Best Weight Loss Programs That Work

The 3 Week Diet

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

The 3 Week Diet Overview

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Obesity as a Chronic Disease

Along with genetics, except for certain medical conditions, most patients' obesity is the result of an unhealthy lifestyle of overeating and lack of physical activity. Fortunately, improved medical management has lowered the prevalence of some cardiac risk factors, especially among obese patients. From 1962 to 2000, hypercholesterolemia was reduced among obese patients 21-percentage-points (39 vs 18 ), and hypertension by an 18-percentage-point reduction (42 vs 24 ) 5 . Yet even with improved medical management of comorbidi-ties associated with obesity, the estimated number of excess deaths in 2000 associated with oesity was 111,909 6 . The DPP showed patients with glucose intolerance could reduce their risk of becoming diabetic by losing weight (7 the first year and keeping at least 5 off) and walking about 150 minutes per week. The results indicate that those with healthy lifestyle choices reduced their relative risk of becoming diabetic by 58 compared to a 31 reduction in those who...

Who Should Give Dietary Advice

What evidence indicates who should give dietary advice to reduce cardiovascular risk A systematic review of randomised controlled trials addresses this issue.9,10 This systematic review aimed to assess how effective dietary advice provided by a dietitian was, compared with such advice provided by other health professionals and In conclusion, the studies included were not of good quality and analyses were based on limited numbers of trials (and participants). However, the evidence suggests that dietary advice from a dietitian is more effective for lowering total serum cholesterol than is advice from a doctor, but may not be more effective than advice provided by trained nurses or self-help materials. More high-quality trials would be useful to help elucidate longer-term results, the effects of contact time (the period over which contact takes place), the effects of training other health professionals, the settings that are most effective, and the effects of offering other lifestyle...

The Obesity Epedemic in America

America is in the midst of an obesity epidemic that is rapidly growing. The prevalence of obesity increased about 50 from 1991 to 1998 11 . The Behavioral Risk Factor Surveillance Survey (BRFSS) for 2000 to 2001 reported the incidence of obesity increased in that one year by 5.6 12 . The National Health and Nutrition Examination Survey (NHANES) of 1999 and 2000 reported a national prevalence of overweight and obese adults of 64.5 , an increase from 55.9 reported in the 1988-1994 NHANES III survey 13 . The military must also deal with the obesity crisis. Not only are new accessions drawn from a culture that is more overweight than previous generations but the current force is also struggling with the same health problem. Dr Richard L. Atkinson, Jr announced at the 2001 American Obesity Association meeting that the proportion of overweight military men increased from 54.1 in 1995 to 58.6 in 1998, and of women from 21.6 to 26.1 14 . Obesity has dramatically increased among the children...

Protective Dietary Changes For Cardiovascular Disease Patients

Since dietary support and advice by health professionals and self-help materials are effective at reducing cardiovascular risk, at least in the short term, what actual changes to diet are effective in protecting people from cardiovascular disease Again considering systematic reviews of randomised controlled trials as the best level of evidence, we are lucky that quite a few have been published in the area of diet and cardiovascular disease. The most important studies show that dietary intervention actually makes a difference to health or mortality. 1.4.1 Dietary Interventions That May Reduce Illness and Death To date, the most effective dietary intervention for people who already have cardiovascular disease is omega-3-rich fish oil. Evidence for this comes from a high-quality systematic review of randomised controlled trials.14 Advice to increase intakes of long chain omega-3 fats for people with some cardiovascular disease (compared with no such advice) appears to reduce the risk of...

Basic Physiology of Obesity

Obesity is the result of excess calories, in the form of triglycerides stored in billions of fat cells or adipocytes. When the calories in versus calories out equation favors excess calories in, then the patient gains weight as fat cells fill up with triglycerides. Excess calories, ingested from carbohydrates, proteins, or fats, are not melted away, eliminated through the kidneys, or passed through the colon. The math is simple. A weight increase of one pound is the result of 3500 extra calories consumed, and the loss of one pound of weight is the expenditure of 3500 calories. Obesity is a chronic disease based on the fact that fat cells shrink or expand but they never go away. When communicating this to patients, I use the analogy that adipocytes are like balloons. Without water in them, they have little weight, Most obese patients have lost and regained weight over the years but never knew this simple fact about adipocytes. Repeated weight loss followed by weight gain is easily...

Long Term Control of Obesity

Studies regarding the ability of patients to first lose weight and then keep it off long-term have been discouraging. A recent study by Heshka et al. highlights this dilemma. A 2-year, multicenter, randomized clinical trial involving 65 men and 358 women compared weight loss between a self-help group and a structured commercial program. At 1 year, weight loss through the structured group was a mean 4.3 kg versus 1.3 kg in the self-help group. However, weight regain occurred in both groups. At the end of 2 years, the structured group had lost 2.9kg and the self-help group 0.2kg 38 . One implication that could be drawn from this study is that if weight regain is inevitable, then why go to the time, expense, and effort to lose it in the first place Such a position has discouraged many physicians from trying to help obese patients, and insurers from providing financial coverage for treatment. Today anyone wanting to be a successful miler studies those who run under-4-minute miles, not...

The Primary Care Setting for Controlling Obesity

Larry Peterson goes around the country encouraging people that they can lose weight and keep it off long-term. His personal story is remarkable. He lost over 265 lb without surgery or using medication. He did it through an intense lifestyle change that he continues to this day. He shares his story with other obese individuals in the hope that they will be inspired to lose weight. Unfortunately, as amazing as Larry's story is, a chronic disease that impacts the majority of Americans, and whose rate increased by over 5 in one year, is not likely to be slowed, stopped, or reversed by one person's success story. The epidemic is simply too great and advancing too rapidly. Last year approximately 103,000 patients underwent gastric surgery of one form or another 42 . However, even with large numbers of bariatric operations for the morbidly obese, the incidence of this disease may slow but will not stop or reverse its upward trend. The problem is that millions of American adults and children...

Molecular Targets For Chemopreventive Action Of Dietary Components

This outline of genetic changes can be used as a structure for illustrating the chemopreventive actions of dietary components in cancer prevention. Ample evidence exists to demonstrate that bioactive compounds can act in each of these areas. Table 2.2 cites several examples of molecular targets and representative nutritional factors that can act at these sites.2728 The overview presented in this chapter is by no means a comprehensive catalog of all bioactive compounds, nor of all of their defined mechanisms of actions. Note that most compounds have a pleiotropic action that is, they can act at a number of sites in the carcinogenesis pathway. In addition, many different compounds can act on a single molecular target. We outline one example of a nutrient, the active form of vitamin D, 1a,25-dihydroxyvitamin D3 , with many different mechanisms of cancer preventive action. The activities of many other compounds are further detailed in later chapters. Note that all of the biochemical and...

Recommended Dietary Allowances

The Recommended Dietary Allowances (RDA) and the Dietary Reference Intakes (DRI), shown in Table 2-2 and Table 2-3, are the amounts of the vitamins and minerals that a healthy person should eat to meet the daily requirements. Your vitamin and mineral needs can be met by eating a variety of foods. However, if you elect to take vitamin and mineral supplements, you are urged to take only the RDA DRI amount for each micronutrient (see Chapter 14, page 80). Taking more than the RDA of a micronutrient could lead to toxicity and create deficiencies of other micronutrients.

Dietary Prevention Of Sudden Cardiac Death

In the absence of a generally accepted definition, SCD is usually defined as death from a cardiac cause occurring within 1 hour from the onset of symptoms.1 The magnitude of the problem is considerable because SCD is a very common, and often the first, manifestation of CHD and accounts for about 50 of cardiovascular mortality in developed countries.1 In most cases, SCD occurs outside a hospital and without prodromal symptoms. We shall now examine whether diet (more precisely, certain dietary factors) may prevent (or help prevent) SCD in patients with established CHD. We will focus our analyses on the effects of the different families of fatty acids, antioxidants, and alcohol.2 Using an elegant in vivo model of SCD in dogs, Billman and colleagues recently demonstrated a striking reduction of VF after intravenous administration of pure n-3 PUFA, including both the long chain fatty acids present in fish oil and alpha-linolenic acid, their parent n-3 PUFA occurring in some vegetable...

Dietary Guidelines for Americans

The US Department of Agriculture (USDA) and the Department of Health and Human Services (DHHS) prepared Dietary Guidelines for all Americans 2 years of age and older. (http www.nal.usda.gov fnic dga). The seven guidelines are 2. Balance the food you eat with physical activity - maintain or improve your weight. Dietary Guidelines for Americans For more specific guidance on food selection, the USDA and the DHHS developed the food guide pyramid in Figure 3-1.

