Best Weight Loss Programs That Work

Eat Stop Eat

This book by Brad Pilon explains on both fasting and routine weight training practices whereby fasting takes the center stage. A day of fasting serves to get rid of all those toxic substances in addition to boosting the general bodys metabolism. Brad Pilon has been in this particular field for quite some time and I do trust that the information contained on this book- Eat Stop Eat, are as a result of his huge bank of experience and careful experimentation on the theme. With Eat Stop Eat you can forget about all of these obsessive compulsive eating habits. Your metabolism will not slow down and you will not go into starvation mode. With Eat Stop Eat you will clearly see the research behind why short periods of fasting will Never cause you to go into starvation mode. Your metabolism will stay just as high as it ever was. The goodness about this approach is that its safe and easy to follow especially for anyone who cannot stay away from their favorite meals. You will have access to your meals over the fasting periods and still get the desired result. Continue reading...

Eat Stop Eat Summary

Rating:

4.8 stars out of 82 votes

Contents: Ebook
Author: Brad Pilon
Official Website: eatstopeat.com
Price: $10.00

Access Now

My Eat Stop Eat Review

Highly Recommended

It is pricier than all the other ebooks out there, but it is produced by a true expert and includes a bundle of useful tools.

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

Considering Total Calories First

Thinner, age 46, was a new type 2 diabetic patient who came to me because of high blood glucose levels, some blurring of her vision, and some numbness in her toes. She was 5 feet 5 inches tall and weighed 165 pounds. She was taking pills for the diabetes, but they were not helping. Her doctor had told her she needed to lose weight but gave no further instructions. I started her on a diet based on the principles in this chapter. She was willing to follow the diet and lost 20 pounds, which she has kept off. Her blood glucose is now in the range of 110 most of the time. She no longer suffers from blurred vision, and her toes are beginning to improve. She is not taking the diabetes medication and feels much better. No matter how you slice it, your weight is determined by the number of calories you take in, minus the number of calories you use up by exercise or loss of calories in the urine or bowel movements. If you have an excess of calories coming in and have insulin...

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...

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...

What is the importance of the total amount of calories in the diet of the diabetic individual

The total intake of calories is very important, particularly in obese diabetics who should lose weight. A diet of 500-1000 calories per day less than what the person needs to maintain their current weight, will generally lead to a loss of roughly 2-4 kg (4.4-8.8 lb) per month, which is a healthy degree of weight loss and helps ensure the maintenance of the lost weight (the biggest problem in the management of obesity). During childhood and adolescence, however, individuals with Type 1 DM should not be deprived of the calories essential for their growth. A temporal correlation between the intake of energy and the administered insulin should exist. In general, diabetic individuals who make use of insulin need to synchronize their meals with the administration and the type of insulin, so that they avoid large fluctuations of blood sugar and hypoglycaemias.

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...

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...

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...

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...

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...

Calculating Total Energy For The Diet And Setting Safe Weight Gain Targets

In our practice we calculate an individual's energy requirement using the pre-pregnancy weight to calculate resting energy expenditure, using Schofield's formula (61), and a physical activity ratio of 1.6. To this we add 200kcal for the energy requirements for the third trimester. If we wish to induce a mild degree of negative energy balance we subtract 500 kcal from this calculated daily energy requirement to provide the total energy for the diet. The American Diabetic Association (ADA) have endorsed dietary guidelines for diabetes in pregnancy (62) that are based on pre-pregnancy weights, see Table 7.3. As previously mentioned, current American guidelines recommend a minimum weight gain of 7.0 kg for all obese (BMI> 29 kg m2) women, both diabetic (63) and non-diabetic (24). No equivalent weight or daily calorie guidelines exist for the UK. Our own unit limits weight gains in diabetic pregnancies to the bottom rather than the top of those recommended for average, overweight and...

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).

Recommended Maternal Weight Gains In Nondiabetic Pregnancies

Optimal weight gain for pregnancy needs to reflect the woman's pre-pregnancy weight (22). The guidelines on recommended maternal weight gains are based on large obstetric surveys in non-diabetic women in the United States (23). The maternal weight gain required to minimise the frequency of small-for-gestational-age (SGA) infants is higher for underweight (BMI< 19.8 kg m2) than overweight or obese women, see Table 7.2. As the majority of women with pre-existing Type 2 and GDM are already obese it is important that the dietary advice given does not result in higher post-partum than pre-pregnancy weights. When the pre-pregnancy BMI is > 35 kg m2, the risk of a SGA infant is low and even when little or no maternal weight gain occurs the risk of a SGA infant does not appear to increase (11). Overweight (BMI 26.1-29 kg m2) and obese (BMI > 29 kg m2) women are more likely to give birth to a LGA infant than normal weight women and this risk increases with increasing maternal weight...

