Best Practices in the Prevention and

Treatment of Childhood Obesity

Michael Coles, Ph.D.
Wade Gilbert, Ph.D.
Department of Kinesiology
California State University, Fresno

June 2005

2

Table of Contents

I. ACKNOWLEDGMENTS 3

II. INTRODUCTION 4

III. EXECUTIVE SUMMARY 7

IV. RESEARCH COMPENDIUM 23

V. WEB-BASED RESOURCES 246

3

Acknowledgements

This report was sponsored by the Central California Center for Health and Human Services
(CCCHHS) at California State University, Fresno.

Data collection and report formatting assistance was provided by Andres Hernandez, Sarah
McCord, and Adam Smith.

4

Introduction

The purpose of this report is to present a summary of research and resources that directly address
prevention and treatment strategies for obesity. This report is designed to complement other
obesity best practice reports and research reviews (i.e., Colorado Department of Public Health
and Education, 2003; Parizkova & Hills, 2005; Taskforce on Community Preventive Services,
2005; Voss & Wilkin, 2003).

Although the consequences of obesity have been debated (Gibbs, 2005), there is no challenge to
the fact that obesity is now prevalent both in the United States and globally (World Health
Organization, 1997). Results of a recent national study show that approximately 16% of youth
12-19 years of age are considered overweight (National Center for Health Statistics, 2004b). This
is triple the amount from measures done in 1980 (National Center for Health Statistics, 2004a).
Inactivity among adolescents is a contributing factor for the increasing trends in overweight
(USDHHS, 2000). In fact, in 1996, the Surgeon General classified inactivity as a health risk and
recommended physical activity promotion as a critical policy and research area.

More than ever, children and adolescents are developing cardiovascular disease, Type II
diabetes, metabolic syndrome, and other chronic disease. For example, risk factors for
premature coronary heart disease (CHD) include family history, cigarette smoking, elevated
blood pressure, severe obesity, diabetes mellitus, physical inactivity, elevated concentrations of
total and low-density lipoprotein (cholesterol), and a low concentration of high-density
lipoprotein (cholesterol). A number of these risk factors, including, obesity, hyperlipidemia, and
inactivity have been tracked from adolescent into adulthood (Anding et al., 1996). In a study
done on CHD risk factors in youth, more than 80% of the subjects had at lease one risk factor
and 25% demonstrated two or more risk factors (Anding et al., 1996). In a recent study on youth
with Metabolic Syndrome (also known as Insulin Resistance Syndrome, or Syndrome X),
metabolic risk was inversely related to physical activity and there was a significant positive
interaction between physical activity and fitness (Brage et al., 2004).

Obesity has been identified by the US Surgeon General as one of the most preventable chronic
diseases and billions of dollars are spent each year to fight obesity. The prevention and treatment
of obesity is extremely complicated because obesity is the result of many factors. In the latest
Dietary Guidelines for Americans it is explicitly acknowledged that the two most significant
causes of rising obesity rates in America are declining levels of physical activity and poor diet
(USDHHS & USDA, 2005). Poor diet together with lack of physical activity is now considered
the second leading cause of death, behind only tobacco use, in America (USDHHS, 2004).

Therefore, the purpose of this report is to summarize common best practice recommendations
that address the two primary causes of obesity, diet and physical inactivity. The report includes
three sections: (a) an executive summary of best practice information directed at diet and
physical activity solutions to the problem of childhood obesity, (b) a compendium of research
related to obesity prevention and treatment, and (c) a listing of web-based resources which
provide information about obesity prevention and treatment.

5

Methodology and Delimitations
The information presented in these three sections is based on a comprehensive search and review
of English journal articles published between 1995 and 2005 and websites related to obesity. The
following electronic databases were searched using the terms ‘obesity prevention’ and ‘obesity
treatment’: Agricola, Biological Abstracts, CAB Direct, CINAHL, Expanded Academic ASAP,
GPO, PAIS International, Physical Education Index, PsychInfo, PubMed, and SPORT Discus.
Online resources were identified by searching known obesity related web sites and their links, as
well as conducting a Google (www.google.com) search combining ‘obesity’ and the following
terms: treatment, prevention, education, treatment programs, prevention programs, education
programs, health, and fitness. A record for each journal article and website was entered into the
EndNote bibliographic software program (Thomson ISI ResearchSoft, 2004).

The executive summaries are best viewed as brief overviews of the empirically-based strategies
that have been reported in the recent literature. The annotated bibliography includes reference
information, abstracts, and a subject index for over 930 journal articles. The online resources
section includes web addresses and site descriptions, and is organized by type of source (i.e.,
government, corporate, association).

References

Anding, J. D., Kubena, K. S., McIntosh, W. A., & O’Brien, B. (1996). Blood lipids,
cardiovascular fitness, obesity, and blood pressure: The presence of potential coronary
heart disease risk factors in adolescents. Journal of American Dietetic Association, 96(3).
238-243.

Brage, S., Wedderkopp, N., Ekelund, U., Franks, P. W., Wareham, N. J., Andersen, L. B., &
Froberg, K. (2004). Features of the metabolic syndrome are associated with objectively
measured physical activity and fitness in Danish children: the European Youth Heart
Study. Diabetes Care, 27(9). 2141-2149.

Colorado Department of Public Health and Education (2003). Best practices: Obesity
prevention for children and youth. Retrieved May 15, 2005 from
http://www.cdphe.state.co.us/ps/bestpractices/topicsubpages/obesity.html

Gibs, W. W. (2005, May 23). Obesity: An overblown epidemic? Scientific American. Retrieved
June 8, 2005 from
http://www.sciam.com/article.cfm?chanID=sa006&articleID=000E5065-2345-128A-
9E1583414B7F0000

National Center for Health Statistics. (2004a). Obesity still a major problem, new data show.
Hyattsville, MD: USDHHS.

National Center for Health Statistics. (2004b). Prevalence of overweight among children and
adolescents: United States 1999-2002. Hyattsville, MD: USDHHS.

(2004). & Wilkin. Physical activity. Retrieved June 15 from http://www. Retrieved June 15. Promoting physical activity. (2005). FL: CRC Press. Dietary guidelines for Americans 2005.healthypeople. Progress review: Physical activity and fitness. (2003). Retrieved June 22.gov/data/2010prog/focus22/ USDHHS & USDA.healthierus. CT: Author. T. London: Taylor & Francis.).gov/Document/html/uih/uih_bw/uih_4. & Hills.). (2005). A. (1997). (2005).gov/dietaryguidelines/ Voss. Obesity: Preventing and managing the global epidemic. 2005 from http://www. Retrieved May 15. Stamford. EndNote v8. . 2005 from http://www.. USDHHS (2000).healthypeople.org/pa/ Thomson ISI ResearchSoft. J. 2005 from http://www. 6 Parizkova. Childhood obesity: Prevention and treatment (2nd ed. Taskforce on Community Preventive Services. Geneva: WHO.thecommunityguide. Boca Raton.htm#physactiv USDHHS (2004). L. World Health Organization. (Eds.. Adult obesity: A pediatric challenge.

prevention should be the primary focus when considering a best practice approach to deal with the problem of childhood obesity. With regard to prevention.. 7 Executive Summary Obesity Best Practices: Diet and Physical Activity Evidence Diet and Dietary Habits Clearly. A variety of best practice themes related to improving the dietary habit of children and adolescents aimed at prevention have been offered in the literature and through various programs and organizations. especially in those young individuals that are at high risk for developing increased adiposity. But after weight loss. It can play a role in the treatment of the problem or it can function to help prevent the condition from occurring. The treatment of childhood obesity is very difficult and only necessary if prevention has failed. 2004). 2004. There are two primary ways in which diet can have an impact in this battle. So. 2002) and fiber (Kimm. This education should include . It has been suggested that infants and toddlers should eat less protein and that toddlers and children in preschool consume more carbohydrates (Caroli & Lagravinese. This is true both for adults and children. Diet and dietary habits do play a role in the treatment of obesity. experts generally agree. In addition. it has been suggested that child and adolescent obesity preventative strategies should emphasize increased physical activity rather than diet because of fears relating to the adverse effects of fostering inappropriate eating patterns and/or disorders (Watts et al. especially in high-risk children. however. that are often mentioned when describing successful programs include. It appears that composition of food in toddler and children’s diets may have a greater impact on the development of childhood obesity that merely overeating (Parizkova & Hills. 1995).. Experts have summarized the ideal obesity prevention program as being multi-faceted and agree that there are very few proven preventive strategies for children (Caballero. that dietary treatment of obesity alone is relatively ineffective in these groups of individuals. Kaur et al. after weight loss there was a concurrent shift back towards obesity-associated behavioral patterns. However. 2003). the prevalence of childhood obesity is increasing (Caballero. 2005). This has been demonstrated in a study conducted using differing weight reducing diets on massively obese. mean weight again increased in these individuals. Authorities also argue that successful programs need to include monitoring. Even with this important point made. Those things.. experts do agree that it is likely that habits learned during early childhood and into adolescence can profoundly influence the development of adult obesity and the subsequent development of chronic disease that goes along with it. Substantial weight loss was obtained with moderately energy-restricted diets with normal fat content. 11. Many individuals have offered educated opinions related to the most important factors associated with the ideal obesity prevention program. Emphasis instead will be placed on the more important practice of prevention.to 16-year-old children. 2005). A more successful approach to treatment has been established using multidisciplinary dietary-behavioral- physical activity intervention programs (Nemet et al. and education to children and primary care givers in an attempt to enlighten them as to the real dietary needs of the children. 2005). breastfeeding infants and generally improving infant and toddler diets. The following information will illustrate the ineffective role diet manipulation strategy alone has on treatment of child or adolescent obesity.

it is suggested that risk factors associated with dietary and physical activity histories should also be closely monitored.. genetics and environment). McCarter Spaulding. and begin comprehensive monitoring. Nutritional education programs have been shown to be effective in the prevention of childhood obesity. Some experts suggest that by age 4 children’s propensity to eat a variety of foods begins to decline. 2004). 2004). These education programs can be both formal and traditional and/or they can be informal and non-traditional. 8 lessons on not using food as a form of reward and/or consolation (Caroli & Lagravinese. when a mother is obese during pregnancy there is a greater likelihood that the child will become obese. however. economic. This study revealed a more than double the risk of obesity for children at 2 to 4 years of age when the babies were born to mothers who were obese during early pregnancy (Whitaker. If variety is not introduced during this time . The use of formal educational programs and strategies should be considered when discussing best practices related to obesity prevention. Likewise. including reducing the potential for the development of obesity in childhood (Grummer Strawn & Mei. an analysis of longitudinal data from the Centers for Disease Control and Prevention Pediatric Nutrition Surveillance System suggest that breastfeeding longer than 6 months will provide health benefits to children. Research suggests that when a developing fetus is exposed to hyperglycemic conditions it is likely to develop obesity during childhood (Barker. These points suggest that a strategy to prevent obesity in preschoolers is to provide prenatal nutritional education and promote proper nutritional practice during pregnancy. While this effect is thought to be less influential than others (i. modeling. 2001). reduced breastfeeding practices have also been linked to the eventual development of obesity in the child. 2004). These practices are especially important when other highly interdependent factors. and formal and informal education programs (both nutritional and physical activity based) for these children and their care givers. It has been suggested that these educational based programs should focus on teaching about the importance of consuming a balanced diet and increasing food variety (Westenhoefer. Monitoring obesity development in children seems to be a key part of a preventative practice (Shephard. environmental. 2003. research shows an increase risk of childhood obesity in children who have mothers that smoke (Toschke. and body composition analysis. After the birth of the child. 2004). communities. and cultural. specifically those with obese mothers who will not breastfeed for extended lengths of time and who smoke. 2000). geographic. 2004). such as hereditary. should emphasize the importance of using healthy weight-control practices (Neumark Sztainer et al. Good nutritional practice for children starts before the child is born. Lastly. It has also been suggested that schools. Dewey. 2003. it is still important enough to be considered when examining nutritional best practices (Campbell. Furthermore. All. 1998). It is important to recognize that malnutrition during the early stages of fetal development may bring about obesity later in life (Popkin. 2002). predispose a child to a higher risk for developing the condition. and mass media get involved in an effort to promote environments that encourage healthy nutrition (Sothern. It is suggested that children’s growth should be monitored using the body mass index (BMI). In addition it is important to identify at risk newborns. food industries. A specific example of this is illustrated in the results of a study with low-income children whose mothers were obese in early pregnancy. As a reference.e. 2002). 2003).

experts report that parents play many roles when it comes to managing a child’s weight and eating patterns (McCaffree. These roles include that of a provider. and program evaluation (CDC. it is unfortunately not always readily accessible. Being a positive role model. family and community involvement. provided these programs are multi-dimensional and include nutritional education and physical activity promotion for the whole family (Story et al. In addition. They should involve all children in a school. 2003). 1994). It has been suggested that television watching promotes unhealthy habits both in the form of reduced physical activity and poor dietary example.. multi-faceted and sustainable. While this formal education is important. Research shows that the number of . In this regard. a parent can unknowingly promote a reduction in a child’s ability to self-regulate food intake. This may dramatically influence healthy eating choices (Cashdan. undoubtedly profoundly influence the nutritional habits of children during the formative years. is critical (McCaffree. The Center for Disease Control and Prevention issued a recent report with guidelines for ensuring a quality nutrition program within a comprehensive school health plan. 2004). and they should be behaviorally focused (Warren et al. an enforcer and a role model. the CDC recommends integration of school food service and nutrition education. Another approach is to use the less traditional and very influential popular media as a vehicle for good dietary practice promotion. Schools seem to be a viable place for these kinds of programs. 1996). 2003). When this is the case an informal education offered by the family becomes very important. Therefore. caution must be exercised when restricting or managing a child or infant’s diet or over-management could result that may lead to an inability in a child being able to self- regulate later in life. Other educational practices should include providing guidance regarding a range of healthy and acceptable body weights and body compositions. 2003). It has been suggested that a child’s weight is directly impacted through the family’s food preferences as well as eating and activity patterns.. 9 life-long aversions to foods may develop. The family. As an enforcer. This modeling serves as a direct reflection of good self-care that reinforces the promotion of healthy behaviors by presenting a positive self-image by the parent or primary care provider. but it also requires follow-up in other social environments. 2005). especially parents or primary care providers. The recommendations include advancing school policy on nutrition. 2003). As a provider. a parent or primary care provider should make healthy foods available at home as research has shown that children who eat more fruits and vegetables in early years are more likely to consume these foods in greater abundance later in life. Researchers have confirmed the positive impact that the CDC guidelines can have on lowering the rates of childhood obesity and improving the overall eating and exercise behaviors in children that attend schools that follow these guidelines (Veugelers & Fitzgerald. they should target the whole environment. while at the same time promoting a variety of flexible healthy eating strategies that allow children to maintain a healthy weight and body composition. Formal education programs and less formal family based nutritional edification and modeling situations are very important best practices in obesity prevention. staff training. and developing a sequential and coordinated curriculum that includes appropriate and fun instruction for students. as it relates to healthy weight management. The results of a recent pilot study has demonstrated that school may be a good setting for promoting healthy lifestyles in children. Television watching is highly related to obesity in children and adolescents (Caroli et al. There has also been some promising work done in community-based after school programs.. School-based programs should be long-lasting.

The recommendation for healthy adults wanting to reduce their chronic disease risk is 30 minutes daily of moderate- intensity PA. This is especially true for at risk individuals. It also includes combining the efforts of many. Finally. less educated. as with any program that requires dietary manipulation. and/or whose primary care giver(s) are obese and/or practice poor dietary modeling. 10 television food advertisements targeting children has increased recently. It has also been shown that obesity treatment. These individuals. Research shows that school-based programs that follow clearly defined recommendations are most successful. and carefully managed way. Diet and Dietary Habits: Best Practices Summary In summary. who did not breastfeed or breastfed for short durations. low socioeconomic status. it is clear that the best diet practice is to prevent obesity from occurring. as opposed to or at least in combination with dietary resolutions. Prevention is not easy either. integrated. and that there has been an increased emphasis in the promotion of junk food in all of its forms. Based on evolving policy. such as minority. in the form of dietary intervention. It is clear that the popular media has a profound influence on children. is critical. and those over the age of 75 are identified as populations with low rates of PA (USDHHS. that a best practice may be to use this media in a more constructive and positive way. guidelines. African Americans and Hispanics. whether it be formal or informal. In order to manage body weight and prevent unhealthy weight gain 60 minutes of moderate to vigorous intense PA on most days of the week is recommended. women. Physical Activity The widely accepted scientific definition of physical activity (PA) is a bodily movement produced by skeletal muscles resulting in caloric expenditure (Caspersen. 2005). and children. In this regard an attempt can be made to model healthy dietary habits and spread correct information on good nutrition and obesity prevention during the important early childhood years. It has been suggested. to sustain . there is increased potential for the development of eating disorders. 1985. It requires consistent monitoring of obesity status in the form of BMI and/or body composition. It is generally accepted that the relationship between PA and health outcomes is curvilinear. and interdisciplinary links there has been a recent shift in PA interventions from vigorous exercise to moderate intensity activity. USDHHS. 2000). have mothers who were obese and had poor diets during pregnancy. generally speaking. Populations shown to be at high risk for physical inactivity. In the federal government’s Healthy People 2010. must be done in a highly controlled. disabled. The 2005 Dietary Guide for Americans provides adults with three sets of recommendations for PA in order to promote a healthy body weight (USDHHS & USDA. Therefore the potential for greatest public impact is found with moderate physical activity interventions developed for physically inactive individuals. treatment-based or preventative. Powell. may be a superior method to dealing with child and adolescent obesity. It has been repeatedly shown that treatment is very difficult and requires major life-style and behavioral modification. Because of this many may argue that promotion of increased use of physical activity as prevention and/or treatment. therefore. 2005). & Christenson. It appears as though education. This education needs to come at an early stage in a child’s life as dietary habits and food preferences seem to develop very quickly. Lastly. have been the primary target of most PA intervention research.

the President’s Challenge. 11 weight loss it is recommended that adults participate in 60 to 90 minutes of moderate intensity PA daily. and the You Can!. The question then becomes: Which intervention programs are most effective at helping Americans adhere to physical activity guidelines in order to prevent weight gain and promote weight loss? The following strategies are highlighted in the recent Progress Review for Physical Activity and Fitness as ones that have demonstrated strong evidence of effectiveness in increasing PA: ‘point- of-decision’ prompts. individually adapted behavior-change programs. Must et al.. Healthy People 2010’s latest progress review for physical activity and fitness shows that 38% of adults don’t participate in any leisure time PA (USDHHS. aerobic dance. and informational outreach activities (USDHHS. Telama et al. swimming.5 to 7 calories per minute (USDHHS. creation of or enhanced access to places for physical activity. Activities classified as vigorous intensity PA include jogging. physical education has repeatedly been identified as the optimal context for promoting the adoption and maintenance of a physically active lifestyle (NASPE. 2004). targeting all high risk groups. 2004). Unfortunately we now live in a society that has systematically removed opportunities for daily PA. 3 to 6 metabolic equivalents (oxygen use). communitywide campaigns. This is evident in the physical inactivity statistics for the adult population. a perceived exertion of 11 to 14 on the Borg scale. Steps to a HealthierUS. Less than 5% of the nation’s high schools require daily physical education and less than 30% of high school youth participate in daily physical education. school-based physical education. 2005). is needed otherwise only certain segments of the community will participate . or any activity that results in an expenditure of 3. a perceived exertion of 15 or greater on the Borg scale. 1997). 2003. Even in schools that do require daily physical education. or mowing the lawn. most students (62%) are inactive over 50% of the class time. 2005).. USDHHS. Steps to Healthier Aging campaign (USDHHS. Pangrazi. 2004). What is perhaps most troubling about the physical inactivity epidemic is that patterns of physical activity developed in youth predict lifelong physical activity behaviors and well-being (Guo et al. there have been many government initiatives to promote physically active lifestyles. Only 33% of adults meet government guidelines for PA and these statistics have not changed significantly from the 1997 data used to prepare the Healthy People 2010 objectives. 2002. Examples of moderate intensity PA include brisk walking. The remainder of this executive summary provides a brief overview of some of the recent research on these types of strategies. The recommendation for youth is to complete at least 60 minutes of PA each day of the week. No research on the effectiveness of ‘point-of-decision’ prompts were identified with the search criteria used to prepare this obesity best practices report and therefore no further discussion of this strategy is provided. It appears that a multiple method recruitment strategy. 2000). These include the VERB media campaign. Given the scope of the physical inactivity problem. Because youth spend most of their time in school. 1992. more than 6 metabolic equivalents. Moderate intensity PA is characterized by an increase in breathing or heart rate. or cycling uphill. or any activity that expends more than 7 calories per minute (USDHHS.. Vigorous intensity PA is associated with large increases in breathing or heart rate. Communitywide Campaigns A major concern for these types of campaigns is their ability to effectively reach and recruit members of the community. 1994.

and income levels than a random sample of Richmond residents. 2000). and teachers (Neumark-Sztainer et al. eating patters. numerous studies are available documenting school-based interventions outside of the physical education curriculum. school district. A Los Angeles County example focused on workplace PA integration for African Americans and reported that nearly 50% of the organizations made some changes in their workplace routines demonstrating broad.. and local government. however. parents. 2003b). 12 (Yancey et al. It was concluded that a decrease in perceived time constraints would result in a mean weekly increase of 53 minutes of PA. the comparison intervention participants only showed trends toward positive health (BMI and waist circumference). Participants in the intervention were compared against a control group and the strongest predictors for behavioral change were time constraints and social support for PA from peers. and automobiles (Nestle & Jacobson. particularly new curricular additions and after-school programs. showed no statistically significant . 2003). In contrast.. At postintervention participants showed significant changes in PA. other suggestions for increasing the effectiveness of communitywide campaigns include local tax initiatives on products that are contraindicated with increasing PA. One such example is the Action for Healthy Kids (AFHK) program that has established teams in 51 states (Moag Stahlberg. The participants were also found to have higher employment. In contrast. 2004). social support. School-based Physical Education Although school-based physical education curriculum interventions are consistently advocated as one of the most effective contexts for changing PA attitudes and behaviors. and progression in their stage of behavioral change (Neumakr-Sztainer et al. support for PA integration (Yancey et al. 2004). Communitywide campaigns that intentionally target specific high risk samples of the community have been shown to be effective. Although not evidence based. there is surprisingly scant evidence of this strategy being implemented or studied. There were observed differences by organization type suggesting that different types of PA initiatives may need to be offered for different types of workplace contexts. 2004). The New Moves program has been tested in multiple school sites and includes nutritional guidance. and an increase in perceived social support would lead to an additional 35 minutes of weekly PA (Miller. self-image. education. such as soft drinks. A review of the ROCK! Richmond initiative shows that individuals who responded to the recruitment media were mostly African Americans and females with significantly higher BMI’s and a family history of chronic disease. An 8-month follow-up. One physical education program that was identified was the New Moves program which is an obesity prevention program for adolescent girls. 2003a).. but not complete. The active intervention participants made significant gains in healthy diet and PA behaviors.. Interactive weekly group sessions on diet and PA topics and a comparison intervention that focused on global self-esteem were compared in a communitywide campaign targeting African Americans in Memphis (Beech et al. 2003).. In just 12 weeks the participants increased their moderate to vigorous PA by 12%. and daily physical activity across a 16 week curriculum. Another suggestion is to integrate communitywide campaigns into a multidisciplinary collaborative that includes state. fast food.

(b) health related family events on-site. 1999). Other significant positive changes were found in the areas of knowledge and attitudes (Caballero et al. although school administration and lack of family support were perceived as barriers at some intervention sites... No significant decrease was noted in the primary dependent variable (percentage body fat). The intervention is framed by social learning theory and includes four components: (1) change in dietary intake.. However. 2003.. Stone et al. school climate did not show any association with family attendance.. family advisory councils. Teufel et al. 2003. was difficult to implement and did not receive high ratings (Teufel et al. However. and (c) formation of school- based family advisory councils. 2003). school administrators. Intervention participants also reported increases in PA (self-report) and healthy behavior knowledge (Stone et al... body image) and health (body fat.. and teachers). nor were significant changes found in PA levels.. Multiple quantitative and qualitative methods such as in-depth interviews. 2004). 2003. The school climate was also assessed and the school climate score was positively associated with classroom curriculum and student exposure indices. behavioral intentions. The mean score for attitude toward the program was 3. 2003. The 3-year program designed for American Indian youth used a randomized control design with 41 schools (21 intervention and 20 control) and nearly 2. 2003b). The year-end Family Celebration included a healthy meal and student demonstrations of Pathways curriculum activities. Gittelsohn et al.. Stevens et al. Going et al. Pathways has received strong support by all groups of participants. direct observations and accelerometers were used to collect data on a wide range of psychosocial (self-efficacy.. food service. The greatest challenge with the program appears to be increasing parent involvement. PATH is a 12-week health and wellness school-based intervention for adolescents that has been implemented in dozens of . questionnaires. Overall only 45% of the parents participated at grade three and 63% at grades four and five (Steckler et al. At the beginning of the school year a Family Fun Night with learning booths was provided and the year ended with a Family Celebration. (3) a classroom curriculum focused on healthy eating and lifestyle. 2003). 2003. Steckler et al. Healthy food intentions and participation in physically active behaviors increased both in boys and girls (Stevens et al. 2003. but no differences were found in food content knowledge. 1999). 2003. The family (parent) component of the intervention included three components: (a) ‘family packs’ with diet tips and interactive assignments. (2) increase in physical activity. Evaluation data show that the ‘family packs’ and the health related family events were well received.. Davis et al.. percent of calories from fat and saturated fat in school lunches was significantly reduced in the intervention schools as was total energy intake from 24-hour recalls. 2003). PA) variables. Knowledge of health messages increased. 2003). and (4) a family-involvement program. 2003).000 grades 3 to 5 students (and their parents. knowledge.. One of the most visible examples of a non-physical education school-based PA modified curriculum intervention is Pathways (Caballero et al..5 on a 5-point scale (5=very positive). The third strategy. 13 differences between intervention and control participants for most outcome variables (Neumark- Sztainer et al. Another example of a highly successful school-based intervention is the PATH (Physical Activity and Teenage Health) program (Fardy et al. or physical activity implementation (Gittelsohn et al. Evaluation of program delivery shows that teachers trained to provide the Pathways curriculum almost always delivered it as expected (93% of lessons delivered).

2004). 2001). Following a 6-month in-person behavioral obesity treatment program. stress management. and dietary habits (Carels et al. Results have yet to be published on the effectiveness of this program. and smoking avoidance” (Fardy et al.. Interventions that match the counseling strategies to participants’ stage of change for PA have demonstrated positive changes in fat reduction and PA (Steptoe et al. 2003). appropriate diet modification. Yin and colleagues (2005) recently initiated a 3-year after-school program designed to increase PA in elementary school children in 18 schools. PATH includes a workbook designed to help students “establish a personalized wellness program that includes exercise prescription. Greatest changes were found in children with parents who scored in the highest quartile of standardized BMI change. Significant positive changes have consistently been found on measures of self-efficacy. Interventions that include the development of self-control skills have produced significant increases in PA. but generally these interventions suffer from low attendance (Jago & Baranowski. Results are based on hierarchical regression models that examined BMI change independent of factors such as age. 2004). BMI. Students who complete the PATH intervention show significant improvements in health knowledge and behaviors. blood pressure. cognitive restructuring.. Individually Adapted Behavior-change Programs Numerous family-based interventions that involve parents in treatments designed to change PA behaviors and attitudes in their children have been conducted (Berry et al. reduced body weight. Stimulus control and reinforcement interventions also show positive immediate and long- term changes in PA. Non-curricular interventions to increasing PA with youth in schools have also been tested. cardiorespiratory fitness.. both at 6-months and 24-months following treatment (Wrotniak et al. 2002). and dietary habits (Epstein et al. (b) a healthy snack. (b) minimal in-person support.. It is recommended that behavioral counselors use multiple intervention-related strategies such as self- monitoring. controlled studies found that changes in parent standardized BMI scores significantly predicted child standardized BMI score changes. social support. 2004).. and baseline parent and child BMI. and (c) physical activity in a mastery-oriented environment. p. 14 schools in New York State. and in aerobic fitness (Fardy et al. 2004). The type and frequency of social support received during a PA intervention is an important consideration. the group support participants had statistically significant changes in PA and cholesterol reduction (Mello et al. 366). 1998). 2004)... 2004). both at intervention completion and at long-term follow-up intervals (Dallow & Anderson. A study comparing individual versus group support showed that although both strategies were effective. participants were separated into three 12-month maintenance conditions: (a) frequent in-person support. SES. gender. PA. 2004). stimulus control. cholesterol. Internet-based social support has been examined in at least one study (Harvey-Berino et al. 2004. Positive results have been found with theory-based interventions designed to change PA attitudes and behaviors. cardiorespiratory fitness. and (c) .. Although participants had maintained increases in PA at a 1-year follow-up they regained 63% of posttreatment weight loss. fat mass.. This large-scale randomized control study will include three components: (a) academic enrichment. A secondary analysis of randomized. and relapse prevention (Foreyt & Poston.

15 Internet support. 2003). water quality. than control variables like steep terrain. 2001). 2004). Best practices for community design and revitalization will be extremely limited until the proposed research is completed and disseminated. 2004). 2004). This gap between scientific evidence and practical guidelines provided the initiative for the Centers for Disease Control and Prevention to host a special workshop on this topic in May 2002 (Dannenberg et al. transportation. parent history of school transport. but the message is not consistently received across all segments of the population and behavioral change is rare. Although weight loss did not differ significantly among the groups during the obesity treatment phase. Participants from a wide range of community interests such as air pollution. It has also been found that traffic congestion and parent fears for child safety influence active travel to school (Jago & Baranowski. A comprehensive study of a national campaign in England shows a much different trend when data from across the entire population are included. Over 50% of the population recognized the campaign and 30% remembered the healthy lifestyle message (Wardle et al. at least with certain age groups of the population.. and the President’s Challenge reports that 7 million fitness awards were processed in the 2002-2003 school year (USDHHS. 2003). is walking patterns of residents. Recent data from American campaigns do show significant behavioral changes. It was concluded that much more evidence is needed before recommendations can be provided. 2004). There was no difference in awareness between overweight and normal weight individuals.. Low caregiver motivation for PA has also been shown in other studies to be a perceived barrier for PA (Gordon et al. One potential area of study related to access to PA. There is evidence that national outreach campaigns do create awareness. social marketing and architecture contributed to the creation of a research agenda. Based on these results it appears that built environment policies will have limited impact on resident PA patterns unless coupled with interventions designed to change parent attitudes toward PA and healthy lifestyles. Information Outreach Activities There appears to be very limited scientific evidence on the efficacy of information outreach activities. The government’s VERB media campaign targeting youth 9-13 year old claims a 34% increase in physical activity among children aged 9 to 10 years and a 27% increase for girls. the Internet support group participants gained significantly more weight during the maintenance phase Access for Places for PA It appears that few published studies are available to show the impact of environment modifications on PA at the community level. from a community perspective.. A study of children’s walking patterns to and from school shows that the three most statistically significant factors determining this type of PA are parent perception of PA.. on walking and bicycling. and household distance from school (Ziviani et al. but much less so.. One example of research on the built environment is a case study of the San Francisco region using household activity data to examine the relation between urban design and nonmotorized travel (Cervero et al. Results show that built- environment factors were influential. Although no . housing.

and parent-targeted interventions: The Memphis GEMS pilot study. S1-53. gender differences are consistently found on a wide range of dependent variables following interventions. M.. M. A. Ethnicity and Disease. C. (1998). C. 2002). K.. 22. Despite these research limitations. Fulton and colleagues (2004) reviewed PA recommendations provided for the public health community and the clinical community and found inconsistent recommendations. B. D. of all the strategies recommended by the CDC. Kumanyika. Second. McClanahan. McLain. R. M. 2004). In the clinical community the recommendations were seldom explicit and in both contexts recommendations specific to overweight youth were rarely provided. B. Klesges.. 19(5). J. M. Physical Activity Interventions: Best Practices Summary The ultimate goal of PA interventions is to increase actual PA that will be sustained over time.. evidence of long-term maintenance of positive changes PA (and associated diet and health variables) following an intervention is almost nonexistent. Heschel. International Journal of Obesity Related Metabolic Disorders. (2004). Rochon. J. S. Melkus.... B. several trends are evident. Fourth. R. a lifestyle change that will reduce the risk of obesity and related diseases. V. C. individually adapted behavior-change programs appear to have the most empirical support. (2002). despite repeated calls for school- based physical education interventions few published reports are available from studies using this approach. 13(Supplement 1).. Child. 16 differences in awareness were found across socio-economic groups. Researchers must address basic methodological problems such as establishing standard and valid methodologies for measuring PA.. in essence. & Pree. Beech. Murray. less than 1% actually registered to participate in the campaign. Fifth. & Conn. Interventions to promote physical activity among African American women. (2003). as a promising assessment tool for PA intervention research (USDHHS. duration.. D. Fetal undernutrition and obesity in later life. J. parental involvement is critical to realizing positive changes in PA attitudes and behaviors in youth. Perhaps one explanation for the low integration (message recall and behavioral change) of information outreach programs is the format of the message and apparent lack of consistency across health-care professionals. B. Furthermore. K. & Grey. Other research weaknesses that have been identified include lack of participant randomization. Knafl. Although there are many recommendations and highly visible campaigns. there still remains relatively sparse data that can be used to make evidenced-based decisions... G... message recall was significantly lower in low education and ethnic minority populations.. Nunnally. L. Third. Barker. Slawson. Public Health Nursing. R. Sheehan. Berry. First. a belt-worn device that automatically records locomotion. References Banks Wallace. Klesges. and intensity. The CDC recently identified the Physical Activity Monitor. 321-335.. D. and single group designs (Banks Wallace & Conn. Family-based . participant attrition.