Observing the eating habits of small children provides clues to their developing appreciation of food

Food-minded parents are forever complaining that their children like only starches (pasta, rice, potatoes), the blandest cheeses, and tasteless meats (especially the white meat of chicken). Why do we begin our eating lives liking such dull foods How can children be set straight about food before it's too late It used to be that psychologists and sociologists were likeliest to wonder about the biological motivations that cause parents to despair for their offspring. Today it is the sensory biochemists who have taken the lead in exploring the dietary preferences of children and how these change.

The contribution of reduced thermogenesis and fat oxidation to obesity and its metabolic complications

In rodents, there is compelling evidence that obesity may develop as a result of a deficit in energy expenditure and more specifically in adaptive thermogenesis. A feature of most animal models of obesity, whether genetic-or lesion-induced, is a decreased energy expenditure and an abnormally low BAT thermogenic response to cold or feeding 26 in these models, even when food intake is restricted to that of wild-type or control animals (a maneuver termed pair feeding) marked obesity still develops. The contribution of reduced energy expenditure to human obesity is less clear. The concept was supported by early epidemiological studies showing that obese subjects maintained their obese state with self-reported energy intakes that were on average less than those of lean subjects, but has been challenged by more recent studies - using the doubly labeled water method, which allows capturing of total energy expenditure for long periods of time with the individual under free-living conditions -...

Obesity see chapter

Obesity is a risk factor for the development of Type 2 diabetes. Weight gain (particularly centrally distributed) is associated with metabolic processes that increase the risk of cardiovascular disease. These metabolic disturbances include an atherogenic lipid profile, hyperinsulinaemia, hypertension and thrombogenesis. Diabetes UK estimate 75-90 of people with diabetes have Type 2 diabetes, of these 80 are overweight or obese. The risks of hypertension, dyslipidaemia, atherogenesis and premature death from cardiovascular disease are all increased with increasing obesity in Type 2 DM. This is illustrated by the ten-fold increased risk of premature death when Type 2 DM is associated with a BMI above 36 kg m2. By contrast, intentional weight loss of between 8-13 kg can reduce mortality by 33 in obese diabetic subjects. For overweight Type 2 diabetic patients, the most important dietary objective is to achieve and maintain a desirable weight and BMI. However, the weight loss required to...

Dietary protein and amino acids

High-protein diets for weight management have being revisited in recent years (reviewed in references 46 and 129). Proteins are more thermogenic (see Section 4.2.3) and satiating (see Chapter 2) than fats and carbohydrates. There is convincing evidence from human intervention studies that a higher protein intake (25 or more of the total energy as protein) increases ther-mogenesis and satiety, and reduces subsequent energy intake in the short-term compared with diets having the usually recommended protein content (15 or less of total energy as protein).46 1 29 There is also evidence that higher-protein diets can result in an increased weight loss and fat loss as compared with diets lower in protein, probably due to reduced perceived hunger and energy intake.46'129'130 Higher fat loss with high-protein diets is evident, however, even under isocaloric conditions, where total weight loss is not affected, pointing to a metabolic effect of protein favoring energy repartitioning towards lean...

Using ergogenic aids for weight control

A comprehensive definition of the use of nutritional ergogenic aids is 'dietary manipulation to improve physical and sports performance'. Nutritional ergogenic aids are a growing market and are increasing in popularity and variety. There are a large number of products marketed as nutrititional ergogenic aids that also claim to assist in weight management, by virtue of a purported capability to affect some aspects of energy metabolism or, more often, body composition, increasing lean body (muscle) mass and or reducing fat mass. These include protein and amino acid supplements, and combinations of ephedrine and caffeine, already presented in the preceding section. Caffeine has been proven to have ergogenic effects in a number of human studies, although the mechanism(s) behind these effects are largely unknown the popular view is that caffeine, by virtue of its capability to inhibit cAMP phosphodiesterases, increases fat supply to the muscle, which in turn can increase fat oxidation,...

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...

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...

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.

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...

Obesity And Type 1 Diabetes

The strong association between obesity and Type 2 diabetes has generally overshadowed obesity in relation to Type 1 diabetes. Obesity is relevant, however, as increases in body fat stores generally dictate an increase in insulin requirements, mainly as a result of a further decline in insulin sensitivity. Conversely, excessive dosages of insulin can lead to weight gain, presumably through the lipogenic effects of hyperinsulinaeima and possibly compounded by overeating during the hypoglycaemic episodes, which become more frequent as insulin therapy is intensified. Weight gain, following intensive treatment of those with Type 1 diabetes, has been shown to induce unfavourable changes in lipid levels and blood pressure, similar to those observed in the insulin resistance syndrome (12). However, if intensive therapy results in improvements in glycaemic control, this can reduce the impact of weight gain on such cardiovascular risk factors (13). Of concern also is that obesity, or the fear...

The Association Between Obesity And Type 2 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)...

Physical Activity for Obese Patients

For people with a normal BMI, the spectrum of PA or scheduled exercise options is almost unlimited and is largely dependent upon interest, skill, time, and financial resources. For the obese patient, another factor that influences participation in PA is the patient's weight and ability to move without injury. It is not uncommon for patients to lose weight through dietary means before increasing their LTPA. When obese patients begin to consider PA as an important component of their obesity treatment program, walking can be a fundamental component of that program for both scientific and practical reasons. How does walking impact the ability to lose weight or maintain weight loss Is it a dose-response relationship In a 12-week study by Jakicic et al., 184 sedentary women were divided into four groups of various physical intensity and duration levels. During follow-up at 12 months, women who reported walking < 150 minutes week maintained a mean weight loss of 4.7 , whereas those who...

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...

Recommended Dietary Allowances for Protein

In 1989, the Food and Nutrition Board subcommittee of the U.S. National Research Council updated their recommended dietary allowances (RDAs) for protein and amino acids (157). The RDAs are largely based upon the 1985 FAO WHO UNU committee report (156). The RDA values for protein shown in T. ble 2 13 were based largely upon N balance data (rather than factorial method data) from studies using a high-quality, highly digestible source of protein. The protein intake values that produced zero N balance were then increased by two standard deviations to encompass 97.5 of the population to get the RDA for the reference protein. For example, from studies of young adult men, the value of 0.6 g kg day was increased to 0.75 g kg day.

Risk Factors For Obesity

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

Current Dietary Guidelines

A number of national or professional health organizations have recommended guidelines for healthy diets, either for general health or focused on specific aims such as controlling obesity or diabetes, or preventing heart disease. Most current guidelines emphasize limitation of caloric consumption from fats. For example, the Chinese Ministry of Health guidelines for prevention and control of overweight and obesity in adults included moderate caloric restriction plus physical activity with an emphasis on diets with low fat content, complex carbohydrates (including cereals), and fresh fruits and vegetables 2 . In the setting of dyslipidemia, they also recommend limitation of saturated fat and cholesterol. The American Diabetes Association published a technical review of dietary guidelines for people with or at high risk of developing diabetes 3 . Recommendations for people with either type-1 or type-2 diabetes were to include carbohydrates from whole grains, fruit, vegetables, and low-fat...

Dietary Effects on Mortality

Despite the abundance of dietary guidelines, it is hard to find evidence that dietary composition has major effects on longevity. In the Malmo Diet and Cancer Study, all-cause mortality rates were not significantly related to the fat content of the diet in either men or women 7 . The rate of death attributable to cardiovascular disease, however, was significantly inversely related to dietary fat intake in men, but not in women. The EPIC study evaluated dietary intake as a predictor of mortality among over 70,000 people at least 60 years of age in 10 European countries 8 . Instead of evaluating simple dietary composition (i.e. percent of calories from fat, carbohydrate, protein, and alcohol), they constructed a 'Mediterranean diet score' reflecting the dietary composition previously shown in Greece to be associated with longevity. The score was derived from points for answering dietary questions on consumption of various types of foods. Higher scores, indicating dietary composition...

Assessing Motivation To Lose Weight

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

Childhood and Adolescent Obesity

This chapter addresses the science of childhood and adolescent obesity and the approach to treatment. Although the principles and tools discussed in other chapters are applied to this population, that does not mean that children and adolescents are little adults and do not have unique needs. It does mean that people of all ages physiologically respond in the same way to excess caloric intake. People of all ages also experience the same comorbidities of obesity. The incidence of chronic conditions like hypertension and diabetes has dramatically increased among obese children and adolescents when present these conditions need to be aggressively treated with the same seriousness in young people as in adults. The long-term health impact for the young obese patient with early onset of these diseases is not known. The potential morbidity and mortality from either hypertension or diabetes after 20 to 30 years may begin to occur during young adulthood. With an early age of onset for these...

