary Care (DSM-PC) distinguishes dieting body image behaviors that were, in the past, difficult to categorize as eating disorders. Children and adolescents may exhibit behaviors that do not meet full DSM-IV criteria, yet still deserve attention. The two specific complexes in the DSM-PC-related diagnostic categories include dieting body image behaviors and purging binge-eating behaviors (125). There are two levels of pathology for both of these behavior patterns in children that do not fulfill DSM-IV criteria for an eating disorder. In DSM-PC, variations constitute minor deviations from normal that still might be of concern for a parent or clinician (125). An adolescent with a dieting body image problem will be one who exhibits voluntary food...

Diabetes Obesity and the Brain

Insulin Brain

Recent evidence suggests a key role for the brain in the control of both body fat content and glucose metabolism. Neuronal systems that regulate energy intake, energy expenditure, and endogenous glucose production sense and respond to input from hormonal and nutrient-related signals that convey information regarding both body energy stores and current energy availability. In response to this input, adaptive changes occur that promote energy homeostasis and the maintenance of blood glucose levels in the normal range. Defects in this control system are implicated in the link between obesity and type 2 diabetes. the brain in glucose homeostasis, its importance was largely neglected after the discovery of insulin in 1923. However, new findings have revived interest in the role played by the brain in both glucose homeosta-sis and the mechanism linking obesity to type dinal features that link obesity with type 2 diabetes. The hypothesis that brain insulin action is required for intact...

Physical activity and obesity

Exercise is the most variable component of energy expenditure it is therefore clear to see why exercise has been adopted as a component to treat overweight and obesity. Indeed, exercise or physical activity is promoted within a range of guidelines for the prevention and treatment of overweight and obesity (WHO, 1997 NIH, 1998). Understanding the impact of physical activity and exercise on obesity and associated variables is important, as an increase in physical activity not only has significant positive effects on body mass and body fat mass, but also on a range of other variables associated with health (Blair and Brodney, 1999). Physical activity has been suggested to have favourable effects on weight loss, decreased fat percentage, decreased skinfold thickness, android disease, decreased risk of coronary heart disease (CHD), improved glucose metabolism, increased basal metabolic rate (BMR), prevention of loss of fat free mass (FFM), increased dietary thermogenesis, reduced blood...

Obesity and Type Diabetes in Children

The epidemic of obesity, which has spread to children in the United States in the past few decades, has led to a much higher prevalence of type 2 diabetes in children than was ever seen before. Overweight or obesity is present in as many as 25 percent of all children. Only a fraction of these children go on to develop diabetes. There are a number of conditions that can cause obesity in children but they represent probably 1 percent of the causes. Most of them can be diagnosed during the course of a good physical examination by your child's pediatrician. By far the major reason for obesity in children is too many calories in and too few burned up by exercise. Even without diabetes, obesity is a burden for children. The obese child faces severe psychological and social consequences Defining obesity in children The definition of obesity in children age 2 to 19 is based on the body mass index, BMI (see Chapter 7). A child is obese or overweight if his BMI is at the 95th percentile or...

Exercise tolerance and cardiorespiratory fitness in overweight and obese adults and children

There is very little data published on the exercise tolerance of obese adults. We tested 19 obese adults (4 males and 15 females aged 40.3 13.5 years) for exercise tolerance (Gately et al., 1997). Mean body mass and BMI of the group was 112.6 18.9 and 37.9 10.6 kg m, respectively. Exercise tolerance was assessed using the treadmill walking test protocol developed for the Allied Dunbar National Fitness Survey (ADNFS Activity and Health Research, 1992). Exercise tolerance was low as identified by a symptom limited mean peak VO2 of 2.05 0.51 l-min-1 or 19.62 5.45 ml-kg-1 -min-1 for the females and 2.15 1.06l min or 16.28 8.56 ml-kg-1-min-1 for males, respectively. Average values for the ADNFS for females and males aged 35 to 44 years were 34.8 and 45.5 ml-kg-1 -min-1 respectively. Even comparing the values with the 5th percentile from the ADNFS (24.5 ml-kg-1-min-1 for the females and 34.2 ml-kg-1-min-1 for the males respectively) the values for the obese are significantly lower (20 and...

Obesity and the Abdominal Phenotype in PCOS

This could be due to a depot-specific inhibition of the expression of hormone-sensitive lipase (HSL) by testosterone and or to a decrease in the amount of b2 adrenergic receptors. This could also be an important pathophysiological factor behind the insulin-resistant phenotype of the upper-body obesity in men and of the hyperandrogenic PCOS (104). Obesity has profound effects on the clinical and hormonal and metabolic features of PCOS, which largely depend on the degree of excess body fat and on the pattern of fat distribution. The recognition of the impact of obesity on PCOS may have some relevance in the pathophysiology of the disorder. In addition, obesity intuitively represents a target for therapeutic strategies, as weight loss produces several benefits on major complaints of women with PCOS, including hormonal and metabolic abnormalities, menses and ovulation, and therefore, fertility (107). Finally, the definition of the obesity phenotype is of...

Ectopic fat storage fat content in obesity

Positive energy balance produces an excess of triglyceride with storage in the liver (Ryysy et al., 2000) and skeletal muscle (Goodpaster and Kelley, 1998 Goodpaster et al., 1997, 2000 Shulman, 2000) which is subsequently followed by insulin resistance, glucose, intolerance and diabetes. This similar effect is also observed in patients with lipodystrophy characterized by a severe reduction in adipose tissue with increased triglyceride storage in the liver and skeletal muscle (Robbins et al., 1979, 1982) and subsequent type 2 diabetes disease. These observations suggest that in either the obese or lipodystrophic state, adipose tissue mass is unable to sequester dietary lipid away from the liver, skeletal muscle or the pancreas. As a result, too much or too little adipose tissue mass leads to ectopic fat storage and may further predispose individuals to insulin resistance and finally type 2 diabetes (Figure 4.3). of fat is insufficient to cope with the accumulation of dietary fat being...

Quick Permanent Weight Loss

Quick Permanent Weight Loss

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