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Aguilar. More than 20% of adolescents and 10% of 6. A report from the SOS intervention study. and Peltonen. it has reached epidemic proportions. S.to 12-year-olds are overweight. and Rossner. To identify which factors are considered important for eating habits and weight change in obese participants in a one-year weight reduction programme at a primary health care centre. P.. B. K. J. Recognizing and treating childhood obesity. A. T. is to reduce the prevalence of overweight and obesity in children and adolescents to 5%. The goal of "Healthy People 2010. 400-413. Franco. Unden. A. International Journal of Obesity and Related Metabolism Disorders. Naslund. Gomez. J. J. A. M. Rojas. F. G. medication and related costs are rarely studied. The American Journal for Nurse Practitioners. M. and more than 25% of children are clinically obese. Treating obesity: a qualitative evaluation of a lifestyle intervention for weight reduction. Sepulveda. 569-574. Long-term effects of weight loss on pharmaceutical costs in obese subjects.. population- based study. G. American Journal of Medicine. the associations between weight reduction. K.. making it the most prevalent nutritional disease in US children. (2003). L.. 35(3).. Prevalence and characteristics of early-onset type 2 diabetes in Mexico. S. Valles. J...3% in 2000. 23 Research Compendium Abdel-Hamid. A. T. Rios. Demonstrate the utility of System Dynamics computer modeling to study and gain insight into the impacts of physical activity and diet on weight gain and loss. R... Sjostrom. Narbro." a national health promotion and disease prevention initiative. the proportion of overweight/obese children in the United States has increased from 4% in 1974 to 15. in fact. This study investigates the long-term effects of weight change on medication for diabetes and cardiovascular disease (CVD) in severely obese subjects. (2002).. Exercise and Diet in Obesity Treatment: An Integrative System Dynamics Perspective. Although intentional weight reduction improves obesity-related comorbidities. Olaiz. 35-38. Over the past three decades. 244-258.. V.. and Rull. E. (2004). 8(9). To investigate the prevalence and characteristics of patients with type 2 diabetes diagnosed before the age of 40 years (early-onset disease) in a nationwide. 113(7).. Garcia. C. Medicine and Science in Sports and Exercise. Abraham. A. Childhood obesity is a major public health problem that is getting worse every year. Journal of health Education.. Carlson. . I. 184-192. Agren.. 31-32. (2002). Adolfsson. 61(3). (2002). K..

Lipids. 26(6). among Black adolescent girls: genetic. Touger Decker. B. (2003). This article clarifies common misconceptions about the role of the environment and the potential for behavioral intervention. B. Alfano. B. Obesity. Knowledge of genetic influences on human obesity has dramatically advanced in recent years. However. The purpose of this study was to investigate whether a history of youth sport participation was related to adult obesity.. and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III [ATP III]) of North America. what doesn't work. 30(3). (2002). A survey of obesity management practices of pediatricians in New Jersey. African American adolescent girls are discussed. J.. consequences and prevention of obesity among a subgroup of American population. Mohammed. B. 18(1). 3-12. (2000). and Weber. Genetic. Alleyne. A. Treatment and prevention of obesity: What works.. and dietary intake among women. C.. data that documents the critical role of genetic factors have also provided some of the strongest support for the importance of the environment. psychosocial. J. A.. O'Sullivan Maillet. 34(1). 18-21. and LaPoint. 82-90. and Faith. H... Allen. M. Nutrition Today.. 1781-1885. Beech. Point/counterpoint. S. M. Topics in Clinical Nutrition. and Jousilahti. psychosocial and cultural factors that may influence susceptibility to obesity. R.. 38(2). Q. B. R. Organized sport participation in youth is a common form of physical activity. C. 344-365. P.. and cultural influences. (2003). Genetic and environmental influences on human body weight: implications for the behavior therapist. Data suggest that clinicians have some ability to . 24 Al Lawati. V. I. physical activity. Preventive Medicine. Allison. Prevalence of the metabolic syndrome among Omani adults. M. History of sport participation in relation to obesity and related health behaviors in women. and Holland. The purpose of this study was to examine obesity management practices and variables influencing those practices of members of the New Jersey Chapter of the American Academy of Pediatrics (n = 1246). Allison. D. To estimate the prevalence of the metabolic syndrome by age and sex in the Omani population as defined by the third report of the National Cholesterol Education Program Expert Panel on Detection. (2003). Al Hinai.. Evaluation. The causes. little is known about how it is associated with adult obesity and related health behaviors. Murray. M. Journal of Black Psychology. T. Diabetes Care.. M. 35(1). D. We provide a very broad conceptual overview of some of the issues involved in the treatment and prevention of obesity. D. and preventive strategies are highlighted. M. and what might work.. S. 147-155. yet. J. Klesges. (2004). and McClanahan. S.

This suggests that we should seek treatments that maximize the proportion of weight lost as fat. intervention would ideally target all these factors. [3] Economic aspects of obesity: a managed care. A second issue concerns the composition of weight lost. Canada. though important in influencing one's degree of adiposity. D. Although insulin resistance plays a critical role in the pathogenesis of type 2 diabetes-related cardiovascular disease. Type 2 diabetes and associated cardiovascular disease have reached global epidemic proportions. and microalbuminuria. the genetic influences on body mass index at any one time do tend to carry over to later times. American Journal of Clinical Nutrition. Andersen. The therapeutic potential of conjugated linoleic acid against insulin resistance-associated cardiovascular disease is discussed on the basis of the reported effects of conjugated linoleic acid on individual components of the metabolic syndrome. Thus. (2003). I. these other components of the metabolic syndrome confer additive risk. fat loss has been associated with a decreased MR. The Multiple Risk Factor Intervention Trial showed that. Part II - . reduced HDL cholesterol. March 13-15. central obesity.. weight loss has been associated with an increased mortality rate (MR) whereas. (2004). Conjugated linoleic acid could represent a candidate agent. We need both to increase the efficacy of our treatments dramatically and help patients adjust their expectations so that they can take satisfaction in smaller weight losses. According to the World Health Organization definition. to effectively address cardiovascular disease in persons with diabetes. R. has largely transient effects that do not tend to carry over from one time to substantially later times. assessment. In contrast. IL: Human Kinetics. Champaign. and Anderson. other related risk factors often cluster in a single patient. we will see incremental advances in the treatment and prevention of obesity. This information influences the types of approaches that are and are not likely to be successful in terms of preventing obesity or reducing obesity on a population level. with continued efforts at enhancing treatments. The environment. V. 79(6S). Obesity: Etiology. Aminot Gilchrist. Perhaps. Third. Conditional on fat loss. this constellation of risk factors includes hypertension. D. 2003. the efficacy of current treatments is far below patients' expectations and desires. The Role of Conjugated Linoleic Acid in Human Health: proceedings of a workshop held in Winnipeg. [4] Genetic influences on obesity. 1159S-63S. Insulin resistance-associated cardiovascular disease: potential benefits of conjugated linoleic acid. H. the combination of insulin resistance and these risk factors is known as the metabolic syndrome. CONTENTS: Part I . and prevention. treatment. 25 promote positive changes with obesity treatment.Etiology of obesity: [1] Prevalence of overweight and obesity in the United States. conditional upon weight loss. [2] Psychosocial correlates and consequences of obesity. Recent data from the World Health Organization Multinational Study of Vascular Disease in Diabetes indicate that cardiovascular disease is the leading cause of mortality (52% of deaths) in individuals with type 2 diabetes. elevated plasma triacylglycerol. although diabetes or insulin resistance is an independent risk factor for cardiovascular disease mortality.

There are many indications that obesity levels within each of the UK countries are following a North American trend where there has been an increase in obesity from 14. (2004). A.0 . Understanding the barriers to activity that overweight people face--such as fear or embarrassment--can help physicians prescribe appropriate exercise routines. [14] Physical activity as a therapeutic modality. [13] Physical activity treatment. All rights reserved. [12] Medical nutrition therapy application. Physician and Sports Medicine. [18] Future directions in treating obesity. Andersen. D. Shared lives-an opportunity for obesity prevention? Appetite. dietary intake and body weight around three months prior to cohabitation and again about three months after the moving-in date. R. (2004). an active lifestyle. (1999). Body weight increased significantly in women (58. 44. [17] Medication for weight. [7] Clinical evaluation of the obese patient.8 +/. [16] Physical activity promotion as a public health strategy for obesity prevention. This life stage may be a missed opportunity for obesity prevention initiatives. 41-42. [15] Helping individuals reduce sedentary behavior. and obesity: making the exercise prescription work. (see record 2004-17060-005) demonstrate that satiety levels influence portion weight recall and illustrate this point well with respect to chips. . S. [9] Assessment of physical activity and energy expenditure. Anderson.7.7 +/. 43(3).5 kg). Index. Recent data suggest that accumulating several short bouts of moderate to vigorous activity each day may improve adherence to the program. E. W. Marshall. Changes after cohabitation included an increase in shared meal occasions..7. Beasley et al.9 kg) and in men (76. An active lifestyle can play an important role in helping overweight patients both lose and manage their weight.5 to 30.9% in the population between 1971 and 2000. [11] Treating and preventing pediatric obesity. increased likelihood of including alcohol at meal times and social support for dietary temptations (and restrictions).12. there are a number of factors that will impact on recall. Journal of Human Nutrition and Dietetics. Exercise. Food intake and obesity . S. Copyright 2004 Elsevier Ltd. 181-182. A longitudinal design was used to survey individual members of 22 couples about food choices. 27(10). [6] Body composition assessment in the obese. which may ultimately help them with better weight management..59. J. About the editor. 327-329.Treatment and prevention: [10] The importance of body weight maintenance in successful aging. Clearly. E.12. 26 Assessment of the obese patient: [5] Health-related quality of life in obese individuals. 47-48. It is clear that on both sides of the Atlantic that food consumption data will be less than perfect because it is self reported and subject to recall bias. and Lea.3 +/.the hidden details.1 . The traditional exercise prescription of regular bouts of continuous vigorous exercise may need to be modified to increase rates of adoption and compliance.4 +/. Anderson. 17(3). Part II .78. A. [8] Dietary intake: recording and analyzing.

C. Journal of Clinical Psychopharmacology. Associations between central obesity and indexes of hemostatic. (2002). S. as measured by a temperament questionnaire. Long-term weight-loss maintenance: a meta-analysis of US studies. 28(2). Jr. Central obesity was measured as either waist circumference or waist/hip ratio. Anderson. 74(5).3 kg/msuperscript 2 for a period of 96 weeks. lipid and glucose metabolism both at baseline and after 1 year of diet and exercise intervention were examined in 209 sedentary middle-aged men and women with increased coronary risk factor levels. G.. body composition. I. Konz. L..5 and 38. R.. and Szegedi. 22(5). 8(2). 39(1). nonresting energy expenditure. C.. Anghelescu. (2001). and physical activity in girls. Current perception is that participants of a structured weight-loss program regain all of their weight loss within 5 y. and Hjermann. Bandini. In this observational study. A. E. The association of activity temperament with nonresting energy expenditure in girls with low and high levels of physical activity was evaluated. A. Holme. S. The objective was to examine the long-term weight-loss maintenance of individuals completing a structured weight-loss program. 109-115. I. The patients showed restrained and unrestrained eating patterns according to a German version of the Three-Factor Eating . C. American Journal of Clinical Nutrition. C.. (1998)... Ann Pharmacother. Anderssen. Pharmacologic prevention or delay of type 2 diabetes mellitus. and Must. Body composition was estimated by total body water. 300-306. The relationships of central obesity and physical fitness to indexes of hemostatic.6 years and an initial body mass index between 34. contributes to nonresting energy expenditure and body composition in girls. (2004).. The aim of this study is to assess the extent that predilection for movement.. I. 579- 84. D. 102-9. Urdal. carbohydrate and lipid metabolism: results of a 1-year intervention from the Oslo Diet and Exercise Study. Dietz. P. Relationship between temperament. Maximal oxygen uptake was used as a measure of physical fitness. Frederich. To evaluate the current data on pharmacologic interventions intended to prevent or delay the onset of type 2 diabetes mellitus. E. International Journal of Obesity and Related Metabolism Disorders. Klawe. and Wood. W. H. C. Anderson. 521-524. a new drug treatment regimen was evaluated in 5 obese patients with a mean age of 39. Add-on combination and maintenance treatment: Case series of five obese patients with different eating behavior. W. Scandinavian Journal of Medicine and Science in Sports.. Baseline data for 196 premenarcheal non-obese girls aged 8-12 y were obtained from a longitudinal study of growth and development. L. (2005). 27 Anderson... J. A.

Respondents were asked to rate how useful and how feasible they felt each of the listed actions would be for the prevention of obesity in their home countries. A questionnaire listing 20 public health strategies was mailed to pre-registrants of an international obesity prevention symposium. J. 629-652. 28 Questionnaire and were treated in an add-on regimen with the combination of three drugs with different anorectic properties that were consecutively introduced in an interval of 16 weeks. M. J. Antipatis. The etiology of obesity is complex and includes a host of genetic influences in addition to overconsumption of energy and a sedentary lifestyle. (2004). In addition. clinical studies have demonstrated that a modest weight loss of 5% to 10% can produce significant decreases in comorbidities. P. The prevalence of obesity in the United States has been increasing since the 1980s and has become a public health concern.. (2001). Obesity is strongly associated with several chronic diseases.. . Armstrong. exercise therapy.. The medical management of obesity and the role of pharmacotherapy: an update. 5-12. and Duhme. Appolinario. they have been used by clinicians as a therapeutic tool in daily clinical practice. W.. C.. there are few anti-obesity agents available on the market. S. for the potential use of these agents in obesity treatment. Jeffery. The effect of commercial thermogenic weight loss supplement on body composition and energy expenditure in obese adults. such as cardiovascular disease and diabetes. Apovian. 28-32. Although psychotropic agents are not approved for the treatment of obesity. Confidence of health professionals in public health approaches to obesity prevention. Obesity is a chronic and highly prevalent medical condition associated with increased risk for the development of numerous and sometimes fatal diseases. Despite its severity. 23(9).. Psychotropic drugs in the treatment of obesity: what promise? CNS Drugs. Morabia. and Coutinho. S. This articles summarizes the current medical approach to the treatment of obesity and includes strategies for diet modification. 18(10). Nutrition in Clinical Practice. and thus accounts for significant morbidity and mortality. Kumanyika. The previous failures of short-term therapy for obesity have led experts to recognize that obesity is a chronic disease that should be treated with long-term programs to ensure the best chance for maintenance of weight loss. (2000). (1999). C. A. Bueno. W. 1004-1006. J. R. The purpose of this article is to review the rationale. 15(1). K. and lifestyle change. J. and Ritenbaugh. Journal of Exercise Physiology.Evidence for the efficacy of psychotropic agents in obesity treatment comes from different sources.. R.. C. International Journal of Obesity. W. To assess the views of professionals working in the obesity field on the potential usefulness and feasibility of implementing different types of public health prevention strategies. 4(2). Johnson. as well as the evidence. V.

making greater weight losses possible. hypertension. L. e. Diet. 115. Obesity Surgery. J. bitter orange and guarana on resting energy expenditure (REE). Recognition by the American Heart Association that obesity is a major modifiable risk factor for coronary heart disease has prompted health providers to take a more active role in obesity management. (2004). We now recognize that obesity is itself a chronic disease with a complex etiology. medication and surgery should be considered for appropriate patients. gastric stimulation should work best when combined with other treatments such as diet. have shown that once adipose tissue accumulates. 14(1). Progress in Cardiovascular Nursing. J. and behavior modification with antiobesity agents suffered a setback when fenfluramine and dextenfluramine were withdrawn from the market because of an association between these medications and valvular regurgitation. it is treatable with a similar chronic disease treatment model. The Food and Drug Administration has recently approved sibutramine (Meridia). a norepinephrine and serotonin reuptake inhibitor that was originally developed as an antidepressant. exercise. This counter-regulatory mechanism. causes changes in appetite and metabolism that limit the amount of weight lost with every obesity intervention. Obesity has long been considered a behavioral disorder. but which has also been shown to reduce weight. 23-28. however. 29 The purpose was to determine the effects of an herbal preparation containing ma huang. a system of overlapping neuroendocrine systems actively resists weight loss. including surgery. (1998). which has evolved as protection against starvation.. and behavior modification still compose the gold standard of treatment. 98-106. The medical model of obesity treatment-combining diet. exercise. Treating obesity: a new target for prevention of coronary heart disease. Journal of the American Dietetic Association. exercise. many patients can achieve realistic weight goals that can be maintained over the long term. Modern medical management of obesity: the role of pharmaceutical intervention. and body composition in obese adults. L. Recent breakthroughs in our understanding of body weight regulation. 16(3). blood chemistries. Aronne. improving a roster of risk factors. Thus. and behavioral change. . L. type II diabetes. gastric stimulation appears to play a role in suppressing the compensatory mechanisms of the gut. At this point. Aronne. Aronne. Relatively modest weight loss confers disproportionate health benefits. J. (2001). Future therapies for obesity will focus on neutralizing the counter-regulatory mechanisms in a coordinated manner. like diabetes and hypertension. S23-S26. Gastric pacing is not enough: additional measures for an effective obesity treatment program. Obesity has long been known to accompany a host of chronic diseases. and dyslipidemia.g. With current techniques. If these measures fail.

(2003). The risk factors were considered in reference to individuals who needed to change a particular risk factor behavior. Experimental drugs or drugs not currently approved. K. Centrally active adrenergic agents. M.. 12(4). The purpose of this study was to determine if gender differences exist in attempts to change cardiovascular disease (CVD) risk factor behaviors. 58(S9-S12.. and overweight. Guy-Grand. R. proceedings of the Kellogg's Nutrition Symposium 2000. Topiramate: Long-Term Maintenance of Weight Loss Induced by a Low- Calorie Diet in Obese Subjects. is an independent risk factor for weight gain and obesity. Sun. and Carleton. particularly in sedentary individuals with a genetic predisposition to obesity. Categories of obesity drugs and biochemical mechanisms of action. The use of drug therapy in obesity is reviewed under the headings: Physiological mechanisms of action of obesity drugs.. A. Lapane.. and these complications may account for five to ten per cent of all health costs. 17. 321-330. Astrup.the importance of carbohydrates. Dietary strategies for weight management -. specifically cigarette smoking. Reduction of energy intake. X. Journal of Women's Health. B. D. A.. Skipping breakfast may further increase the risk of obesity. (2001). Theory of altered defense of body weight. E. 1658-1669. A. Suppl 1). Atkinson. 383-403. Australian Journal of Nutrition and Dietetics... There is robust evidence to support the view that a diet which is low in carbohydrates and high in fat is energy dense and. 8 August 2000. Obesity is followed by serious co-morbidities such as type 2 diabetes. cardiovascular disease.. and Fitchet. Annual Review of Nutrition.. (2004). Evangelou. E. thermogenic agents. I. L. Furthermore. Gene products. Coccio. Zelissen. (1997). 12(10). Carruba. M. The prevalence of obesity is increasing rapidly in all age groups globally and is one of the fastest growing epidemics. Levy. and reduced life expectancy. R. Centrally active serotonergic agents. Astrup. CNS neurotransmitter agonists and antagonists.. A diet with a higher fat content seems to be better tolerated without weight gain by physically active individuals than by sedentary people. . To examine the safety and efficacy of topiramate (TPM) for maintaining weight following a low-calorie diet. now affecting 4 to 8% of children and 10 to 20% of adults. Gut peptides. B. P. Parker. Increase in energy expenditure.. sedentary lifestyle. Use of drugs in the treatment of obesity. L. Does the Y Chromosome make a difference? Gender differences in attempts to change cardiovascular disease risk factors. Sydney. and if the success of these attempted behavior changes also differs by gender in the Pawtucket Heart Health Program (PHHP).. 30 Assaf. R. Caterson. together with physical inactivity. certain cancers. so that the obesity promoting effect of a high fat diet is enhanced in susceptible subjects. interactions between dietary fat and physical fitness determine fat balance. Obesity Research. A.

. E. About 80 million Americans are obese. Guidelines for the initiation of obesity treatment. 31 Practical aspects of integrating drugs into obesity treatment. Cochran. the presence of complications.. (2005). A BMI of "> or =" 35 produces a high risk from obesity and of "> or =" 40 produces a severe risk.. Journal of Pediatrics. interleukin-6 (IL-6). etc. Despite this. Strauss. Yarandi. molecular biology and medical conditions associated with overweight. Roberts. Klish. Who should be treated with obesity drugs? How should obesity drugs be used? Studies with single drugs. Journal of Nutrition. L. Atkinson. Concerns about drug treatment of obesity.4% of adults and about 20% to 25% of children. there are few preventive and therapeutic strategies of proven effectiveness available to public health and clinical practitioners. Balagopal. and fibrinogen. . Changes in the central nervous system. The primary goals were to understand the relationship among the inflammatory factors. behavioral.. sleep apnea. George.. Primary pulmonary hypertension. (2005). Fuchs. L.. S.. and Gidding.. N. and Udall. Baker. S. J. The definition of obesity has not been standard. but there is an urgent need to intervene even before comprehensive solutions are fully established. 533-43. Obesity is epidemic in America. Recently. exercise. Obesity produces morbidity and mortality: there are 300.. R. 342-8. Bayne. W. Studies with drug combinations.. Tershakovec. 40(5). W. The presence of complications of obesity (hypertension. and on the primary prevention of overweight in children and adolescents. and indices of obesity in normoglycemic. A... Childhood overweight and obesity are major health problems with immediate and long- term consequences of staggering magnitude. 546-552. Journal of Pediatric Gastroenterol Nutrition. S. and the absence of exclusions. diabetes. the Word Health Organization defined overweight as a body mass index (BMI = kg/m2) of 25 and obesity as a BMI of "> or =" 30. Accruing such evidence is currently and appropriately a health policy priority. D. G. on dietary.. N. W. Krebs. Treatments of obesity depend on the severity of obesity. and Integration of obesity drugs into a comprehensive obesity treatment programme.. R. Patton. Lifestyle-only intervention attenuates the inflammatory state associated with obesity: a randomized controlled study in adolescents.) increases the risk. pharmacological and surgical treatments. 146(3).000 obesity-related deaths annually in America. Barlow. dyslipidemia. Overweight children and adolescents: a clinical report of the north american society for pediatric gastroenterology. P. The aim of this Clinical Report on Overweight Children and Adolescents is to present information on current understanding of pathogenesis and treatment of overweight and obesity. (1998). C-reactive protein (CRP). hepatology and nutrition. 33. H. insulin-resistant adolescents and to investigate the impact of a lifestyle- only intervention on these nontraditional risk factors for cardiovascular disease (CVD). We report on the epidemiology.

coordinated efforts at all levels (family. Strategies to design and deliver culturally appropriate interventions are reviewed. D.. 102-116. Specifically. 28(1).. are provided. Canadian Journal of Applied Physiology. Advances in Nursing Science. and Conn. risk factors for cardiovascular diseases (CVD) and type 2 diabetes are known to develop early in life and tend to emerge in clusters among overweight youngsters. Interventions to promote physical activity among African American women. J. cut-offs. This review examined the intervention research literature testing strategies to increase activity among African American women. 117-140. significant attrition. G. 27(2).. J. Enyart. and questionable timing of outcome variable measurement. settings. This article examines the effectiveness of preintervention meetings as well as interactions between African American research team . Diverse interventions. Eighteen studies with 1. 32 Ball. all contribute to increased risk. and McCargar. physical inactivity). V. J.. Childhood obesity in Canada: a review of prevalence estimates and risk factors for cardiovascular diseases and type 2 diabetes. instruments without documented validity and reliability. The lack of routine physical activity among African American women places them at risk for negative health outcomes associated with inactivity. and a centralized body fat distribution. 19(5). such as examining intragroup differences and communal resources. A number of risk factors and health consequences have been associated with increased levels of body fatness in youth. (2003). Suggestions for future research. (2002). (2004). Recruitment and entrance of participants into a physical activity intervention for hypertensive African American women. Unhealthy lifestyle behaviours (i. In order to prevent future generations of children from experiencing increased morbidity and mortality as overweight and obese adults. Common methodologic weaknesses included lack of randomization of subjects. and government) must be established with a long-term commitment to promote healthy nutrition and physical activity behaviours in our youth. C. The number of studies focused on African American women has increased dramatically in the past decade. Banks Wallace. single-group design. Banks Wallace. and Johnson. and measures were reported. and reference populations. C. a genetic disposition. Childhood obesity in Canada has become increasingly prevalent over the past 2 decades. Decreasing health disparities between White Americans and racial/ethnic minority populations is a public health priority.. 321-335. Despite inconsistencies regarding different anthropometric indicators. both regional and national investigations have revealed high numbers of overweight and obese children and adolescents.623 subjects were retrieved. school. L.e. An ongoing inability to attract sufficient numbers of African Americans and other people of color to participate in research studies is a major barrier to accomplishing this goal. J. Public Health Nursing. community. Participation of racial/ethnic minorities in intervention studies is especially critical to the development of appropriate strategies to promote health among these populations.

independent of age. Obesity is a global problem. enhanced physical activity is a cornerstone in a multidisciplinary approach to preventing and treating juvenile obesity. like watching TV. The pathophysiology of obesity. Cutting down on sedentary behaviors. Bar Or. and lifestyle changes: cornerstones for prevention and management. The first goal of management of the obese patient will involve dietary and behavioural modification and a programme of physical exercise. Juvenile obesity. Obesity. Banning. Banning. nurses are suitably placed to assess and manage obese patients (National Institute for Clinical Excellence (NICE). 2001a). This is contributing to the risk of inherent comorbidity. The management of obesity: the role of the specialist nurse. . but as yet no one genetic mutation is felt to be entirely responsible. O. Obesity is a global problem. The nursing profession needs to rise to the challenge and prepare nurses for a specialist role in obesity management. M. but a low level of physical activity has not yet been proven as a cause of obesity. Biochemical manifestations such as diabetes may play a role. 2001a). For example. The nursing profession needs to rise to the challenge and prepare nurses for a specialist role in obesity management. can reap long-term benefits. is still unclear with suggestions that multiple genetic mutations may have a key role in the development. 14(3). The management of obesity: the role of the specialist nurse. nurses are suitably placed to assess and manage obese patients (National Institute for Clinical Excellence (NICE). M. The numbers of obese individuals are now. In primary care settings. 51-52. Obese children and youth are often more sedentary than their nonobese peers. 33 members and potential participants as recruitment strategies.reaching epidemic proportions around the world. Biochemical manifestations such as diabetes may play a role. British Journal of Nursing. The first goal of management of the obese patient will involve dietary and behavioural modification and a programme of physical exercise. Intersections between recruitment and health promotion are also addressed. (2005). although widely debated. patients may do best with aquatic exercise and in groups of obese peers. but as yet no one genetic mutation is felt to be entirely responsible. (2000). (2005). 139-44. 28(11). although widely debated. The pathophysiology of obesity. Giving exercise recommendations focused for obese youth is crucial. is still unclear with suggestions that multiple genetic mutations may have a key role in the development. independent of age. In primary care settings. Physician and Sports Medicine. 139-144. This is contributing to the risk of inherent comorbidity. British Journal of Nursing. Nevertheless. the recent rapid increase in juvenile obesity poses a major public health challenge. 14(3). The numbers of obese individuals are now reaching epidemic proportions around the world. physical activity. Because many obese children and adolescents become obese adults.

D. S1-S13. Bouchard. Salbe. Physical activity. Reviewed the literature on school-based obesity prevention programs to identify what can be done to minimize the increasing levels of obesity. 1-6. It is intriguing that the increase in prevalence has been occurring while overall fat consumption has been declining. St. Reviews the dramatic surge in prevalence of children and adolescent obesity in many developed and underdeveloped countries. Brownell.. Jeor. W. S.e. Medicine and Science in Sports and Exercise. Low reliability of measurement (i. T. W.. Nicklas. L. T. Bar Or.. The juvenile obesity epidemic: is physical activity relevant? Sports Science Exchange. D. Measurement enables intervention scientists to determine whether their interventions had the intended outcome effects and the expected pathways of effects across mediating variables.. 486-493. American Journal of Health Behavior. K.. M. Preventive Medicine. and inactivity reduction was promoted. Body mass and composition are influenced by genetic factors. School- based obesity prevention: A blueprint for taming the epidemic. and nutritional considerations in childhood weight management. E. J. including treatment effects. K... (2002). W. Schwenger... 16(2). and Himes. 2-10. a dramatic increase of over 20% in the past decade... Foreyt. There has been little assessment of the quality of measurement in obesity prevention trials. Almost one-quarter of US children are now obese. A. 26(6). H. mediators. An 8-step research strategy was delineated to develop and evaluate programs with a maximum chance of taming the obesity epidemic. Discusses juvenile obesity which is a serious.. intervention targeted middle or high schools. but the actual heritability of juvenile obesity is not known. substantial random error) attenuates the relationships of these measures to other variables. and Baranowski. D. Baranowski. genetic.. Thompson. Dietz. when in truth they were.. (1998). 30(1). H. J.. and Torun. O. 20 articles reporting school-based dietary or physical activity change programs were identified that used BMI or skinfolds as part of the evaluation. Cullen. the reduction in time spent in physical activity and the increase in sedentary pursuits such as television viewing and computer games are likely contributing factors. K. (2004).. Baranowski. S. C. Although the causes of this epidemic are not clear. increasingly prevalent problem in technologically developed societies. Klesges. . Ravussin. This attenuation may indicate that interventions were not effective.. J. T. (2003). Seven studies obtained change in BMI and differed from those not finding change in 3 ways: Program implementers were not classroom teachers. Cullen. Measurement of outcomes. 38(Supp). O. B. and moderators on behavioral obesity prevention research. 34 Bar Or.

H. M. The first part concentrates on the pathology and treatment of the overweight or obese individual. B.. Troiano. F. Inverse association between body mass and frequency of milk consumption in children. Family Practice Recertification. This study examined the effect of two intensities of physical training on leptin in obese teenagers. Russo. 28(3). BMI can be used to reassure a teenager whose weight is within the normal range and to educate an overweight patient about obesity. C.. (2002). and explored correlates at baseline and in response to 8 months of physical training. T. S. 35 Barba... Barnes. Waitz. Little is known about the effects of different intensities of physical training on plasma leptin. Barlow. E. Treatment of child and adolescent obesity: reports from pediatricians. Kottenhahn.. J. J. A secondary aim was to examine the association of certain provider characteristics with recommended evaluation practices. L. A. 64-65.. Gutin. M. Cannady. (2003). L.. Influence of physical training on plasma leptin in obese youths. J. and Dietz. Useful tools for evaluation are body mass index (BMI) and growth charts. Recent studies have shown an inverse association between the level of dietary Ca. This 2-part column focuses on exercise recommendations and considerations for overweight and obese individuals.. The primary aim of this study was to identify interventions used by pediatric health care providers in treatment of overweight children and adolescents to identify provider educational needs... Barbeau. Canadian Journal of Applied Physiology. Robinson. M. T. there is. W. A. Using BMI to monitor and treat adolescent obesity. and Pujol. Such identification allows for early intervention. Litaker.. pediatric nurse practitioners. E. Klish. Strength and Conditioning Journal. Overweight and Obese Adults: Pathology and Treatment. Allison.. Venezia. Lemmon. G. K. 93(1). Elder. 15-9. (2004). T. Pediatrics... Trowbridge. P. A persistently elevated BMI should trigger screening for related morbidities. L. and Owens. Primary care physicians play a pivotal role in the identification of overweight and obese adolescents and prevention of subsequent health problems. and Siani. III. P. S. a paucity of data regarding this relationship in children. and registered dietitians. C.. particularly from dairy sources. 110(1). 29- 37. G. L. S. W. Barkley. 382-396. and Datto. (2003).. 25(1). W. and body weight in adults. British Journal of Nutrition.. R. K. 26(3).. L... 229-236. (2005). J. We therefore investigated this issue in 1087 children who underwent body weight and height measurement during a survey on childhood obesity. . Ramsey. E.. however. R. A. C.