The Definition of Overweight and Obesity

For some parents and young patients, using two definitions of overweight to describe someone who is either overweight or obese may be confusing. Consistent with the terminology used for adults, the American Obesity Association (AOA) uses the 85th to the 95th percentile to define overweight and the 95th percentile and greater for obese 3 . In order not to confuse parents and young patients with at risk for overweight when the patient is obviously overweight and overweight when the patient is obviously obese, the AOA terminology for overweight and obesity will be used to describe young patients who are in the 85th and 95th percentile by age and gender.

The Prevalence of Childhood and Adolescent Obesity

The worldwide prevalence of overweight and obesity among children is not evenly distributed. The overall global prevalence of both is 10 , while in Europe it is 20 , and in the Americas 30 4 . Even in Europe the distribution is not homogeneous but ranges from 10 to 20 for Eastern Bloc nations to 20 to 40 for non-Eastern Bloc Mediterranean nations 5 . In countries where the In the United States, the prevalence of overweight and obese children and adolescents since 1980 has increased at an alarming rate. In the last 20 years, the prevalence of obese children aged 6 to 11 years more than doubled from 7 to 15.3 and for ages 12 to 19 tripled from 5 to 15.5 (Figure 5.1) 7 . The National Health and Nutrition Examination Survey (NHANES) for 1999 to 2002 reports that 31 of children 6 to 19 years old are either overweight or obese, and 16 are obese, with significant differences among races. The obesity rate for non-Hispanic whites is 13.6 , for non-Hispanic blacks is 20.5 , and for Mexican...

Causes of Overweight and Obesity

The cause of childhood and adolescent obesity is multifactorial and includes genetic, parental, and environmental factors. Concordance rates of BMI were 0.74 for monozygotic twins, 0.32 for dizygotic twins, and 0.24 for siblings, which explains up to 80 of the BMI variance among siblings 12 . This means that if siblings are exposed to an excess amount of calories, they tend to process those calories in a similar way. However, it is not likely there has been in the past 20 years a genetic shift or drift within the population to explain the dramatic increase in obesity during this time. The exact amount of influence genetics plays in the obesity epidemic for children and adolescents is not known, though it may well play a role in the individual's susceptibility to become obese if exposed to an excess amount of calories. The primary care physician must consider genetic syndromes and endocrine conditions as possible explanations for a child's obesity. Prader-Willi syndrome is...

Maintain A Healthy Weight

Achieving a healthy weight means eating Your current weight is the result of lifelong eating habits, heredity, and level of physical activity. Changing your weight is a matter of energy balance. Food energy is measured in calories. Carbohydrates, protein, fat, and alcohol are the sources of energy in foods. Fat is the most concentrated source of calories. If you are eating more calories than your body needs, regardless of the source, you will gain weight. If you are not getting enough calories, you will lose weight. If you are not as active as you once were, you may need fewer calories to maintain your weight. It may be important to choose more carefully. If your dexterity and ability to prepare food have decreased, you may be eating less and losing weight. If you have a poor appetite or are too fatigued, you may be eating less and losing weight. A healthy weight is important for maximizing your ability to ambulate, as well as helping to control blood pressure, blood cholesterol, and...

BGlucans and weight control

Various epidemiological studies have shown an inverse correlation between fibre intake and body weight, BMI and body fat.75 In the CARDIA study, a population-based cohort study of the change in cardiovascular risk factors over 10 years, it was shown that dietary fibre was inversely associated with fasting insulin levels (mean difference across quintiles -5.6 pmol l, p 0.007 in whites -9.7 pmol l in blacks, p 0.01), weight gain (mean difference across quintiles in both populations -3.65 kg, p > 0.001) and other risk factors for cardiovascular diseases in young adults.76 White men and women consuming diets supposed to be the lowest in GI (high fibre, high fat) had the least weight gain over 10 years compared with those consuming supposedly high-GI diets (low fibre, low fat). Another epidemiological study carried out on a cohort of 27 802 men demonstrated a reduced risk of weight gain (8 years of observation) associated with increased whole-grain or bran intake.77 Dietary fibre was...

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...

Pharmacological treatment of obesity

The pharmacological treatment of obesity has been a source of both great hope and controversy. In 1992, interest in pharmacotherapy increased with the report from Weintraub et al.(34) that low doses of fenfluramine (30 mg day) combined with phentermine (15 mg day), produced substantial weight losses that were maintained for as long as 3 years. This interest was dashed by the report in 1997 that fenfluramine and dexfenfluramine, when taken in combination with phentermine, were associated with cardiac valvular damage. They were promptly withdrawn from the market.(35) Intensive pharmaceutical research now under way will probably produce safe and effective medication for weight control within the next few years. Already two new medications, sibutramine(36) and orlistat,(37) have been approved for long-term use in several countries. Weight-loss medications are usually reserved for patients with a body mass index over 30 kg m 2 who have failed to reduce with conservative approaches. They...

Health Impact of Obesity

Obesity has a negative impact on a child's nervous system, vascular system, and metabolic condition. In one study obese children appeared to have a depressed sympathetic nervous system (SNS), which lowers the rate of thermo-genesis, thus setting the stage for a positive energy balance and increase in weight 31 . Thermogenesis is involved in 70 of the body's caloric expenditure. The actual amount of weight gain attributed to a lowered SNS is not known, but this finding suggests a possible vicious circle where increasing weight negatively impacts the nervous system and a depressed nervous system in turn results in an increase in weight. A major metabolic impact of obesity is the development of insulin resistance that predisposes the child or adolescent to develop the metabolic syndrome. The components of the syndrome are glucose intolerance, a low HDL, elevated triglycerides, increased abdominal circumference, and elevated blood pressure. By definition, a patient with at least three of...

Obesity And Insulin Resistance

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

Dietary fibres and food intake

Knowledge of the biochemical mechanism allowing DF to modulate satiety, glucose or lipid metabolism, and hypertension is essential when proposing key nutritional advice for specific disorders associated with the metabolic syndrome. In this context, the modulation of gastro-intestinal peptides by NDOs, such as fructans, is an interesting area of research, leading to an understanding of how events occurring in the gut participate in the control of food intake, obesity and associated disorders. We propose, before entering into discussion about the relevance of NDOs in the modulation of food intake, to describe current knowledge related to the nutritional properties of NDOs.

Evidence Of Cardioprotection By Mediterranean Diets

For years, serum cholesterol has been accepted as a major risk factor for coronary artery disease (CAD).1 This view led to the hypothesis that reduction of plasma cholesterol by dietary means might reduce cardiovascular risk. It must be noted, however, that among all the many dietary trials conducted, only those reproducing Mediterranean or Asian-vegetarian types of diets have shown significant reduction of CAD morbidity and mortality.2 The phenomenon occurred independent of dietary effects on plasma cholesterol.3-5 The basic observation that spurred interest in the Mediterranean dietary style, at least until the early 1960s, was that adults living in certain regions around the Mediterranean Sea had rates of chronic diseases among the lowest in the world and life expectancies among the highest. Such favorable statistics could not be

Treating Overweight Pre Adolescents

The goal for treating the overweight pre-adolescent is weight maintenance over time, not weight loss. The pediatric BMI chart guides the physician as to a healthy weight and height for a particular age. Plotting the child's BMI on the pediatric BMI chart identifies how serious the child's excess weight condition is compared to peers and provides guidance regarding a healthy weight for the future. An elevated BMI above the 85th percentile should encourage the parents, at the physician's suggestion, to implement health behavior changes within the family to improve everyone's dietary and physical activity choices. The physician can provide handouts and website information to educate parents (Table 5.1). The websites are interactive for both the child and the parents, which makes improving health fun for everyone in the family. The pediatric BMI chart provides guidance and encouragement. The physician monitors the child's progress on a periodic basis when the child is seen in the clinic...

Antioxidant Potential Of Mediterranean Diets

Interest in the antioxidant contents of Mediterranean diets has increased with the recognition that oxidative damage is an important factor in the pathogenesis of chronic and degenerative diseases.18 Fruits and vegetables are rich in natural antioxidant nutrients such as vitamin C, vitamin E, beta-carotene, lycopene (in tomatoes), organic sulfides (in garlic and onions), glucosinolates, dithiothiones, ubiquinone, and polyphenols such as quercitin, anthocyanines, procyanidines, and tannins. Their consumption has been shown to be associated with low risk for CHD.19 Few prospective studies have specifically examined the role of dietary antioxi-dants on CHD risk. In a Finnish study examining the association of fiber, vegetable and fruit intake, and CHD mortality, a strong inverse association was found between vegetable and fruit intake and CHD risk in both men and women, and vitamins A and E appeared particularly protective.20 These results are consistent with other prospective studies...