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...

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)...

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.

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

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...

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 are the quantity and type of recommended fat in the diet of diabetic individuals

Especially for saturated fat, however, it should not exceed 10 percent of the daily calories (< 8 percent if the LDL-cholesterol is increased). The poly-unsaturated fat should not exceed 10 percent of total calories. As was already mentioned, particular emphasis is placed today on the mono-unsaturated fats (main representative, olive-oil), which, together with carbohydrates, are recommended to constitute 60-70 percent of the total energy intake (mono-unsaturated fat may constitute 10 -20 percent of the total energy, on condition that the total fat intake does not exceed 35 percent). The dietary intake of cholesterol is also recommended to be decreased (no more than 300 mg daily - and no more than 200mg day for individuals with dyslipidaemia. The trans-fatty acids, which emanate from hydrogenated fats (fried oils, etc.), are very detrimental (equally as saturated fat) and should be avoided. The n-3 fatty acids, found mainly in fish or administered as dietary supplements, are...

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. Replacement of saturated or trans fat in the diet by carbohydrates or other types of fat reduces the risk of coronary heart disease.11'12 Margarines were rich sources of...

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 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. intake by the order of 20 per cent. (Prentice et al., 1986). The energy intake required to maintain body weight is best estimated by using standard formulae derived from metabolic rate measurements and appropriate reductions in intake advised by altering proportions of foodstuffs in the diet. 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.

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...

Obesity and type diabetes

Obesity is a powerful risk factor for the development of type 2 diabetes and more than two-thirds of patients with type 2 diabetes are obese. The risk of type 2 diabetes correlates positively with increasing obesity (Larsson et al., 1981 Harris, 1989). In the Nurses Health Study, the risk of developing diabetes increased five-fold in women with BMI of 25 kg m2 compared with those with BMI of 22 kg m2 The risk becomes higher reaching 28-fold with BMI of 30 kg m2 and 93-fold with BMI > 35 kg m2 (Colditz et al., 1996). The risk of obesity and type 2 diabetes was better defined by a high WHR and waist circumference (Larsson et al., 1984). Additionally, the duration of obesity was directly related to the risk of diabetes (Everhart et al., 1992). The risk of type 2 diabetes from obesity is more prevalent across certain ethnic groups such as South Asians and Afro-Caribbeans (Bhopal, 2002). The increasing prevalence of type 2 diabetes is paralleled by the rise in the level of obesity in the...

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...

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...

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....

Why We Gain Weight The Arithmetic of Obesity

With more than 60 percent of the population either overweight or obese, weight gain is a problem that apparently affects most of us. The usual explanations for those extra few or more pounds range from, The holidays killed my diet, to, I couldn't get to the gym this week, to, My scale must be broken. However, there is a simple (yet somewhat painful) reason for weight gain it's the calories We take in fuel in the form of food. The energy we extract from food fires our basic biological functions and provides the energy we need to work, play, think, and survive. But what happens when we take in more fuel than we use In your car, unused gasoline sits in the tank until it's needed. In your body, unused fuel gets stored for future use as fat. Any imbalance between energy in and energy out results in weight gain or loss. This simple equation explains virtually all we need to understand about why we gain or lose weight.

Use of other drugs that may cause weight gain

There is a long list of drugs, mainly centrally acting, that can cause weight gain (Table 10.1), and these are often prescribed to patients with diabetes. Of particular note are tricyclic antidepressants and anticonvulsants such as carbamazepine and gabapentin used for symptom control in painful neuropathy. Other drugs include antipsychotic drugs, notably the newer atypical antipsychotic agents, such as clozapine and olanzapine, that can cause substantial weight gain, and have been suggested to independently worsen insulin resistance and perhaps increase diabetes risk in non-diabetic subjects (Hedenmalm et al., 2002). Pizo-tifen, a serotonin antagonist used in the management of migraine, may cause increased appetite and therefore weight gain (Galanopoulou et al., 1990). Cor-ticosteroids and some progesterone preparations, such as medroxyprogesterone acetate may also cause substantial weight gain, and in the case of corticosteroids, worsen insulin resistance and impair f-cell function....