Physician and Sports Medicine. Georgia. A. Type 2 diabetes and cardiovascular disease. the present level of interaction between professionals in the two areas is limited. Primary care physicians may feel ill-equipped to counsel patients about practical methods for weight loss. In part one of a four-part series. S. 31(11). Describes the APEX (Adiposity Prevention through Exercise) in Black Girls Project which the National Institutes of Health implemented in Richmond County. Nursing Times. Using exercise as preventive medicine. GAHPERD Journal. part one. (2001). and are viewed by the public as closely related and synergistic. (2003). Overcoming the barriers to a frank discussion of weight and using available resources for weight management can make a healthy difference for overweight and obese patients. osteoporosis and obesity as examples of chronic conditions that affect the health and well-being of Canadians. 62(3). Anthony Barnett shows how managing risk factors can reduce mortality and cardiovascular events. Both nutrition and physical activity have important roles in health promotion and disease prevention. 29-36. However. S. (2001). and behavior change. J. and could be described as a "casual acquaintance. 134-139. Bartlett. Canadian Journal of Dietetic Practice and Research. The long-term complications of type 2 diabetes. 33-35. 97(5). K. The tools physicians need for tailoring therapy are a range of options that address exercise. 35(3). reasons why the level of interaction between nutrition and exercise professionals must move to a "lifelong partnership" are discussed. diet." Using heart disease. . are of great concern. 36 Barnett. Motivating patients toward weight loss: practical strategies for addressing overweight and obesity. particularly cardiovascular disease. even though the benefits of maintaining a healthy weight are well known. 1. Nutrition and physical activity: why we must move from a casual acquaintance to a lifelong partnership. I. Barr. (2002). Barry.

eating. this review explores whether increases in physical activity in later life can reduce the risk of developing certain chronic diseases. Barton. (2000). 22.. Eating disorders and obesity are rising in prevalence and are problems of considerable public health significance. 8(1). and for ameliorating symptoms. 313-319. and Brownell. 37 Bartlett. J.. 17-31. B. Lambert. Shifting from a medical to a public health model argues for increased focus on both prevention and public policy. J. and whether exercise has any ameliorating role once these diseases are established. L. and appearance and whether these cognitions change over the course of a residential weight loss camp. 25-28. P. obesity. . G. falls. Even less is known about policy. 12(2). cancer risk.. E. The effects of exercise on the immune system. 755-765. K. Pediatric obesity: use a team approach. The benefits of exercise for the health of older people. and clinician participate. Presents evidence that physical activity can contribute to health and wellbeing in old age. A. Specifically. or disease-specific mortality. Addictive Behaviors. L. Gately. Cognitive change in obese adolescents losing weight. N. skeletal and respiratory diseases. Bassey. Confronting a rising tide of eating disorders and obesity: Treatment vs prevention and policy. Obesity Research. and New.. T. Reviews in Clinical Gerontology. D. (2005). and Hill. (1996). M. Battle. and levels of physical activity are enhanced. but recommendations are made to alter policy so that consumption of healthful foods increases. osteoporosis. The authors conclude that active lifestyles reduce disease incidence. 31. In addition.. family. consumption of unhealthful foods decreases. with a long time-course that allows for adequate statistical power. With excess weight in children reaching epidemic levels. and psychological health and cognitive function are discussed. the better. To investigate how obese adolescents think about themselves in terms of exercise. Most of the evidence reviewed rests on large prospective epidemiological studies of disease incidence. (2004).. E.. and osteoarthritis are outlined. Clinical Advisor. Research on prevention is in its early stages but must be aggressively pursued. 10(1). the benefits of exercise for patients who suffer from stroke. diabetes. S. Walker. R. the earlier the active lifestyles are established. 21(6). Particular attention is given to cardiovascular. treatment will be successful only if the patient. Lancaster. but increasing activity levels even late in life is also beneficial for reducing morbidity and mortality. metabolic. Prevailing treatments have a limited impact on public health because the disorders do not yield easily to intervention and because the treatments are costly and available to few.

C. in a group of Spanish subjects. R. has increased considerably over the past few years and has become a serious public health problem. We reviewed the different strategies employed. and the degree of effectiveness. Deeks.8-76. A single-centered. Doreste. K. and Serra Majem. schools and community.. and Brownell.1) seeking help to lose weight at a specialist obesity clinic. it seems that nutritional education and promotion of physical activity together with behaviour modifications. C. the different criteria used in defining weight status. Once established. 19(7). J. (2004). Maternal perceptions of overweight preschool children.. hence. 21(6). Montoya Alonso. The differences in design. K. its treatment is very difficult and. L. S. 755-765. (2000). 106(6). I.. bulimia and binge eating disorder.. Variables predictive of adherence to diet and physical activity recommendations in the treatment of obesity and overweight. duration and outcome assessments make direct comparison difficult. Data were obtained on 1018 overweight subjects (788 women. Nevertheless.. Confronting a rising tide of eating disorders and obesity: treatment vs. 38 Battle. J. and Whitaker. 1380-1386. Powers. . Treatment and prevention of <i>anorexia nervosa</i>. In our review. Childhood obesity is a major public health problem.7 (range 25. prevention of childhood obesity using different types of intervention appears promising. E.. The prevalence of childhood obesity.4) and body mass index (BMI) of 31. prospective study conducted over 4 y. Pediatrics. To assess the factors that could predict a successful completion of a weight loss program. Effectiveness of Interventions in the Prevention of Childhood Obesity. and obesity are reviewed. prevention and policy. M. A program involving a hypocaloric. Bautista Castano. A. W.. decrease in sedentary activities and the collaboration of the family could be the determining factors in the prevention of childhood obesity. Bautista Castano. 28(5). 617-622. 230 men) aged 14.. 697-705. International Journal of Obesity. Molina Cabrillana. L. A. Mediterranean diet was prescribed plus recommendations for free-time exercise and day-to-day activity. Chamberlin. Baughcum. and directed towards the prevention of childhood obesity.. (1996). as well.Benefits other than reduced weight gain were assessed. as with that of adulthood. Addictive Behaviors. (2004). A.. Factors for consideration in developing a public policy to combat the problem of appetite disorders are also discussed. I. E. European Journal of Epidemiology.3 y (mean 38. J. cross-sectional.03-57. D. The objective of this present report is to review interventions that had been conducted over the past 11 years in the environment of the family. we selected 14 intervention studies. L. and Serra Majem. and prevention efforts should begin early in life and involve parents. the evaluation and follow-up methods.

. C. With the current high-technological. issues related to obesity. 739-46. L. Leptin is an attractive candidate for the treatment of obesity as it is an endogenous protein and has been demonstrated to have potent effects on bodyweight and adiposity in rodents. L. 7S-19S. This article takes an overview on how physical activity can play an important role in prevention and treatment of chronic diseases. The obese gene (ob) protein product leptin is a hormone that is secreted from adipocytes and functions to suppress appetite and increase energy expenditure. C. and Bryson. McClanahan. A. Murray. Pratt. N. N. Update on lifestyle and hypertension control. L. Baranowski. T. Nunnally. J. Zhou.. J. Obesity Research. Klesges. S. Prevention is better than a cure. Ethnicity and Disease. M. C. S. coffee consumption and magnesium and some recent data on antioxidant vitamins.. and Thompson. A. J.. 26(7-8). A strong association exists between physical inactivity and the emergence of chronic diseases in modern industrialised societies.. Beilin. and outcomes of 2 versions of a culturally relevant.. Kumanyika.. M. alcohol. Treatments in Endocrinology. (2004). S1-53. 3(1).. D. W... and Pree. B. Parental cultural perspectives in relation to weight-related behaviors and concerns of African-American girls. E. M.and parent- targeted interventions: The Memphis GEMS pilot study. To determine whether cultural perspectives of parents may influence children's eating and physical activity behaviors and patterns of weight gain. B. To assess the feasibility. D.. N. Relyea.(14): 9-11... C. which is expected to increase the incidence of obesity-related disorders. K. Davis. Slawson... M. (2003). hypertension and dietary sodium. T.. Owens. This brief update on lifestyle and blood pressure control will focus on complex dietary patterns. Rochon. S. A. Taylor. Leptin as a potential treatment for obesity: progess to date. (2004). Robinson.... labour-saving and sedentary lifestyle. Clin Exp Hypertens. acceptability. Child. S. B. SportEX Health. . McLain. 12 Suppl. K. B. the human body is failing to function properly to maintain health. G. Kumanyika. 39 Beale. Beech.. Of particular concern is the recent epidemic of childhood obesity. The human genome has evolved with an environment of high physical activity through the hunter-gatherer and agricultural eras. the prevalence of obesity is steadily rising in western civilization. M. C. Klesges. Despite significant reductions in the consumption of dietary fat. (2002). meta-analyses on exercise.. 11-19. Bell-Anderson. (2004).. J. R. 13(Supplement 1). family-based intervention to prevent excess weight gain in pre-adolescent African-American girls. Beech. K. Sherwood.

339-42. relationship to community institutions. M. Raben. Flint. but it can do little to eliminate them.. Effect of 3 modified fats and a conventional fat on appetite.. This Perspective presents examples of successful community involvement and policy change. and neighborhood economic conditions. dissection of the complex genetic architecture of obesity will provide new avenues for treatment and prevention. Communities and health policy: a pathway for change.. (2005). and will increase our understanding of the regulation of energy balance in humans. J. Walley. Mu. energy expenditure. Bendixen. O. H. 37-38. The genetics of human obesity.. 40 Bell. 75(1). Health Aff (Millwood). 221-34.. lifestyle and body composition are responsible for the development and progression of chronic diseases such as insulin resistance. A. A combined focus on community and the policies that affect communities' environments presents opportunities for altering and ameliorating the underlying forces at the heart of the determinants of health. M. and Standish. In the future.. . Bartels. Interaction between lifestyle. Bell. hypertension and coronary heart disease. A. Improving the health system can reduce the effects of health disparities. People are eating more and exercising less resulting in a positive energy balance and an increase of body weight. energy intake. all of which affect health status over time.. C.. and economic environmental factors: air quality. social. An upsurge in new research is documenting the impact of physical. and body weight regulation. G. and Froguel. (2004). syndromic and polygenic obesity has greatly increased our knowledge of the mechanisms that underlie this condition. Although environmental factors are important. appetite regulation. body composition and activities of daily living. type II diabetes. substrate oxidation. 47-56. Nat Rev Genet. (2005). A. and Astrup. racism. Berg. and substrate oxidation in healthy men. there is considerable evidence that genes also have a significant role in its pathogenesis. (2002). 24(2). Obesity is an important cause of morbidity and mortality in developed countries. A. C. P. H. American Journal of Clinical Nutrition. E. 12(1). housing conditions. Isokinetics and Exercise Science. The identification of genes that are involved in monogenic. Xu. J. and is also becoming increasingly prevalent in the developing world. In combination with genetic factors. X. A. H... 6(3). Lifestyle and body composition are significant variables influencing the scenario of morbidity and mortality in our population. Different dietary fats are metabolized differently in humans and may influence energy expenditure.

17(3). American Journal of Clinical Nutrition. physically. Buechner. D. and creating a nurturing environment that helps children recognize their own worth and respects cultural foodways and family traditions. Many weight loss techniques widely available and widely used have adverse physical effects. size discrimination. including prescription and over-the- counter diet pills. V. 55(2).. Growth of children at high risk of obesity during the first 6 y of life: implications for prevention. 62(2). These guidelines for obesity prevention programs encourage a health-centered. nutrient deficiencies.. Nursing Science Quarterly. 140-6. (2005). An emerging model of behavior change in women maintaining weight loss. R. 81(1). The contribution of familial factors to adiposity in children is poorly understood. F. Berry.. This study is based on and expands Newman's theory of health as expanding consciousness with women who maintained weight loss for at least 1 year. G. This article reviews the research on risky weight loss methods. 419-426. a large number of people are trying to lose weight at any given time. A. and Parham. 448. and body hatred are all interrelated and need to be addressed in comprehensive ways that do no harm. 1-4. The researcher engaged in two in-depth interviews with twenty women. rather than weight-centered. and socially. and fasting. Because treating obesity through weight loss has been a major public health priority. eating disorders. laxatives. Journal of Nutrition Education and Behavior. It is a cause of significant morbidity and mortality and generates great social and financial costs. 303-306. E. M. 242-250. M. 35(1). 41 Berg. Journal of Social Issues.. semistarvation and other food restriction diets. 277-298. Berkowitz. The objective was to assess differences in growth in the first 6 y of life in children born to either overweight or lean mothers. The emphasis is on living actively. diabetes. (2003). purging. Medical management of obesity. E. It is recognized that obesity. N. Obesity is one of the most common medical problems in the United States and a risk factor for illnesses such as hypertension. Guidelines for childhood obesity prevention programs: promoting healthy weight in children. diuretics. (2004). Berg. hazardous weight loss. stomach reduction surgery. E. eating in normal and healthful ways. American Family Physician. Berke. mentally. J. (2000). A. and Morden. J. Stallings. (1999). degenerative arthritis and myocardial infarction. F. Maislin. Health risks associated with weight loss and obesity treatment programs. vomiting. and Stunkard... approach that focuses on the whole child. I. Individual patterns for participants who maintained weight loss revealed a personal journey of self-discovery .

Berteus Forslund. Recent research suggests a genetic and environmental etiology associated with impaired glucose tolerance. family. type 2 diabetes. Promoting children's health: Integrating school. L. Galasso. and community. Behavioral modification interventions targeted children and parents together or separately and were reported to be successful in improving weight-loss outcomes in both parents and children. and then emergence of behaviors reflecting expanded consciousness. J. Thirteen studies were included. including behavioral modification. M.. G.. 29(6). Looking across participants. Family-based interventions for childhood obesity: a review. increasing physical activity. Journal of the American Academy of Nurse Practitioners. (2004). 42 and control with initial chaos.. This reviewed book is written with the premise that professionals must work to integrate systems of care to manage successfully and prevent health care concerns. Heschel. Berry. To discuss the advanced practice nurse's diagnosis and management of obesity in youth in primary care. International Journal of Obesity and Related Metabolism Disorders. A. 29(3). Journal of Pediatric Psychology. Obesity in youth: implications for the advance practice nurse in primary care. and behavioral interventions. K.. Knafl. 711-9. and CINAHL search identified articles published between January 1980 and January 2004 relating to family-based interventions. K. The purpose of this article is to critically evaluate the evidence related to family-based interventions designed to treat childhood obesity. A MEDLINE.. P. hyperlipidemia. (2004).. and behavioral modification have been used with varying success. M. . Melkus.. Journal of Family Nursing. 429-449. D. Their models and guidelines are both grounded in evidence- based strategies and a consistently strong linkage of science and practice. 10(4). and hypertriglyceridemia. Snacking frequency in relation to energy intake and food choices in obese men and women compared to a reference population.. The authors offer theoretical models as well as provide specific guidelines for both developing and evaluating programs of care. and Grey.. Management is directed at healthy lifestyle behavior change for youth and their families. S. six patterns emerged from the data with evolution of a model of change that has implications for nursing practice at defined times within the change process of weight loss. 326-334. Problem-solving interventions that targeted parents of children showed improved weight outcomes for their children. choice. (2004). D. hypertension. (2005). S. and Grey. exercise. and Lindroos. G.. or problem solving. Sheehan. Berry. and all of the interventions used nutrition education. Nutrition education. H.. R. Torgerson. Behavioral therapy interventions targeting children and parents together or the parents of children separately improved weight outcomes. behavioral therapy. Sjostrom. 16(8). Melkus. PSYCLIT. decreasing sedentary behaviors. Berry. R. 241-242.

43 To investigate snacking frequency in relation to energy intake and food choices. H. R.. involved in neurological diseases. soy protein has been shown to reduce serum insulin and insulin resistance. 30-32. G. New knowledge about substances that stimulate or inhibit appetite offers hope that drug- based solutions will be found for the current high prevalence of obesity in the United States.. Sibutramine favors a negative energy balance and also has the potential to increase heart rate and blood pressure.. (2001). 76(6). and Velasquez. We investigated if a progressive supervised sibutramine-diet- exercise clinical intervention could increase the body weight loss previously reported while minimizing the potential cardiostimulatory effects of this drug. Obesity treatment with a progressive clinical tri-therapy combining sibutramine and a supervised diet- exercise intervention. Marzocchi. G. Prud'homme. The beneficial effects on nutrition were reported to improve . D. Symposium: second of two articles on obesity. in obese vs. Bianchi. are likely to benefit from amino acid administration. Bhathena.. Berube Parent. taking physical activity into account. 1191-1201. St Pierre... In addition. Dr Bessesen highlights some of the new molecular and genetic discoveries related to obesity and outlines the hypothalamic neural pathways involved in regulating food intake. In animal models of obesity and diabetes. Update on nutritional supplementation with branched-chain amino acids. American Journal of Clinical Nutrition. E. S. F. J. T. Agostini. Bessesen. (2005). S. Nutritional intervention studies performed in animals and humans suggest that the ingestion of soy protein associated with isoflavones and flaxseed rich in lignans improves glucose control and insulin resistance. (2002). Beneficial role of dietary phytoestrogens in obesity and diabetes. 35-38. the competitive action of BCAAs on amino acid transport across the blood-brain barrier may ultimately alter the synthesis of brain neurotransmitters. 8(1). 1144- 1153. S. M. and Marchesini. characterized by protein loss and catabolic status. In this article. A. D. (2003). accordingly. Postgraduate Medicine. reference men and women. International Journal of Obesity and Related Metabolism Disorders. Evidence is emerging that dietary phytoestrogens play a beneficial role in obesity and diabetes. Curr Opin Clin Nutr Metab Care. and Tremblay. 83-7. several conditions. RECENT FINDINGS: Both putative actions of BCAAs have been tested in controlled clinical studies in the last few years. aided by a complex biologic system that regulates appetite and favors intake. Obesity is the result of a long-standing imbalance between energy intake and energy expenditure. BCAAs are not only a substrate for protein synthesis. Branched-chain amino acids (BCAAs) have a peculiar role in whole-body nitrogen metabolism. Future directions in weight control: molecular and genetic discoveries pave the way. but also modulate several components of the synthetic machinery and help to conserve muscle mass... Doucet. 1147(6).

P.. Blevins. 54(2). E. S646-S662. N. Kaaks. body mass index (BMI). these associations with cancer risk may be explained by alterations in the metabolism of endogenous hormones-including sex steroids. differentiation. L. insulin... and Vainio. H. (1999). reduce protein loss during bed-rest. About 50% of men and 35% of women in Europe are currently estimated to be overweight or obese. successfully tested in mania. a serotonin and norepinephrine transporter blocker. T.. Over the past few decades the proportion of people with excess body weight has been increasing in both developed and less developed countries. G. In part. F. Tank. Wang. C.. Boschmann. K. C. 180-7. Franke. ApoC-III bound to apoB-containing lipoproteins increase with insulin resistance in Cherokee Indian youth. body mass index 23. and apoptosis. Stoddart.. In this last area.. Circulation. Luft. Avoidance of weight gain thus seems to be an important factor for cancer prevention.. age 27+-2 years. 14. oesophagus. tardive dyskinesia and spinocerebellar degeneration. the effects on nutrition might be coupled with the effects on hepatic encephalopathy mediated by improved neurotransmission.. S.. 106(19). A. Bianchini. and cancer risk. 2459-2465. is widely used as an adjunctive obesity treatment.. Lancet Oncology. Paradoxical effect of sibutramine on autonomic cardiovascular regulation. Medicine and Science in Sports and Exercise. Sharma. A. apoB. Sibutramine.7 kg/m2). (2002). Methods and Results: In 11 healthy subjects (7 men. J. M. F. P. R. and kidney. and insulin-like growth factors-which can lead to distortion of the normal balance between cell proliferation. we compared the effect of sibutramine or matching placebo (ingested 26. Because Native Americans are predisposed to obesity and type 2 diabetes associated with coronary artery disease. J. we assessed whether apoC-III bound to apoB-containing (LpB:C-III) and apoA-containing (LpA:C-III) lipoproteins. and Lee. E.. Blackett. Overweight. Biaggioni. Blair. . the evidence summarised here shows that excess body weight is directly associated with risk of cancer at several organ sites. and plasma lipids are associated with insulin resistance. and Brodney.. and Jordan. (2005). R. and 2 hours before testing) on cardiovascular responses to autonomic reflex tests and to a graded head-up tilt test.. breast (in postmenopausal women). and waist circumference in Cherokee children and adolescents aged 5 to 19 years (n = 975). 3(9). I. W. 31(11 Suppl). total apoC-III. M. M. reduce catabolism in trauma patients and improve clinical outcomes in patients with advanced cirrhosis. Birkenfeld. 565-574. Alaupovic. S. obesity.. Schroeder. (2002). Quintana. 44 muscle performance. endometrium. favor weight loss in obesity. Metabolism. In addition to an increase in the risk of cardiovascular disease and type II diabetes. S. including colon...1+-0. Effects of physical inactivity and obesity on morbidity and mortality: current evidence and research issues. Norepinephrine reuptake inhibition with sibutramine conceivably could exacerbate arterial hypertension and promote cardiovascular disease.

Mackey. This paper uses an ecological approach to suggest multilevel public health strategies to reduce obesity among urban African- American women. researchers need to better understand the unique nutritional problems facing low-income African-American women residing in inner cities. nutrition. P. African-American women. DeSalvo. M. societal. E.. and Fisher. This paper briefly reviews many of the known effects of physical activity and nutrition on the prevention and treatment of coronary heart disease. Block. S. urban. Journal of the American Medical Women's Association. Distinct physiological. R.. (1996). 45 The purpose of this review was to address three specific questions. Drinkwater. L. W. and Kienholz. Lee. obesity. and Freudenberg. Individual and community interventions to promote weight reduction have been insufficient to reverse the epidemic. 669-675. B. M. Disman. we surveyed residents about their knowledge and attitudes regarding obesity. and osteoporosis as well as how exercise and diet may work together. E. N. Obesity presents a major threat to the health and well-being of low-income. animal. Are physicians equipped to address the obesity epidemic? Knowledge and attitudes of internal medicine residents. A problem of this magnitude requires concerted and comprehensive policy interventions. A. B. Leon. cultural.. To analyze whether internists are suited for their role in treating the growing numbers of obese patients. Developing comprehensive approaches to prevention and control of obesity among low-income. To develop specific strategies to improve their health. S. and metabolic studies demonstrate the independent roles of physical activity and nutrition in the prevention and treatment of several chronic diseases. Fewer data are available to describe the synergistic effects of exercise and diet. and environmental factors form a mosaic of forces that promote weight gain and prevent weight loss in these women.. L. African-American women have among the highest rates of obesity in the United States and suffer from a corresponding excess burden of obesity- related diseases. Preventive Medicine.. Blocker. 36(6). Medicine and Science in Sports and Exercise. P. (2003). K.. Epidemiologic. African-American women. J. (2001).. .. Horton. 59-64. K. Previous assessments have not analyzed familiarity with obesity measurement tools or the correlation between knowledge and attitudes. and questions remain as to whether and how these two lifestyle factors work together to promote health and prevent disease.. urban. N. 56(2). and chronic disease. Physical activity.. M. 1) Do higher levels of physical activity attenuate the increased health risk normally observed in overweight or obese individuals? 2) Do obese but active individuals actually have a lower morbidity and mortality risk than normal weight persons who are sedentary? 3) Which is a more important predictor of mortality. overweight or inactivity? Blair. non-insulin-dependent diabetes mellitus. 335-349. 28(3). clinical. I. D.

46

Blundell, J., and Le Noury, J. (2001). Carbohydrates and appetite control. proceedings of the
Kellogg's Nutrition Symposium 2000, Sydney, 8 August 2000. Australian Journal of Nutrition
and Dietetics, 58, S13-S18 Suppl 1.

Many studies have shown that consumption of high carbohydrate foods can give rise to a
clear modulation of the expression of human appetite. The potency and time course of the
effects of various carbohydrates on satiety vary with the amount consumed and the
chemical structure. There is evidence that this biological effect can modulate the
temporal profile of hunger and the eating pattern of meals and snacks. One important
issue is the action of carbohydrate foods on satiation (within meals) and satiety (after
meals). These effects can be contrasted with the relatively weaker effects of high fat
foods. The physiological mechanisms through which carbohydrates exert an action on
appetite include plasma glucose levels, glucoreceptors, hepatic glucose metabolism and
glycogen stores. Experimental evidence indicates that the encouragement to eat high
carbohydrate (low fat) snacks or high carbohydrate breakfasts can significantly reduce
daily fat intake, limit energy intake, prevent weight gain and even induce weight loss. It
is therefore possible to design high carbohydrate diets that provide good nutrition with
adequate control over appetite and a beneficial effect on body weight.

Blundell, J. E., and Halford, J. C. G. (1995). Pharmacological aspects of obesity treatment:
towards the 21st century. International Journal of Obesity and Related Metabolism Disorders,
S51-S55.

A bio-behavioural-environmental phenomenon: Obesity is on the increase all over the
world in technologically advanced countries, developing countries and rural
communities. What is causing this upward drift in body weight? Can drugs do anything
to ameliorate the situation?

Blundell, J. E., and King, N. A. (1999). Physical activity and regulation of food intake: current
evidence. Medicine and Science in Sports and Exercise, 31(11 Suppl), S573-S583.

The evidence was reviewed on how physical activity could influence the regulation of
food intake by either adjusting the sensitivity of appetite control mechanisms or by
generating an energy deficit that could adjust the drive to eat. Interventionist and
correlational studies that had a significant influence on the relationship between physical
activity and food intake were reviewed. Interventionist studies involve a deliberate
imposition of physical activity with subsequent monitoring of the eating response.

Boreham, C., and Riddoch, C. (2001). The physical activity, fitness and health of children.
Journal of Sports Sciences, 19(12), 915-929.

It is clear that, despite their natural tendencies, children have become less physically
active in recent decades, with children today expending approximately 600 kcal.day-1
less than their counterparts 50 years ago. Although the health consequences of a reduced
energy expenditure in adults is well documented, there is little direct evidence linking
sedentariness with health in children. However, three main benefits arising from adequate

47

childhood physical activity have been postulated. The first is direct improvements in
childhood health status; evidence is accumulating that more active children generally
display healthier cardiovascular profiles, are leaner and develop higher peak bone masses
than their less active counterparts. Secondly, there is a biological carryover effect into
adulthood, whereby improved adult health status results from childhood physical activity.
In particular, childhood obesity may be a precursor for a range of adverse health effects
in adulthood, while higher bone masses in young people reduce the risk of osteoporosis
in old age. Finally, there may be a behavioural carryover into adulthood, whereby active
children are more likely to become more active (healthy) adults. However, supporting
evidence for this assertion is weak. Given this background, recent health guidelines
suggesting that children should accumulate 60 min of moderate-intensity physical activity
every day - supplemented by regular activities that promote strength flexibility and bone
strength - appear to be justified. Future developments should include the implementation
of large-scale, longitudinal studies spanning childhood and young adulthood, the further
refinement of tools for measuring physical activity accurately in young people, and
research into the relative strength of association between fitness - as well as activity - and
health in children.

Bosch, J., Stradmeijer, M., and Seidell, J. (2004). Psychosocial characteristics of obese
children/youngsters and their families: implications for preventive and curative interventions.
Patient Education and Counseling, 55(3), 353-62.

A profile will be given of the psychosocial characteristics of obese children and
youngsters, as well as those of their families. Then several attempts of (particularly)
preventive interventions will be sketched. Differences found between clinical and non-
clinical groups of obese children and youngsters do not permit generalized statements
regarding specific psychosocial characteristics. Just as little as there exist a simple and
unequivocal image of family functioning with these children. There are great differences
between the psychological assumptions and the biological concepts about obesity.
Whereas, biological concepts are relevant for the whole obese population, psychosocial
characteristics seems to hold mainly for the clinical group of obese persons. The gap
between clinical versus non-clinical as well as curative versus preventive approaches will
be explained. There are remarkable differences between curative versus preventive
intervention goals in terms of the extent to which they focus on life style habits or
psychosocial (dys)functioning. Where prevention strategies focus more on enhancing
physical activities, curative interventions focus more on changing eating behavior
patterns and (depending on chronicity and seriousness of obesity) modifying
psychosocial dysfunctioning.

48

Bouchard, C. (1996). Can obesity be prevented? (Conference on Nutrition and Physical Activity
to Optimize Performance and Well-Being). Nutrition Reviews, 54(4), S125-S131.

Overcoming obesity should become a national priority in North America and affluent
Western countries. Many children and adults chronically take in more calories than they
expend, an easily reversible trend. Recommended actions include establishing regular
meals, drinking water, keeping fat intake to 30% or less, walking, having regular sport
activities eliminating snacks and reducing TV time. Massive public health efforts are
needed to change the comfortable life style and excessive consumption.

Bowyer, C., and Trotter, K. (1997). Obesity treatment: future directions for the contribution of
dietitians. Journal of Human Nutrition and Dietetics, 10(2), 95-101.

This paper discusses strategies that dietitians can use, as part of a multidisciplinary team,
to promote weight loss and maintenance in obese adults.

Bowyer, C., and Trotter, K. (1997). Position paper approved by the Council of the British
Dietetic Association on 16 January 1997. Obesity treatment: future directions for the
contribution of dietitians. Journal of Human Nutrition and Dietetics, 95-101.

The British Dietetic Association (BDA) recognizes that obesity is a serious and growing
health problem in the UK. It welcomes the inclusion of reduction in the prevalence of
obesity as one of the targets of the Health of the Nation (DoH, 1992). The achievement of
this target will depend upon measures aimed at prevention, as well as improved treatment
for obesity. State Registered Dietitians (SRDs) are qualified to provide scientifically
based, independent information on nutrition and eating behaviour. They have an
important contribution to make to both public health measures and health promotion, as
well as to the development and implementation of more effective therapeutic strategies to
help those who are already obese.

Bradham, D. D., South, B. R., Saunders, H. J., Heuser, M. D., Pane, K. W., and Dennis, K. E.
(2001). Obesity-related hospitalization costs to the U.S. Navy, 1993 to 1998. Military Medicine,
166(1), 1-10.

The objective of this work was to estimate the cost to the U.S. Navy for obesity-related
hospital admissions by examining (1) inpatient utilization associated with obesity; (2) the
rank order, probability, and total facility costs of obesity-related diagnosis-related groups
(DRGs); and (3) expected inpatient expenses. The frequency and probability of inpatient
events in the Navy's active duty population were derived from the Department of
Defense's Retrospective Case Mix Analysis System. Medicare-based facility costs per
DRG were estimated. These measures were combined in a decision-analytic model.
Expected facility costs per obesity-related admission for active duty Navy personnel
increased by age group from $3,328 for 18 to 24 year olds to $5,746 for 45 to 64 year
olds. The annual avoidable inpatient cost for the Navy was estimated to be $5,842,627 for
the top 10 obesity-related DRGs. Improvements to the Navy Physical Readiness Program

49

and other interventions that may reduce obesity, obesity-related health care use, and the
public economic burden should be pursued.

Braet, C. (1999). Treatment of obese children: A new rationale. Clinical Child Psychology and
Psychiatry, 4(4), 579-591.

The treatment of moderately overweight children should focus on changes in eating styles
rather than on dietary restraint. An educational programme has been designed with the
aim of normalizing eating behaviours in a child-friendly way and without the prescription
of a strict diet, and is illustrated with a case-report of a 12-year-old boy. The programme
is based on the principles of cognitive-behavioural therapy. Strong emphasis is put on the
therapeutic goal of self-regulation of a healthy life style. The philosophy adopted in the
programme assumes that teaching healthy eating habits has a preventive function, notably
the prevention of undesirable dieting habits and their possible side effects, such as binge-
eating. But this also has a healing function (e.g., the restoration of an adequate
intake/consumption balance and, to a lesser extent, weight control).

Bravata, D. M., Sanders, L., Huang, J., Krumholz, H. M., Olkin, I., Gardner, C. D., and Bravata,
D. M. (2003). Efficacy and safety of low-carbohydrate diets: A systematic review. JAMA:
Journal of the American Medical Association, 289(14), 1837-1850.

Reviewed literature to evaluate changes in weight, serum lipids, fasting serum glucose,
fasting serum insulin levels, and blood pressure (BP) among adults using low-
carbohydrate diets in an outpatient setting. The authors included articles describing
recipients of low-carbohydrate diets of 4 days or more in duration and 500 kcal/d or
more, and which reported both carbohydrate content and total calories consumed. The
included studies were highly heterogeneous with respect to design, carbohydrate content,
total caloric content, diet duration, and participant characteristics.

Bray, G. A. (2004). The epidemic of obesity and changes in food intake: The Fluoride
Hypothesis. Physiology and Behavior, 82(1), 115-121.