Relevance of resistant starch to weight management

RS appears to play two roles with respect to weight management. Firstly there is a reduction in the digestible energy available from the RS compared with a readily digestible starch. The presence of RS in foods reduces their caloric density. Recently, research has demonstrated a second role for RS in energy metabolism and metabolic control. The lower glucose and insulin impact of RS causes changes in lipid metabolism that favor lower levels of lipid production and storage. In addition, RS is fermented within the large bowel by the indigenous colonic bacteria producing an important range of compounds called short-chain fatty acids (SCFAs). The amount and type of SCFA produced are proposed to affect carbohydrate and lipid metabolism in the body, particularly in the liver, muscle and adipose tissue. The known effects of RS in relation to weight management are listed in Table 8.1. Each of these aspects will be discussed later in this chapter.

Treating Overweight Adolescents

There is a fundamental difference between treating overweight or obese adolescents and treating pre-adolescents. In most situations, the teenager decides what particular food will be eaten and how much of it will be consumed. Parents are not the primary decision-makers in terms of what food and how much food a teenager eats. Parents may influence the teenager as role models and by the kinds of foods purchased for the house, but that is where their influence ends. Parents cannot plead, cajole, or threaten their teenager to eat certain foods. The adolescent's personal preferences, peers, school and work schedule, and extracurricular activities strongly influence the teenager's dietary habits. However, both parents and the physician can provide information on healthful eating and physical activity if the teenager asks otherwise, they must stand by and let the adolescent make his or her own choices, whether good or bad. Treating overweight adolescents is difficult. The physician can show...

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...

Altitude effects on obesity

Owing to the high concentration of nitrogen in adipose tissue, which can be released into the bloodstream in large quantities, leading to hypoxemia, the bariatric patient must be transported with great care. In addition, large concentrations of lipids can be released, leading to fat embolism. Severe dyspnea, chest pain, and petechias in the shoulders, neck, and axilla, pallor, and tachycardia in the obese patient should raise concern. Many of these effects can be minimized by utilizing 100 per cent oxygen 15 min prior to transport, which will help decrease the nitrogen levels in these patients.

Metabolic disorders Obesity

More than one-third of Americans have a body weight of 20 per cent or more than their desirable weight. Approximately 50 per cent of women and 25 per cent of men are 'dieting' at any one time, generally with little prolonged benefit. Using standard treatments in university settings, only 20 per cent of obese patients lose around 9 kg (about 20 pounds) at 2-year follow-up and only 5 per cent of patients lose about 18 kg (40 pounds). (53) The majority of people who lose weight on a diet gain it all back. There is considerable mortality associated with obesity. This is predominantly due to coronary artery disease and associated risk factors, such as diabetes, hypertension, and hypercholesterolaemia. Numerous lines of evidence suggest strong genetic influences on the aetiology of obesity, (53) accounting for about two-thirds of the variations in weights among studied populations. However, environmental factors are also important. These include low physical activity levels and poor food...

Types Of Dietary Fat And Their Sources

Fatty acids are long, straight-chain molecules of 4 to 24 carbon atoms that can be categorized as saturated, monounsaturated, or polyunsaturated. The differences between these are based on the chemistry of the molecule. Saturated fats contain only single bonds between all carbon atoms single bonds leave the maximum number of bonding sites open, which are then filled by hydrogen atoms. As a result, these compounds are said to be fully saturated with hydrogen. In contrast, mono-unsaturated fatty acids contain one double bond, and polyunsaturated fatty acids contain more than one double bond. The primary dietary source of saturated fats is animal fats, the primary source of monounsaturated fats is olive oil, and that of polyunsaturated fats is vegetable oils like corn oil.

Increased Calorie Intake

Calorie intake by itself may stimulate cancer progression, and dietary fat is a major source of calories. In a study of 149 women treated for breast cancer, higher levels of total fat intake were associated with increased risks of recurrence and death. A large part of this risk increase appeared to be due to increased calorie intake.59 In rats, a 30 percent reduction of calorie intake reduced growth of transplanted human prostate cancer cells, vascular endothelial growth factor (VEGF) production, and tumor angiogenesis.60 Interestingly, exercise, which burns calories, reduced the growth of transplanted human breast cancer cells in mice fed a high-fat diet.61

Dietary Fats and APCDriven Intestinal Tumorigenesis

11.5 Dietary Polyunsaturated Fatty Acids and Tumorigenesis 239 Epidemiological evidence clearly links dietary fat intake with colorectal cancer risk.1,2 As fat intake increases, the risk for colorectal cancer increases however, the risk associated with individual fatty acids is less defined. This chapter is particularly interested in addressing what is known about the impact of dietary fatty acid composition on intestinal

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

Dietary Components Implicated in Carcinogenesis

Procarcinogenic factors in the diet include sedentary lifestyle, excess energy intake and specific dietary substances. Energy intake is positively correlated with cancer risk and mortality 9 . Interestingly, elevated BMI, an indicator of obesity and therefore a surrogate for excess energy intake, does not seem to influence cancer risk, whereas actual energy expenditure and energy intake significantly influence risk 10 . Epidemiologic studies indicate that cancers of the gastrointestinal tract are amongst the most susceptible to modification by dietary factors 11 . The mechanisms of dietary carcinogenesis fall into several categories direct DNA damage (e.g., nitrites), cytochrome activation or inhibition (e.g., alcohol), carcinogen activation (e.g., pickled salted foods), direct cytotoxicity (e.g., mycotoxins), oxidative damage (e.g., saturated fats), alterations in physiology (e.g., rice, dietary fiber) and hormonal effects (e.g., phytoestrogens).

Dietary Salt Intake and Arteriolar Function

Many individuals exhibit salt-sensitive forms of hypertension, in which elevated dietary salt intake leads to an increase in arterial blood pressure. This elevation of blood pressure is accompanied by an increase in peripheral vascular resistance. A particularly valuable genetic animal model of salt-sensitive hypertension is the Dahl salt-sensitive (Dahl S) rat, an inbred strain of rats in which elevation of dietary salt intake leads to an elevated vascular resistance and a substantial degree of hypertension. In Dahl S rats, the development of hypertension in response to elevated dietary salt intake is accompanied by a uniform increase in hemo-dynamic resistance throughout most of the peripheral vas-culature. In the spinotrapezius muscle, this increase in resistance is largely due to an intense constriction of proximal arterioles. The mechanisms responsible for this increased arteriolar tone include increased responsiveness to oxygen and a loss of tonic nitric oxide (NO) availability...

Dietary Polyunsaturated Fatty Acids and Tumorigenesis

Western style diets characterized by high intakes of energy, fat, meat, refined grains, and sugar combined with low intakes of fiber, calcium, and fruits and vegetables have been strongly linked to an increased risk of colorectal can-cer.261 62 Similar correlations have been observed in animal models with Apc gene defects. Increasing beef and fat content positively affects intestinal tumor load and some dietary fibers appear to be protective.63-66 The feeding of a Western style diet has been shown to increase intestinal tumorigenesis in the Apc1638 mouse model67 and enhance hyperproliferation of epithelial cells (in various tissues) in null mice (wild type for Apc).68 69 Among the components of the diet, the amount and type of dietary fat consumed is of particular importance.170-72 Certainly, a number of PUFAs have proved to be very promising as antitumorigenic lipids in both chemically induced tumor models and models containing germline mutations.73-77 In an effort to systematically...

Obesity and Type 2 Diabetes

During the last 20 years, obesity has reached epidemic proportions in the United States and worldwide. Recent data from the National Center for Health Statistics indicate that 30 of U.S. adults 20 years of age and older (over 60 million people) are obese (Ogden, Carroll, Curtin, McDowell, Tabak, and Flegal 2006). Visceral obesity and three other pathologic conditions (dyslipidemia, hypertension, and insulin resistance) comprise the so-called metabolic syndrome, also known as Syndrome X. Syndrome X is a major risk factor for type 2 diabetes (T2D also called non-insulin-dependent diabetes mellitus, or NIDDM) (Haffner, Ruilope, Dahlof, Abadie, Kupfer, and Zannad 2006). A common feature of obesity, insulin resistance, and T2D is chronic, low-grade inflammation (Dandona, Aljada, and Bandyopadhyay 2004 Dandona, Aljada, Chaudhuri, Mohanty, and Garg 2005 Weisberg et al. 2006 Weisberg, McCann, Desai, Rosenbaum, Leibel, and Ferrante 2003 Wellen and Hotamisligil 2005). Markers of chronic...