Promotion of Weight Gain

In the UKPDS, weight gain was significantly greater in the intensively treated group (mean of 2.9 kg) compared with the conventional group. Patients treated with insulin had greater weight gain (mean of 4 kg) compared with those receiving chlorpropamide (2.6 kg) or glibenclamide (1.7 kg) (UKPDS 1998). Changes in bodyweight may be inversely related to change in HbA1c and directly related to the change in free insulin levels (Yki-Jarvinen et al 1992). Initially weight gain after a long period of poor glycaemic control may be associated with a reduction in basal metabolic rate and rehydration resulting from the amelioration of the osmotic diuresis associated with glycosuria (Makimattola, Nikkila and Yki-Jarvinen 1999). However, about two-thirds of subsequent long-term weight gain is associated with an increase in adipose tissue (Groop et al 1989), with the remaining weight gain due to an increase in lean muscle mass. Since excessive weight gain is undesirable for elderly patients with...

Increased height and weight gain

Birth height and weight of children who later developed type 1 diabetes have been similar to the controls in most of the studies (Virtanen & Knip 2003), although in some studies cases have been longer and weighted more than controls at the time of birth (e.g. Dahlquist et al. 1999). In the only cohort study available, higher birth weight was related to an increased risk of type 1 diabetes (Stene et al. 2001). Increased height gain during childhood seems to be related to greater risk of type 1 diabetes (e.g. Blom et al. 1992 Price et al. 1992). Higher weight gain in infancy is consistently related to greater risk of type 1 diabetes according to case-control evidence (e.g. Baum et al. 1975 Hypponen et al. 1999), whereas the findings on the role of weight gain after infancy are inconsistent (e.g. Blom et al. 1992 Hypponen et al. 2000). Clearly results from cohort studies are awaited to settle the putative importance of height and weight gain in the development of this disease.

Weight gain and improved glycaemic control

Weight gain is associated with improved glycaemic control, and is a complication of therapy with both insulin and oral insulin secretagogues, such as the sulphonylureas. This is a major problem when considered in terms of the poor compliance with medication that is known to be prevalent in patients with diabetes (Morris etal., 1997). Often weight gain following improved glycaemic control is a reflection of the previous poor glycaemic control and associated weight loss, secondary to the catabolism of adipose tissue and protein, however this is seen by many patients as a major disadvantage of the treatment of diabetes, particularly in the young. In the main DCCT study, intensified therapy was associated with an increase in the risk of becoming overweight, and at 5 years the mean weight gain was 4.6 kg greater in those receiving intensified than conventional therapy. In an ancillary study of the DCCT, it was observed that patients who gained most weight on the intensified treatment arm...

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

Hypothalamus Energy Homeostasis Mc4r

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 Conversely, a decrease in neuronal input from one or more of these afferent signals is proposed to alert the brain to a...

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...

Carbohydrate And Dietary Fibre

The suggestion that refined carbohydrates, and sugars in particular, might be involved in the aetiology of Type 2 diabetes dates back to the writings of early Indian physicians. However, in the 1960s, Yudkin resurrected the suggestion that high intakes of sucrose may be particularly important in the aetiology of Type 2 diabetes when he drew attention to the positive correlation between intakes of sucrose and diabetes prevalence in 22 countries (11). But it has subsequently become clear that the correlations were heavily dependent upon which countries were selected for inclusion and that such geographic correlations do no more than provide clues for further research, they certainly do not imply causality. Over 40 studies have examined the role of sugars in the aetiology of Type 2 diabetes, with about half suggesting a positive association and a comparable number suggesting no association. Some have even suggested an inverse association between diabetes incidence and sucrose intake...

The epidemiological link between obesity and diabetes

The link between obesity prevalence and rates of diabetes in different populations was demonstrated by West with an increase in the prevalence of type 2 Figure 1.1 Prevalence of obesity in the UK from 1980 to 1997 from Joint Health Surveys Unit on behalf of the Department of Health 1999. Within populations there is clear evidence of a strongly positive relationship between obesity and the risk of diabetes. Data in the United States from the Health Professionals' Follow-up Study in men (Chan et al., 1994) and the Nurses' Health Study in women (Colditz et al., 1995) graphically illustrates the increasing risk of diabetes that obesity brings (Figure 1.3). Compared with those of a BMI less than 21, women with a BMI greater than 35 had a 93-fold excess risk of developing diabetes. The risk of developing type 2 diabetes rises progressively with increasing adiposity (whether assessed by BMI, or percentage of ideal body weight). Data from NHANES shows that for each kilogram increase in weight...