The epidemic of obesity is worldwide. It will be followed by an epidemic of diabetes.
Although there is a genetic basis for obesity and diabetes, the current epidemic reflects
the failure of our ancient genes to cope with a modern toxic environment. To put it
another way, the genetic background loads the gun, but the environment pulls the trigger.
Diet, lifestyle and exercise are the cornerstones of current approaches to treating obesity.
However, these approaches that depend on individuals making lifestyle changes have
been ineffective in preventing the epidemic. An alternative model views obesity as an
epidemiological disease with food(s) and other environmental agents acting on the host to
produce disease. The consumption patterns for many foods have changed over the past 30
years, but the increase in the consumption of high-fructose corn syrup (HFCS) for soft
drinks is far and away the largest. Moreover, the rise in HFCS intake is an environmental
insult that has occurred at exactly the same time as obesity began to increase in
prevalence. Rising soft drink consumption is associated with a decrease in milk

50

consumption and a decrease in calcium intake, which has an inverse relationship to body
mass index (BMI).

Brochu, M., Poehlman, E. T., and Ades, P. A. (2000). Obesity, body fat distribution, and
coronary artery disease. Journal of Cardiopulmonary Rehabilitation, 20(2), 96-108.

Obesity is an independent risk factor for the development of coronary artery disease
(CAD). Obesity also increases risk for CAD indirectly through its association with
insulin resistance, hyperlipidemia, and hypertension. An increased accumulation of fat in
the intraabdominal cavity, termed visceral adiposity, is highly correlated with an adverse
coronary risk profile. In patients at risk for coronary artery disease, the treatment of
obesity results in an improved coronary risk profile. The prevalence of obesity is
extremely high in coronary populations, yet the effect of weight loss on cardiovascular
outcomes in CAD patients has received relatively little attention.

Brown, K. M., Akintobi, T. H., Pitt, S., Berends, V., McDermott, R., Agron, P., and Purcell, A.
(2004). California school board members' perceptions of factors influencing school nutrition
policy. Journal of School Health, 74(2), 52-58.

Enactment and enforcement of school nutrition policies represent key components in
adolescent overweight and obesity prevention. This study determined: 1) California
school board members' attitudes, perceptions, and motivations related to enactment of
policies that support healthy eating in schools; and 2) barriers to adopting school policies
that support healthy eating. To understand board members' decision-making process, key
informant interviews were conducted and a survey was administered to 404 school board
members. Though school board members care about the well-being of pupils, competing
priorities limit the extent to which nutrition issues get addressed at board meetings.
Members' decisions center primarily around academic achievement issues, yet they are
interested in nutrition's overall impact on children's health and academic achievement.

Brownell, K. D. (1995). Exercise and obesity treatment: psychological aspects. International
Journal of Obesity and Related Metabolism Disorders, S122-S125.

Exercise is clearly beneficial as a means for losing weight and keeping it off. Given
recent studies showing its association with maintenance, it would be difficult to argue
that any factor is more important than exercise. For an exercise program to be helpful for
obese persons, the challenges of exercise adherence must be considered, as must the
mechanisms linking exercise to weight control. Both argue for whatever activity an
individual will undertake that will produce the psychological effects that promote weight
control.

Bruce, C. R., and Hawley, J. A. (2004). Improvements in insulin resistance with aerobic exercise
training: a lipocentric approach. Medicine and Science in Sports and Exercise, 36(7), 1196-1201.

Traditional views on the metabolic derangements underlying insulin resistance and Type
2 diabetes have been largely "glucocentric" in nature, focusing on the hyperglycemic

B. especially African-American women. the efficacy of aerobic endurance training in human subjects in mediating the association between deranged lipid metabolism and insulin resistance will be examined. diet-related subjects are in vogue and over the past few years there has been an explosion of interest in any aspect of diet (the "dieting industry"). Velicogna. Brizzi. The purpose of this literature review is to examine the risk factors for obesity that relate to African-American women.. scientists have studied the personalities. Medicina Psicosomatica. Nutrition Today. and biochemistry of people with these illnesses. today there are more questions than answers regarding why we have this crisis and how to solve it. Unfortunately. there is a coordinated breakdown in lipid dynamics in individuals with insulin resistance. Minorities. M. also known as compulsive overeating. Accordingly. Journal of Multicultural Nursing and Health. The obesity epidemic in the United States is growing and will only get worse unless effective. A. Risk factors and interventions for obesity in African- American women. (2004). Balancing the energy equation to attain and maintain a .. Leonardi. 39(6). diminished rates of lipid oxidation. Buracchi. share the US trend toward an increased prevalence rate in obesity but they bear a heavier burden of obesityrelated diseases such as hypertension and diabetes than the rest of the population. manifested by elevated levels of circulating free fatty acids. Interventions must be targeted at this population's specific needs. In trying to understand the causes of eating disorders. Binge eating disorders (BED). and Petersen. Bryant. (2004). and excess lipid accumulation in skeletal muscle and/or liver. 51 and/or hyperinsulinemic states that result from impaired glucose tolerance. from healthy eating throught eating disorders.. 54-56. A. Many people with these disorders are obese and have a history of weight fluctuations. it should be possible to demonstrate that interventions that improve lipid homeostasis cause reciprocal changes in insulin sensitivity. H. General and social- cognitive aspects of non-control alimentation disease and obesity / Aspetti generali e socio- cognitivi dei disturbi da alimentazione incontrollata e dell'obesita. J. and Neff Smith. enzyme regulation. intracellular signaling.. H. G. But in addition to glucose intolerance. The obesity epidemic: stakeholder initiatives and cooperation. R. 41-48.. 235-244. coordinated strategies are developed and policies put into place to stem this tide. S. are characterized primarily by episodes of uncontrolled eating or binging. F.. 7(1). and Cioffi. In parallel. If a breakdown in lipid dynamics is causal in the development of insulin resistance (rather than a coincidental feature resulting from it). R. 49(1-2). and/or gene transcription. (2001). genetics. African American women's obesity must be placed within a context that shows the interplay between social and political forces that influence and shapes individual behavior. Overweight and obesity are on the increase and many people diet to lose weight. This review examines the premise that an oversupply and/or accumulation of lipid directly inhibits insulin action on glucose metabolism via changes at the level of substrate competition. Butchko. environments.

. (2004).. 78(2). J. 308-312. There are a number of key stakeholders in the obesity epidemic-the public. Ethelbah. and Pablo. S. randomized controlled trial for the prevention of obesity in American Indian schoolchildren. Preventing childhood overweight.. International Journal of Obesity. . M.. Lohman. T. and yet there are still relatively few proven prevention approaches for children. 78(5). consumer groups. 28(Supplement 3). however. beverage. Body composition and overweight prevalence in 1704 schoolchildren from 7 American Indian communities.. parent-child feeding relations. focusing on the experience in the USA and Canada. B. Children and choice. multicomponent intervention for reducing percentage body fat in American Indian schoolchildren. The objective was to evaluate the effectiveness of a school-based. J. Story.. J. M. J. Stone. An article is presented briefly discussing some of the common features of childhood obesity prevention programmes. regulators and policy makers. H. Norman. Television viewing habits. This article reviews data pertaining to these 4 environmental considerations. Stephenson. Clay. C. Evans. J. Lohman... M.. J. (2004). (2004).. as well as practical strategies that caregivers might use for their management. and vending machine snack prices and availability may promote overweight in children to varying degrees. S. Longitudinal survey data from a number of countries confirm that the number of overweight children continues to increase at alarming rates. and Faith. Stevens. S. T. Caballero. A large research base exists to guide the development of solutions. (2003). 1030-1038. Caballero. S90-S95... M. Obesity prevention in children: opportunities and challenges. Callery. M.. food portion sizes. J. B. (2003). and Stevens. There is ample consensus that prevention strategies are essential to turn the tide of the obesity epidemic. H. 14. We describe the body composition and anthropometric characteristics of schoolchildren from 7 American Indian communities enrolled in the Pathways study. P. Gastrointestinal Nursing. Calamaro. Caballero. Rock. American Journal of Clinical Nutrition. and restaurant industries. T. Davis. S. putting this concept into practice in everyday life has clearly become a losing battle. 194-199. 52 healthy body weight seems a simple concept. B. American Journal of Clinical Nutrition. 39(5). Nutrition Today. Davis. and even developing countries are experiencing a rise in their overweight population. a randomized field trial evaluating a program for the primary prevention of obesity.. Himes.. Going. However.. E. and the food. Pathways: a school-based.. L. understanding the underlying science and applying that science to create practical and successful solutions is our challenge. B. Nationwide data on obesity prevalence in American Indian communities are limited.. B. 2(5). Childhood overweight continues to increase in prevalence in the United States.

The prevalence of obesity has increased because of a combination of excessive calorific intake (for example. type 2 diabetes. and osteoarthritis. Campfield. J. (2001). Objective To assess the effectiveness of interventions designed to prevent obesity in childhood. Campbell. Obesity has reached epidemic proportions in the UK. D. Obesity in children impacts on their health in both short. be left solely to health professionals. It is well demonstrated that eating behaviours are likely to be established early in life and may be maintained into adulthood. 53 Dr Peter Callery believes nurses play an important part in helping children to make healthy choices. S. Smith.. 149-158. which include cardiovascular disease.and long-term. 1383-1387.. P.. It is important because of the associated co-morbidities. however. (2003). K. and society as a whole. Obesity treatment in primary care includes lifestyle modification and drug treatment. 29. The obesity epidemic: Can we turn the tide? Heart. and child-parent interactions around food. is associated with significant health benefits. 2(3). and Crawford. and its subsequent effect in the development of obesity. Factors that are important in the family environment are enumerated. Family food environments as determinants of preschool- aged children's eating behaviours: implications for obesity prevention policy. and these eating behaviours are greatly influenced by the family food environment. Although treatment is available. E. Obesity prevention strategies are poorly understood. which can be achieved in primary care. 89(Supplement 2). Campbell. L. Obesity Reviews. O Meara. Science. the food industry. Australian Journal of Nutrition and Dietetics. Waters. Background The prevalence of obesity and overweight is increasing worldwide. the long-term maintenance of medically significant weight loss (5 to 10 percent .. 19-25. Weight loss of 5- 10%. A review. Strategies and potential molecular targets for obesity treatment. Obesity is an increasingly prevalent and important health problem. and include parental food preferences and beliefs. F. media exposure. in Australia). Action is needed by government. and Burn.. 58(1). (1998).. Search strategy Electronic databases were searched from January 1985 to October 1999. and Summerbell. Campbell. Interventions for preventing obesity in childhood. K. The prevention and treatment of obesity cannot. (2001). D. role modelling. Further examination of these factors can help in the development of better nutrition intervention policies and strategies addressing the problems of chronic health conditions (including obesity. A systematic review. I. A. This review focuses on the role of family food environments in the establishment of eating behaviours in preschool children. children's food exposure. from increased intake of energy dense foods) and insufficient energy expenditure (associated with a sedentary lifestyle). ii22- ii24. C.

M. Journal of the American Medical Association. R. sedentary. Carnethon.. Gidding.. (2003). S. which center on prevention. Research has lead to the discovery of many risk factors for obesity. reduced insulin sensitivity and ultimately type 2 diabetes later in life. Reducing cardiovascular risk factors in postmenopausal women through a lifestyle change intervention.. Journal of Women's Health. Cacciapaglia. To test whether low fitness. and gender groups. A secondary aim of this investigation was to determine whether the addition of self-control skills training to an empirically supported lifestyle change intervention would result in greater cardiovascular risk reduction.. K. Carlisle. T. Characterization of obesity-associated gene products has revealed new biochemical pathways and molecular targets for pharmacological intervention that will likely lead to new treatments. H. and Douglass. K. seat belt use. sedentary. and Sothern. further inactivity and increased sedentary behaviors. Nehgme. S.. This should be a primary goal of pediatricians. such as smoking. Darby. predicted the development of cardiovascular disease risk factors and whether improving fitness . however. and public health professionals. The prevalence of obesity in children and adolescents is higher than 20 years ago in all racial-ethnic. 290(23). A. Ideally. these treatments will be viewed as adjuncts to behavioral and lifestyle changes aimed at maintenance of weight loss and improved health. 13(4). Insight concerning obesity prevention can come from examining other public health programs. Carels. Jacobs. and Liu. Low cardiorespiratory fitness is an established risk factor for cardiovascular and total mortality. 3092-3100. non-nutritious environments challenge metabolic capacity and promote overweight conditions. Cardiorespiratory Fitness in Young Adulthood and the Development of Cardiovascular Disease Risk Factors. Sidney. R. L. S. Since 1995 there has been an explosion of research focused on the regulation of energy balance and fat mass. rather than weight loss. The goal of prevention should always be maintenance of normal growth patterns.. S34-41. Prevention of future chronic disease in children and adults may depend on our ability to prevent the onset of obesity in young children. Prevention and treatment interventions for childhood obesity should promote the replacement of unhealthy eating and exercise practices with healthier behaviors. estimated by short duration on a maximal treadmill test. M.. The impact of a 6-month lifestyle change intervention on cardiovascular risk factors in obese. postmenopausal women was examined. D. S. Can obesity prevention work for our children? Jo La State Med Soc... L. In predisposed children. Another guide when establishing obesity prevention is evaluation of currently successful programs. M. which may help practitioners target at-risk individuals. R. Jr. 157 Spec No 1. M. 412-426.. O. A. (2005). This results in clinically significant obesity. family health care professionals. mechanisms responsible for these associations are uncertain. R. age.. 54 of initial body weight) is rare. Gordon. and sexually transmitted disease. (2004). S.

Obesity has become one of the major health burdens of the westernized world with an increasing number of people affected at any age. L. Argentieri.. and obese subjects shown in TV programmes are in a much lower percentage than in real life and are depicted as being unattractive. Prevention of obesity. 22(1/2). (2002). eating habits and body shape perception was done. A review of available literature on the relationship between TV and childhood obesity. modifying wrong weaning patterns. D. Nutrition Research. modifying the nutritional factors would be necessary: increasing breast feeding in terms of percentage and duration. S104-S108. reward. A. obesity may and should be controlled . consumer unions. decreasing fat intake and increasing carbohydrates and fibre intake.. M. emotional and social cues related to food intake must be considered. M. Role of prevention in the contention of the obesity epidemic. and/or consolation for every negative feelings and situations. during the last 30 years. The increased prevalence of obesity highlights the need of programmes for its prevention. M. there is a positive correlation between time spent watching TV and being overweight or obese on populations of different ages. and Garcia Cebrian. Thus. The reviewed studies showed the following: watching TV replaces more vigorous activities. Caroli. helping parents and/or guardians to understand the real needs of their children without using food as form of gratification. children are exposed to a large number of important unhealthy stimulations in terms of food intake when watching TV. (2003). in order to prevent development of obesity. modifying toddler and school age children eating habit. 55 (increase in treadmill test duration between examinations) was associated with risk reduction.. Role of television in childhood obesity prevention. Cardone. the present use of food in movies.. European Journal of Clinical Nutrition. shows and cartoons may lead to a misconception of the notion of healthy nutrition and stimulate an excessive intake of poor nutritional food. In the obesity prevention programmes calorie and nutrient intake. International Journal of Obesity. the number of TV food commercials targeting children have increased especially when it comes to junk food in all of its forms. food industries. 221- 226.. Carraro. R. obesity prevalence has increased as well as the number of hours that TV networks dedicate to children. over the last few years. Caroli. Although genetic factors explain around 40% of individual susceptibility to the disease. asking governments. M. 57(9). 28(Supplement 3). the rate of children watching TV for more than 4 h/day seems to have increased. and Lagravinese. A study was conducted to assess the role of television (TV) as a tool for childhood obesity prevention. (2004). unsuccessful and ridiculous or with other negative traits and this is likely to result in a worsening of the isolation in which obese subjects are often forced. and Masi. and mass media to reduce and regulate non-nutritional food advertising during children television time. decreasing protein intake and increasing fat intake until 2 years of age. S94-S97.

Metabolic markers included fasting glucose. and BMI. S.9 +/. The relationship of both physical activity and predicted maximum oxygen consumption (VO2max) with the clustering of metabolic risk factors associated with the metabolic syndrome (MS) was examined within 711 employed middle-aged (46. Carroll. 371-418. M. and Swinburn. Metabolic clustering. Information is needed to guide interventions that reduce the 'obesogenic' (obesity-promoting) elements of school environments. (2004).. Health Promotion International. Medicine and Science in Sports and Exercise. Despite a general acknowledging of the urgency for effective preventive measures at social. Carryer. Sports Medicine. and Butterly. This paper describes a three-year long research project in which nine large-bodied women have engaged in a prolonged dialogue with the researcher about the experience of being 'obese'. Carter. C. 32(12). 34(6). 8(2). economic and political level to contrast the increasing prevalence of obesity. physical activity and fitness in nonsmoking. triglycerides.8 yr) men. Insulin resistance/hyperinsulinaemia are consistently linked with a clustering of multiple clinical and subclinical metabolic risk factors. blood pressure. Carroll. (2000). 56 through interventions on the individual behaviour and on the social environment. J. Prevention of the metabolic syndrome and treatment of its main characteristics are now considered of utmost importance in order to combat the epidemic of type 2 diabetes mellitus and to reduce the increased risk of cardiovascular disease and all-cause mortality. Very promising to this aim is the role of prevention. Several levels of action have been established as well as different types of interventions according to th targeted population. The aim of this study was to . Childhood obesity is an increasing health problem in New Zealand and many other countries. B. Nursing Inquiry. 90-97. no clear nationwide policies have yet been established. (2004).. and the educational and public health measures adopted so far lack that coordination and integration that the magnitude of the situation requires. (2001). 19(1). J. The study involved an extensive review of the multidisciplinary literature that informs our understandings of body size. Embodied largeness: a significant women's health issue. middle-aged men. S. high-density lipoprotein cholesterol. Of special importance is the contention of childhood obesity with home and school as privileged settings for intervention. 2079-2086. B. M.7. and Dudfield. 15-20. R. defined by highest risk quintiles or clinically relevant risk thresholds. The literature review was shared with participants in order to support their critical understanding of their experience. What is the relationship between exercise and metabolic abnormalities? A review of the metabolic syndrome.. Measuring the 'obesogenic' food environment in New Zealand primary schools. Cooke..

and in growing numbers. P. A. We used factor analysis to represent the urban design and land-use diversity dimensions of built environments. H.. Mixon. 142-149. Furthermore. M. 93(9). and Duncan. In this article. Journal of Park and Recreation Administration. However. (2003). and state systems. Evaluating the quality of recreation facilities: development of an assessment tool. over-the-counter weight loss products. K. (1999). 12: 9-11 Like high blood pressure and elevated serum cholesterol. The purpose of this study was to develop a tool for assessing the quality of public recreation facilities' amenities.. M. obesity is a silent killer. county. Quest. we use household activity data from the San Francisco region to study the links between urban environments and nonmotorized travel. and maintenance of recreation facilities. Cerrato. that gauge impediments to walking and bicycling. Based on a literature review. gastric surgery). It is unlikely that most obesity treatments will be successful unless people learn to address the environmental. Kirtland. (2004). Walking. Cervero.. Clinical guidelines for adult obesity. L. J. Some claim that car-dependent cities contribute to obesity by discouraging walking and bicycling. M. Williams.. distribution. 1478-1483. H. K. Behavioral approaches to obesity treatment. M. with all the emphasis on the health risks of obesity and the availability of multiple treatment options. K... Chambliss. Knowing the location. specific eating or exercise plans. D. and Henderson. and quality of recreation facilities can assist administrators in developing more effective programs for encouraging physical activity across city. (OFFICE-NURSE) 1999 Feb. 56(1). many people attempting weight loss focus on narrow aspects of weight loss behaviors (e. Cavnar. (2004).. G. Behavioral approaches to obesity treatment help . and behavioral barriers that influence their ability to make eating and physical activity choices that promote long-term weight management. bicycling.g. Combining factor scores with control variables. O. a tool was developed for assessing the safety. A. E. Reviewing the evidence. condition. American Journal of Public Health. Office Nurse. expert opinions. Why. 12(2): 9-11 (3 ref). weight gain is ultimately a consequence of multiple environmental and biologic factors that encourage behaviors that result in positive energy balance. and professional standards. 57 identify and measure the obesogenic elements of the school environment and the canteen sales of energy-dense foods and drinks. and urban landscapes: evidence from the San Francisco Bay area. R. like steep terrain. Wilson. 22(1).. Informing patients about the latest federal guidelines can help them reduce the potentially life-threatening effects of carrying around too many pounds. we estimated discrete-choice models. Evans. is it so difficult for people to successfully lose and maintain weight? The answer is simple: Most obesity treatment plans tell people what to do but not how to change their behavior. medication. Obesity is at the forefront of the public health agenda. biologic. 96-114. M.

a slim image is overwhelmingly preferred.. Chen-Stute.. M. and looking for potential mates are usually concerned about their weight and figure. nurses should play an active role in weight education based on a deeper and more dynamic understanding of being overweight. 58 people develop the skills they need to successfully manage their weight in a way that is consistent with their individual barriers.. and Chen. (2005). and Schroeder. Y. and Hsu. Chen... 262-279. and the impact of this thinking. 12(2). goals. Chang. this qualitative pilot study conducted semi-structured interviews with five participants. (3) Weight reduction and self control . 26(1). O. (2002). (2) Pursuing attractiveness or health .O. Young women establishing self-image. Chen. C. J. On the basis of the qualitative method. Overweight people have a very negative image due to the marketing strategies for weight reduction and beauty products. Lawrenz. C. The goal is to maintain or slightly reduce body weight. Y. C. Krogmann. Being overweight is a hazard to health. how they come to think in this way. Kevenhoerster. W. Childhood obesity is an important health problem affecting Chinese and Chinese American children. K.a self-struggling process.). The experiences of female overweight adolescents undergoing weight reduction are rarely reported.. S. D. Unbearable weight: young adult women's experiences of being overweight. Journal of Nursing Research.M. and lifestyles. and Kennedy. The result of the study suggests there is a need for a competitive image to counter current obsessions with painfully slender figures in society. M. 10(2). (2004). self-control and longterm evaluation of their individual concept on their daily base. E.) The treatment of obesity includes different physical activities 3 times/week. Journal of Family Nursing. and Chinese children's weight status. Journal of Nursing Research.O. education in nutrition and behavior by a nutritionist and psychologist with current healthy eating guidelines... to learn self-monitoring. The experiences of overweight female adolescents after health promotion counseling. Kinzius.an endless struggle. Sheu. 13(1). There is a paucity of studies using qualitative methodology to evaluate weight-reduction experiences.. Family functioning. International Journal of Obesity. parenting style. K. To investigate the experience of young women who think they are overweight. Since 1997 164 obese children aged 8 to 17 years have been participating together with their parents in our outpatient program (T. 41-47. 153-160. A. The phenomenon can thus be described in three major categories: (1) Social labeling of the overweight . The aim of this study was to understand the main themes of the experiences of overweight female adolescents undergoing weight reduction after . (2004).. To protect the public's mental and physical health. Liou.. Chou.M. Out patient program for obesity in childhood (T. seeking affirmation of social peers. data was subjected to constant comparison and content analysis.

C. Huang. (2002). It has now been demonstrated that diet and exercise. Topics in Geriatric Rehabilitation. Health promotion activities have been shown to be effective as secondary health promotion strategies for older adults. N. E. 18(1).and post-quasi-experimental research design from September 1997 to June 1999. M. Its associated morbidity and mortality is imposing a major burden on the health care system. Qualitative design was adopted and seven focus group discussions were conducted. smoking cessation programs. Maintenance of health and function contributes to older adults' ability to care for themselves. Hung. junior college nursing students were found to be overweight according to the results of a health examination at the school health center at a junior college in the Taipei Metropolitan Area. can contribute to an increase in life expectancy and better health for older adults. SBP. dietary interventions and nutrition education. All of them had been overweight or obese throughout the past four years. Chernoff.. and to have a positive quality of life. R. R. Chen. metformin.. Health promotion activities. 18(5).. (2004). 350-356. including improving dietary habits and participating in physical exercise. On the basis of the qualitative method. Health promotion for older women: benefits of nutrition and exercise programs.. 58 were randomly selected and 49 of these had complete participation records for the 2-year study. Of these 166 students. Y. This study examined the effectiveness of health promotion counseling for overweight adolescent nursing students. L. A total of 166 (17%) first-year. 53 Suppl 3. and exercise and physical activities. Health promotion programs designed for older women should include multiple facets: immunizations. and Rabasa-Lhoret. (2001). to live independently. K. S34-8. J. Type 2 diabetes is increasing worldwide in epidemic proportions. L. Hsu. All subjects received 8 hours of whole group and 12 hours of small group health promotion counseling over a 1-year period. 59-67. Wang. It is now generally accepted that insulin resistance and beta-cell dysfunction are major factors involved in the development of diabetes. Cheng. The Chinese version of an established health promotion counseling booklet developed by the author of this study was used in the counseling. A total of 30 female participants studying in a junior college of nursing were recruited in this study. Diabetes. Public Health Nursing. TC) were significantly improved.. Based on a better understanding of the pathophysiology of glucose intolerance. The relative contribution of insulin resistance . L. and Shiao.. HDL. Prevention of type 2 diabetes: insulin resistance and beta-cell function. 59 receiving school based health promotion counseling. The results show that health promotion counseling enabled subjects to adopt healthier lifestyles and most of the physiological variables (WLI. The study employed a one-group pre. the data were subjected to content analysis by means of the constant comparison method.. The effectiveness of health promotion counseling for overweight adolescent nursing students in Taiwan. acarbose. Chiasson. alcohol counseling. clinical trials on the prevention of diabetes have been performed. and troglitazone can prevent or at least delay the development of diabetes in subjects with impaired glucose tolerance (IGT).

Epidemiologic studies have shown a direct relation between lack of physical activity and the presence of multiple risk factors such as those found in the metabolic syndrome. (2004). Regular physical activity practice has been recommended for the prevention and rehabilitation of cardiovascular diseases and other chronic diseases by different health care associations world-wide. National Institute of Health. the risk for osteoporosis may be compounded in women who have both conditions. the US Surgeon General. V. Perry PA. such as the American College of Sports Medicine. G. and Guimaraes. The regular practice of physical exercise has been show to have beneficial effects in the prevention and treatment of blood hypertension. Evidence from the Health Development Agency recommends the focus of research should be redirected to look at the effectiveness of prevention and management strategies rather than the generation of statistics confirming the existence of the problem. the Centers for Disease Control and Prevention. Ciolac. 100(23). Insulin resistance may be mostly explained by the presence of obesity and accelerate the progression to diabetes in subjects with the propensity to beta-cell failure. (1997). The role of the school nurse in tackling childhood obesity. NT clinical. 10(4). This study investigated the frequency of eating disorders in 25 women who misuse alcohol and compared bone-mineral density between those with and without multiple disordered eating behaviors. E. When this relationship is taken into consideration. and other weight-control behaviors.. Disordered eating behaviors were assessed through the EAT-26 (Eating Attitudes Test) and a structured interview addressing binge eating. including commentary by Allan JD. insulin resistance. Bone-mineral density was measured using dual energy x-ray densitometry. the Brazilian Society of Cardiology and many others. A. Western Journal of Nursing Research. 60 versus beta-cell dysfunction on the pathogenesis of diabetes has aroused much debate. G. 19(1). The prevalence of obesity and overweight children of all ages is increasing. Clark. These two processes should be studied in relation to one another: their relationship is best described as hyperbolic in nature. Nursing Times. 32-55. K. Physical training therefore should be encouraged for both healthy individuals and those with multiple risk factors if they are capable of participating in a physical fitness program. diabetes. purging. 28-29. and obesity. all of which must be considered and understood before an effective strategy can be implemented to tackle the problem. and Hall JM with author response. Revista Brasileira de Medicina do Esporte. American Heart Association. Because lower bone-mineral density is one potential physiological consequence of eating disorders and chronic alcohol misuse. it becomes evident that subjects at risk of developing type 2 diabetes have beta-cell dysfunction before they develop glucose intolerance. Disordered eating behaviors and bone-mineral density in women who misuse alcohol. (2004). Ciliska D. Physical exercise and metabolic syndrome. Although only one woman . Clark. dyslipidemia. There are many factors that can lead to obesity in children.

and health status: pretreatment predictors of attrition in obesity treatment. V. JOGNN: Journal Obstetric Gynecologic and Neonatal Nursing. 801-808. few Americans do it. As the obesity epidemic continues. (2004).. K. T. Putting weight management on the nursing agenda. M. current smoking. and Hayman. J. M. J.. K. L. (2003). Cobb. and Wallymahmed. K. eating out. Bone-mineral density of the femoral neck was 9. Higher levels of depression. D.. 8(6). 21(4). Niaura. Topics in Clinical Nutrition. and Solera. Consistent predictors of attrition in obesity treatment have not been identified. 12% had past histories suggestive of anorexia nervosa and 40% had multiple disordered eating behaviors with bulimic features. M. the harmful effects of central adiposity will result in a large increase in cases of type 2 diabetes.. and Hayman. L. Journal of Diabetes Nursing. Addictive Behaviors. 18(4). Increasing activity to reduce obesity in adolescent girls: a research review. D. multidisciplinary approach to weight management and nurses must consider how best to contribute to this process by collaborating with other disciplines to develop the appropriate skills. 33(6). 801-8. R. Clinical issues. placing yet greater demands on the dietetic profession. To provide a systematic review of physical activity intervention research conducted with adolescent girls (12-19 years of age and/or in middle or high school) in the United States and Canada during the past two decades. activity level.05). Wilding. Despite the well-documented health benefits of eating 5+ fruits and vegetables. and Pera. King. Increasing activity to reduce obesity in adolescent girls: a research review. (1996).. 5-A-Day: a strategy for environmental change. 245-253. To provide a systematic review of physical activity intervention research conducted with adolescent girls (12-19 years of age and/or in middle or high school) in the United States and Canada during the past two decades. Cleator. M. being sedentary. This study examined whether pretreatment psychological and health behavior variables would predict attrition from a 26 week clinical multidisciplinary VLCD and behavior therapy program.3% greater in women with multiple disordered eating behaviors (p </=. Clemmens.. 232-236. (2004). Clemmens. and changes in the traditional family meal . L. JOGNN: Journal Obstetric Gynecologic and Neonatal Nursing.. F. L. People with type 2 diabetes respond best to an integrated. The majority of these people will require weight management. and having non- treated high blood pressure were associated with treatment attrition. 509-514. smoking. 33(6). Clark. Convenience. Depression.. 61 met the DSM-III-R criteria for a current eating disorder. (2004).

and treatment. Total of 24 obese patients were involved in this study. Mortality. Obesity in women of childbearing age: risks. obesity and its related chronic diseases are increasing to epidemic proportions. Cogswell. L. M. C. which has stagnated our understanding of health.. J. H. positive concepts with positive health benefits. S. 8(3). The primary objective needed for a new national health agenda is for the government to provide the public with complete and accurate information about health. E. A. operative delivery.. focusing on the dangers of obesity and need for weight loss. Schieve. W. 55(2). Environmental/policy research interventions that promote 5-A-Day in work sites and supermarkets show promise as effective strategies to support health and to prevent obesity. Cogan. For decades the recommendations provided by federal agencies have been decidedly one- sided. Therefore the public has been presented with incomplete and inaccurate information. congenital malformations and perinatal mortality. 53-60. The importance of obesity prevention among women (both non-pregnant and pregnant) is emphasized and behavioural therapy strategies are presented. Physiological Research. 5-A-Day provides simple. Twelve of them were subjected to DO therapy only and the remaining 12 patients participated in a regular aerobic exercise-training program in addition to DO therapy (DOE). and Dietz. chronic disease. (2001). (2004). (1999). O. and dieting. At the same time. Primary Care: Update for Ob/Gyns. A new national health agenda: providing the public with accurate information. fertility and pregnancy risks associated with overweight and obesity are described. Colak. Perry. R. Pregnancy outcomes include: maternal morbidity. Effects of short-period exercise training and orlistat therapy on body composition and maximal power production capacity in obese patients. Criteria for overweight and obesity are discussed together with the prevalence and incidence of these conditions.. 62 make eating 5 to 9 fruits and vegetables a day challenging. 383-401. 53(1). We examined the effects of weight loss induced by diet-orlistat (DO) and diet-orlistat combined with exercise (DOE) on maximal work rate production (Wmax) capacity in obese patients. and Ozcelik. prevention. weight. . high infant birth weight.. Journal of Social Issues. The environment presents both causes and possible solutions for the high prevalence of obesity. G. 89- 105.