Obesity and Type2 Diabetes

Epidemiological studies show that increasing body weight is associated with an increasing risk for type-2 diabetes (T2D) 1 . More than 90 of individuals with T2D are obese. Conversely the prevalence of T2D is 46 among individuals with a BMI of 30 (kg m2) and higher. Obesity is a contributing factor in the development of T2D in an estimated 60-90 of patients with this condition 2 . The data indicate that the current epidemic obesity may be the major causative factor in the worldwide increase of the prevalence of diabetes.

Dietary Manipulation of Glycogen Stores Carbohydrate Loading

Dietary manipulation can be used to increase the stores of glycogen in muscle and liver. Glycogen increases when more carbohydrate is eaten. The practice is called carbohydrate loading. The athlete has 3 days of exhausting physical exercise on a low-carbohydrate diet followed by 3 days of rest on a high-carbohydrate diet. In general, athletes dislike both phases in the first, they feel exhausted both mentally and physically, and in the second, they feel bloated because the glycogen retains extra water. However, other feeding programs exist that do not use the carbohydrate depletion phase. For athletes in general, it makes sense to eat plenty of carbohydrate to maximize glycogen storage, as the usual training periods of several hours per day deplete it. There is little doubt that a high-carbohydrate diet improves glycogen storage and athletic performance (see also Chapter.47). What to advise athletes to ingest just before an event is difficult. Solid food is not advisable before...

Dietary Interventions

There are no controlled trials that suggest that any specific diet interventions assist curing cancer 5 . Many diets such as the macrobiotic diet, Gerson therapy and the Gonzalez protocol claim to cure cancer there is no evidence that substantiates these dubious claims. Dietary interventions that may be of help should be directed at maintaining appropriate calorie and protein intake to prevent malnutrition in cancer patients 61 . Nutrition status can affect a cancer patient's surgical outcomes, QOL, complication rates and tolerance of therapy 5 .

Older age and obesity

High BMI adversely influences successful mapping of SLNs. Patient age did not alter SLN localisation in the ALMANAC trial (11), though it has been reported in several other studies which have shown that accurate identification of the SLN decreases with increasing age as well as weight (31, 68, 69). The specific causes for mapping failure in overweight patients are unclear. Sentinel node identification may be difficult in obese women because of the higher content of subcutaneous and axillary adipose tissue. Furthermore, the increased fatty tissue may impede the flow of the tracer through the lymphatics in the breasts of these patients. Additionally, the lymph nodes in obese patients may have undergone fatty degeneration reducing their capacity to concentrate the tracer.

Introduction role of dietary and supplementary calcium in weight control

The recommended daily intake of calcium (1000 mg day for most adults, 1200 mg day for pregnant women) has been set to meet the requirements of bone-health and the prevention of osteoporosis. Beyond this, calcium plays an essential role in numerous other vital functions regulation of cell membrane fluidity and permeability, nerve conduction, muscle contraction and blood clotting. Calcium has anti-hypertensive properties and the consumption of calcium in sufficient amounts may reduce the risk of colon cancer. Various studies over the last few years have shown that increased calcium intake can significantly fight overweight and obesity. In the following sections the question will be addressed as to whether a role for calcium in weight control is substantiated by facts gained from epidemiological studies and the results of in vitro, animal and human intervention studies, showing either a positive role for calcium in lipid metabolism and weight control, or no effect at all. In order to...

Determining the role of calcium in weight control

Recently, an anti-obesity effect of dietary calcium has been postulated (for reviews see Teegarden (2003), Zemel (2002) and Zemel and Miller (2004a)). Although first observations in rats and men showing an inverse relation between calcium intake, adipocyte intracellular calcium and obesity had already been published at the end of the 1980s (Draznin et al., 1988), this idea has never been more popular in the scientific community since the publication of the papers of Zemel and colleagues (Xue et al., 1998, 2001, Zemel et al. 1995, 2000). These publications were based to a major extent on investigations on obese and insulin-resistant mutant mice ('agouti mouse') and led to an intensive re-examination and extended interpretation of data from several epidemiological studies. 11.2.1 Epidemiological and intervention studies showing a role for calcium in weight management Data from the US NHANES III (Third National Health and Nutrition Examination Survey), the CSFII study (Continuing Survey...

Dietary versus supplementary calcium and weight control

On the other hand, these studies also show that calcium has an anti-obesity effect of its own that is independent from other components of the diet. However, based on the results of the available positive studies and without exact knowledge of the mechanism, it is not possible to answer the question as to what extent this calcium effect is independent from the level of the 'normal' dietary calcium intake. According to our current understanding it could make sense to increase calcium intake above that of the recommended intake by using calcium-fortified food and or calcium supplements in order to optimise intake for an anti-obesity effect. Independent of the answer to these questions, some quantitative information can be given to the extent of the anti-obesity effects of calcium. A quantitative re-analysis of the data from Davies and Heaney (Davies et al., 2000), using simple bivariate and multiple regression models, revealed The actual importance of these effects becomes evident...

Efficacy of Risk Reduction Overweight and Obesity

There is no end in sight for the epidemic of overweight and obesity in the United States. In 2001, a national survey observed more than 67 of adult men and 50 of adult women to be overweight body mass index (BMI) greater than 25), and of those an equal number of men and women (21 ) were classified as obese (BMI greater than 30).34 Although overweight and obesity are associated with breast cancer incidence, few studies have examined the effect of weight loss on the incidence of cancer, which precludes any firm conclu-sions.35,36 Although firm conclusions are not possible, some evidence can be found in the Nurses' Health Study, in which women who gained more than 20 pounds from age 18 to midlife doubled their risk for breast cancer, compared to women who maintained a stable weight.37

Effectiveness of Physician Counseling Overweight and Obesity

There is inconclusive evidence about the effects of physician counseling to help patients lose weight.65,81-85 In one such study, physicians counseled patients and incorporated meal replacements and nurse visits, which led to losses of approximately 4 of body weight, equal to the effects of two nutritionist-led intervention conditions.81 There have been few studies, however, and many studies that showed an effect on weight loss were actually designed to improve dietary patterns, such as decreasing saturated fat intake.64,65,86 A significant barrier to physician counseling for overweight and obesity is the apparent complexity of counting calories, which is the basis of all weight loss recommendations.87 Training programs have been developed and user-friendly reminder cards have been developed, but many barriers remain and conclusions based on the available evidence are difficult to make.87,88

Overview of Defects in Thermogenesis in Rodent Models of Obesity

From the earliest studies of the obese mouse (now called leptin-deficient C57BL 6J Lepofe), there was evidence that these mice were not only obese, hyperglycemic, and hyperinsulinemic, but that they exhibited extreme sensitivity to the cold.10 Histologically, brown adipose tissue in these obese animals appears inactive in that it is infiltrated by white adipocytes and does not possess the rich density of mitochondria expressing UCP1 as normally seen in lean animals. The blunted capacity for adrenergic stimulation of lipolysis in adipose tissue of these animals (described below) probably also hinders the activation of UCP1 function by free fatty acids. Other monogenic obesity models and hypothalamic lesioning studies in rodents indicated a complex set of neural and endocrine abnormalities, culminating in the loss of homeo-static mechanisms controlling both food intake and metabolic efficiency.11 The suggestive role for brown fat and thermogenesis in body weight regulation was...

Creating a Caloric Deficit

A reasonable weight loss goal for patients with a BMI between 27 and 35 is 1 2 to 1 lb per week, which requires a caloric deficit of 300 to 500 calories per day. For patients with a BMI > 35, a deficit of 500 to 1000 calories per day is needed, which will result in a 1 to 2 lb weight loss per week 4 . One way a patient can create such a deficit is to stop eating particular foods that contain a definite amount of calories. The patient's food diary is an excellent tool to identify foods or drinks routinely consumed. The food diary will show that some patients eat donuts every morning while driving to work. Other patients eat a candy bar every afternoon, and some cannot watch TV each evening without eating ice cream or popcorn. The patient's decision to remove a particular food that is high in calories is a sound way to create a caloric deficit and can result in weight loss. The other approach to create a caloric deficit recommended by the NHLBI is to limit total daily caloric intake....

Determining the role of omega3 fatty acids and other polyunsaturated fatty acids in weight control

The positive effects of omega-3 PUFAs were observed early on among Greenland Inuits, who, despite high fat intake, displayed low mortality from coronary heart disease (Dyerberg et al., 1975). Other epidemiological studies have reported lower prevalence of obesity, type 2 diabetes and cardiovascular diseases in populations consuming large amounts of omega-3 PUFAs from fatty fish (Mouratoff et al., 1969 Kromann and Green, 1980). Subsequent studies have demonstrated that dietary supplementation of omega-3 PUFAs exerts positive effects in several metabolic diseases including coronary heart disease, hypertension, arteriosclerosis, diabetes and inflammatory diseases (Terry et al., 2003 Din et al., 2004 Calder, 2004 Ruxton et al., 2004). 13.2.2 Dietary sources The different forms of the PUFAs are found in different food sources (Table 13.1). Plant seed oils like corn oil, sunflower oil and safflower oil are rich in omega-6 PUFAs, constituting up to 75 of the fatty acid content. Most plant...