Maternal obesity and inflammation

Studies of inflammation and insulin resistance in pregnancy were performed in non-obese women.1317 Since obesity precipitates inflammatory responses, excessive free fatty acid release, and subsequent insulin-resistant states in non-pregnant individuals, it is reasonable to assume that inflammatory responses and insulin resistance would be enhanced in obese compared to lean pregnant women. Comparisons of metabolic adjustments in lean and obese pregnant women are limited, but the few studies done show that obese women rely more on fat oxidation as a source of energy in late pregnancy than do lean women.18,19 The increase in fat oxidation among the obese women was significantly correlated with serum leptin concentrations (r 0.76, p < 0.005).19,20 Longitudinal changes in insulin sensitivity were also compared among women with BMIs < 25, between 25 and 30, and > 30.21 Although 50 to 60 decreases in insulin sensitivity were noted in all groups from before conception through late...

The Epidemic of Type Diabetes Mellitus Its Links to Obesity Insulin Resistance and Lipotoxicity

The Epidemic of Type 2 Diabetes Mellitus Metabolic Consequences of Obesity Why Does it Predispose to T2DM Role of Lipotoxicity in the Development of Skeletal Muscle Insulin Resistance FFA and the Liver The epidemic of type 2 diabetes (T2DM) is a public health problem that threatens to spiral out of control in the twenty-first century. Early intervention can greatly mitigate the serious socioeconomic impact of the disease, driven largely by disabling microvascular complications and cardiovascular disease. Obesity is at the core of the epidemic of T2DM, affecting 2 3 of adults and reaching alarming rates in children in modern society. Our understanding of adipose tissue has evolved drastically in the past decade being now viewed as a dynamic endocrine organ responsible for the development or worsening of insulin resistance and lipotoxicity in obese individuals. Lipotoxicity describes the damage that occurs when chronic energy supply exceeds metabolic needs and lipid accumulates in...

Obesity and inflammation

The above data explain why an insulin-resistant state may be pro-inflammatory. They do not, however, explain the origin of insulin resistance. Mutations of the genes involved in insulin signal transduction provide one approach to the study of this issue in humans and in mice with specific gene knockouts. Such lesions are of interest but are too infrequent to provide a basis for the understanding of the pathogenesis of insulin resistance at large in humans. Thus, some recent observations on the interference of insulin signal transduction by inflammatory mechanisms are of great interest because obesity is a pro-inflammatory state (Figure 2.2). Even if we accept that inflammatory mechanisms are involved in the patho-genesis of interference with insulin signal transduction and of insulin resistance itself, how does inflammation arise Over the past decade, obesity has been associated with inflammation. This association was first proposed in a landmark paper by Hotamisligil et al. in which...

Hunt P. 1995 Dietary Counselling Theory Into Practice. J Inst Health Educ 33 4-8

Counselling strategies for dietary management expanded possibilities for effecting behaviour change. J Am Diet Assoc 1986 86 924-928. 9. Glanz K, Eriksen MP. Individual and community models for dietary behaviour change. J Nutr Educ 1993 25 (2) 80-85. 10. Hunt P. Dietary counselling theory into practice. J Inst Health Educ 1995 33 (1) 4-8. 28. Travis T. Patient perceptions of factors that affect adherence to dietary regimens for diabetes mellitus. Diabetes Educ 1997 23 (2) 152-156. 29. Delamater AM, Smith JA, Kurtz SM, White NH. Dietary skills and adherence in children with Type I diabetes mellitus. Diabetes Educ 1997 14 (1) 33-36. 31. Thomas D. Dietary care - negotiation or prescription Diabetes Care 1994 3 (3) 8-9. 39. Health Behaviour Change in Managed Care. A Status Report on Selected Evidence for Behavioural Risk Reduction in Clinical Settings Dietary Practices. Florida Centre for the Advancement of Health, 2000, http www.cfah.org

How Obesity Causes Diabetes Not a Tall Tale

The epidemic of obesity-associated diabetes is a major crisis in modern societies, in which food is plentiful and exercise is optional. The biological basis of this problem has been explored from evolutionary and mechanistic perspectives. Evolutionary theories, focusing on the potential survival advantages of thrifty genes that are now maladaptive, are of great interest but are inherently speculative and difficult to prove. Mechanistic studies have revealed numerous fat-derived molecules and a link to inflammation that, together, are hypothesized to underlie the obesity-diabetes connection and thereby represent prospective targets for therapeutic intervention. Type 2 diabetes stems from the failure of the body to respond normally to insulin, called insulin resistance, coupled with the inability to produce enough insulin to overcome this resistant state. This common form of diabetes is often associated with obesity, and the current epidemics of these two conditions are seemingly...