K. Prevention of the epidemic increase in child risk of overweight in low-income schools: the El Paso coordinated approach to child health. Insight.to 5- year-olds? Yes! Contemporary Pediatrics. Waiting until a child gets older before addressing weight concerns may be too late. obesity is one of the few health problems that is moving in the wrong direction. 177-185. Collins. P. L. While life expectancy and some health statistics are improving. 217-24. C. A. E. (2005). J. Overweight and obesity are increasing. 65-66. and Dzewaltowski. To assess the impact on children's health of translating an evidence-based national intervention trial (Child and Adolescent Trial for Cardiovascular Health [CATCH]) to low-income elementary schools with primarily Hispanic students. The aims of this member survey were to describe current dietetic services and intervention strategies in obesity management and to compare current practice with that reported previously. determined what action was being taken in line with the national strategic plan.. C. F. C. 386-394. Johnson. Routinely assessing weight and providing anticipatory guidance about eating and physical activity can help prevent weight problems from taking hold--possibly for a lifetime. (2003). Tiller. Survey of dietetic management of overweight and obesity and comparison with best practice criteria. A. and Pasanisi. Contaldo. An audit conducted in June 2000 in the Greater Bunbury area. Heath. 60(3). 242-245.. (2005). Collins. 4(4). N. 68. F. and Krebs. This article discusses the expression of melanin-concentrating hormone (MCH) and MCH receptors (MCHR) in the brain and other regions of the central nervous system.. 60-62. . 58(4)... Screen for and treat overweight in 2. F. 1-4. J. Sy. Nutrition & Dietetics. Acting on Australia's weight: a local areas focus on a national strategy. Arch Pediatr Adolesc Med. R. A. Collins. 24(1). (2001). K. M. O.. Sanchez. L. Acting on Australia's weight: a strategic plan for the prevention of overweight and obesity was developed by the National Health and Medical Research Council in 1997.. 63 Coleman. The Dietitians Association of Australia (DAA) is endeavouring to support best practice for dietetic management of overweight and obesity in Australia. 21(10). Australian Journal of Nutrition and Dietetics. D. (2004). (2003).. Prospects for obesity treatment: MCH receptor antagonists. Current Opinion in Investigational Drugs. S. Collins.. Milliken. Obesity epidemics: simple or simplicistic answers? Clinical Nutrition. J. and Kym. and their involvement in body weight regulation by triggering an increase in food intake as observed in mouse models. G... 159(3). and Pronk. F. Western Australia. Includes a Guide for Parents.

V. 1990). The incidence of type 2 diabetes has increase dramatically in the past decade in Pima children (aged 5-17 yrs). Costa. .. 123-129. Conget.. IGT is characterized by an increase in postprandial glucose levels.) and the Centers for Disease Control and Prevention were applied to 20 health plans from two Fortune 500 companies as well as the Federal Employee Health Benefits Plan to investigate the extent of diabetes-related benefits available to employees.C. vice versa. Cooksey. S. There is good evidence from epidemiologic and prospective trials [e. (2002). J.. and Hurley. less mouthfuls of food and a little more walking every day. C.e. (3) increased daily physical activity at school.g. and Gomis.. Cook. (2003). A. R. Impaired glucose tolerance (IGT) is determined by measuring plasma glucose levels 2 hours after glucose loading in the oral glucose tolerance test. V. Examining diabetes health benefits in health plans of large employers. The purpose of the Quest program is to conduct a health evaluation of the children and to provide them and their parents with information about diabetes prevention through nutrition education and an exercise program. A. Prevention of type 2 diabetes in childhood.. "simplicistic and unrealistic" solutions? A possible source of such confusion comes firstly from dietary guidelines: the "food pyramid" may easily lead to misinterpretation as low-fat foods enriched in simple sugars produce similar metabolic abnormalities as saturated fat rich foods. (1998). As a result. Quest is made up of 4 components: (1) biochemical and anthropometric assessments. 205-10. and (4) a structured school breakfast and lunch program. Journal of Public Health Management and Practice. C. 64 Among the strategies suggested to face obesity epidemics there is also a mere reduction of only 100-200 kcal day. i. I. 1(4). Are these proposals "simple and feasible" or. Preliminary results of the program indicate that the school provides a stable environment for behavior change and interventions that slow weight gait gain in early childhood. Diabetes Epidemiology: Collaborative Analysis of Diagnostic Criteria in Europe (DECODE)] linking IGT with the development of type 2 diabetes mellitus and cardiovascular disease (CVD). which is considered the earliest metabolic abnormality in type 2 diabetes mellitus. Clinical Pediatrics. Replacement of fruit derived fructose with other fructose-enriched beverages is not adequately considered. 37(2). living in the Gila River Indian Community.g. Components of the contract specifications (also known as model purchasing specifications) for diabetes care that were developed by George Washington University (Washington. Obesity and development of diabetes are strongly related in Pima Indians (e. W. the primary prevention program called Quest was implemented in 1996 at an elementary school in the Gila River Indian Community for students in kindergarten and grades 1-2. Knowler et al. S30-S35. (2) classroom instruction about diabetes. Impaired glucose tolerance: is there a case for pharmacologic intervention? Treatments in Endocrinology. and Lanza. D. P.

. But could obesity be linked to tobacco consumption-with a decrease in one leading to a rise in the other? Coveney. R. 188. 113-119. International Journal for Quality in Health Care. U. and suggested that efforts to curb cigarette smoking could have had unintended side-effects. Annual Review of Nutrition. This review examines research on food and family life. Food choices change as reciprocal responsibilities develop when couples establish . The article discusses the link between obesity and culture. and glucose tolerance. T. (2002). The UK House of Commons Select Committee's report on obesity suggests that obesity "will soon surpass smoking as the greatest cause of premature loss of life". Nutrition and prevention of type 2 diabetes. respectively) are combined.. 65 Costacou. it has been estimated that up to 75% of the risk of type 2 diabetes is attributable to obesity. 147-170. decreased fat intake. and reflects on directions for future work toward primary prevention of type 2 diabetes. giving diabetes the dimension of an epidemic. 364(9441). in improving insulin sensitivity (SI) and reducing the risk of diabetes.. Service quality and attrition: an examination of a pediatric obesity program. (2004). If the overweight (47% of men and 33% of women) and obese groups (21% and 23%. and Daniels. as well as regular participation in physical activity. The authors linked the price of cigarettes with increases in the number of obese people. S. Lancet.. 16(2). J. Comments on an article "The economics of obesity: the public interest.. Kotagal. including decreased energy intake. Cottam. Obesity and culture. Byczkowski. the healthiness of their choices and the social patterns that evolve from family food events. Striking parallel increases in the prevalence of obesity reflect the importance of body fatness as a contributing factor to diabetes incidence. T. and quality of care determinants of service attrition in a paediatric obesity program. 23. and weight loss. The evidence suggests that the dynamics of family relationships crucially affects individuals' food choices. over two-thirds of men and over half of women in England were either overweight or obese in 2001. the prevalence of type 2 diabetes has increased alarmingly worldwide. 1202-1203. M. S. insulin secretion. To examine the demographic. In recent years." by Michael Grossman and Inas Rashad. (2004). 165-173. 59(2). Cote. M. Moreover. Zeller. This review evaluates evidence of the effect of diet on insulin resistance. and Mayer Davis. What does research on families and food tell us? Implications for nutrition and dietetic practice. which are now having to be tackled. E. Nutrition and Dietetics: Journal of the Dietitians Association of Australia. (2003). and to elucidate factors that may promote families' return to care. Kirk. J. illness. P.. Recent clinical trials and observational epidemiologic studies demonstrate the efficacy of lifestyle changes.

T. (2003). K. Professional Nurse. C.. Cybulski. The role of social class and single parent status play an important role in food choice. Infants. Strode. E.. 33-5. L. While cholesterol is produced naturally by our bodies.. K. Some of the reasons for developing unhealthy levels of cholesterol are discussed. Here's how nurses can have an influence Cowbrough. obesity has reached epidemic proportions in the United States. 23-28. Kasgorgis. L. Duca. C. and Sell. Walking the Talk: Fit WIC wellness programs improve self-efficacy in pediatric obesity prevention counseling. The prevalence of obesity is higher among non-Hispanic black (36%) and Mexican American women (33%) than among non-Hispanic white women (22%).. they would benefit from more evidence about food choices within this important social context. and Yancey. Most research addressing family food choice is not situated within a social setting which limits its usefulness markedly. T. outcome measures included staff perceptions of the intervention's effects on the workplace environment. 66 relationships and cohabit. Davis. Farrell. (2004).. M. J. L. a high blood concentration of certain types of cholesterol is a predisposing factor for coronary heart disease. C... J. W. even among children. and young adults. 31(11). L. 73-75. 20(4). Crespo. adolescents. and their counseling self-efficacy. How dietary measures can help reduce unhealthy blood cholesterol levels. E. Covington. Physician and Sports Medicine. Craypo. Since nutritionists and dietitians deal with individuals and groups for whom family life is an important influence. but 'dieting' isn't the answer. A pre- post test design with intervention and control groups was used.. G. together with some dietary strategies to reduce them to acceptable levels. A. Samuels. Obesity in the United States: a worrisome epidemic. B. B. P. Crawford. 94(9). Kator. including decreases in exercise and occupational and recreational physical activity and an increase in sedentary lifestyles.. and Arbesman.. J. P. E.. (2004). Television watching is directly related to obesity and energy intake among children age 8 to 16 years and may be a target for . The arrival of children also changes family dynamics. Kids on the move: preventing obesity among urban children. Children of low-income urban families are at increased risk for obesity. American Journal of Nursing.. 1480-1485. their personal habits and health beliefs. L. (2001)... 77. children can also influence adult food choice in families. American Journal of Public Health. and Children (WIC) participated in a staff wellness pilot intervention designed to improve staff self-efficacy in counseling WIC clients about childhood overweight. M. C. Y. Gosliner. Burnett. In the past decades. 101(3). Various explanations for increased obesity have been proposed. Food preferences are influenced by family rule-setting as adults attempt to shape food choices of children. 79. S. Conversely. Six sites of the California Special Supplemental Nutrition Program for Women.

P. Crow. and eating a diet rich in fruits and vegetables with reduced saturated and total fat. Annual Review of Medicine: Selected Topics in Clinical Sciences. E. SportEX Health. 348-353. S. Crump. Peterson.. Over 1 billion people are now overweight or obese. International Journal of Eating Disorders. 54. 453-471. and Schwartz. J. and ghrelin. C. Levine. especially in reducing inactivity and overeating. such as leptin. 67 intervention. have been linked to hypothalamic neuropeptide systems. M. (2004). exercising regularly. reducing dietary sodium intake. J. The objective of this study was to examine physician knowledge and treatment recommendations regarding binge eating and obesity. 35. A survey of binge eating and obesity treatment practices among primary care providers. Key peripheral signals. (2003). It is unclear how much knowledge physicians possess regarding binge eating. insulin. maintaining adequate potassium intake. D. limiting alcohol consumption. and the prevalence of these conditions is rising rapidly.. Thuras. (20): 9-10. Obesity has become a leading public health concern. This article highlights some of these recent findings and their implications for the future of obesity treatment. 20: 9-10.. J. (2004). but the limited existing data suggest that primary care physicians frequently do not identify obesity as a clinical problem.. 26(4). Policy round-up. Physicians can use these data to help counsel patients about weight management. W. Genetics and pathophysiology of human obesity. The need to address the future problems caused by the current rising trend of obesity has given an added impetus to encouraging physical activity in the general population. 60. and Mitchell. (SPORTEX-HEALTH) 2004 Apr. J. A.. (2004). Primary prevention of hypertension: the seventh Joint National Committee report. Obesity is an increasingly prevalent condition and many obese individuals binge eat. and the anatomic and functional networks that integrate these systems have begun to be elucidated. Remarkable new insights into the mechanisms that control body weight are providing an increasingly detailed framework for a better understanding of obesity pathogenesis. 61-66. Prevention can be considered a population approach for everyone or a more specific approach targeted to those with high-risk factors. S. These include maintaining normal body weight. Family Practice Recertification. . This article gives a brief overview of the various Government initiatives and strategies set to encourage our population to get moving. The seventh report of the Joint National Committee has continued to place emphasis on the need to prevent high blood pressure through lifestyle changes. W. Cresswell. Cummings. B. E.

To assess the effectiveness of applying behavior change theory to a physical activity intervention for obese. Orlistat is an inhibitor of gastrointestinal lipases and. hypercholesterolaemia. Anliker. L. Preventive Medicine.. 37(6). J. in addition to lifestyle and dietary intervention. L.. and Nielsen. A university classroom and a local health club.. L. The goal of the school breakfast and lunch component was to reduce fat content of school meals to 30% or fewer calories from fat without compromising dietary quality. obese women. J.. L. 373-381. therefore. P.. K. J. orlistat in combination with a hypocaloric diet improved metabolic risk factors and reduced the risk of developing type 2 diabetes. P. Pathways was a multisite. P. 17(6). especially those with associated comorbidities or at risk of developing type 2 diabetes. Dallow. (2003). Thompson. M. 37(6 Part 2).. B. Cunningham. Thompson. L. metabolic syndrome) who received up to 4 years of therapy in conjunction with a hypocaloric diet. Using Self-efficacy and a Transtheoretical Model to Develop a Physical Activity Intervention for Obese Women. (2004). Curran. Impact of the Pathways food service intervention on breakfast served in American-Indian schools. 2845-64. S.. Fifty-eight sedentary. Subjects were randomized to one of two intervention groups. Orlistat: a review of its use in the management of patients with obesity. J. Orlistat. D. Ring. 64(24). A 48-week randomized controlled trial. O. In obese patients. Weber. Pathways was a multisite. H. with gastrointestinal adverse events being most commonly reported.. . Impact of the Pathways food service intervention on breakfast served in American-Indian schools. this agent was cost effective in patients with obesity. and Anderson. sedentary women.. Thomas. Preventive Medicine. Snyder. Thomas... Stewart. The goal of the school breakfast and lunch component was to reduce fat content of school meals to 30% or fewer calories from fat without compromising dietary quality.. J. is thus an attractive option for the treatment of patients with obesity. K. D. J. Snyder. This agent reduces weight in obese adults and adolescents with or without comorbidities (including type 2 diabetes mellitus. S46- S54. M. J. and Nielsen. multicomponent obesity prevention intervention for American- Indian schoolchildren. Weber. particularly those with type 2 diabetes. Orlistat is generally well tolerated. hypertension. H.. J.. prevents the absorption of dietary fat. Ring.. (2003). Platero. O. and Scott. Anliker.. L. C. multicomponent obesity prevention intervention for American- Indian schoolchildren. Drugs. 68 Cunningham Sabo. S46-S54.. Platero. L. Stewart. (2003).. American Journal of Health Promotion. Furthermore.. M..

Aging Clin Exp Res. The causes of overweight and obesity in children are multifactorial as are the solutions. to pass on healthy eating habits... In an ideal world. and opportunities to learn about food and health in the classroom. and Mueller.. Working with schools is an excellent way to restore the health of our children by providing attractive and nourishing food choices... K. Spethmann. M. A. B. To identify the major risk factors of overweight and obesity in prepubertal children. R. Life-style habits and homocysteine levels in an elderly population. 74(12). 34-40.body facism to coin a media mantra -. Schools and the rising rate of overweight children: prevention and intervention strategies. and Muller. family meals provide the opportunity for parents to serve nutritious food in appropriate portion sizes. S. and to strengthen family bonds through mealtime conversations. Increasingly. Danielzik. socioeconomic status and high birth weight are the major determinants of overweight and obesity in 5-7 y-old children: baseline data of the Kiel Obesity Prevention Study (KOPS). Impact of parental BMI on the manifestation of overweight 5-7 year old children. B.. diabetes mellitus and obesity. Parental overweight. J. Mast. 456-457. S. 16(6). physical activity and alcohol consumption in CVD prevention. Tackling teenage obesity.. M. Increased plasma total homocysteine (Hcy) is a known cardiovascular disease (CVD) risk factor. The QNI's Karen Daniel looks at a project helping overweight teenagers to help themselves. (2001).. Langnase. Dilba. (2004). Dankner. Genetic and environmental factors are contributing factors but the influence of parental nutritional state on early manifestation of overweight is not well characterised.. S.. a variety of physical activities for children of all sizes and abilities. C. Observational studies support the role of modifying life-style related risk factors such as diet. European Journal of Clinical Nutrition. F. Community Practitioner. Czerwinski. The aim of our . (2002). Lubin. J.is having on a generation of teenagers. 19(1). There is an increase in the prevalence of overweight and obese children. 437-42. Newspaper cuttings files have grown heavy over the past five years with horror stories on the effect that western society's obsession with super slimness -. Langaese. International Journal of Obesity. related to several components of the established CVD risk profile. Topics in Clinical Nutrition.. Daniel. Danielzik. possibly through its role in controlling risk factors such as hypertension. 69 Dalton. (2004). 28(11). A. 41(3). Chetrit. children eat 1 or 2 meals in school. K. 1494-1502. M. M. To systematically investigate the impact of parental BMI on the manifestation of overweight in 5 to 7 year old children. but also independently. Regular physical activity protects against coronary artery disease. M. K. (2004). Schools are one place where several factors promote obesity-or could prevent its rapid rise. and Sela. 132-138.

H. R. American Journal of Public Health. mental health.. Kochtitzky. 38(3). air pollution. housing. and social marketing. social capital. The next steps are to define priorities and obtain resources. Workshop participants' areas of expertise included physical activity. land use. Datar. and Tilson. American Journal of Public Health. architecture. L. The impact of community design and land-use choices on public health: a scientific research agenda. A. The faculty consultants from the Texas Christian University and the Cornerstone Community Center of Texas together organized an obesity prevention and dietary guidelines training program. A. injury prevention. Dannenberg. 360-363. as once a large amount of excess weight is gained. epidemiology. We examined the effect of physical education instruction time on body mass index (BMI) change in elementary school. The design of a community's built environment influences the physical and mental health of its residents. water quality. 97(2). Traditional treatment strategies and public health interventions aimed at reducing the incidence of obesity are proving inadequate at controlling the global epidemic of this condition. which lead to large weight gain over time. C. L. and rationing the purchase of others. 1501-1506. Jackson. The only effective approach is for governments to implement radical policy change. R.campus partnership. The main focus of any intervention should be on preventing small excesses of weight.. Public health matters. transportation. 1500-1508. M. 70 study was to test the hypothesis that there is an association between physical activity. The details of the program that was based on giving health awareness to families are presented. A. 93(9). R.. Because few studies have investigated this relationship. H. urban planning. The obesity epidemic: too much food for thought? British Journal of Sports Medicine. Journal of Family and Consumer Sciences. R. (2004). Dart. and Sturm. This report describes the 37 questions in the resulting research agenda. H. to regulate food consumption and control the food industry in a similar way to that of the tobacco industry. Frumkin. C. Schieber.. . life-style habits and plasma Hcy levels in an elderly population. J.. the Centers for Disease Control and Prevention hosted a workshop in May 2002 to help develop a scientific research agenda on these issues. 20-29. Physical education in elementary school and body mass index: Evidence from the Early Childhood Longitudinal Study.. 94(9). (2003). (2004). it is very difficult to lose. taxing certain foods. Pratt.. Working with families to prevent obesity: a community . (2005). by banning the advertising of selected produce. Davey.

with fewer participating each year. and Altaha. students. Metcalfe. S.. A review is presented concerning "Pathways".. The Pathways intervention was developed through a collaboration of Universities and American Indian nations. M.. physical activity. Snyder. B. S24-S34.. and results from formative research.. Pathways. V. M. 796S-802S. Flint Wagner. L.. Gittelsohn. Process evaluation data were collected from teachers. formative assessment. The Pathways programme was developed during 3 years of feasibility testing in American Indian schools.. school food service and family components of the intervention are the focus of this review.. S.. was a randomized field trial including 1704 American Indian third to fifth grade students from 41 schools in seven American Indian communities. R.. behavioural. The theoretical and cultural underpinnings of the programme. I. . Therefore. S. Pathways: a culturally appropriate obesity-prevention program for American Indian schoolchildren. M. a multisite school-based study aimed at promoting healthful eating and increasing physical activity. Journal of the American Dietetic Association. Going.. American Journal of Clinical Nutrition. E.. and family modules. N. (2003). V. Metcalfe. Glycemic load represents the total glycemic effect of the diet and may reduce the risk for chronic disease by affecting the risk for obesity and by altering metabolic endpoints. The intervention schools received four integrated components: a classroom curriculum. L. H. Preventive Medicine. a culturally appropriate obesity prevention study for American Indian schoolchildren. that promotes increased physical activity and healthy eating patterns. M. Vu. Family members participated in Family Events and take-home activities. Helitzer. M. Pt 2).. Davis. C. Holy Rock. A. Knowledge. the curriculum and physical education components of the intervention. the purpose of this research was to examine the food patterns associated with lower-glycemic-load diets to establish targeted intervention messages. 1828-35.. grades 3-5.. Pathways curriculum and family interventions to promote healthful eating and physical activity in American Indian schoolchildren. Clay. J. T. R. There were significant increases in knowledge and cultural identity in children in intervention compared to control schools with a significant retention of knowledge over the 3 years. food service. K. Brice. and Behavior Questionnaire data were collected from 1150 students including both intervention and controls. (2004).. Smyth.. Attitudes. P. D. Teufel. D. and Stone. C. Arviso. Smyth. and environmental factors and merges constructs from social learning theory with American Indian customs and practices. American Indian concepts. and families and focuses on individual. Stewart. D. Davis. B. The food choices associated with lower-glycemic-load diets have received little investigation. S. Gittelsohn. J. 104(12). schools. and families. The curriculum and family components were based on Social Learning Theory. Brice... J.. and Mitchell. Miller.. 37(6. M. based on the results of repeating the third and fourth grade test items in the fifth grade. L.. 71 Davis. 69(Supplement 4).. Evans. More favorable dietary patterns are associated with lower glycemic load in older adults. the construction process of the intervention. (1999).. J. Arviso. M.

. 19(3). 25(3-4). M. practitioners need to be mindful of the cultural norms surrounding body size. We investigated the effect of fruit intake on body weight change. A. 13(6). C. Private enforcement. P. In treating childhood obesity among ethnic minorities.. R. Litigation is often employed as a means to protect public health when government regulation is absent or ineffectual. P. C. (2003). were randomized to receive. Night time eating: a review of the literature.. 7-24. Results from the Third National Health and Nutrition Examination Survey reveal that ethnic minority children in the United States are at particular risk for development of cardiovascular disease due to their disproportionate levels of obesity. De Zwaan. Studies were identified by a computerized literature search (PubMed. has played a historic role in protecting public health in the United States. 253-256.. While opponents to the use of litigation often cite personal responsibility and the individual as the true locus of liability. Schenck.. Brazil. Daynard.. and Wilking. E. M. C. S.. Childhood obesity reduction by school based programs. 11(1). European Eating Disorders Review. (2002). Litigation is effective because it makes public industry practices and increases industry self-policing.. Strategies given to address the problem of childhood obesity among ethnic minorities include. or litigation. 30 to 50 y of age. G. L. or oat cookies. Northington. Sichieri. Howard. (2003).. and Kolar. K. S. L. H. and Moura. Moll. (2004). Hypercholesterolemic. Weight Loss Associated With a Daily Intake of Three Apples or Three Pears Among Overweight Women. including the night eating syndrome (NES) and the nocturnal eating/drinking syndrome (NEDS). Davis. J. pears. Nutrition. reducing television viewing and the adoption and maintenance of healthy lifestyle practices for the entire family. and Mitchell. A. 72 Davis. 408-17. Journal of Public Health Policy. A. This study reviews the published research on night time eating. PsycInfo) and by references from . overweight (body mass index > 25 kg/m super(2)). Private enforcement: litigation as a tool to prevent obesity. Litigation related to obesity would likely employ theories of "unfair and deceptive trade practice" or general "personal injury" or tort claims. Burgard. increasing the child's physical activity. Childhood obesity has become one of the most common health problems facing children in America. these arguments fail to take into account the context of an individual's choice. ABNF-Journal. De Oliveira. and non-smoking women. R. M. T. to name a few. 145-149. Litigation has been successfully employed to control both asbestos and tobacco and is poised for success in combating the obesity epidemic. Additional concerns that must be addressed include the effects of target marketing of unhealthy foods toward ethnic minorities and environmental deterrents to outside physical activities.. Women were instructed to eat one supplement three times a day in a total of six meals a day. one of three dietary supplements: apples. M. Participants (411 women) were recruited at a primary care center of the State University of Rio de Janeiro. free of charge..

25(2). The data suggest an early age of onset with a chronic course in many patients.. their ABMI 1. E.5 year later. or a substitutional diet containing a high-soy-protein low-fat diet with (SD/PA-G) or without (SD-G) a guided physical activity program. In addition. The impact of a shipboard weight control program. Wakeful night time eating appears to be a frequent symptom which is more common among the obese. metabolic and hormonal parameters induced by different intervention protocols. 1. Landmann. Dennis.001)... The current nosologies may not capture the natural clustering of eating and sleep-related pathology as it occurs in general population samples. (2001). fat and fibre intake (Flemish short fat and fibre test) were measured in 24 children (pretreatment Adjusted Body Mass Index (ABMI) = 179.. Individual studies were reviewed and their results summarized. Q. 73 the papers obtained.1 plus or minus 24. Although children have a quite healthy food and exercise behaviour... Schmidt-Trucksaess. Adams. and BingBing. S. Zaenker. K. U.. Pane. Obesity Research. and Bouckaert.5 year after treatment. It is unclear if the night eating syndrome presents a distinct entity that is of clinical relevance. J.5 year after treatment has increased from 122 plus or minus 14% to 154 plus or minus 22% (p <. K. Deforche. B.5 and 35. published abstracts from recent conferences in the areas of eating disorders and obesity were included. W. At the end of treatment and 1. and their prevalence rates remain a matter of debate. Koenig. (2004). A. There appears to be considerable overlap between NES and NEDS. determinants of PA (structured interview). 60-67. International Journal of Obesity. K. and Berg. 7(1). 1349-1352.5 year follow-up of obese children after a 10 month residential program. their comorbidities.6%). De Bourdeaudhuij. D. physical activity (PA) (Taylor questionnaire). .. This study investigates the evolution of overweight and health behaviour 1. A.. Frey.. Weight loss without losing muscle mass in pre-obese and obese subjects induced by a high-soy-protein diet. The specific aim was to determine whether a multifaceted approach to weight loss and physical readiness could be implemented onboard a deployed combatant ship of the US Navy. P. (1999). Deibert. Three different interventions containing lifestyle education (LE-G). B. To determine change of weight. 28(10). The clinical features of these syndromes. K.. I. International Journal of Obesity. Treatment studies are sparse. DESIGN: Randomized. controlled study including participants exhibiting a BMI between 27. body composition. I.

obesity in childhood and adolescence has become a major public health concern due to dramatically increasing prevalence rates.. A report to the President from the Secretary of Health and Human Services and the Secretary of Education. K. European Journal of Pediatrics. fewer symptoms of binge eating.5). At baseline. E. Thus. the self- efficacy type may serve as a means to identify different types of treatment needs (flexible vs. Bunyard..9 years) enrolled in a single centre outpatient obesity intervention programme consisting of periodical visits to the outpatient unit with regular medical and dietetic counselling aiming at a modification of dietary and activity patterns of patients and parents. postmenopausal (60 +/. 159 boys) aged 6-16 years (median 10. the Assureds had significantly smaller body girths and reported significantly greater self- esteem. Reithofer.. Self-efficacy targeted treatments for weight loss in postmenopausal women. K. and less negative affect overeating than the Disbelievers. B. Denzer. L.. Over the last 20 years. 163(2). Scholarly Inquiry for Nursing Practice. Treatment delivery type may have influenced attrition rate. E. postmenopausal women. Tomoyasu. 259-276. N.6 years old) women (n = 59) participated in a 6-month weight loss program. S. McCrone. Wabitsch. wavering) were randomized to Disbeliever (DT) or NT treatment. thus guidelines for identifying who might benefit most from which program remain elusive. (2000). (2001). Promoting better health for young people through physical activity and sports. This study categorized the weight control self-efficacy beliefs of obese.. Goldberg. A. The outcome of childhood obesity management depends highly upon patient compliance. and eating behaviors). and determined the effects of self-efficacy targeted versus non-targeted (control) treatment on weight loss outcomes (body habitus. H. physical conditioning. 74 Dennis. and Widhalm. (2004). 99-104. Department of Health and Human Services. affect.. . the 22 Disbelievers (doubtful. The 37 women categorized by Q methodology as Assured (self-confident. Obese (BMI 33 +/. independent) were randomized to Assured (AT) or Non-Targeted (NT) treatment. rigid) to sustain women's adherence and success in the program. M. Matching behavioral treatment programs to different types of obese clients is a rarely studied strategy. C.. Improvement in these variables with weight loss erased significant differences between the groups and was a desired outcome. P. and Qi. 15(3). The significant weight loss outcomes for women in all groups argues for the incorporation of strategies to enhance self-efficacy but not the need for specific treatments that directly target self- efficacy types. B. We evaluated the outcome of 294 children (135 girls. since significantly more Assureds dropped from NT than AT and significantly more Disbelievers dropped from DT than NT..

Obesity is a highly prevalent condition with significant health implications. (2003). 1011-1017. G. M. isolation. P. Of 11 studies that examined prevalence of overweight in children older than 3 years of age and that had a sample size of > or = 100 per feeding group. Malays and Indians) in order to evaluate the validity of the BMI cut-off points for obesity. 75 Deurenberg-Yap. and Deurenberg. and Amella. (2000). W. a greater threat to this population than obesity. Dewey. Further weight gain of individuals and populations can be prevented if energy intake balances energy expenditure. Assessment and nursing interventions are also addressed.. quiz 50-1. A. reduction in weight can only be achieved by a negative energy balance in which energy expenditure exceeds intake. 19(1). . Nutrition in older adults. 854-866. J. Z. R. Schmidt. and Wilson.. DiMaria-Ghalili. Is breastfeeding protective against child obesity? Journal of Human Lactation. The 3 "negative" studies lacked information on the exclusivity of breastfeeding. T. American Journal of Psychiatry. DESIGN: Cross-sectional study. E. G. Obesity: what mental health professionals need to know. S. International Journal of Obesity and Related Metabolism Disorders. including diet. and physiologic changes. G. Both physiologic and psychosocial changes affect the nutritional status of adults over the age of 65. Recent studies suggest that breastfeeding reduces the risk of child obesity to a moderate extent. 105(3). (2005). H.. Malnutrition is. and the steps necessary to achieve energy balance within the population. 1-11. A. limited income. W. chronic illness. The epidemic of obesity has resulted from an imbalance of energy intake and energy expenditure... after controlling for potential confounders. To study the relationship between body fat percentage and body mass index (BMI) in three different ethnic groups in Singapore (Chinese. the role that physical activity plays in weight reduction. Dietz. Devlin. M. K. This report summarizes recent clinically relevant findings concerning the pathogenesis and treatment of obesity and considers their implications for psychiatric diagnosis and management. Malays and Indians in Singapore. (2004). 56(1). 157(6). v. in fact. This article reviews the intake requirements of older adults and discusses the risk factors that can lead to malnutrition. Staveren. For those who are overweight. (2000). In this manuscript.. The effects of physical activity on obesity. Yanovski. 9-18. we will describe the epidemic of obesity and explore the evidence that reduced energy expenditure accounts for obesity. Quest. American Journal of Nursing. 8 showed a lower risk of overweight in children who had been breastfed. 40-50. The paradox of low body mass index and high body fat percentage among Chinese.

hyperplasia and hypertrophy of adipocytes.. M. (2001). Obesity is one of the most common disorders in clinical practice. A. Literature was reviewed of current findings from large population-based studies of forward directionality in which physical activity was considered as a primary study factor. Children talking about healthy eating: data from focus groups with 300 9-11-year olds. 31(11 Suppl).. adipsin. S542-S546. E. The longitudinal evidence suggests that habitual physical activity plays more of a role in attenuating age-related weight gain. Assuming obesity as an endocrine tumor may bring out new treatment modalities. Dixey. P. and to explore the barriers and facilitating factors for dietary behaviour change in children. 63(5). 71-79. etc. including leptin. 76 DiPietro. Physical activity in the prevention of obesity: current evidence and research issues. The purpose of this study is to document the prevalence of households with underweight and overweight persons (henceforth referred to as dual burden households) and their . International Journal of Obesity. O. small savings in excess weight gain accumulate into net savings that may be quite meaningful with regard to minimizing the risk associated with obesity-related disorders. The aim of this project was to gain insight into children's understanding of healthy eating. (2004). The prevalance of obesity has increased by more than 60% since 1990. Atwal. Moreover. (2005). Monteiro. L. neovascularisation within the adipose tissue associated with growth. Over decades. Copyright 2004 Elsevier Ltd. Dizdar. adiponectin.. 129-136. rather than in promoting weight loss. The dual burden household and the nutrition transition paradox. C. Liposuction as "cytoreductive surgery". already-active people of normal body weight. 26(1). Sahota. S. This article examines the hypothesis that obesity may be evaluated as an endocrine tumor. The 'Apples' project is concerned with obesity prevention. acytation-stimulating protein. M. antiangiogenic teraphy or antineoplastic drugs may be important components of obesity treatment in future. BNF Nutrition Bulletin. S. Obesity: an endocrine tumor? Medical Hypotheses. and an understanding of children's perceptions of healthy eating. and beneficisal metabolic effects of surgical removal of excess adipose tissue by liposuction. (1999). L. 790-792. and Popkin. The question remains as to how important maintaining a constant body weight through middle age and into older age is to healthy.. R. known as adipokines. The relation between habitual physical activity and the prevention of overweight and obesity in adults based on the evidence from the epidemiologic literature is described. fatness and thinness are vital in order for school-based programmes to be appropriately designed and delivered.. Bentley. Adair.. and Turner. All rights reserved. Doak. and Alyamac. Adipose tissue acts as an endocrine organ secreting many factors into the blood. B.. Medicine and Science in Sports and Exercise. recent data suggest that increasing amounts of physical activity may be necessary to effectively maintain a constant body weight with increasing age.. C. 29(1). regarding its genetic basis. M.