Physical Activity in Obesity Treatment

While it is possible to lose weight with physical activity alone, the amount of physical activity required for substantial weight loss is well beyond what is feasible for most Americans. Wing 17 reviewed several studies in which physical activity alone was used for weight loss. While the amount of weight loss with physical activity was significantly greater than 0, it was in the order of only a few pounds. In many studies, high levels of physical activity have been found to predict success in long-term weight loss maintenance 19-22 . For example, subjects in the National Weight Control Registry who are maintaining an average weight loss of about 30 kg for about 5.5 years, report expending about 2,800kcal week ( 60-90 min day) in physical activity 19 . Less than 10 of the successful weight loss maintainers report that they are maintaining their weight loss with diet alone. Decreases in physical activity in this group predict weight regain over time. Others 20-22 have found that amounts...

Dietary Considerations

Fat intake of the average North American diet represents 38 of total calories consumed (8, 9). Over 95 of the total fat intake is composed of TG the remainder is in the form of PL, free Fa, CH, and plant sterols. Total dietary TG in the North American diet is about 100 to 150 g per day. In addition to dietary intake, lipids enter the gastrointestinal tract by release from mucosal cells, biliary expulsion into the lumen, and bacterial action. In almost no other instance can food choice influence nutrient composition as much as in the case of fats. As dietary TG vary widely in their FA composition, so does Intake of trans FA in the North American diet has not been firmly established, but it appears to range from 2 to 7 of the total energy intake ( 7, 10). Amounts of trans FA in the diet have remained relatively constant over past decades, partly because the rise in vegetable fat consumption has been counterbalanced by a decline in the trans FA content of many foods made with vegetable...

Dietary Modification

Dietary information is reviewed with all patients to assist in improving bowel and bladder function. Patients are provided with written informational handouts regarding foods that are high in fiber or foods that either stimulate or slow transit. Offering creative fiber alternatives that may be more appealing for the individual to easily incorporate in their daily diet regime assists with compliance. Such alternatives include unrefined wheat bran that can be easily mixed with a variety of foods, cereals, muffins, as well as over-the-counter bulking agents. Adequate fluid intake and limiting caffeine intake are essential for normal bowel and bladder function. It is essential to monitor the amounts and types of fluid intake. Urinary oxalates can be irritating to tissue therefore, avoidance of oxalate-containing foods may improve irritative bladder and vulvar symptoms.

Impaired Adipose Tissue Adrenergic Signaling in Obesity

White adipose tissue.46-49 These animals are also unable to recruit brown adipose tissue for thermogenesis in response to cold temperature-induced adr-energic stimulation,4950 indicating that adrenergic mechanisms regulating metabolism in both white and brown fat are affected in obesity. While defects in sympathetic outflow have been shown to be associated with obesity,51-53 other experiments also clearly indicated that there was impaired P-adrener-gic receptor (PAR) function at the level of the adipocyte itself, independent of the availability of catecholamines.48 Figure 12.3 shows the impaired ability of white adipose tissue from genetically obese (C57BL 6J Lepob) mice to stimulate adenylyl cyclase activity in response to P-agonist stimulation, and the dramatic decrease in expression of the newly discovered P3AR, as well as of the P1AR. Although these ade-nylyl cyclase data are similar to many previous reports (e.g., Reference 46), a unique aspect of our method of analysis was the...

Dietary recommendations and therapeutic use

As presented here, PUFAs have the potential to affect a large number of metabolic processes and, therefore, these fatty acids are beneficial in obesity and its related diseases. The most important effect of omega-3 PUFAs, and in particular EPA and DHA, is the triglyceride-lowering effect observed in humans (Connor et al., 1993). Lowering circulating triglycerides has been proven to protect against coronary heart disease and the use of fish oil or increased consumption of fish after myocardial infarction reduced reinfarc-tion and mortality (Calder, 2004). The American Heart Association have presented guidelines for dietary fish intake, proposing that patients without documented coronary heart disease should eat a variety of fish, preferably oily fish, twice a week (Kris-Etherton et al., 2002). Patients with documented coronary heart disease should consume dietary supplementation of at least 1 g EPA and DHA per day. Long-chain omega-3 PUFAs derived from fish and fish oils have...

Selective P3AR Agonists as Potential Thermogenic and Antiobesity Agents

Since the first reports by Arch and colleagues that atypical P-adrenergic ligands had thermogenic and weight-reducing properties in C57BL 6J Lepob mice,30 there has been great interest in trying to understand their biochemical and physiological effects and to develop such compounds as therapeutic agents. In most species studied, including some studies in non-human primates, P3AR-agonist treatment is associated with increased density of brown adipocytes expressing UCP1 within typical white adipose depots.40-427374 From our studies in various inbred strains of mice, the relative success of P3-agonists as an anti-obesity therapy appears to parallel the extent of this expansion of brown adipocytes.41 Others reported similar effects of cold-exposure as well as acute P3-agonist stimulation in a series of recombinant inbred strains.75 Importantly, in our studies we have observed that the beneficial effects of P3AR agonists to decrease adipose tissue mass and improve glycemic control in mouse...

Examination of the obese patient

According to the NHLBI guidelines 5 , assessment of risk status due to overweight or obesity is based on the patient's body mass index (BMI), waist circumference and the overall risk status. BMI is calculated as weight (kg) height (m)2, or as weight (pounds) height (inches)2 x 703. A BMI table is more conveniently used for simple reference (see Table 9.1). Classifying obesity by BMI units replaces previous weight-height terminology such as percent ideal or desirable body weight. These previous terms were often difficult to interpret and difficult for patients to understand. BMI is recommended since it provides an estimate of body fat, is related to risk of disease and has been established as an independent risk factor for premature mortality 6 . A desirable or healthy BMI is 18.5 to 24.9kg m2, overweight is 25 to 29.9kg m2, and obesity is > 30kg m2. Obesity is further sub-defined into class I (30.0-34.9kg m2), class II (35.0-39.9kg m2) and class III (> 40kg m2) (Table 9.2). Lower...

Regulation of UCP2 and UCP3 Expression by Dietary Manipulations

Differentially regulated in response to high-fat feeding in obesity-resistant and obesity-prone strains of mice supported this idea since this dietary upregulation occurred in at least two obesity-resistant strains. If UCP2 is an uncoupler of oxidative respiration, this would be consistent with increased expenditure of metabolic energy.2021

Potential Mechanisms Responsible for Deficient Skin Vasodilatation to Mental Stress in Obesity

Several mechanisms could possibly lead to the observed impairment in skin vasodilatation to mental stress in obesity. Skin vasodilatation in response to mental stress in humans occurs due to both local sympathetic nerve traffic withdrawal and b2-adrenergic vasodilatation from circulating epinephrine and norepinephrine. It is possible that circulating norepinephrine causes vasodilatation by stimulating b-adrenoreceptors located predominantly on the inner layer of smooth muscle. Given that nerve terminals are located in the adventitia of the blood vessels, neurally released norepinephrine causes vasoconstriction by stimulation of a-adrenoreceptors, located predominantly in the outer layer of vascular smooth muscle 14 . The sympathetic withdrawal during mental stress might be attenuated, because it is known that baroreflex control of muscle sympathetic nerve activity is impaired in obesity and improves with weight loss in obese individuals. There is an endothelium-dependent component of...

Prevalence Of Overweight And Obesity

The prevalence of obesity has increased rapidly over the past two decades, reaching epidemic levels in many parts of the world.3 Currently worldwide, more than 1 billion adults are overweight and at least 300 million of them are obese.3 Present levels of obesity vary from less than 5 in China, Japan, and certain African nations, to over 75 in urban Samoa.3 Recent data from Europe found that the prevalence of obesity varied from 8 to 40 in men and from 5 to 53 in women, with high prevalence (> 25 ) in Spain, Greece, Ragusa and Naples (Italy), and the lowest prevalence (< 10 ) in France.4 Obesity is more common in Eastern Europe than in other parts of Europe, especially among women.5 Obesity prevalence remains at 1 to 5 in most populations in sub-Saharan Africa however, it has risen to 8 in men and to 34 in women in some areas of South Africa and in neighboring countries.6 Obesity is becoming a problem in some urban areas of developing countries, especially in those undergoing...