The approach to dietary prescription

The initial approach to the patient and the initial emphasis on diet and dietary alterations are of extreme importance. This may be the only advice the patient remembers, and first approaches to dietary intervention are liable to provide the best outcomes relative to both improved control and weight loss in the overweight obese diabetic. The restriction of single nutrients such as sugar, is not advised but dietary habits in general should be discussed, as well as the modification and reduction or increase in specific food groups, e.g. reduction in overall fat and increase in complex carbohydrate. Simple guidelines for dietary manipulation, suitable for the primary care health team to provide at the time of diagnosis, are preferable until, and if, fuller advice is given by the community and hospital dietitian. It is well recognized, however, that weight loss and maintenance in the overweight obese diabetic is more difficult than in the non-diabetic, generally speaking about half that...

Pathological causes of obesity

Genetic and endocrine abnormalities are rare causes of obesity in childhood. However, they are important to mention as many parents of obese children are convinced that their child has an underlying 'hormonal' problem and this belief can be a significant barrier to the lifestyle changes that need to be made when tackling childhood obesity. The clinical features of these genetic and endocrine disorders are highlighted in Table 12.2. Children with simple obesity tend to be tall for their age as excess nutrition supplements the growth hormone drive to growth. They are also more likely to develop early puberty. Obese children with short stature, poor growth or delayed puberty should raise concern as they are more likely to have an underlying disorder for which they should be screened. Single gene defects, including leptin deficiency, leptin receptor deficiency, melanocortin-4 receptor deficiency and pro-opiomelanocortin deficiency, have been described in children but are extremely rare...

How to identify obesity genes

The ultimate goal of obesity genetics is to identify a gene defect found exclusively in obese patients producing a functional variant (for example with altered or absent protein function, the so-called 'smoking gun'). The approaches that may be used in the attempt to identify such mutations depend to a large extent on what is known a priori about the function of the normal protein product. If there is knowledge that an abnormal protein product is capable of causing obesity (or counteracting it), evidence for the presence of mutations in the responsible 'candidate gene' may be sought in the population at large and related to measures of adiposity. In general, a gene may be considered a candidate gene for obesity based either on knowledge of its physiological role or because it becomes implicated in one or more forms of experimental or naturally occurring animal or human obesity. effects. Furthermore, the presence of a polymorphism may not necessarily lead to alterations in protein...

Obesity inflammation and insulin resistance

Obesity in non-pregnant adults is associated with subclinical inflammation and insulin resistance.7 The inflammatory and insulin-resistant states arise from changes in cellular and molecular functions and metabolism when adipocytes become enlarged in obese individuals. Perlipin, a phosphoprotein on the surfaces of triglyceride droplets that acts as a gatekeeper preventing lipases from

Dietary Prescription and Monitoring

The goal of dietary management for the type 1 diabetic woman is to maintain nor-moglycemia (54). Moreover, in the type 1 diabetic woman, the food and the insulin must match. The diet shown in Table 5 demonstrates a frequent small-feedings schedule designed to avoid postprandial hyperglycemia and preprandial starvation ketosis, as well as to promote an average weight gain of 12.5 kg in accord with the Committee on Maternal Nutrition (55). In the obese type 1 diabetic woman (> 120 of ideal body weight), fewer calories per kilogram of total pregnant weight are needed to prevent ketosis yet provide sufficient nutrition for the fetus and mother (about 24 kcal kg 24 h). Recently, it has been reported that when overfeeding of the pregnant woman completely suppresses ketone production, there is an increased risk of macrosomia (56).