Summary Stearoyl-CoA desaturase (SCD). . liver steatosis and other diseases of the metabolic syndrome. Russia. These data are consistent with the hypothesis that elevated PKC activity may cause insulin resistance by phosphorylating the insulin receptor to decrease tyrosine kinase activity. Herein is reviewed the recently published data supporting the hypothesis that protein kinase C (PKC) phosphorylates the insulin receptor on serine/threonine residues to decrease tyrosine kinase activity and cause insulin resistance. increased insulin sensitivity and are resistant to diet-induced obesity and liver steatosis. 77 association with income and urban residence. reduced body adiposity. The beta isoform of PKC was elevated in muscle of obese. Much evidence indicates that the direct anti-steatotic effect of SCD1 deficiency stems from increased fatty acid oxidation and decreased lipid synthesis. The explorations by urban residence and income will test whether dual burden households differ from 'underweight only' and 'overweight only' households. In support of this notion. respectively. 169-175. Incubating human muscle fiber strips with PKC inhibitors restored insulin action in muscle of obese patients. while activating PKC with a phorbol ester caused insulin resistance in muscle from lean control patients. we have shown that SCD1-deficient mice have increased energy expenditure. suggesting that the reduced activity was a result of hyperphosphorylation of the receptor. the rate-limiting enzyme in monounsaturated fatty acid synthesis. L. (2005).. Mechanisms of Muscle Insulin Resistance in Obese Individuals. Population: Data analysis is based on national surveys conducted in Brazil. G. Vietnam and the United States. insulin-resistant patients. China. J. Indonesia. Obesity Reviews. and leptin-deficient obob mice lacking SCD1 showed marked correction of the hypometabolic phenotype and hepatic steatosis. diabetes. Dohm. (2001). and Ntambi. M. Treatment of insulin receptors from obese subjects with alkaline phosphatase restored tyrosine kinase activity. A. we propose that SCD1 may be a potential therapeutic target in the treatment of obesity and the metabolic syndrome. Furthermore. Dobryzn. SCD1 was found to be specifically repressed during leptin-mediated weight loss. the Kyrgyz Republic. International Journal of Sport Nutrition and Exercise Metabolism. S64-S70. 6(2). As several manifestations of the metabolic syndrome and type 2 diabetes mellitus are associated with alterations in intracellular lipid partitioning. We previously reported that insulin resistance in skeletal muscle of obese individuals was associated with decreases in insulin signal transduction and tyrosine kinase activity of the insulin receptor. These comparisons are relevant to differentiating or adapting nutrition-related interventions wherever obesity and undernutrition cluster at the household level. 11. All of these findings reveal that pharmacological manipulation of SCD activity might be of benefit in the treatment of obesity. has recently been shown to be the critical control point regulating hepatic lipogenesis and lipid oxidation. Stearoyl-CoA desaturase as a new drug target for obesity treatment.

. Hill. The role of exercise for weight loss and maintenance. 78 Doll.. and Johnson.. Jacobson. 513-525. G. A. Kirk... B. and Tremblay. 160(4). Donnelly. One program sought to reduce tobacco use. Bouchard. In this commentary. E.. prevention of further weight gain or no intervention. A. G.. (2004). Health Promotion Practice. V.. E. . J. 1999 update: 1. P. Modifications in food-group consumption are related to long-term body-weight changes. C.. D. American Journal of Clinical Nutrition. D. specifically. Attia. K. Feightner. 950-957.. two examples of successful collaboration between academic research centers and public health agencies at a statewide level are described.. Detection. and Washburn. R. D. American Journal of Clinical Nutrition. J. Canadian Medical Association Journal. K. prevention and treatment of obesity. an increase in carbohydrate intake at the expense of fat intake. J. It is commonly believed that moderate aerobic exercise leads to changes in diet composition. Mills. C. 29-37.. At least 30 minutes a day of moderate intensity aerobic exercise per day is recommended for weight loss and maintenance but greater amounts appear to increase the magnitude of weight loss and maintenance. L... J. 18(6). A meta-analysis to evaluate evidence relating to the effectiveness of methods to prevent and treat obesity was performed in order to provide recommendations for the prevention and treatment of obesity in adults aged 18 to 65 years in Canada. E. Dino. E. Linking research and practice: two academic-public health collaborations that are working.. Drapeau. 2(4).. J. Leblanc. (2001). Smith. Fournier. L. Hyder. 80(1). 78(5). Circle of research and practice. Effects of 16 mo of verified. W. Douketis. B. D. and Horn. Dubose.. Periodic health examination. D. P. supervised aerobic exercise on macronutrient intake in overweight men and women: the Midwest Exercise Trial. W. C. and Feldman. 296-300.. Thefatures of the collaboration contributing to their success are outlined.. Deutsch. Best Pract Res Clin Gastroenterol. 1009-29. Sullivan. (2003). Holmes. Jacobsen. O. In adults with obesity (body mass index (BMI) greater than 27) management options include weight reduction.. F. Resistance training has recently been shown to have positive effects on body composition but does not typically show significant decreases in weight. Donnelly. K.. (2004).. Despres. S. Exercise provides a means of increasing energy expenditure and may help adjust energy balance for weight loss and maintenance.. Allard.. J. J. whereas the other has the goal of improving physical activity and nutrition among children and youth and reducing child and adolescent obesity and subsequent health risks.. (1999). M. J. as is the federal role in fostering these partnerships. J.. Bailey. Kirk.

especially by low-income households. Drewnowski. Drohan. Objective: The aim of this study was to verify whether changes in some dietary patterns over a 6-y follow-up period would be associated with weight changes. diet quality. Fournier. 189-195. Dietary patterns play an important role in the control of body weight. S. Objective: The aim of this study was to verify whether changes in some dietary patterns over a 6-y follow-up period would be associated with weight changes. A. 161-168. P. 79(1). and added fats. Drapeau. Is visceral obesity a physiological adaptation to stress? Panminerva Medica.. Therrien. 45(3). A. provide dietary energy at a far lower cost than do lean meats. fresh vegetables. Do healthier diets cost more? Nutrition Today. A.. Furthermore. V. C. (2004). L. Drapeau. 80(1). Després. diabetes and cardiovascular diseases. The purpose of this article is to encourage primary care pediatric nurses to begin behavioral-based obesity treatment efforts as early as the preschool years. (2004). There is a need for more studies on the relationship between socioeconomic factors. fish. Dietary guidelines. stress-induced HPA axis activation has been identified to play an important role in this preferential body fat accumulation. Modifications in food-group consumption are related to long-term body-weight changes. some of which are high in refined grains. Allard. 599-610.. H. (2004). Energy-dense foods. E. 79 Dietary patterns play an important role in the control of body weight. Bouchard. American Journal of Clinical Nutrition. J. C. V. D. and Tremblay. Primary care approaches. added sugars.. and Barratt Fornell. dietary energy density. 6-16... and Specter. Leblanc. Drewnowski.. based on a pyramid of relatively costly foods.. the theory of behavior . the value of initiating early obesity treatment will be highlighted. A. This review focuses on the relation between obesity and diet quality. By examining the critical periods for obesity development and how the formation of food and activity behaviors interacts with those critical periods during the preschool years. Visceral obesity represents an important risk factor associated with hypertension. and fruit. and Tremblay. 29-37. F. Richard. and energy costs. and diet costs. (2003). Pediatric Nursing. 39(4).. Managing early childhood obesity in the primary care setting: a behavior modification approach. Evidence is provided to support the following points. Since this condition is associated with a disruption of the functioning of the HPA axis. American Journal of Clinical Nutrition. Food costs may be one barrier to the adoption of healthier diets. may not be the best approach to population-based interventions in public health.. Poverty and obesity: the role of energy density and energy costs. S. G.. (2002). 28(6). Many health disparities in the United States are linked to inequalities in education and income. A.

Population reports from 1988 indicate that there were approximately 406.. Avoiding winter weight gain. and Simmons.000 Soviet immigrants in the United States at that time. Sandra Drummond discusses ways in which community nurses can work towards detecting and preventing obesity in their clients. A. (1998). Pfeiffer. Only 6% of the cardiovascular disease (CVD) risk factors articles in the Medline search and 5% in the medical magazine search covered prescribing exercise or ways to start and keep up exercise programs. G. B. very little is known about the health status and health practices of this population. (2001). 129-137.. although some published data indicate that life expectancy and infant mortality rates compare poorly with those of the general population in the United States. immigration from the former Soviet Union to the United States has increased significantly. Duncan. Acta Medica Austriaca. Drummond. hypercholesterolemia.. The amount of material on physical acitivity. L. 13(2). 80 modification is presented and core principles are applied to early childhood weight management efforts. 30(2). 12(10). K. F. 171(11- 12). Getting to grips with obesity. E. P. Bauman. Running and fitnews. due to political and legislative changes. and Lin. Dupen. (1996). S. R.. 6.. (1999). S. Obesity is a serious health problem in industrialized countries and is associated with a significant increase in total health care costs. 51-54. Dr. M. the management of smoking. The influence of obesity on the frequency and distribution of medication. Health practices among Russian and Ukrainian immigrants. which raised the Soviet refugee ceiling to 50. 4.. Dzien. Eberle. and Lechleitner. Currently. The sources of risk factor information for general practitioners: is physical activity under-recognised? The Medical Journal of Australia. (2003).. C.000 per year. Journal of Community Nursing. This number is expected to increase due to the Immigration Reform Act of 1990. in journals and magazines frequently read by this group was investigated through qualitative study of the total number of articles and advertisements. Such data could support efforts to intensify obesity prevention and treatment programmes in order to reduce comorbidities and costs. Dzien. Hoppichler. 19(11). Only few data are available about the costs of drug therapies in patients with an increased body weight treated under clinical routine procedures. 601-604. F. Strategies for runners to put in place in the winter to avoid packing on excessive pounds. 1. . hypertension. Journal of Community Nursing. M. A. Since 1990.

Minerva Pediatrica. and Jacobson. S. Obesity in children with special health care needs. Type 2 diabetes is a major cause of death among American Indians and obesity and physical inactivity are modifiable risk factors in the development of type 2 diabetes. Part II. 56(3). age. (EXCEPTIONAL-PARENT) 2003 Jun.. There is no effective pharmacological or surgical treatment available for this entity but if left unaddressed it can lead to detrimental medical complications. S. M. (2004).. The existence of bad food habits and other risk factors leads to an increase in the development of chronic diseases. M. Such diseases occupy greater rates of morbidity and mortality in European countries. and obesity among inner city youth. (2000). D. 81 Edwards. D. Copperman. Diet and physical activity: a helpful binomial. (2003). 57(9). Jacobsen. S. S. Culture- specific physical activity may be an intervention to reduce obesity and prevent diabetes- related complications.. (2003). Koralewicz. obesity. hygiene. After school activities. diabetes. W. and Taylor. Individual health status is the result of a combination of different factors such as genetics.. European Journal of Clinical Nutrition. Physical activity may have both a preventive effect and a secondary preventive effect of lessening insulin resistance in persons with type 2 diabetes. A. We examined the association of adolescent obesity with participation in sports among 5489 low-income. Pryor. C. Pediatric obesity prevention and management. Elkins. 33: 102-105 Information and suggestions to assist in the prevention of obesity in children with special health care needs. inner city public high school students. Journal of Adolescence. S63-S69. We attempt to provide the appropriate guidelines for childhood obesity prevention in this review. overweight. Journal of Cultural Diversity. S. D. a paediatric practitioner should be equipped with the skills of identification of overweight and its risk factors as well as strong knowledge of treatment options... 265-276.. Obesity has reached epidemic proportions worldwide in turn redirecting the goals of the Paediatric well care visit. M. Several known contributors to obesity exist which allow the development of successful prevention programs. Ekvall. 27(2). stress and tobacco consumption. 33(6): 102-5. cardiovascular disease. Prior to initiating such a program. L. as well as environmental factors.. Cohen. nutritional status. Iglesias. J.. Moreover. and Booton Hiser. 36-40. N. (2004). dowry. Elliot. K. for some individuals participation in daily regimens of physical activity is very difficult. 181-189. physical activity.. and De Jesus. Exceptional Parent. 7(2). osteoporosis and certain types of cancer. M. Entrala-Bueno. A. Campbell. N. Calorie use and obesity among diabetic and non-diabetic Mvskoke Indians. L. . A.. salubrity.

Obesity Research. Epstein. Treatment of pediatric obesity. L. K. H. controlled studies. Thirteen controlled outcome studies were identified. 2) subjects were randomly assigned to groups or assigned by matching on demographic and anthropometric variables. A.. L. and Goldfield. Studies included for review met two criteria: 1) children or adolescents were defined as obese using objective criteria for obesity. 28(4). Epstein.. Obese children were randomly assigned to a family-based behavioral treatment that included either stimulus control or reinforcement to reduce sedentary behaviors. D. S. H. and 3) the exercise program was at least 2 months in duration. M. Health Psychology. R. 82 Epstein. 371-380. B. L. Physical activity in the treatment of childhood overweight and obesity: current evidence and research issues... H. L. Medicine and Science in Sports and Exercise. (2004). (1996). increases in physical activity and fruits and vegetables. and 2) obese children or adolescents were provided either different types of exercise programs or an exercise program compared with a no-exercise control condition. 428-435. R. highlights important contributions and developments in primarily dietary. The effect of reinforcement or stimulus control to reduce sedentary behavior in the treatment of pediatric obesity. H. 23(4). E. and outcomes are presented and evaluated for each study.. and Raynor. S553-S559. D. 554-570. and Raynor. Paluch. Exercise in treating obesity in children and adolescents. Significant and equivalent decreases in sedentary behavior and high energy density foods. Kilanowski. Epstein. H. Computer database searches identified 13 studies that met the following criteria for inclusion: 1) obese children or adolescents were provided either different types of exercise programs or an exercise program compared with a no-exercise control. and decreases in standardized body mass index (z-BMI) were observed. H. 746-753. K.. A. This paper reviews the use of exercise programs with obese children and adolescents. (2001). The primary goal was to evaluate sex differences in child weight control programs that targeted increasing physical activity (increase) or the combination of reducing sedentary . Paluch. and Saelens. Epstein. Medicine and Science in Sports and Exercise. (1998). and Myers. A. C. activity and behaviour change interventions. (1999). 101(3). Coleman. Raynor.. A. Experimental design. 31(11 Suppl). and identifies characteristics of successful treatment and maintenance interventions.. H. 9(12). J. using predominantly randomized. Myers. Pediatrics. This review of paediatric obesity treatment. H.. G.. A. L.. This paper reviews the utility of exercise as a treatment for overweight and obese children and adolescents. M. methods. Sex difference in obese children and siblings in family-based obesity treatment.

E. This new approach should improve the physical and mental well being of obese patients. and Wilfley. N. J. 47-57.. M. Addresses the prevailing view of obesity as a major threat to public health. To evaluate the effects of behavioral. H. Sprawl indices.. Setting. counties (448) and metropolitan areas (83). (1999). obesity. L. H. derived with principal components analysis from census and other data. Journal of Social Issues. and a disregarding of predetermined weight standards in favor of preventing further weight gain and reducing risk factors is offered.. B. Residents of sprawling counties were likely to walk less during leisure time. and coronary heart disease. 206. served as independent variables.. family-based treatment on disordered eating and child behavior problems for obese 8. The authors found that this paradigm is based on incomplete consideration of the evidence.992 adults pooled from the 1998. Paluch. A. positive attitude to health and self-care. and Raynor. 83 behavior and increasing physical activity (combined). The purpose of this study was to investigate how experimental changes in the amount of sedentary behaviors influence energy intake. (2003). Killingsworth. A. R. Cross-sectional analysis using hierarchical modeling to relate characteristics of individuals and places to levels of physical activity.. E. and Raudenbush. Ewing. Self-reported behavior and health status from BRFSS served as dependent variables. weigh more. and 2000 Behavioral Risk Factor Surveillance System (BRFSS). American Journal of Health Promotion. P. J. Saelens. Schmid. sprawl was similarly associated with minutes walked . The study aims to determine the relationship between urban sprawl. R. R. Roemmich. and health- related behaviors. BMI. and Koletsky. Relationship Between Urban Sprawl and Physical Activity. S. American Journal of Clinical Nutrition.S. H.. A wellness approach which focuses on a healthy lifestyle. R. and hypertension... and Morbidity. body mass index (BMI). Biomedical rationale for a wellness approach to obesity: An alternative to a focus on weight loss. R. 55(2). 361-6.. D. T. Journal of Pediatrics. health. obesity. hypertension. and have greater prevalence of hypertension than residents of compact counties. 81(2). Changes in sedentary behavior may be related to changes in energy intake. the county sprawl index had small but significant associations with minutes walked. Ernst. (2005). Obesity. After controlling for demographic and behavioral covariates. (2001). diabetes. A second goal was to evaluate the benefits of family-based interventions on nontargeted siblings. 1999. Paluch. 18(1).. 139(1). Epstein.. Epstein. Changes in eating disorder symptoms with pediatric obesity treatment. U. 221-259. 58-65. A. Influence of changes in sedentary behavior on energy and macronutrient intake in youth. At the metropolitan level. L. Ernsberger. A. Zlot.to 12-year-old children. M..

Physical activity in the prevention and treatment of hypertension in the obese. which was either independent of body size or more pronounced in the overweight. We describe epidemiological studies and report meta-analyses of randomized intervention trials. were more likely to report positive associations with child eating and weight status. Fabricatore. Epidemiological studies show an inverse relationship between physical activity or fitness and the incidence of hypertension. A comprehensive literature review was undertaken to summarize the associations between parental feeding styles and child eating and weight status. L. Obesity Research.001). and adding exercise to diet does not appear to further reduce blood pressure. L. Physical activity contributes to the control of blood pressure in overweight as well as in lean subjects. Parent-Child Feeding Strategies and Their Relationships to Child Eating and Weight Status. (1999). (2003). Scanlon. S. Faith. Parental feeding styles may promote overeating or overweight in children. This ecologic study reveals that urban form could be significantly associated with some forms of physical activity and some health outcomes. which appears to be unrelated to the initial body mass index (BMI) and to its training-induced changes. . Birch. although study methodology and results varied considerably. as opposed to general feeding control or another feeding domain..e. T. Future studies should observe scientific criteria more strictly. and Sherry. 16(4). Fagard. S624-S630. 84 but not with the other variables. We systematically coded study attributes and outcomes and tested for patterns of association. Pharmacotherapy and psychotherapy may be of benefit in this subset of individuals. Obese women. Psychological functioning of obese individuals.. however.m-2) and attempt to resolve the blood pressure lowering mechanisms. B. (2004). 31(11 Suppl). and Wadden. This review found that obese individuals in the general population have essentially normal psychological functioning. address the truly obese (BMI greater than or equal to 30 kg. K. Francis. Certain associations differed by gender and by outcome measurement (e. The weighted net reduction of blood pressure in response to dynamic physical training averages 3. Nineteen studies (86%) reported at least one significant association between parental feeding style and child outcome. L. Medicine and Science in Sports and Exercise.4/2. rate of eating as opposed to total energy intake). H.. Diabetes Spectrum. The purpose of this paper was to assess the value of physical exercise in the prevention and treatment of hypertension with particular attention to possible interactions with relative weight.02).. Exercise is less effective than diet in lowering blood pressure (P < 0.g. M. are at greater risk than obese men of depression and related complications. S..4 mm Hg (P < 0.. A. 1711-1722. randomized controlled trials on dynamic physical training and randomized comparative trials of exercise and diet. A. A. 12(11). Studies measuring parental feeding restriction. Binge eating and extreme obesity further increase the likelihood of patients reporting emotional complications. i. R. Twenty-two studies were identified. 245-252. N.

F. H. 683-686. Sibutramine and orlistat offer new weight reduction opportunities for obese patients. (2002). Kuttesch. Metabolism. E. We added triiodothyronine (T sub(3)) supplementation in 3 such patients and present their response. Fernandes. and diabetes-are still unresolved issues. (2002). 56(9). diabetes. obesity. improving academic performance. 6-13. Research still being conducted suggests that physical activity may have a great impact on cognitive function.I. 7 Suppl 1. Fernstrom. Besides the benefits to one's physical and mental health. Creating a viable plan for losing weight and maintaining weight loss is difficult. Obesity is associated with an increased risk for a wide variety of chronic health conditions. J. Disease Management. All had previous nutritional counseling without benefit. J. but no other feeding domain. Feingold. 72(1/2/3). F. (2002). L. less than half of obese patients are advised by healthcare professionals to lose weight. but two new therapeutic agents approved for long-term use. serum free thyroxine (T sub(4)) level was normal. and Vassilopoulou-Sellin. Evidence-based disease management: its role in cardiovascular risk reduction. Ater. Traditional risk factors--hypertension. J. M. Despite this fact. J. and Fernstrom. S7-10. Cardiovascular disease remains the most pressing healthcare problem in the United States.. and has a direct effect in their later years. Making a case.. J. K. R. Studies over the last 20-30 years have shown the benefits of physical activity in preventing cardiovascular diseases. Fanning. Bulletin. . L. Klein. insulin resistance. The new role of pharmacotherapy for weight reduction in obesity. International Journal of Clinical Practice. and osteoporosis. R.E.. It has been found that an active life contributes to improve health conditions and reduce obesity in children and adolescents. (2004). sibutramine and orlistat. M. All were treated for diabetes insipidus (DI) and hypopituitarism. and pediatric and adolescent diabetes-have emerged. was associated with increased child eating and weight status. and new risk factors--pre-diabetes. This article presents and discusses research evidence in support of the importance of physical activity for people of all ages. D. Patients with suprasellar lesions develop profound hypothalamic obesity and listlessness with no effective treatment. 51(11).P. can help maximise success.. Lifestyle change is always the cornerstone of treatment. 1381-1383. colon and breast cancer. 85 Parental feeding restriction. Increased weight loss can lead to reductions in the risk of obesity- related co-morbidities.. physical activity is also considered to play a role in the development of social interaction skills through the practice of planned and controlled games and sports. Important mental health benefits such as depression and stress reduction have been reported. Triiodothyronine supplementation for hypothalamic obesity.

E. were in an ongoing cohort study. and Colditz. the metabolic syndrome is an increasingly frequent risk factor for cardiovascular disease. M. Rosner. M. when the study began. Field. R. Gillman. Gillman. B. and lifestyle) in 364 individuals (189 women). We investigated the time course. 821-826. C. R. (2004). van Mechelen. Association between fruit and vegetable intake and change in body mass index among a large sample of children and adolescents in the United States. S. W. METHODS: A prospective study was conducted of 8203 girls and 6769 boys who were 9 to 14 years of age in 1996. G. Prospective cohort study of children and adolescent who were 9-14y of age in 1996. Malspeis.... E.. Twisk. 9-14y of age in 1996.... A. binge eating. 27(7). A. 112(4).. and completed at least 2 annual questionnaires between 1996 and 1999. 36 years). Rosner. C. A. 86 Ferreira. cardiopulmonary fitness. Development of fatness. W.. 42-8. incompletely understood.and sex-specific z score of body mass index (BMI).. M.. Rockett. from adolescence (age. Rockett.. . The objective of the study was to assess whether intake of fruits and vegetables was associated with change in body mass index (BMI) among a large sample of children and adolescents in the United States. B. W.. Rosner. Field. 1210-1216. Its determinants are. (2003). E. Pediatrics. 900-906.. J... Arch Intern Med. Kemper. Austin. however. H. and lifestyle from adolescence to the age of 36 years: determinants of the metabolic syndrome in young adults: the amsterdam growth and health longitudinal study. Dieting to control weight. H.. Rockett. and Colditz. C. 28(10). of important potential determinants (body fatness and fat distribution. A. Taylor. S. and Colditz. Snack food intake does not predict weight change among children and adolescents.. D. and dietary intake were assessed annually from 1996 through 1998 with instruments designed specifically for children and adolescents. A. The subjects included 8203 girls and 6715 boys in an ongoing cohort study who completed at least two questionnaires between 1996 and 1999. S. Among young adults. A. To assess whether intake of snack foods was associated with weight change among children and adolescents. International Journal of Obesity and Related Metabolism Disorders. and Stehouwer. R. I. fitness. (2003). G. W. (2005). B. B. B. Austin. Intake of snack foods was assessed in 1996-1998 with a validated food frequency questionnaire designed specifically for children and adolescents. Gillman. H. H. G. W. International Journal of Obesity and Related Metabolism Disorders. 165(1). B. The outcome measure was age. Relation between dieting and weight change among preadolescents and adolescents. Field. Methods: Prospective study of 8203 girls and 6774 boys. 13 years) to young adulthood (age. To assess whether dieting to control weight was associated with weight change among children and adolescents. in an ongoing cohort study who completed at least two questionnaires between 1996 and 1999...

910-915. Fifty coronary heart disease (CHD) patients scheduled for bypass answered questions about Transtheoretical Model (TTM) change strategy (process) use. and quality of life at 1 month prior to CABG and again at 1-month and 8-month postsurgery. M.452 men and women. There were no significant relationships among these variables in older adults (aged 40-59 yrs). These data suggest that increasing activity levels and decreasing the time spent in sedentary behavior such as watching television should both be considered as potential intervention strategies in obesity prevention programs. The increased prevalence and costs associated with the obesity epidemic have made preventive efforts a public health priority. P. E.. Fitzgerald. We argue that interventions targeted at youth are relatively easy to justify on economic grounds due to the additional protections that this group requires. (1997). but that justification for government interventions aimed at curbing obesity among adults requires additional evidence that private markets are not functioning properly. N. T. possibly because of low reported levels of physical activity and TV.. Weaker associations were found between TV and BMI. S. and obesity in adult Pima Indians. This study provided the opportunity to examine the relationship between television watching. Medicine and Science in Sports and Exercise. and will rely on similar strategies to combat obesity. Prochaska. .. Multiple linear regression analysis revealed that physical activity and television watching in men and activity in women were significantly related to BMI. Health risk reduction and functional restoration following coronary revascularization: a prospective investigation using dynamic stage typology clustering. television watching. A. and body mass index (BMI) in adult Pima Indians. M. and education efforts to curb epidemics. Kriska.. J. Associations among physical activity. Fitzgerald. S. O. 163-171. 29(7). and Haines. mood. Hours per day of television watched. a population with a high prevalence of obesity. 5(2). physical activity. past- year physical activity levels (leisure and occupational combined) and BMI were measured in 2. This evaluation will allow policymakers to make more informed decisions concerning the relative merits of these strategies in combating the obesity epidemic. J. French. M. (2000).. Variyam. taxes. 87 Finkelstein. and De Courten. (2004). 27(Suppl3). and use an economic framework to discuss the relative merits of the interventions. J. In adults between the ages of 21 and 39 yrs. Pros and Cons of Proposed Interventions to Promote Healthy Eating. International Journal of Rehabilitation and Health. S. Public health has historically relied on a series of targeted regulations.. P. aged 21-59 yrs). E... We identified patterns of coronary-prone behavior modification in a prospective cohort investigation of health risk reduction following coronary artery bypass graft (CABG) revascularization surgery. A. Pereira. and Pransky. We then present seven proposed intervention strategies to promote healthy eating. G. S. TV and physical activity levels were negatively correlated. 99- 116. American Journal of Preventive Medicine.

R. A significant increase over time in nutrition knowledge was noted for the treatment group. 131(2). 88 Fitzgibbon. Subjects included 24 African-American women and their preadolescent daughters living in a low-income urban housing complex in the USA. (1995).. 93- 99. W. R. 27(2). Stolley. and Kaufer Christoffel. R. V. Physician counseling on and referral for physical activity is generally recognized as a component of obesity treatment. and Jennings.. VanHorn. Flegal. R. Pre.. S. D. 440S. P. Results showed that the treatment group. 47-51.. nutrition attitudes and food intake. (2001). Troiano. M. This study examined the effects of an obesity prevention programme on eating-related knowledge and behaviour. Surgeon General's Call to Action on Overweight and Obesity 2001 proposes inclusion of health care providers in prevention efforts and suggests classification of obesity as a disease category for reimbursement coding. Preventive Medicine.to 3-year-old children. differences within dyads showed that the mothers significantly improved their eating patterns (fat g and fat percentage intake)..and post-treatment measures included assessment of nutrition knowledge. Higher rates of overweight/obesity among minority women place their children at increased risk. M. compared with controls. K. Managed Care Interface. The increasing prevalence of overweight among children in the United States presents a national health priority. A community-based obesity prevention program for minority children: rationale and study design for Hip-Hop to Health Jr. low-fat food planning and preparation. N.. M. A. Additionally. risks of high-fat eating. (2002).. Aim for a healthy weight: What is the target? Journal of Nutrition. The 6-week treatment addressed the identification of high. Therefore. K.. The U. Stolley. and Kirschenbaum. Trendell. early prevention efforts incorporating families are critical. L.. Recent changes in the interpretation of the federal tax law may influence physicians' and health plans' roles in promoting physical activity. Bondi. they are not observed in 2. although not significant. An obesity prevention pilot program for African-American mothers and daughters. Fitzner. how to read food labels and calculate percentage of fat in energy in food.. French. M. more so than the daughters. 289-298. M. 34(2). but data on the effectiveness of these measures remain inconclusive. compared to controls. The dyads were randomly assigned to the treatment or control group. M. K. L. 55. a trend for a greater increase in knowledge for the treatment group. A. Dyer. Furthermore. Caputo. 16(1). Journal of Nutrition Education. Recent tax changes may assist treatment of obesity. was observed.S. Although increased rates of overweight are observed in 4- to 5-year-old children. and Ballard-Barbash.and low-fat foods. These preliminary findings support the importance and effectiveness of parent-child prevention programmes in high-risk communities.. (2003). Fitzgibbon. C.. M. decreased their intake of fat in grams and in percentage of total energy.. L. . and the problems associated with obesity in general and within the African-American community in particular.

Insulin resistance syndrome. K. (1997). 56(1B). Journal of Cardiovascular Nursing. Insulin resistance syndrome. The purpose of this article is to (1) describe the insulin resistance syndrome and discuss the current focuses for inquiry in major outcome areas (eg. (2004). and Widhalm. New insights into the field of children and adolescents' obesity: the European perspective. A. Obesity is a chronic disease due to excess fat storage. Flodmark. 28(10). Surgical Treatment of Obesity: A Review. and thus is of tremendous interest to nurses seeking to measure their impact on patient outcomes. Moreno. Fear of fatness and adolescent girls: implications for obesity prevention. L. The awareness of childhood obesity as a major health problem and an uncontrolled worldwide epidemic has to be increased in the society. 19(5). Fletcher. and exercise). and the incidence is increasing . B. M. This problem is worldwide... (2004). and strong environmental contributions. 1189-1196. Flynn. (2) describe the status of specific lifestyle interventions (weight loss. (3) identify outcomes that nurses could measure to assess their impact on patient care. T.. The key lifestyle interventions essential to treating this syndrome are weight loss and physical activity. The incidence of this morbid syndrome is expected to continue to grow both in the United States and worldwide. also referred to as the metabolic syndrome. International Journal of Obesity. This review discusses some of the social. DESIGN: In order to improve the quality of the health care and to minimize the cost it is important to investigate and standardize pediatric obesity prevention and treatment and to adapt to social and cultural aspects. and (4) identify areas for future nursing research. These clinical abnormalities include dyslipidemia. costs). Lissau. A. and Lemendola. Journal of the National Medical Association. elevated glucose. economic and psychological aspects of adolescent obesity Fobi. diet. mortality. A. specifically elevated triglycerides and low high-density lipoprotein cholesterol. affects 1 in 3 to 4 adults older than 20 years. Proceedings of the Nutrition Society. I." The purpose of this paper is to describe the evolution of the weight guideline and discuss some issues related to it. E. (2004). C. This syndrome consists of a clustering of metabolic abnormalities that put people at risk for type 2 diabetes and cardiovascular disease. 89 The first guideline statement of the Year 2000 edition of Nutrition and Your Health: Dietary Guidelines for Americans is "Aim for a healthy weight. and hypertension. 305-317. Pietrobelli. L. A.. a genetic predisposition. morbidity. We reviewed current and previous editions of the Dietary Guidelines and the corresponding advisory committee reports. 339-345. C.. 96(1). 61-75. M.