National weight control registry

Rena Wing and James Hill, the National Weight Control Registry (NWCR) is an on-going surveillance project to learn more about the healthy behaviors of those individuals who have successfully lost weight (> 30 pounds) and maintained that loss groups while staying within energy needs o Caloric deficit 500 to 1,000 calorie deficit day o Increase physical activity 30 min on most, preferably all, days of the week o Patient with low probability of success with non-surgical measures, as demonstrated by failure in established weight control programs o Informed, well-motivated patient with acceptable operative risks Many people wishing to lose weight experience an important trigger event in their lives that becomes self-motivating.

Weight Reduction Medication

The evidence-based studies regarding the indications and effectiveness of medication for weight reduction were described in an earlier chapter. During the third appointment, the physician might discuss the potential use of medication. However, in view of the 1997 complications with Redux, like primary pulmonary hypertension and valvular heart disease, there are two important considerations to discuss before prescribing weight loss medication. One is that, since obesity is a chronic, recurrent disease, it is likely that duration of medication use will be indefinite or weight regain will likely occur 2 . Second, according to the USPSTF report on obesity, long-term studies have not gone beyond 2 years, so the physician is unable at this time to tell the patient if adverse side effects are likely to result from long-term use of any weight reduction medication 2 .

The Five Principles of Long Term Weight Control

During the first monthly monitoring appointment, after reviewing the top ten questions in Figure 11.1, the physician presents the five principles of long-term weight control (Figure 11.2). These principles are meant to help the patient remember the key steps of the program. Ultimately, the patient's long-term success is based on internalizing the evidence-based science in a way that the patient can use in any social or private situation. This goal is accomplished by teaching the patient the five principles. 1. Preference versus Passion. The first principle, Preference versus Passion, defines how serious the patient is in wanting to lose weight. Patients who exhibit wishful thinking, who expect someone or something else to be responsible for weight loss success, or who are not willing to focus daily on trying to achieve success will not lose weight long-term. On the other hand, patients who demonstrate passion for wanting to lose weight accept a realistic weight loss goal, hold...

Dietary Reference Standards

The Food and Nutrition Board of the Institute of Medicine (IOM) has been developing reference standards for vitamins and other nutrients called Dietary Reference Intakes (DRIs). In the past, the recommended dietary allowances (RDAs), which are the levels of intake of essential nutrients that are considered to be adequate to meet the known nutritional needs of practically all healthy persons, were the primary reference value for vitamins and other nutrients. The DRIs also include other reference values, such as the estimated average requirement (EAR) and the adequate intake (AI). The RDA, EAR, and AI reference standards define nutritional intake adequacy. Since these recommendations are given for healthy populations in general and not for individuals, special problems, such as premature birth, inherited metabolic disorders, infections, chronic disease, and use of medications, are not covered by the requirements. Separate RDAs have been developed for pregnant and lactating women....

Recommended Dietary Intake Chart

For more than 50 years, nutrition experts have produced a set of nutrient and energy standards known as the Recommended Dietary Allowances (RDA). A major revision is currently underway to replace the RDA. The revised recommendations are called Dietary Reference Intakes (DRI) and reflect the collaborative efforts of both the United States and Canada. Until 1997, the RDA were the only standards available and they will continue to serve health professionals until DRI can be established for all nutrients. For this reason, both the 1989 RDA and the 1997 DRI for selected nutrients are presented here.

Recommended Dietary Intakes

1989 Recommended Dietary Allowances (RDA) 1997 Dietary Reference Intakes (DRI) 1989 Recommended Dietary Allowances (RDA) 1997 Dietary Reference Intakes (DRI) Source RDA reprinted with permission from Recommended Dietary Allowances, 10th edition 1959 by the National Academy of Sciences. Courtesy of the National Academy Press, Washington, D.C. Committee on Dietary Reference Intakes, Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride (Washington, D.C. National Academy Press, 1997). Source RDA reprinted with permission from Recommended Dietary Allowances, 10th edition 1959 by the National Academy of Sciences. Courtesy of the National Academy Press, Washington, D.C. Committee on Dietary Reference Intakes, Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride (Washington, D.C. National Academy Press, 1997).

Dietary Reference Intakes Recommended Intakes for Individuals

Note This table presents Recommended Dietary Allowances (RDAs) in bold type and Adequate Intakes (AIs) in ordinary type followed by an asterisk (*). RDAs and AIs may both be used as goals for individual intake. RDAs are set to meet the needs of almost all (97 to 98 ) individuals in a group. For healthy breastfed infants, the AI is the mean intake. The AI for other life-stage and gender groups is believed to cover needs of all individuals in the group, but lack of data or uncertainty in the data prevent being able to specify with confidence the percentage of individuals covered by this intake.

Dietary Reference Intakes Recommended Intakes for Individuals Continued

DAs dietary folate equivalents (DFE). 1 DFE 1 ig (mcg) food folate 0.6 ig of folic acid from fortified food or as a supplement consumed with food 0.5 ig of a supplement taken on an empty stomach. dAs dietary folate equivalents (DFE). 1 DFE 1 ig (mcg) food folate 0.6 ig of folic acid from fortified food or as a supplement consumed with food 0.5 ig of a supplement taken on an empty stomach. e Although Als have been set for choline, there are few data to assess whether a dietary supply of choline is needed at all stages of the life cycle, and it may be that the choline requirement can be met by endogenous synthesis at some of these stages.

Other Evidence for Dietary Effects

There has also been substantial controversy regarding the potential benefits of several recently popular diets, especially those with extremes of fat and carbohydrate content. A recent randomized controlled clinical trial attempted to evaluate four such diet plans ranging from the lowest carbohydrate and highest fat content (the Atkins diet) to the lowest fat and highest carbohydrate content (the Ornish diet) 15 . Forty persons were randomized to each of the four diets and followed for 1 year. As is typical in many published diet clinical trials, the dropout rate was high, making interpretation difficult, because dropping out of a weight loss trial may not be random but related to success with weight loss. Perhaps because of the dropout problem and the limited sample sizes, there were no significant differences between the treatment groups in weight loss or changes in lipids or other cardiovascular risk factors. Such studies, directly comparing different diet regimens for longer...

How does obesity develop

If an individual is overweight or obese, then clearly that individual must have been through a period when his or her intake of energy was consistently greater than his or her energy expenditure. (Note that this is true for everyone during the period of growth.) It does not necessarily follow that this is true now an obese subject may be in energy balance, with a stable weight. Then we can ask the question if energy intake was greater than energy expenditure, did this arise through (1) an elevated rate of energy intake, compared with people of normal and steady body weight or (2) a diminished rate of energy expenditure (again, compared with people of normal and steady body weight) The answer may not, of course, be the same for all obese subjects. This question is of interest because if the answer is (2) - i.e. diminished energy expenditure - then it implies that the individual will also have a particularly hard job losing excess calories, because he or she has a 'biologically' low...

Importance of Skin Microvasculature and Alterations of Skin Microcirculation in Obesity

Adipose tissue receives a rich capillary blood supply. Capillary rarefaction and increased vasoconstrictor response to local cooling in the human skin has been demonstrated in individuals with essential hypertension 7, 8 . Alterations in skeletal muscle microvascular function are paralleled by alterations in skin microvascular function in hypertensive humans 9 . Sympathetic control of skin blood flow is reduced in obesity 10 . Even young children with obesity have morphologic alterations in skin microvasculature, such as increased number of tortuous loops in finger nailfold capillaries. Obese children have also been shown to have decreased capillary blood cell velocity after a 1-minute arterial occlusion 11 . These children's blood flow response to 1-minute arterial occlusion, as measured by laser-Doppler flowmetry, was not altered. This could represent shunting of blood from capillaries through arteriovenous anastomoses. Increased arteriovenous shunting of blood in human skin has...

Substances reducing the rate of de novo lipogenesis and their possible therapeutic potential for the control of obesity

C75, an inhibitor of the enzyme FAS, was initially developed for the treatment of certain cancers (Kuhajda et al. 2000) because many common human cancers express high levels of FAS. Subsequent tests revealed that systemic and intracerebroventricular (i.c.v.) administration of C75 in mice reduced food intake and body weight (Loftus et al. 2000), making FAS also an interesting target in the therapy of obesity. C75 blocks the conversion of malonyl-CoA into fatty acids and, hence, increases tissue levels of malonyl-CoA Although C75 clearly increases malonyl-CoA, which should inhibit CPT 1 and, hence, mitochondrial fatty acid oxidation (McGarry and Foster 1980) (Fig. 1.1), the published results on the effect of C75 on CPT 1 activity and fatty acid oxidation are controversial. Bentebibel et al. (2006) demonstrated that the CoA derivative of C75 is a potent inhibitor of CPT 1 and fatty acid oxidation, whereas Thupari et al. (2002) showed that i.p. injected C75 increased CPT 1 and fatty acid...