Dietary prevention of sudden cardiac death SCD the role of dietary fatty acids alcohol and antioxidants

We now examine whether diet (and more precisely, certain dietary factors) may prevent (or help prevent) SCD in patients with established CHD. We focus our analyses on the effects of the different families of fatty acids, antioxidants and alcohol.2 The hypothesis that eating fish may protect against SCD is derived from the results of a secondary prevention trial, the Diet And Reinfarction Trial (DART), which showed a significant reduction in total and cardiovascular mortality (both by about 30 per cent) in patients who had at least two servings of fatty fish per week.3 The authors suggested that the protective effect of fish might be explained by a preventive action on ventricular fibrillation (VF), since no benefit was observed on the incidence of nonfatal acute myocardial infarction (AMI). This hypothesis was consistent with experimental evidence suggesting that n-3 polyunsaturated fatty acids (PUFA), the dominant fatty acids in fish oil and fatty fish, have an important effect on...

Dietary Modifications

Alterations in neuroendocrine-immune balance and movement toward intracellular fermentative metabolism create intracellular acidity and heightened risk for other chronic disease, including cancer. Dietary changes can reduce the progression to these shifts and are imperative in controlling inflammatory signaling and its complex milieu of comorbid symptoms, conditions, and pathologies. The focus of treating a patient with type 2 diabetes, obesity, cancer, or any other condition should be on the impact of multiple nutritional imbalances (both excess and deficiency) in the individual. Various nutrients specific for an individual's biochemistry may help to modulate factors associated with disease. Using dietary changes and nutritional supplements to help bring homeostasis back to the individual's biochemical makeup is of upmost importance. Dietary factors have effects on inflammatory signaling, independent of smoking, hypercholesterolemia, and hypertension. The dietary sources of high...

Obesity and the risk of type diabetes

Several prospective studies have documented that obesity is probably the most powerful predictor of the development type 2 diabetes (Knowler et al., 1981 Colditz et al., 1990 Manson et al., 1992). However, not every obese subject develops diabetes, i.e. obesity alone is not sufficient to cause type 2 diabetes there are other factors that considerably modify the effect of obesity on diabetes risk. For instance, it is likely that genetic susceptibility to diabetes is a necessary prerequisite for diabetes. This was demonstrated in the Pima Indians in whom the incidence increases more steeply with body mass index (BMI) in those whose parents have diabetes than in those who do not (Knowler et al., 1981). Vice versa, in non-obese people the incidence of type 2 diabetes is low in the middle-aged even in populations such as the Pima Indians where the overall risk of the disease is very high. However, a large proportion of the human populations possess genes that permit type 2 diabetes to...

Using the food guide pyramid

The federal government, with the assistance of many experts, has come up with a simple way for you to eat a good, balanced diet the food guide pyramid. This pyramid was recently completely revised so that you can be more specific about food choices and portions depending on your specific needs. For complete information about the new pyramid and how you can use it to your best advantage, be sure to check out www.mypyramid.gov. After you enter some basic information about yourself, using the site's interactive tool, you can get specific portion sizes for each food group. This Web site is full of great nutritional information and tips on how to adapt the pyramid's recommendations to your lifestyle. The food guide pyramid is probably a good tool for a person with type 2 diabetes who doesn't tend to gain weight, but the person with type 1 diabetes or the person who is obese with type 2 diabetes needs to know the specific number of calories and particularly the carbohydrate calories that he...

Genetic basis of obesity in PCOS

Several studies have shown that PCOS is a familial disorder and various features of the syndrome may be differentially inherited (Franks et al., 1997). However, the genetic basis of the syndrome remains controversial. Since then, many studies have revealed that most women with PCOS, both obese and lean, have a degree of insulin resistance and compensatory hyperinsulinaemia, and genes involved in the secretion and action of insulin have been investigated. Molecular studies of the insulin receptor gene in women with PCOS have shown a large number of polymorphisms, which are common in normal subjects and do not lead to any disturbance of receptor function (Talbot et al., 1996). The observation that although insulin resistance is largely reversible by weight reduction in obese women with PCOS, an abnormality of first-phase insulin secretion from i-cells of pancreas still exists, led to investigation of the insulin gene in the pathogenesis of PCOS. Waterworth et al. reported an association...

Losing Weight Rapidly at Kilocalories

If you're a moderately active male, 5 feet, 6 inches tall, you need 1,680 or approximately 1,700 kilocalories daily to maintain your weight. (Refer to Table 3-2.) If you eat only 1,200 kilocalories daily, you'll have a daily deficit of approximately 500 kilocalories. By dividing the kilocalories in a pound of fat (3,500) by 500, you can see that you'll lose 1 pound per week (3,500 divided by 500 is 7, so the loss will take 7 days). You can create your diet using recipes where you know the grams of carbohydrate, such as the ones in this book. Table 3-2 shows you such a diet. The portions on all food labels are based on a 2,000-kilocalorie diet. Not one of the diets in this chapter allows you to eat that many calories. Such a portion may be much too large for a person on a 1,200-kilocalorie diet.