Patients. and health food stores. more Americans are overweight than ever before.. H. To examine the ability of the personality dimension dispositional optimism to predict short-term obesity treatment outcomes (weeks of program attendance and weight loss). The role of the behavioral counselor in obesity treatment. (2005). There are medical. W. Ford. But despite the proliferation of health clubs. JAMA: Journal of the American Medical Association. To examine the variation in the prevalences of obesity and type 2 diabetes in weight loss counseling by health providers and in other potential obesity-related determinants in 100 metropolitan statistical areas in the United States. S. About half of US women and one-third of US men say they are trying to lose weight. K. P. (1999).. 118-22. A. 55(1). Obesity Research. K. W. S27-S30. E. A. Galuska. 1581. 141-144. economic. R. II. Giles. J.. bariatric surgeries should be performed in a multidisciplinary setting. Journal of Clinical Psychology. (1999). & Bridges. and Serdula. Behavioral counselors. diabetes. 177 consecutive persons seeking outpatient treatment at a university-based weight management center completed the revised Life Orientation Test (LOT-R. M. People who did receive such advice were three times more likely to try to lose weight.. Doctors can do more to encourage their patients to control their weight. fitness centers. who are often also registered dietitians provide multidisciplinary . Scheier. Mokdad. and Poston. S. 282(16). Two 1999 articles report that many doctors do not encourage their obese patients to lose weight. The laparoscopic approach is being used by some surgeons in performing the various operations. L. social. J. (1998). Fontaine. and obesity-related behaviors. P. physicians. The overall LOT-R and optimism subscales did not correlate with either attendance or weight loss. B. D. and Cheskin. physical. and weight control.. Gastric bypass operations are the most common operations currently used. C. Optimism and obesity treatment outcomes. 13(1). Because there are inherent complications from surgeries.. and psychological comorbid conditions associated with obesity. surgery offers the only viable treatment option with long-term weight loss and maintenance for the morbidly obese. H. Geographic variation in the prevalence of obesity. Fontanarosa.. Foreyt. There is no cure for obesity except possibly prevention. 1994) and underwent a comprehensive medically monitored weight loss program. Surgeries for weight loss are called bariatric surgeries. Journal of the American Dietetic Association. However. the pessimism subscale was positively associated with weeks of attendance. This review summarizes the role of behavioral counselors in obesity treatment. Currently. Carver. 90 daily.

Shape Up America! hosts DIABESITY conference. identified prevention and treatment modalities. Forman-Hoffman. A. including children. Haenni. High prevalence of abnormal eating and weight control practices among U. Interventions that incorporate these strategies are effective in producing gradual and moderate weight loss in persons with obesity. V. They discussed the causal pathways between obesity and type 2 diabetes. (2001).. multiple intervention-related strategies can be used to further enhance adherence to treatment and elicit behavior change. M. The first step is to establish a collaborative alliance that will facilitate adherence and behavior change. 91 treatment teams with expertise in the modification of diet and physical activity behaviors. Nguyen. International Journal of Obesity. Behavioral counselors use a variety of behavior-change strategies aimed at modifying obesity-related behaviors.. We propose to . At a recent conference on Diabesity(R) in America. (2004). private sector. M. and both genders. 39(6). affecting people of all ages.S. all racial groups. Nutrition Today. physical activity. Amati. stress management. experts addressed the connection between obesity and diabetes from both a basic science and clinical practice perspective.. and relapse prevention.S. March 2001. 36(5). (2004). examined environmental factors contributing to obesity. (2002). C. This study sought to determine the prevalence and to identify correlates of abnormal eating and weight control practices in U. high-school students. and Golay. 266-271. 26(1). and community in establishing intervention programs to reduce the growing prevalence of obesity and diabetes. high-school students. stimulus control. cognitive restructuring. A. M.. and explored the role of the food industry. A distinguished panel of speakers addressed the factors contributing to the increase in type 2 diabetes among people of all ages. F. In response to this phenomenon. Eating Behavior. Reiner. The most important problem in cognitive-behavioral therapies (CBT) for obese patients is to initiate weight loss without reinforcing the eating-behavioral disorders. These strategies include self-monitoring. and suggested practical measures for prevention and intervention that can be implemented now. schools. 245-256. Forman. A. social support. Shape Up America! recently launched the first phase of its DIABESITY public health initiative with a unique and stimulating 2-day conference. Nutrition Today. VA. Forman. The Second National Conference on Diabesity in America.. The prevalence of obesity and diabetes in America is a growing public health threat. Fossati. 325-36. Alexandria. 5(4). including children. Cognitive- behavioral therapy with simultaneous nutritional and physical exercise in obese patients. Then. The prevalence of obesity and diabetes in the United States is spreading at an alarming rate.

Foster. and Didie... however. It is unknown.... T. This pilot study assessed the short. 92 assess the CBT in obese patients suffering from eating disorders with or without combining nutritional and physical exercise approach. Swain. 1168-1177... Stunkard. D. E.. (2003). A. J. M. (1999). Gill. body composition. . Foster. Describe the physical and psychological correlates of the Eating Inventory (EI) (also known as the Three-Factor Eating Questionnaire) factors in an obese sample.. Davidson. (1998).and long-term effects of a modified cognitive behavioral treatment designed to facilitate obese patients' acceptance of a 5% to 10% reduction in initial weight.. D. Foster. Allison.. and determine the relationship between the three factors and weight loss. 69(1).. S. G. (1999). Phelan. We assessed REE. Wadden. A. D. G. Foster. Previous studies showed that resting energy expenditure (REE) is lower in obese African American women than in obese white women. D. and Vogt. G. D. T. American Journal of Clinical Nutrition. A. The Eating Inventory in obese women: clinical correlates and relationship to weight loss. T. T. G. D.. 13-17. (2004). We assessed REE... 1271-1277. R. working on weight management issues if their time was reimbursed appropriately. Wadden.. M. Anderson. and Vogt.. 13-17. 12(8). This study was designed to assess physicians' attitudes toward obese patients and the causes and treatment of obesity. D. Changes in resting energy expenditure after weight loss in obese African American and white women. 778-785. A. P. Obesity Research. body composition. Makris.. Wadden. Previous studies showed that resting energy expenditure (REE) is lower in obese African American women than in obese white women. G. and Vogt. A. Swain. and Kessler. M.. A... Anderson. A.. Swain. Obesity Research. Foster. Primary care physicians' attitudes about obesity and its treatment. R. Wadden. D. A. A. A. R. American Journal of Clinical Nutrition. D. A. and respiratory quotient before and after weight loss in obese black and white women. R. and respiratory quotient before and after weight loss in obese black and white women. Ermold. Sanderson. D. R. B. Wadden. A. A. J. Platte. International Journal of Obesity and Related Metabolism Disorders. whether there are racial differences in how REE responds to weight loss and energy restriction.. Changes in resting energy expenditure after weight loss in obese African American and white women. however. Promoting More Modest Weight Losses: A Pilot Study. R. R. P. whether there are racial differences in how REE responds to weight loss and energy restriction. S. T. 11(10). It is unknown..

Georgia region. enabling the organism to quickly adapt to environmental changes by inducing the appropriate metabolic genes and pathways. 69(11). and street connectivity were developed within a 1- kilometer network distance of each participant's place of residence.878 participants in the Atlanta. and Kahwati. G. To evaluate the relationship between the built environment around each participant's place of residence and self-reported travel patterns (walking and time in a car). Important predictors of overweight include age. unlike classical nuclear receptor ligands.. Nuclear receptors and the control of metabolism. school-based prevention programs are not successful in reducing the prevalence of obesity. Body Mass Index. and an additional 15 percent are overweight. Improving the healthfulness of the diet would therefore require not only a major reduction in the consumption of fats and sweets but also a sharp increase in the consumption of vegetables and fruit. relationships between obesity and aspects of the built environment have not been evaluated empirically at the individual level. To date. and Allshouse. American Family Physician.. 133(3). Picard. Generally. net residential density. L. 65.. Obesity Relationships with Community Design. Francis. educational attainment. (2004). J. race/ethnicity. Overweight in childhood and adolescence is an important public health issue because of its rapidly increasing prevalence and associated adverse medical and social consequences. 2591. The typical American diet is top-heavy in comparison with the Food Guide Pyramid-high in added sugars and fats at the Pyramid's tip.. and low in most other food components at the Pyramid's base. Fayard. A. and obesity for specific gender and ethnicity classifications. 261-311. and parental weight status.. L. American Journal of Preventive Medicine. body mass index (BMI). Objective measures of land use mix. 87-96. and Time Spent in Cars. and gender were derived through a travel survey of 10. 27(2). sex. Physical Activity. E. (2003). The metabolic nuclear receptors act as metabolic and toxicological sensors. A. Strategies for intervention: Commentary and debate. Ligands for these metabolic receptors are compounds from dietary origin. drugs. 844S-847S. T. Prevention and treatment of overweight in children and adolescents. or other environmental factors that. A. intermediates in metabolic pathways. are present in high concentrations. kilometers walked. D. especially fruit and green leafy vegetables. Recent studies have estimated that 15 percent of children in the United States are at risk for overweight. income. and Schmid. Andresen. E. Annual Review of Physiology. (b) increasing nutrition knowledge and (c) manipulating food prices. M. Frank. Journal of Nutrition. Frazao. (2003). 93 Fowler-Brown. and Auwerx. minutes spent in a car. Obesity is a major health problem in the United States and around the world. This report discusses the potential effects on diet quality of three general dietary strategies for obesity prevention and treatment: (a) reducing the fat content of foods.. J.. age. L. It . (2004). C. F.

an increase in perinatal mortality. This paper focuses on the role and components of optimal healing environments (OHEs) that may be useful in the management of childhood obesity: healing intention. M. M. 39-43. M.. 10 Suppl 1.. (2002). During pregnancy. Numerous physical activity and physical fitness recommendations exist for youth. E. 581-599. especially in developed countries. healing relationships. no investigator has systematically reviewed these public health and . and an increase in caesarean section and instrumental vaginal delivery. S.. however. T. J. The prevalence of obesity. notably. Sports Medicine. (1997). MIDIRS Midwifery Digest. Fried. Jo Altern Complement Med. 582-587. Galuska. Garg. Hepato- Gastroenterology. Diet. The role of optimal healing environments in the management of childhood obesity. (2004). M. Obesity in pregnancy. Journal of Family Health Care. Gastric banding in the treatment of morbid obesity. J. and behavior modification strategies used in the treatment of childhood obesity are also reviewed. Last month's House of Commons' Public Accounts Committee Report Tackling Obesityin England was a wake-up call for action on this major UK epidemic. J. diabetes and hypertension... J. A. has dramatically increased in recent years with the trend most marked among women. 5 and 10 years after the operation. To date. and Peskova. and Stern. Obese patients who underwent "laparoscopic" gastric banding were followed up 1. 44(14). Fry. Its publication was timed to precede a conference on obesity organised by the National Audit Office. Public health and clinical recommendations for physical activity and physical fitness: special focus on overweight youth. 12(1).. health promotion and disease prevention. The prevalence of childhood and adolescent obesity has increased steadily over the past three decades such that obesity is now a major worldwide pediatric health risk factor. Obesity is associated with several serious health problems. Frohlich. Freedman. 94 concludes that improving food choices may require a combination of strategies and interventions carefully targeted at changing specific behaviors among diverse population groups. K. R. Obesity has become a pressing public health concern. 5. D. 12(1). 34(9). S231-44. C. T. and Caspersen. and healing spaces. Fulton. Rattay. reaching epidemic proportions. physical activity. 20% men and 25% women obese by 2005. and is an important early risk factor for adult morbidity and mortality. (2004). Pediatric obesity is associated with significant health problems. obesity can predispose to gestational diabetes. (2002). In the Western world we are getting heavier. an adverse effect on fetal growth and development.

Studies have suggested that lifestyle exercise programmes may produce the best long term results. 250 million adults are obese. In this study. 50(1). Efforts are currently being made to reduce the prevalence of paediatric obesity. 31(3). G. This review examines youth-oriented physical activity and physical fitness recommendations for both the public health community and the clinical community. Youth weight loss studies have produced significant long term results.. J. Tea catechin suppresses adipocyte differentiation accompanied by down-regulation of PPARgamma2 and C/EBPalpha in 3T3-L1 cells. M. (-)-epigallocatechin (EGC). K. T. Bessho.. diet and exercise. C. Furuyashiki.. nutritional. Nagayasu.. a non-weight-centered paradigm might be more effective for improving the health of individuals considered overweight or obese. Sports Medicine. and assesses how overweight youth are specifically targeted by each of these two groups. Obesity is a serious health problem. Americans continue to get fatter. above all. (2001). 95 clinical guidelines to determine whether the recommendations address overweight youth. H. McGuire.. Most of these programmes included behaviour modification. 68(11). A. A natural diet versus modern Western diets? A new approach to prevent "well-being syndromes". Actually. T. Eating behavior has strong extraphysiological determinants.. and (-)- epigallocatechin 3-gallate at 5 muM suppressed intracellular lipid accumulation. 56(1). and political and cultural trends.. depending upon interactions between multiple genes and the environment. E. Many obesity-related health conditions can be ameliorated via physical activity and improved nutrition. socioeconomic progress. H. Aoki. and Piscaglia. Caspersen. Gaesser. H. and Dietz. 1-6. Weight loss for the obese: panacea or pound-foolish? Quest. and its prevention is promoted through life style including diet and exercise. Because traditional weight loss programs have poor long-term efficacy. and cognitive stimuli. the consequences of dramatic changes in lifestyle. 153-165. H. Fulton. Gasbarrini. (-)-epicatechin 3-gallate. . independent of weight loss. 12-27. A. Obesity is a complex trait. 2353-9. C. J. and 500 million adults and 22 million children under 5 years of age are overweight. Interventions for weight loss and weight gain prevention among youth: current issues. and Ashida. Obesity is the most common nutritional disorder in the Western world. (2004). Biosci Biotechnol Biochem.. The recent increase in the prevalence of paediatric obesity is one of the most pressing public health concerns today because of the immediate and long term health consequences associated with this often intractable disease. being influenced by neuroendocrine. W. environmental. T... (2005). A. (2004). but its recent rise and "epidemic proportions" are. Despite increasing prevalence of dieting. we investigated the suppressive effects of tea catechin on the differentiation of 3T3-L1 preadipocytes to adipocytes. (-)-Catechin 3- gallate (CG). Dig Dis Sci. Kanazawa. Hashimoto. able to modify the body weight set-point. Y.

(1997). 6(2). Gill. 59(3). followed by an account of various obesity prevention strategies. Associations between energy density and macronutrient composition in the diets of pre-school children: sugars vs starch. The rationale and logistics behind obesity prevention are reviewed. and requires public health programmes that deal with societal and environmental factors which contribute to lack of physical activity and increased energy intake. To investigate the associations between energy density (ED) and macronutrient composition in the National Diet and Nutrition Survey of Children aged 1 1/2. thoughts and attitudes associated with perceived appearance. J. The purpose was to measure the effect of holidays or season on changes in body weight to determine if this was the reason for the low success rate of weight control program participants. and Bar-Or. Sixty-six percent of subjects gained weight during the summer months. L.04. . the average weight gain was 2. It is estimated that 50% of women dislike their bodies and fear being overweight. March-April at p<0. There has been a trend in recent years for more and more individuals to experience a discontent with their bodies. 53(2). including prevention of obesity during childhood.8% of ideal body weight. two manifestations of a negative body image. Changes in percent ideal body weight were gathered on 73 overweight youth (average age: 10. A. (2005). British Medical Bulletin. 359-388. Body image dissatisfaction is not simply a dislike of personal appearance. M. O.04. Key issues in the prevention of obesity.004. McDowell. (1998). Relationship between summer vacation weight gain and lack of success in a pediatric weight control program. It is concluded that obesity needs to be tackled at a population level. (2000). There was a statistically significant gain in percentage of body weight during July-August compared to January-February at p<0. selective (targeting high-risk groups) and indicated (targeting those individuals with existing weight problems) prevention schemes are considered. The application of universal (targeting whole population). Body image dissatisfaction is a serious. Body image dissatisfaction: a framework of development and recommendations for dietitians. Key points for clinical practice are summarized. hypothesizing that high-ED diets tend to be high in sugars as well as fat..001 and September-October at p<0.8 years. and public health approaches to obesity prevention. Areas of priority for preventive action are identified. T. May-June at p<0. but the negative emotions. 633-638. prevalent condition in western culture. 132-137. 137-43. When the subjects who lost weight in the summer period were removed from the analysis. Gillis. Canadian Journal of Dietetic Practice and Research.. Eating Behavior. Perspectives in practice.4 1/2 y. International Journal of Obesity and Related Metabolism Disorders. The integration of obesity prevention into management and the reluctance of the medical profession to embrace the idea of obesity prevention is discussed. percent ideal body weight: 150+/-28%) over 2-month intervals in a 1-year time span.5+/-2. R. S. Gingras. 96 Gibson.

Story. 97 Giovannucci. 251-265. and Iron Cloud. E. The qualitative data identified key social and environmental issues and enabled local people to express their own needs and views. 12(2). (2) it is holistic. M. including data collection from parents. and highly processed carbohydrates and sugars. The feasibility phase of the Pathways study was conducted in multiple settings in 6 American Indian nations. and colorectal cancer: a summary of the epidemiologic evidence. 767S-772S. and some micronutrients may be important as protective agents. Evans. 69(Supplement 4).. (1998). Journal of Women's Health. Health Education Research. M. Davis. using an approach based on social learning theory. Hyperinsulinemia may be an important underlying risk factor. Story. and Clay. administrators and community leaders. Metcalfe. Gittelsohn. 13(2). Evans. body weight. The paper describes the process of developing the different units of the protocol. certain dietary patterns that stimulate insulin secretion. An emphasis is placed on describing which units of the formative assessment protocol were most effective and which were less effective.. saturated and trans-fats. Physical inactivity and excessive adiposity. Formative research in a school-based obesity prevention program for Native American school children (Pathways). and the number of new cases annually is approximately equal for men and women. which induce a state of insulin resistance. The formative assessment work presented here was unique in several ways: (1) it represents the first time formative research methods have been applied across multiple Native American tribes. In conjunction with obesity and physical inactivity.. Diet. The formative assessment process. especially if centrally distributed. 173-182. L. J. Several nutritional factors are likely to have a major influence on risk of this cancer. S. (1999). There is evidence suggesting that some component of red meat may independently increase the risk of colorectal cancer. T. J. Anliker. how data collection was implemented and how analyses were structured around the identification of risk behaviors. The quantitative. Colorectal cancer is the second leading cause of cancer death in the United States. M.. The Pathways formative assessment collected both qualitative and quantitative data. Davis. Helitzer. M. teachers. including substantial input from Native American collaborators.. D.. S. children. may increase the risk of colon cancer. Multisite formative assessment for the pathways study to prevent obesity in American Indian schoolchildren. clearly increase the risk of colon cancer. This paper describes how formative research was developed and implemented to produce obesity prevention interventions among school children in six different Native American nations that are part of the Pathways study. American Journal of Clinical Nutrition.... The formative assessment results were used to identify and rank the behavioural risk factors that were to . L. D. L. (2003). Metcalfe. structured data permitted comparison across sites. Helitzer. for the development of a school-based obesity-prevention intervention into which cultural perspectives are integrated is presented. Both types of data were integrated by using a conceptual and procedural model. and (3) it was developed by a multi-disciplinary group. P.. including high intakes of red and processed meats. Gittelsohn... J. E.. M.

G. M. J. J. and educators: formative assessment findings from pathways. S. A formative assessment was undertaken with teachers. S. S. (2003). the use of food rewards in the classroom. S62-S69. Davis. Merkle.. Hastings... J.. J. Davis. L. at school. J. Norman. high-fat entrees in school meals. Cano. school food-service workers.. (2000). this knowledge does not appear to influence actual food choices.. and the children themselves. Dietary findings from a school-based obesity prevention project (Pathways) are reported for children from six different American-Indian nations.. School climate and implementation of the Pathways study.. physical education. including classroom curriculum. M. C.. Gittelsohn. Preventive Medicine.. J. S. Stewart. Food perceptions and dietary behavior of American-Indian children. . Pathways was a multisite school-based study to prevent obesity in American Indian school children by encouraging healthy eating and physical activity.. food service. This assessment employed a combination of qualitative and quantitative methods (including direct observations. paired-child in-depth interviews. The physiological responses of inactive obese premenopausal African-American and Caucasian women to the identical exercise training and behavior modification program were compared. M. and Durstine... and limited family resources are some of the competing factors that need to be addressed in the Pathways intervention.. L. their caregivers. Going. B. J. Sharma. J. focus groups with child caregivers and teachers. Noel. Glass. C. Physiological responses to weight-loss intervention in inactive obese African-American and Caucasian women. S. Although children and caregivers identified fruits and vegetables as healthy food choices. J. L.. high-sugar foods was detected in children's diets described by caregivers. Journal of Sports Medicine and Physical Fitness. Fernhall. Thompson. and children from nine schools to design a culturally appropriate intervention. E. and family components. rules about finishing all of one's food. (2003). Miller. Harnack.. 37(6). M. J.. (2002). caregivers. 42(1). Story. D. Preventive Medicine. E. and in the community. N. Szymanski. Stone. Toporoff. and Ethelbah. A. Story. Frequent high-fat/high-sugar food sales in the schools. 2-13. J. 37(6 Part 2). C. Anliker. and semistructured interviews with caregivers and foodservice personnel) to query local perceptions and beliefs about foods commonly eaten and risk behaviors associated with childhood obesity at home.. and White. The effects of the Pathways Obesity Prevention Program on physical activity in American Indian children. An abundance of high-fat.... A. Journal of Nutrition Education.. 56-64. and Corbin. Steckler. Evans. E.. W... Martin. C. 98 become the focus of the Pathways intervention and to provide guidance on developing common intervention strategies that would be culturally appropriate and acceptable to all sites. B. Stone. Gittelsohn.. S97-S106..

. 343-354. 12(2). Kelsey. A. Fossati. C. M. 27(6). sophrology and physical exercise are discussed in detail. L. S55-S61. 28(4). Goldberg... Norman.. 218-223. d. Diabetes. Multidisciplinary approach to obesity treatment. A. To report the long-term change in children's overweight following a family-based health- centered approach where only parents were targeted compared with a control intervention where only children were targeted.. A cognitive-behavioural-nutritional programme featuring physical exercise and sophrology sessions in the long-term management of obesity is proposed. Delétraz.. Shields. Luzy. 5(5). particularly in minority populations at high risk for obesity and inactivity... Targeting Parents Exclusively in the Treatment of Childhood Obesity: Long-Term Results. M. Barriers to physical activity . K. Obesity is a condition in which abnormal or excessive fat accumulation in adipose tissue impairs health. (2004).flair-flow. P.. Howles... The different approaches including pedagogical... An evaluation of the programme is also included. psychological-cognitive-behavioural. 357-361. Golan. Obesity Research. Cano. Few studies include data on caregiver and daughter dyads. and Ammerman. FLAIR-FLOW 4: synthesis report on obesity for health professionals. E. (2003). Impact of the Pathways intervention on dietary intakes of American Indian schoolchildren. and Corbin. Stewart. Formative data were used to develop intervention strategies and pathways for the Girls Rule! obesity prevention intervention. Nutrition Bulletin. P. Golay. N. S. Stone.. Harnack. (2003).. J. F. nutritional. J. J. 27(3). 274- 279. K. M. One of the activities of FLAIR-FLOW Europe 4 (http://www. S. Bentley. 99 Inadequate opportunities for physical activity at school and overall low levels of activity contribute to the high prevalence of overweight and obesity in American-Indian children. Inadequate opportunities for physical activity at school and overall low levels of activity contribute to the high prevalence of overweight and obesity in American-Indian children. (2004). D. in under-studied high-risk pre-adolescents.. G. This report on obesity is the third in a series of six synthesis reports written for health professionals. There is little research on household and physical environment barriers to physical activity. C. Gordon. American Journal of Preventive Medicine. D. M.com) is the production of synthesis reports. S. (2003). M. Going. Thompson.. Griffiths. . Preventive Medicine.Qualitative data on caregiver-daughter perceptions and practices. L. Obesity and Metabolism. and Ybarra. Hastings... S. Ward.. E. and Crow.

E.. Managing obesity and glycemic control in insulin-using patients: clinical relevance and practice recommendations. Participants with at least 1 successful partner (weight loss >=10% at 6 months) lost significantly (p =. and 18 months were not associated with the number of partners (0-3) but were associated with the weight loss success of the partners. W. 1154-1160. (2001). bone density and body composition when given for obesity as adjuvant to an energy. Overweight participants (n = 109) assigned to an exercise intensive group in a larger trial were encouraged to invite up to 3 partners to attend treatment. As the prevalence of type 2 diabetes and obesity continues to increase worldwide.. Involving Support Partners in Obesity Treatment. I. and Andersen.. 12. and Wing. In this study. This article reviews several dietary options within a MNT program. (2005). M. 65. D. Journal of Consulting and Clinical Psychology. However.. To investigate the influence of the pancreas lipase inhibitor orlistat (OLS) on calcium metabolism. the authors examined whether the number or success of weight loss partners influences participants' outcomes in behavioral weight loss treatment. Weight losses at 6. Influence of orlistat on bone turnover and body composition. Jeffery. . midarm circumference. Gottesman. Ferguson. The central component in any such strategy is a tailored program of medical nutrition therapy (MNT). Toafa. L. and 18 months than those with no successful partners and those without partners. It also provides several practice recommendations to encourage compliance in patients with type 2 diabetes who wish to manage their weight while receiving insulin therapy. insulin use has been associated with weight gain. Dietary factors are not associated with high levels of obesity in New Zealand Pacific preschool children. we assessed the anthropometric status of 2. physical activity. B.and fat-restricted diet. and 2-d weighed food records (n = 60) and demographic data were collected. Diabetes Research and Clinical Practice. 12. weight (n = 60).. A.to 5-y-old Pacific children (n = 60) in relation to their macronutrient intakes. In this study. health care providers must incorporate the management of weight gain in therapeutic strategies that promote glycemic control. which includes a healthy diet. 2561-2565. bone mass. In a number of large-scale studies. Henry.. N. E. S17-S22... Journal of Nutrition. and triceps skinfold thickness (n = 58). 100 Gorin. Gotfredsen.004) more weight at 6. T. A. R. and education. 134(10). Tate. Pacific children living in New Zealand (NZ) are prone to excessive weight gain. low-glycemic index carbohydrates. Measurements of height (n = 56). and Guthrie. Hendel. (2004). Grant. intensive therapy regimens have improved glycemic control while reducing the microvascular complications of type 2 diabetes. Sherwood. including the uses of liquid meal replacements. R. Phelan. H.. V. (2004). 341-343. and foods rich in monounsaturated fatty acids. S. E. bone turnover. International Journal of Obesity and Related Metabolism Disorders. 73(2). T. thereby hampering patient compliance with intensive insulin therapy. A...

diabetes) require behavioral and medical interventions. Practice Nurse. Green. and Miller. Sue Green and Mary O'Kane explain how. T. Management of obesity commonly takes place in the primary healthcare sector. (1998). Waters. This study set out to examine the socio-cultural. L. 24.. P. Appropriate assessment of risk factors is essential because research has demonstrated successful prevention of heart disease and reduction of morbidity and mortality in patients with existing disease. S. and generation by generation focus groups of grandparents. familial and environmental factors influencing health. Future needs include the study of psychosocial factors in women and ethnic minorities with heart disease and the integration of behavioral medicine with newer medical technologies designed to detect subclinical biomarkers of heart disease. K. 22(3). 101 Graves. This article reviews the role of the dietitian and community nursing professionals in the treatment of obesity in the community. M. and Passway. and social isolation. S. community nursing professionals can give advice on dietary and lifestyle changes that promote weight loss.. E. Australia. 3-25. Most biomedical cardiovascular risk factors (e. Social.. training and support. Green. (2001). hostility. Health and Development.g. Obesity. 441-448. smoking. 20. Raman. (2003). Behavioral medicine screening and intervention have been applied to psychosocial risk factors such as depression. M. Dietitians can also improve the knowledge. Green. skills and confidence of community nursing professionals in dietary and lifestyle counselling of people with obesity through education.. cultural and environmental influences on child activity and eating in Australian migrant communities. including obesity. parents and children from four cultural communities in the state of Victoria. M. (2003). M. high-fat eating patterns. Behavioral medicine in the prevention and treatment of cardiovascular disease. A. The prevalence of obesity in the UK population is increasing. Cardiac behavioral medicine is the application of behavioral and psychosocial principles to the prevention and treatment of heart disease.. METHODS: Semi-structured. J. community-based interviews were conducted with contrasting key informant three-generation families.. eating habits and patterns of physical activity contributing to child and adolescent overweight and obesity. With the guidance of the dietitian. high blood lipids. Community nursing professionals are in a good position. Practice nurses can do a great deal to support people with obesity by offering dietary advice. through group work or . British Journal of Community Nursing. C. Behavioral interventions have been beneficial in improving cardiac outcomes by enhancing compliance with medication taking and dietary/exercise recommendations. D. J. 29(6). Behavior Modification. Management of obesity in the primary care setting.. 22. and inactivity. Other risks.. 244-249. Booth. 27(1). clearly require lifestyle change. Haikerwal. and Gibbons. K.. Child: Care. high blood pressure. 3(5).. and O'Kane. O'Neill. Focus on nutrition. S.

. Z. P. D. 81-86. M. These observations often stimulate basic research into the physiologic mechanisms responsible. M. Being obese can induce multiple metabolic abnormalities that contribute to cardiovascular disease. Obesity threatens to become the foremost cause of chronic disease in the world. to provide psychological support and follow-up consultations for people with obesity who are trying to lose weight. with preferential loss from the visceral compartment. (1998). The hypotheses under examination were (1) preferences for low-fat foods would increase across time and (2) preferences for high-fat foods would decrease across time. To examine whether increasing duration of breastfeeding is associated with a lower risk of overweight in a low-income population of 4-year-olds in the United States. with minority youth at highest risk. Journal of School Health. 98-99. F. Nutrition. we view better treatment as the goal of obesity research. Initial treatments of chronic diseases commonly arise from empirical observations. (2002). and Melkus. S. 74(1). Grieve. Grey... 16(10). Berry. The future of obesity research.. Reasons for the rising . proceedings of a symposium held at The University of Texas Southwestern Medical Center. and preserve lean tissue with a minimum of side effects. Desire to eat high. April 22-23. and other chronic disorders. As endocrinologists... S. Galasso. Obesity has been recognized as a chronic disease since 1985. Preliminary testing of a program to prevent type 2 diabetes among high-risk youth. American Journal of Clinical Nutrition. Multifactorial causation of obesity: implications for prevention. and Smith. Grundy. Does breastfeeding protect against pediatric overweight? Analysis of longitudinal data from the Centers for Disease Control and Prevention Pediatric Nutrition Surveillance System. This study examined changes in desires to eat high-fat and low-fat foods across an obesity treatment program. diabetes mellitus. Grummer Strawn. prevalence of obesity is increasing both in the United States and worldwide. Davidson. This preliminary study tested the feasibility of a school-based program to prevent type 2 diabetes in youth at risk. Unfortunately. Chronic diseases recognized before obesity may predict the future of obesity research. 113(2). M. Journal of Nutrition Education. M. and Vander-Weg. Gustafson. Greenway. G. E. M. Dallas. 102 on a one-to-one basis. Pediatrics. 10-15. Type 2 diabetes is increasing among youth.and low-fat foods following a low-fat dietary intervention. (2004). Such cross-fertilization between the clinic and basic science is desirable and expected.. (2000). (2004).. The ideal obesity treatment would reduce body fat substantially. G. 563S-572S. 1996. 67(3S). L. and Mei. R. L. F. 976- 983. W.

low fat (20-25% of energy). We present the brief case histories of these four subjects. They each required specialized rehabilitation intervention and specialized equipment such as extra large beds and oversize walkers.4%) met the criteria for morbid obesity.a retrospective study of four cases: a brief report. Guernelli. moderate obesity is responsible for most obesity-related disorders. Even so. M. (2005). Therefore.. (2002). J. A total of four patients (3. Body composition assessment and physical examination were performed at the beginning of the study and after 8 weeks of proposed regimen. moderate obesity can elicit several metabolic abnormalities that are precursors to chronic disease. and acquired influences probably exceed genetic factors in its causation. A major public health effort is urgently needed to counter the increasing frequency of moderate obesity in the United States and throughout the world. J. and Miranda Lama. and reduction of physical activity. 78(1). 'Functional Food' is not a new concept but it became more important recently due to the collapse of most social health system because 'Functional Foods' allow low cost prevention of numerous diseases. American Journal of Physical Medicine and Rehabilitation. Diet recommendations included modest energy restriction (500-750KCal/d). S. 60-65. moderate protein (15- 25%) and high carbohydrate (60%) intake together with food combining plan (proteins and carbohydrates eaten in separate meals). S. P. most obesity in the general public is only moderate. for the population as a whole. Pack. All four subjects had obstructive pulmonary disease.. 26(1). increased availability of food supplies. All showed significant functional improvement and were able to return home after a mean length of stay of 61 days. Forum Nutrition. R. Morbidly obese patients with pulmonary disease -. (1999). 103 prevalence include urbanization of the world's population. Gudelj. E. Guesry. These acquired causes thus deserve greater attention in the development of a public health strategy for the control of overweight in the general population. accounting for their initial hospital admission. Although severe obesity has received much attention in the clinical setting. F. 'Functional Foods' are different from 'Neutraceuticals' which remain drug based with poor taste whereas 'Functional Foods' remain good food . Impact of 'functional food'. The effects of dietary change alone (D) or dietary change plus moderate intensity exercise (DE) on weight loss were studied in 40 healthy overweight women. 73-83. A 6-mo retrospective review of 117 consecutive admissions to the rehabilitation unit of a municipal hospital center was conducted. Subjects aged 20-60y were matched on the basis of body mass index (BMI) and percentage of body fat and assigned to diet alone or diet and exercise for two months. Moderate obesity is undoubtedly multifactorial in origin. The purpose of this case series is to highlight the benefit of institutional rehabilitation for this subgroup of patients. Morbid obesity is a common chronic condition that predisposes affected individuals to a decrease in functional status.. Does exercise in combination with food combining low-calorie diet produce greater weight loss than diet only? International Journal of Obesity. Wainapel. (57).