CAMES Approach to Caloric Deficit

After reviewing the Battle in the Mind and the patient's food diary, the physician introduces the CAMES approach to creating a caloric deficit. The physician guides the patient through the concept by showing the example provided (Figure 9.1). The physician explains what each letter means, with special emphasis on the letters C and E. The example in the workbook shows the letter C is applied to 7 out of 10 items, which means the individual can continue to eat most foods eaten in the past but in smaller quantities. This does not mean the physician is blessing the patient's food selections as nutritionally sound. Personal preference for certain foods is a complex dynamic that involves personal likes, family preference, work situation, and cultural tradition. The physician is saying that portion control of whatever foods and drinks the patient consumes is the most important way to create a caloric deficit and lose weight without radically changing the diet. Just as portion control is the...

The Food Guide Pyramid

You must have noticed the food guide pyramid on food labels. The USDA and the DHHS designed this pyramid to be a flexible dietary guide for Americans. Each compartment contains a different food group and the recommended number of servings that should be consumed daily. The primary energy-providing nutrient (Chapter 2) found in each food group is written in parenthesis. See Figure 3-1. Figure 3-1. Food Guide Pyramid Figure 3-1. Food Guide Pyramid Although this Food Guide Pyramid is found on most food labels, many people are unsure how to use its information. The most common questions are about serving sizes and how many servings should be eaten. Often people overestimate the size of a serving, thereby eating more kcals than they anticipated. Table 3-1 gives an estimate of the amount of food per serving for each food group and Table 3-2 lists the number of servings required from each food group to meet the various total daily kcals shown in the left column. Look up the number of...

Pre Adolescent Obesity

If genetic and medical conditions are not the cause of a child's obesity, then family and environmental factors must play an important role. Parents are role models and make decisions that directly impact the types and amount of food eaten by pre-adolescent children 16,17 . Obesigenic family clusters are a risk for young girls to have a higher BMI parents in such family clusters have a greater intake of dietary fat and are less physically active than parents in non-obesigenic family clusters 18 . Added to the factors just mentioned is the reality that many parents do not recognize that their obese child has a medical condition Parents will ask why their child is overweight or obese. If the cause is not the result of a genetic syndrome or hormonal condition then it is related to modifiable behaviors both within the family and the individual. Specific behaviors associated with childhood obesity include a higher dietary fat intake compared to non-obese children 21 , watching > 4 hours...

Mode Of Action Of Types Of Dietary Fats Against Colon Cancer

Successful approach for implementation of preventive strategies depends on a mechanistic understanding of carcinogenesis at the tissue, cellular, and molecular levels. Carcinogenesis is typically a slow, chronic process and the development of invasive disease is characterized by molecular derangements. Although the molecular mechanisms by which n-3 PUFAs inhibit colon carcinogenesis have not been fully elucidated, several putative mechanisms of action have been proposed for colon cancer preventive activity of types of dietary fat (Figure 23.2). As discussed in detail by Hong et al.,44 dietary n-3 PUFAs may protect against colon carcinogenesis by either decreasing DNA adduct formation and or by enhancing DNA repair. Lower levels of AOM-induced DNA adducts were detected in fish oil-fed rats as compared to those fed corn oil, rich in n-6 PUFAs. Also, fish oil supplementation caused an increase in apoptosis in the colon compared with corn oil-fed rats.4445 It is therefore reasonable to...

Carbohydrate type glycaemic response and weight control

It has been debated whether excess dietary carbohydrate can increase adipose stores. Although test animals are able to convert significant amounts of ingested carbohydrate into body fat, in humans, de novo lipogenesis from carbohydrate appears to be limited (Strawford et al., 2004). Despite this, excess dietary carbohydrate may indirectly increase body fat stores. Dietary carbohydrate, in the form of starch or sucrose, increases blood insulin levels, which in turn increase activity of the enzyme lipoprotein lipase. Lipoprotein lipase mediates storage of dietary fat in adipose cells. At the same time, insulin decreases the activity of hormone-sensitive triglyceride lipase, an enzyme that regulates the release of fatty acids from stored fat. Thus, excess dietary carbohydrate increases the amount of dietary fat that is stored, and decrease fat turnover (Allred, 1995). GI of the diet by giving brief instructions and a handout about dietary changes to the parents, resulted in a reduction...

Introduction mediumchain triglycerides and weight control

Medium Chain Fatty Acids And Pancreas

Conventional fats and oils are composed of glycerides of 12- to 18-carbon long-chain fatty acids (LCFA). These compounds are known as long-chain triglycerides (LCT) and are the predominant form of lipids in the diet. Lipids are an essential source of energy and essential fatty acids, and a vital component of body cells. Therefore, it would be beneficial to have a dietary fat with the added benefit of anti-obesity properties. Medium-chain triglycerides (MCT) have a number of unique characteristics relating to energy density, absorption and metabolism, which give them advantages over the more common LCT. Upon hydrolysis, MCT yield medium-chain fatty acids (MCFA) caproic (C6), caprylic (C8), capric (C10), lauric (C12) (Papamandjaris et al., 1997). Naturally occurring sources of MCT are rare, but include milk fat, palm kernel oil, and coconut oil. Human consumption of MCT is currently low but intake should perhaps be greater due to the distinctive properties of MCT, which cause an...

Dieting from the viewpoint of metabolic regulation

Obesity, as we have seen, results from an excess of energy intake over energy expenditure. If the obese or overweight person wants to lose weight, then the solution is simple and unarguable energy expenditure must exceed energy intake for a suitable length of time. The only alternative is surgery to remove some excess fat. Of course, this message is simple in principle, but extraordinarily difficult to put into practice. Here, we shall consider why it is difficult, and also look at dieting from a metabolic viewpoint. be able to minimise the impact of a period of partial or total lack of food. We should not, then, be surprised that dieting is difficult it is a fight against mechanisms that have evolved over many millions of years precisely to minimise its effects. In our consideration of starvation, we saw the factors that bring about this protection. As food intake drops, the level of thyroid hormone falls and metabolic rate is lowered. Then, of course, food intake has to be reduced...

Daily Caloric Deficit

Weight gain, which for most is the result of consuming excess calories, is a gradual but cumulative process. Patients do not become obese in one day of excessive eating no matter how many calories are consumed. Eating 6000 calories in one day may lead to a net weight gain of about 2 lb that day, but it does not take a patient from a healthy weight to obesity. It is the consumption of an extra 100 to 300 calories per day on a regular basis that results in an extra weight gain of 10lb in one year, which turns into 20 or 30lb of weight gain over two or three decades. Likewise, a healthy weight loss does not occur in a few weeks. It, too, is a gradual but cumulative process of caloric reduction over time. To help patients understand the amount of daily caloric reduction needed to lose 10 of their weight over the next 6 months, the patient is presented with a daily caloric deficit worksheet that has two examples. One is of a 250-lb male, which means his weight loss goal over 6 months is 25...

Dietary Carbohydrates

Are commercially significant and used in the food industry, while a similar number are of metabolic importance. Dietary carbohydrate is a major nutrient for both man and omnivorous animals. Human adults in the Western world obtain approximately half their daily caloric requirements from dietary carbohydrates in the developing countries, it is the major source. Of this ingested carbohydrate, some 60 is in the form of polysaccharides, mainly starch and glycogen, but the disaccharides sucrose and lactose represent 30 and 10 , respectively (IabJe. . . .3.1). More recently, in a few Western countries, a significant intake of monosaccharide sugars (glucose and fructose) can be obtained from manufactured foods and drinks. Some oligosaccharides, such as raffinose and stachyose, are found in small amounts in various legumes. They cannot be broken down by the enzymes of the pancreas and small intestine, but they are digested by bacterial enzymes, especially in the colon. Figure 3.1. Structures...

Recommendations of Professional Groups Overweight and Obesity

In the year 2000, the National Heart, Lung and Blood Institute, in partnership with the North American Association for the Study of Obesity, released The Practical Guide Identification, Evaluation and Treatment of Overweight and Obesity in Adults.100 These guidelines defined a healthy body weight, based on the body mass index (BMI) weight in kilograms (height in meters)2 between 18.5 and 25.0.100 According to these guidelines, individuals are considered to be overweight if the BMI is between 25 and 30 and obese if the BMI is greater than 30.100 The guidelines contain specific recommendations, including thresholds for considering various weight loss methods, such as caloric restriction, physical activity, medications, and surgery. These BMI recommendations are consistent with those of the American Heart Association,101 which also recommend that children and adolescents maintain a BMI less than the 85th percentile, according to age-appropriate growth charts. The American Cancer Society...

The Mediterranean Diet Meltdown

The Mediterranean Diet Meltdown

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