Clinical Efficacy of Metformin HbAlc Lowering But No Weight Gain

In placebo-controlled trials, metformin lowered HbAlc concentrations by about 1.0-2.0 8,9 . The efficacy of metformin monotherapy was equivalent to the monotherapy of sulfonylurea or thiazoliden-diones 10,11 . The greatest advantage of metformin compared with other anti-diabetic agents (insulin, sulfonylureas or thiazolidendiones) has been the fact that it is associated with weight loss but not with weight gain 1,9-14 . This has been shown for drug-nai've patients as well as for patients already receiving other oral anti-diabetic drugs. In the UKPDS, weight gain was modest with met-formin and very similar to the diet group, whereas treatment with insulin and sulfonylureas was associated with a significant weight gain of 4-8 kg over 10 years 14 . The effect of metformin to pioglitazone or gliclazide in monotherapy or combination therapy was recently studied in large randomized head-to-head studies (QUARTET Recently, the data of the ADOPT (A Diabetes Outcome Progression Trial) study...

Longterm Dietary Advice For The Mother And Her Child

As most women with GDM are obese and all have at least one child at increased risk of adolescent obesity and diabetes, providing dietary education and advice that extends beyond the pregnancy is extremely important. Lifestyle changes encompassing diet and exercise have been shown to reduce the risk of GDM in subsequent pregnancies as well as delaying the progression to Type 2 diabetes (59,95,96). Women with a history of GDM are an ideal group to target, not only because of their own heightened risk of future diabetes (97,98) but to ensure a healthy lifestyle within the family unit, hence reducing the risk of obesity and future diabetes in the children also.

Diabetes And Minerals Vitamins And Dietary Supplements

At present, megadoses of dietary antioxidants, such as selenium, P-carotene, vitamin E, and vitamin C, have not demonstrated cardioprotection in diabetic patients in some clinical trials, such as the Heart Outcomes Prevention Evaluation (HOPE) trial, they have actually been shown to be inferior to certain medications, particularly angiotensin-converting enzyme (ACE) inhibitors (16). Medical nutrition therapy should be individualized according to the metabolic profile, desired goals, and clinical outcomes, in accordance with the usual dietary habits of the patient. Family members of individuals with type 2 diabetes should be encouraged to engage in regular physical activity and dietary management to decrease their risk of developing the disease. 2. The Rotterdam Study (20). This study evaluated the relationship between dietary intake of P-carotene, vitamin C, and vitamin E in 4800 people aged 55-95 years with no history of myocardial infarction. This study demonstrated that P-carotene...

Why do Obesity TDM and Nafld Cluster The Liver as the Metabolic Sensor of Lipotoxicity

As with obesity and T2DM, there is also considerable concern that NAFLD and NASH are reaching epidemic proportions (287) . However, the true magnitude of the disease is not appreciated by many clinicians because the majority ( 70 ) of patients affected have normal liver enzymes (279, 288-290). It has been recently estimated that fatty liver disease affects 1 3 of the adult population or 80 million Americans, and as many as 2 3 of obese subjects in the United States (278, 279, 288). In a large population-based study (n 2,287 subjects) performed in Dallas, Texas, in which liver fat was evaluated by means of the gold-standard MRS technique, 34 of the population had a fatty liver, being much more common in Hispanics (45 ) compared to whites (33 ) and African-Americans (22 ) (288). That adult Hispanic are affected more than Caucasians and African-Americans has been confirmed by others even after adjusting for major confounding variables (94, 96, 99, 101, 291-294). Recent studies indicate...

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...

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...

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. The recommendation for salt restriction in the diet concerns all individuals today, since foods contain a much bigger quantity of sodium than humans need. For diabetics this recommendation is even more imperative, since as a whole they constitute a group of people generally considered to be 'salt sensitive', particularly if hypertension coexists (as it frequently does) or, even more crucially, nephropathy. It is recommended that salt intake does not exceed 6 g (i.e., one teaspoon) daily. A frequent question regarding the diet of diabetic individuals concerns the...

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...

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

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...

Excessive Weight Gain

Patients who are overweight often have peripheral in-sensitivity to insulin. They may, therefore, develop symptomatic hyperglycaemia and be diagnosed with diabetes at an earlier stage of their decline in beta-cell function than someone who has normal insulin sensitivity. Insulin may exacerbate weight problems for patients who are morbidly overweight and may also increase or aggravate existing insulin resistance. Very often these patients gain more weight than the expected 4 kg when started on insulin because of poor glycaemic control. This is a reflection that the original cause of the patient's hyperglycaemia may have a significant dietary component and is an indication for further strict dietetic advice, concentrating on avoidance of refined carbohydrates and reduced fat intake. Some patients

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.

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...

The Role Of The Dietitian In Diabetes Care

Ideally, it is the role of the dietitian to provide the dietetic intervention. A vital part of the dietetic consultation is the assessment of readiness to change eating behaviour (19). Exploration of barriers to change and awareness of psychosocial issues form part of the dietary consultation process. In the short term, food intake needs to be regulated and balanced against medication, in order to optimise blood glucose control. This also includes assessment of whether current medication matches the meal pattern and therefore whether it is appropriate, as well as the management and prevention of hypoglycaemia and hyperglycaemia. Long-term dietary control can offer protection against cardiovascular disease with weight management and modification of other lifestyle factors being essential. Dietary counselling should be innovative and specific to the requirements of the individual, rather than being rigid, prescriptive and restricted to a particular system of teaching, as may be the case...

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...

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...

Macronutrient Composition Of The Diet

The main dietary components of the diet for an individual with diabetes should be carbohydrate-containing foods with a low glycaemic index and cis-monounsaturated fat. Although it is important to give people with diabetes advice to modify their dietary intakes so that they shift the balance of their nutritional intake in the direction of the recommendations, the relative proportions of macronutrients may vary depending on the markers of diabetes control for the individual.

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...

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

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...

Dietary Treatment For Type Diabetes Mellitus

An integral component of diabetes management by both the health-care professional and the patient with diabetes is the need to know the principles of dietary management of the condition. Nutrition is complex and a registered dietician is best placed to offer advice on recommended diets, although all team members need to be knowledgeable about nutrition therapy. The dietary recommendations for patients with type 1 diabetes mellitus (DM) do not differ greatly from those recommended for the general population. Dietary advice must be tailored to the given patient and certain population groups require special consideration, for example, particular ethnic minorities or children. The total fat intake should not exceed 30 of total energy intake, and < 10 should come from saturated fats. Dietary cholesterol intake should be less than 300mg day. Intake of trans unsaturated fatty acids should be kept to a minimum. Carbohydrates, predominantly complex carbohydrates, should comprise > 50 of...

Weight Gain in Pregnancy

Very similar mean increases in body weight of around 12 kg have been observed by a number of groups (9, 23, 28). Prentice and Goldberg (5) observed that women from poorer countries have a lower percentage weight gain and have a wide variation in absolute weight gain (0-23 kg in women of moderate nutritional status). Women who gain weight prior to 20 weeks gestation were more likely to retain this weight postpartum than women who gained weight after 20 weeks when fetal growth rate is higher (29).

The Impact of Maternal Obesity on the Energy Cost of Pregnancy

The total energy cost of pregnancy is positively associated with prepregnancy fat mass, body fat, and pregnancy weight gain (6), but maintenance costs are only associated with prepregnancy fatness. This might be explained by the fact that prepregnancy fatness is a marker of overall nutritional status or that prepregnancy fatness may indicate a positive energy balance before conception, and this energy balance might be maintained throughout pregnancy. Either mechanism would explain the wide variability in metabolic response to pregnancy and serve to match energy requirements to energy availability, hence optimizing fetal growth. Leptin has been suggested to be the signal that may link prepregnancy fatness with the maternal metabolic response to pregnancy (5). 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...

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...

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 .

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...

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).

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,...

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,

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...

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...

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 >...

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...

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.

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...

More Products

The 2 Week Diet
www.2weekdiet.com
The 3 Week Diet
www.3weekdiet.com
Quick Weight Loss Action

Quick Weight Loss Action

Why Indulge In Self-Pity When You Can Do Something About Your Weight Now. Say Goodbye to Your Weight Problems That Have Only Make Your Life Nothing But Miserable. Have you often felt short-changed because of your weight or physical appearance?

Get My Free Ebook