Gutin.. but in addition have a disease prophylactic function. and diabetes mellitus) and preventive practices (i. 56(1). breast cancer. (2004).United States.. bone density. 829-847. Department of Health and Human Services Dietary Guidelines.. with particular focus on the areas of cardiovascular disease.. S. L. Quest. P. . Hahn. Social Work in Health Care. (b) higher fatness is associated with low amounts of vigorous physical activity (PA) and relatively low energy intake. (d) higher levels of PA are associated with higher bone density only in youths with relatively high calcium intakes. is the leading cause of death in the United States. R. cardiovascular diseases and particularly high blood pressure and atherosclerosis. T. birth defects.e. 71-83. (a) high general and visceral fatness and poor cardiovascular (CV) fitness are linked with dyslipidemia. A.. Using the Eating Disorder Examination in the assessment of bulimia and anorexia: issues of reliability and validity. Barbeau. Cardiovascular disease (CVD). Alcoholism: Clinical and Experimental Research. (1998). The findings were reviewed by external researchers with extensive research backgrounds on the consequences and benefits of alcohol consumption. including coronary heart disease (CHD) and stroke. G. the National Institute on Alcohol Abuse and Alcoholism was asked to assess the strength of the evidence related to health risks and potential benefits of moderate alcohol consumption.. (MMWR-MORB-MORTAL-WKLY-REP) 1998 Dec 11. obesity. osteoporosis. Zakhari. B. They are becoming particularly important for the prevention of food allergy in 'at risk' population. CV fitness. (2000).. 47(SS-5): 35-48 (50 ref). 28(6). 104 which could be consumed for years. and Yin. breastfeeding. 120-141. physical inactivity. elevated blood pressure. Heath. In support of the 2005 update of the U. Several behavioral risk factors (i. National Institute on Alcohol Abuse and Alcoholism Report on Moderate Drinking. W. Already in childhood. Department of Agriculture/U. and insulin resistance. Gunzerath. K. (c) higher CV fitness is more clearly associated with vigorous PA than with moderate PA. The Eating Disorder Examination will be assessed according to its reliability and validity in the assessment of anorexia nervosa and bulimia nervosa. M. Physical training in youths has favorable effects on total body and visceral adiposity. vigorous PA during childhood may help to prevent some major "adult" health problems. and some risk factors for CV disease and type 2 diabetes. Z. The newest trend is that governments and health authorities allow food manufacturers to make health prevention related claims on mass media. and aging.S. hypertension.e. (2004). obesity. and Warren. overweight. 31(4). Thus. Guest. but also for cancer prevention. V.. 1994: a behavioral risk factor atlas. smoking. Faden. and state rates of CVD vary by state and by region of the country. Cardiovascular disease risk factors and preventive practices among adults -. Exercise interventions for prevention of obesity and related disorders in youths.S. and Chang..

diabetes. The main reasons of the unsatisfactory situation in primary care: discouraging results of the treatment. Topics in Clinical Chiropractic. H. Hall.. Responses were obtained from the national obesity associations. absorption. 367-368. . 77(10). Eur J Clin Nutr. Hainer. There is an epidemic of pediatric overweight and obesity leading to type 2 diabetes in youth. M. The relevance of clinical nutrition education and role models to the practice of medicine. (2001). and pulmonary failure. time consuming care and a bad knowledge about obesity. International Journal of Obesity. C. Prevention of overweight and obesity in children: Influences on the food environment. dyslipidemias. V. D. 53 Suppl 2. (2002). and metabolism of dietary constituents and with the promotion of health through the prevention of diet related diseases. The purpose of this paper is to provide resources and practical recommendations for parents who have overweight or obese children. H. Clinical nutrition is concerned with the diagnosis and treatment of diseases that affect the intake. 8(4). Halsted. The purpose of this review is to describe the multiple paths of influence on the food environment of youth and to identify diabetes education strategies focused on early prevention of overweight and obesity. 28(3). Hambleton. 105 weight loss and smoking cessation) are associated with the development of CVD and also vary geographically. (1999). Fit 4 Fun. (2002). Haire Joshu. As chiropractors who promote preventive care and optimal health. Chiropractic influence on childhood obesity. Diabetes Educator. recommendations for reducing overweight through diet and exercise can be an integral part of patient care.. some cancers. 67-69. Adult diseases of clinical nutrition encompass the most common causes of mortality in the developed world and include obesity with its co-morbidities of hypertension. S. S29-34. and malnutrition associated with chronic illness and surgical trauma. None of the responders declared the quality of care of obese patients provided by GPs as appropriate. Community Practitioner. One of the goals of Healthy People 2010 is to reduce child and adolescent obesity from 11 % to 5% by the year 20 t0. increased risks of cardiovascular disease. and Nanney. and Kunesova. Obesity management approaches in Europe. 26(1). intestinal disorders related to inadequate nutrient absorption. Method: This article is based on a qualitative review of relevant clinical literature and government Web sites. The EASO Obesity Management Task Force conducted a survey on obesity management in Europe. A. M. (2004). eating disorders. 415-423.

food intake and physical activity. an imbalance between energy intake and energy expenditure. At the same time. 23(2). promote fat oxidation during the post-exercise period. 1(1). Strategies for the management of patients with obesity.. The results showed that the new way to lose weight by exercise training. Exercise training was carried out in the obesity children for 3 months. (2005). Sports Medicine. Han. was of remarkable effect on the prevention from children obesity. but there is growing evidence that exercise is an important element in obesity prevention. During this period their diet composition was controlled and their life habit was rectified. the skinfold thickness and the estradiol contents of the obesity children were determined before and after training. that is aerobic exercises + mental training + flexibility training. The prevalence of overweight and obesity is increasing worldwide. All intensities of exercise. the benefits of fruit and vegetables . Obesity has become a worldwide problem of pandemic proportions. Treatments in Endocrinology. 21-37. a simple but useful way to lose weight by exercise training was explored. T. We suggest that it is the effects of . These indexes were compared with those of the normal children. 35(5). exercise. S. energy expended during exercise and individual fitness level impact the amounts of fat oxidised at any given time. Shriver.. By definition. Many factors including intensity. (2002).HELEN HAMBLETON. respectively. K. which together determine bodyweight and fat distribution. the prevalence of adults in the higher body mass index (BMI) categories in the US has increased the most. as much as 300 for those with a BMI above 40kg/m. D. (2000). 106 Healthy snacks. During the last two decades. The simple definition of obesity. duration and type (aerobic vs anaerobic) of exercise. ignores the complexity of. however. school nurse manager Hertfordshire Partnership NHS Trust describes an innovative partnership approach to tackling obesity in school-age children Hamilton. genes. The failures in the regulatory mechanisms leading to the development of obesity are still not well understood. and Schoeller. in large part. a doubling of the prevalence of severe overweight poses a serious health risk to future generations of young adults who may develop chronic diseases normally associated with aging. energy balance. The effects of exercise on the storage and oxidation of dietary fat. Hansen. obesity is the accumulation of excess body fat and it represents the long-term results of positive energy and fat balance. Research on ultrasonic cardiogram of simple obesity children and serum estradiol --Discussion on new ways to lose weight by exercise training. In children and adolescents. Evidence suggests that moderate-intensity exercise yields the most cumulative (during and post-exercise) fat grams used for substrate in the average individual. M. and largely unknown interactions between. 177-180. Journal of Beijing University of Physical Education. The cardiorespiratory function. influences whether the fate of dietary fat is storage or oxidation. Exercise promotes energy/fat balance while providing beneficial alterations to obesity/overweight-related comorbidities and mortality. 363-73. Also.

H. Clay. a school-based trial for the primary prevention of obesity in American Indian children conducted between 1997 and 2000. Himes. 1117-1121. children still have available and make nutritionally poor food choices. and alterations in POMC mRNA have been described in genetic models of obesity. Jobe. J. and Morris. M. Nutrient intake estimates for lunch derived from record-assisted 24-hour dietary recalls were compared with intake estimates from observed lunch intakes. J.. Good nutrition is essential to helping children learn and aids in preventing childhood and adult disease. Overall. B.. (2002). (1999). L. H. L. Hardy. Journal of Nutrition. 6% felt they . L. The authors hypothesized that children in the intervention schools may have systematically underreported their dietary intake relative to children in the control schools. and French. While schools may comply with the letter of the law. In-person interviews were conducted with a total of 219 Lakota Indian adults (aged 19-47 years) from 2 reservations in South Dakota. L. we examined the effect of diet-induced obesity on hypothalamic alpha - MSH content and feeding responsiveness lo synthetic melanocortins. J. Gittelsohn. Story.. 137-145. M.. R. (2005).. These laws stipulate that federally funded programs provide a healthy meal choice for school children. When asked how they perceived their body weight. Therefore. Thompson.. R. (2004).. and Weber. However. T. Rock. Mule Sprague- Dawley rats fed a high-fat cafeteria diet (30% fat) or chow (5% fat) for 4 or 12 weeks were implanted with intracercbroventricular cannulae and feeding responses lo the MC3/4R agonist MTU (0.. J. Evaluation of federal school meal programs: more than just laws. Federal legislation provides funding to subsidize state school meal programs. K. J.. Harnack. Feeding responses to a melanocortin agonist and antagonist in obesity induced by a palatable high-fat diet.. P.. H.. S. Hypothulamic melanocortins arc critical for the control of food intake.. Anliker. American Journal of Epidemiology. D. Snyder. 10-15.5% of the sample was overweight. 160(11). Harnack. B. Data collected as part of Pathways. Nutrition beliefs and weight loss practices of Lakota Indian adults. Brain Research. 107 exercise on 24-hour fat balance that are most important in understanding the role of exercise in the prevention of fat accumulation and obesity. J. the time course of changes in brain transmitters over the development of dietary obesity is less clear. J... Journal of Nursing Law. Intervention-related bias in reporting of food intake by fifth-grade children participating in an obesity prevention study. 8(3). Ring. 31(1). Jeffery.. 1039(1-2).5 nmol) and the selective MC4R antagonist 11S014 (0. MTII had a long-lasting inhibitory effect on food intake. Neumark-Sztainer.8 nmol) were determined. B. M. Schioth. were analyzed to examine possible intervention-related bias in food reporting. USA [date not given]. 55. J. 31-38. Hansen.

The purpose of this study was to investigate the effectiveness of a weight maintenance programme conducted over the Internet. J. Effect of Internet Support on the Long-Term Maintenance of Weight Loss.. parents need to have the necessary knowledge and motivation to assimilate dietary guidelines. J. S. To determine whether maternal participation in an obesity prevention plus parenting support (OPPS) intervention would reduce the prevalence of obesity in high-risk Native- American children when compared with a parenting support (PS)-only intervention. Journal of Human Nutrition and Dietetics." 43.4% thought they were "about right. (2004). Does the Internet facilitate the maintenance of weight loss? International Journal of Obesity.. 108 were "too thin. and Rourke.. 41-44. and Bason. Parents represent a potentially powerful intermediary in behaviour change strategies aimed at improving the lifestyle behaviours of young children. C. J. Obesity prevention in preschool Native-America children: a pilot study using home visiting. L. This study aimed to assess these psychosocial constructs. through investigation of the barriers and benefits perceived by parents to the provision of a healthy diet and adequate exercise for their children. Buzzell. A. Munna. (2003). 11(5). R. Moldovan.. Obesity Research. (2002). Obesity Research. A home-visiting program focused on changing lifestyle behaviors and improving parenting skills showed promise for obesity prevention in high-risk Native-American children. A. and subsequent parental receptiveness to nutrition education. J.. J. H. 18(2). The purpose of this clinical project is to emphasize the importance of prevention/treatment of psychotropic medication-induced weight gain. 26(9). to fulfil this role. Harvey Berino. B.. Hash. (2004). J. B. S.." and 50. Promoting healthy diet and exercise patterns amongst primary school children: A qualitative investigation of parental perspectives. and Truby.2% felt they were "too fat.. Clinical Nurse Specialist. Pintauro. Buzzell. C. 89-96. Herriot. H. Gold. K. P. Nursing considerations in psychotropic medication-induced weight gain. (2003). . B.. K. Vogel.. Research Harvey Berino. E. J. Does physician weight affect perception of health advice? Preventive Medicine. However. Bishop. and Gold. E. Pintauro. 1254-1260. 12(2). (2003). and Ramirez. 36(1). 80-87. DiGiulio. R. Harvey Berino. R.. Hart.. M. To investigate the efficacy of an Internet weight maintenance program." Harrison.. P.. 606-611.. Professionals who work with patients taking psychotropic medications should provide a weight management program specifically designed to address the unique needs of the mentally ill patient. 320-329. 16(2). C..

two drugs are available for the adjunct treatment of obesity. Rossler. and.. 109 Obesity is considered a growing health threat in the United States. drugs have been developed or are in development to support and maintain weight loss. Health care providers are increasingly challenged to provide evaluation and treatment for the serious comorbidities and complications of obesity in childhood. D. (2003). ultimately. The Association Between Short Sleep Duration and Obesity in Young Adults: A 13-Year Prospective Study. The current experience with these drugs raises questions related to the long-term efficacy with particular reference to cardiovascular end-points. International Journal of Obesity and Related Metabolism Disorders. Obesity has become a major health problem with increasing prevalence. 661- 666. Primary Care: Clinics in Office Practice. G. 357-374. Although comprehensive obesity treatment programmes were shown to induce weight loss and to improve risk factors and comorbidities. Orlistat is a specific lipase inhibitor that impairs fat absorption. Clearly. (2004). Hasler. H. (2001). Gamma. A. At present.. Treatment of the complication and comorbidity should be focused on preventing progression. thereby decreasing caloric intake and increasing energy expenditure.. physicians themselves are often overweight. S. Sleep: Journal of Sleep and Sleep Disorders Research. community. reversing the disease process. J. Hassink. Eich. Klaghofer. The objective of this study was to test the hypothesis that short sleep duration is associated with obesity and weight gain during young adulthood. public health officials. and families. Problems in childhood obesity. obesity prevention should be at the forefront of our approach to this epidemic problem and the goal of health care providers. J. D. other current and future pharmacological . Buysse. W. Many of these comorbidities and complications are "invisible" and require careful and focused history and laboratory evaluation to elicit.. Both drugs have been found to be effective and safe in a number of clinical studies for up to two years. 27(4).. V. Given the limited availability of effective treatment of weight problems. In addition. achieving control of obesity with family-based lifestyle changes that will allow the child to maintain a healthy balance between his or her genetic predisposition and the environment. the identification of potentially modifiable risk factors may lead to preventive approaches to obesity. Copyright (c) 2003 by Elsevier Science (USA) Hauner. the weight reduction is moderate and most patients will rapidly regain weight. 30(2). The problems of the obese child are no longer solely those of increased risk for disease. Although physicians have an important role in counseling their patients for obesity prevention and treatment. thereby reducing fat uptake. S102-S106. For these reasons. but of disease itself. There are few data regarding how physician body weight might affect patient receptiveness to obesity counseling. and Angst.. Current pharmacological approaches to the treatment of obesity. Ajdacic. Sibutramine is a centrally acting inhibitor of noradrenaline and serotonine reuptake.. R.

It is argued that a comprehensive population model. The importance of the development and promotion of better diets is emphasized. 371-382. H. This article presents current information on the prevalence and consequences of obesity for racial and ethnic groups in the United States and evaluates race/culture-specific causes of obesity for these populations. three-pronged model for eliminating racial and ethnic disparities in obesity is presented and discussed. midstream. and the development of food policies to combat this problem. 1187-1190. (1998). Insulin resistance is a progressive metabolic disorder associated with inactivity. The primary defect in the development of whole body insulin resistance remains unclear. N.. Ruel. and is a hallmark feature of a variety of disease states including obesity. SCN News. by itself. This article discusses the dual burden of malnutrition (undernutrition and obesity) in developing countries. Hawks. (29). and Gast. Eckhardt. A. Such an understanding is critical in the identification of specific . However. The motivational discrepancies between society's media-induced desire for thinness and the health field's risk reduction approach to weight loss are outlined. Weight loss management: a path lit darkly. J. a full-spectrum. This article reviews recent research on the prevalence and virulence of obesity as a causal risk factor for mortality and morbidity. 90-96. arteriosclerosis and noninsulin dependent (Type 2) diabetes mellitus. J. 20-22. and Minot. genetic predisposition and environmental factors. M. and Houmard. The prevailing assumption that obesity. Hawkes. A historical perspective is used to analyze the efficacy of various medical and educational approaches that have attempted to alter body size in the pursuit of enhanced physical health. 34(2). A. (2004)... Hawks. American Journal of Health Education. J. with a balance between downstream. Health Education and Behavior. After analysis of various interventions that attempt to address this problem. obesity and obesity-related illnesses are increasing dramatically. Diet quality. during the past decade major advances have been made in our understanding of the molecular and cellular mechanisms regulating the entry of glucose into insulin- sensitive tissues. 110 principles for weight reduction are discussed. and Madanat. S. As with many other public health problems. 36(7). At the national level.preventing insulin resistance through exercise: a cellular approach. and upstream interventions is necessary. dyslipidemia. Introduction . S. C. There is no doubt that an evidence-based rational pharmacological treatment of obesity is still in an early stage. poverty and food policy: a new research agenda for obesity prevention in developing countries.. (2004). Stemming racial and ethnic disparities in the rising tide of obesity. Medicine and Science in Sports and Exercise. some racial and ethnic populations are disproportionately affected. 25(3). R. is a chronic disease or a primary risk factor for health is challenged.. N. Hawley. polycystic ovarian syndrome.. ageing. hypertension. R. C. (2003).

and Waslaski. K. E. N. Diabetes Educator. I.. exercise training) in the prevention and treatment of insulin resistance. 391-407. Hayamizu.. Pronk. J. C. and Ford. T. and Shimasaki. Kaneko. Ishii. We .e. including commentary by Chalmers K. Moran. M. In the built environment.. This paper describes a telephone-based. M... Matched-pair analyses of twins were used to examine nongenetic influences of obesity on the lipid profile and systolic and diastolic blood pressure (cross-sectionally) during two phases of development -. N. P. Yoshino. Furuse.. Shigematsu... Nongenetic influences of obesity on risk factors for cardiovascular disease during two phases of development. C. This study was performed according to a double-blind. randomized. (2001). Regulating environments to reduce obesity. and receive inadequate nutritional information. M. 277-283. Results of the matched- pair t tests indicated significant environmental influences on obesity in both phases and in the transition (change in obesity) between these two phases. In the United States food environment. Nursing Research. H. Current Therapeutic Research. J. L. Hayne. (1995). H.. 551-567. parallel-group design. Data were collected during an early morning home visit. Coates. Hayman. Spencer.. consumers are bombarded with advertising for unhealthy food. J..(longitudinally) in the transition between these two developmental phases. (2003). Change in obesity (kg/m3) from the school-age years to adolescence was associated with total triglyceride.the school-age years (n = 73 twin pairs) and adolescence (n = 56 twin pairs) and -. Hayes.. at the same time getting inadequate physical activity and nutrition education. 111 glucoregulatory biochemical/molecular sites that can be targeted by treatment strategies (i. 377-386. low-nutrient foods. sprawl has reduced active living. M. Intraindividual associations of obesity (kg/m3) and atherogenic lipids (total and LDL cholesterol) emerged during the school-age years. A. Okuhara. Journal of Public Health Policy. In the US school environment children have access to sugary sodas and unhealthy a la carte foods in their cafeterias. 27(3). R. P. P.. Effects of Garcinia cambogia (Hydroxycitric Acid) on Visceral Fat Accumulation: A Double-Blind.. L. (2004). The role of the certified diabetes educator in telephone counseling. The primary end point of this study was the effects of 12 weeks of G. outcomes-focused approach to diabetes education provided by certified diabetes educators (CDEs). Randomized. obesity was associated with HDL cholesterol and total triglyceride. placebo-controlled. and Gallagher. 44(5). L. J. cambogia extract administration on visceral fat accumulation. Boucher. M. M. Meininger. P. Placebo-Controlled Trial. Y. G... Shen. Gehling. Tomi. In adolescence. especially at restaurants... Y.. 25(3-4). L. 64(8). The marked increase in the prevalence of obesity appears to be attributable to environmental conditions that implicitly discourage physical activity while explicitly encouraging the consumption of greater quantities of energy-dense.

. Journal of School Health.. regulatory opportunities exist at the national. D. Y. (2003). Sports Science. (1998). 141-147. 441-463. Management begins by assessing the degree of obesity and determining the individual's readiness to change. 70(4). Heber. the product of the obesity gene. Yoon. could reduce body weight and fat. B. He.. S. Family Practice Recertification. (2000).. N. The purpose of this study was to investigate the effects of long-term swimming exercise on the intrabdominal visceral fat accumulation and on obesity mRNA expression level in white fat pads and to make a primary study on the molecularbiological mechanism of body fat loss by exercise. the tea catechins include a group of related compounds with effects that are demonstrable beyond those that are seen with epigallocatechin gallate. there has been relatively limited funding for research on herbal supplements compared with the amount of funding that is available for research on pharmaceuticals. 18(4). For example. and Cong. Botanical dietary supplements often contain complex mixtures of phytochemicals that have additive or synergistic interactions. 112 describe these environments and explore the potential effects of regulatory measures on these environments. 30(2). and Bowerman. 34. 23-26. S. L. Practical studies reported that leptin. In the United States. Diet. The role of process evaluation in the training of facilitators for an adolescent health education program. and other lifestyle modifications are the mainstays of treatment. D. D. Y. the most potent catechin. Practical obesity management for primary care physicians. W. citing lack of time and resources. 23(1). exercise.. 31-32. Heber. Some metabolic disorders induced by abdominal obesity have become the major risk factors for cardiovascular disease (CVD). Effects of long-term exercise on the intrabdominal visceral fat accumulation and the obesity gene expression. Wallerstein. and the prevention and cure of CVD by reducing body weight and fat has become one of the important tasks in medical and exercise physiological science. D. 69-72.. (2001). Yao. Unfortunately. and Garcia Velarde.. About half of all patients seen in primary care settings are overweight or obese. Many physicians are reluctant to address this problem.. The opportunities for additional research in this area are plentiful. state and local levels to mandate action and to allocate funds for promising health- promoting strategies. Studies have shown that even brief education and counseling on risk reduction from primary care physicians can be effective. Bai. Helitzer. Herbal preparations for obesity: are they useful? Primary Care: Clinics in Office Practice. Results showed that reduction of intrabdominal viseral fat accumulation by exercise was highly related to the high level of obesity mRNA after long-term swimming exercise.

J. Green. L.. J. Although used by millions of overweight and obese consumers. physical activity and child obesity prevention programmes. Lancet. I. van der Knaap. and use of the program's model designed to promote critical thinking and dialogue. A. This article discusses the use of bariatric surgery as a possible solution. and defines the pediatric nurse's role in helping to assure that youth are included in the current legislative process.. including legislative bills before Congress and a call by the National Academy of Sciences for society to band together to stop the rise in the rates of childhood obesity.. Heo. Childhood obesity is at epidemic proportions in the United States today. van Mierlo. 363(9404). by use of a meta. (2003). Hill. From the process evaluation data collected throughout a four-year period (1995- 1998). 19-26. presents a case study to illustrate the impact bariatric surgery can have on youth who are morbidly obese. The aim of this study was to review. and appropriate modes of delivery. Waters. (2004)... This qualitative study aimed to elicit child and parent views regarding social and environmental barriers to healthy eating. curriculum implementation. and Frier. activity and obesity prevention: a qualitative study of parent and child perceptions in Australia. J. 27(5). J. Heymsfield. Physical activity and obesity. none of these efforts address what can be done today to help those youth that are considered morbidly obese and who have failed to find solutions with the standard medical treatment plan. Preventative health strategies incorporating the views of target participants have improved the likelihood of success.and pooling analysis. 182. New Mexico that trained college students and adult volunteers to work with middle school students. 113 This article reports on the process evaluation of the training of facilitators for the Adolescent Social Action Program. International Journal of Obesity. 537-549. 13-6. H. Although several initiatives are under way to address childhood obesity. S. the existing literature on the safety and effectiveness of a partial meal replacement (PMR) plan using one or two vitamin/mineral fortified meal replacements as well as regular foods for long-term weight management. M. a health education program in Albuquerque. there has not been a systematic assessment on the safety and effectiveness of a meal replacement strategy for weight management. L. acceptable foci. data relevant to training are described: facilitator characteristics. 31(1). C.. E. H. Hesketh. facilitator training.. This epidemic has created a public health crisis. Childhood obesity: what can be done to help today's youth? Pediatric Nursing. Health Promotion International. (2005). M. Their article has an important implications for the future weight and health of individuals . Weight management using a meal replacement strategy: meta and pooling analysis from six studies. (2005). Healthy eating. Comments on the article by John Reilly and colleagues (see record 2004-19393-002). Salmon. Henry.. C. K. B. L. 20(1). and Williams.

J. Bangura.. K. acne. K. (2001). Azoro. O. O. However.. perform a physical examination. Anderson. 280(5368). A. W. American Journal of Clinical Nutrition. transportation. 28(7). Irregular menstrual cycles. Managing PCOS complaints and maintaining important health issues are also addressed. Calvin. Maston. 1371-1374. O'Neil. Hill. A review of literature revealed that over the last decade. placebo-controlled study was designed to test the hypothesis that orlistat. high fat diets. Findings from some studies indicate that African-American women have increased risk factors as compared to other ethnic groups for CVD based upon conditions and behaviors affecting lifestyle. The effects of socioeconomic status and increased body mass index on cardiovascular disease in African-American women. R. polycystic ovary syndrome. 12(2). and order the laboratory tests necessary to diagnose polycystic ovary syndrome (PCOS). (1999).. Orlistat.... and hirsutism often cause women to present to a primary care setting. Smith. and Aronne. 1108-1116. Brown. (1998). including food availability and portion size. (2003). there has been an overall reduction in the death rate due to CVD. D. Environmental contributions to the obesity epidemic.. Zavoral. 11-13. K. C. The increasingly sedentary nature of UK children is not unique and is being seen in most countries around the world. .. N. and Peters. J. CVD is the leading cause of death in women with the highest mortality being seen in African-American women. These researchers conclude that "Modem British children establish a sedentary lifestyle at an early age".. The debate over dietary fat and obesity is discussed. M. With this revelation. sedentary lifestyles. as well as when to refer to a specialist. Hauptman. double-blind. Hill. J. cutbacks in physical education) that promote physical inactivity are considered.. J. M. Today within the United States. TV. a lipase inhibitor. M. Moore. J.. a gastrointestinal lipase inhibitor. within the United States.. C. C. computers. B. 114 within the UK. T. 8. is significantly more effective than a placebo in preventing weight regain. Long-term maintenance of weight loss remains a therapeutic challenge in obesity treatment. electronic games. and the energy density of diets. This article demonstrates how to take a careful history.. J. the rate of decline has been less for women than for men and less for African-American women than for White women. J. This multicenter. Discusses environmental factors that promote overeating. Nurse Practitioner: American Journal of Primary Health Care. H. for weight maintenance after conventional dieting: a 1-y study. L. Journal of National Black Nurses' Association. P. 53- 58. Science. L.. Update: the pathogenesis and treatment of PCOS. Hill. K. 16-17. The modern environment is one in which technological advances have eliminated many reasons for physical activity. they essentially forecast an epidemic of obesity in the UK that will probably rival that already underway in the USA. Fujioka.. and specific environmental factors (technology. Hill. and Boyd.

K. (2004). 3-year trial of obesity prevention in American Indian Children. In New Zealand.2 Despite these high prevalence levels. and Bernudez. and Suchindran. This cross-sectional study examined whether length of time in the U. 104(12). A. Here's how to sort them all out. D. N Z Med J. T. Heim. U1210.. 19-20. Words into action -. (2004). Weber. Himes. 26. C. C. A.. (2004).. Bretnall. Impact of the Pathways intervention on dietary intakes of American Indian schoolchildren. and Loughin. language use.. 37(6 Part 2). 90-96. S55-S61. R. 125(1). Y. L. M. JAAPA: Journal of the American Academy of Physician Assistants. A patient who wants to lose weight is faced with a daunting array of weight-loss options and conflicting claims. eliminate disparities. 1859-62.promoting successful weight loss in overweight patients. obesity and physical inactivity are two health issues affecting young people. 117(1207).. M. Gittelsohn. Ring. S.. (2004). Harnack. and improve the quality of life. Thompson. J.6% of 11 to 14 year olds..1. only 38% of young people aged 13 to 17 years in New Zealand are considered physically inactive.S. Journal of the American Dietetic Association.. Physical activity minimizes the association of body fatness with abdominal obesity in white.. The Pathways study was a randomized. Adolescent obesity and physical inactivity. 115 Fortunately. An important goal of the Pathways intervention was to significantly decrease the percentage of calories eaten as fat by the intervention children. Hines. and birthplace (proxy measures of acculturation) were associated with body mass index (BMI) and obesity in a sample of 174 low-income Puerto Rican women from Hartford. J. Therefore. L. E. it is imperative that health care providers approach the issue of risk factors for CVD in African-American women as a heart disease epidemic. most of the CVD risk factors are modifiable and their occurrence can be widely prevented. 21- 24. Connecticut. This paper reports the effects of the Pathways intervention on dietary intake. This approach is necessary if the United States is going to improve the health of all Americans. Preventive Medicine. and Kolt. J. G.. J. Eells.. American Journal of Physical Anthropology. Himmelgreen. The longer you stay. A.. . D. Perez. E.. the bigger you get: Length of time and language use in the U. B.S. relative to controls. Globally. premenopausal women: results from the Third National Health and Nutrition Examination Survey. and 27% of 15 to 18 year olds. L. Cunningham. H. are associated with obesity in Puerto Rican women. Schofield. D.. G. Peng. Hohepa. S. Martinez.. Holcomb. are considered overweight or obese.... the most current statistics indicate that 33. A. (2003). 17(4).

there is a 1% decrease in mortality. Dissertation Abstracts International Part B: Science and Engineering [Diss. Kuo. Vol. Research indicates that for every 1% reduction in low. W. Kingery. The aims of this review are to describe how exercise alters lipid mobilization from adipose tissue. hypercholesterolemic males. Fatty acid mobilization from adipose tissue during exercise. the purpose of this double-blind. Physical activity was classified into four levels based on fitness criteria from the American College of Sports Medicine.. R.density lipoprotein cholesterol (LDL-C). uptake and oxidation during exercise.. Holcomb. D. Wang. W. Cullen. M. Chen. Honea. (2003). Sherman. Abst.. 14(8). To use this rich source of potential energy during exercise. hypercholesterolemic males. P. and Montgomery. Tung. Smith. M. The primary purpose of Jump Into Action is to help children develop healthy lifelong habits that decrease the likelihood of obesity and sedentary lifestyle. to identify alternative sources of lipids and to discuss some of the key factors regulating fatty acid mobilization. 78-83. Liu. 116 This study explored the association of physical activity with body fatness and abdominal obesity in 1. Chen.. adipose tissue triglycerides must first be hydrolyzed and the resultant fatty acids delivered to the working muscles. placebo-controlled clinical trial was to determine the effects of fluvastatin sub(40mg) and moderate intensity exercise on cholesterol parameters in obese. P. D. 67(1). C.. P. W. B Sci. Hsieh. By far the largest energy reserve in the human body is adipose tissue triglycerides. Journal of health Education.. Orlistat for obesity: benefits beyond weight loss. The impact of understanding factors involved in the coordinated regulation of lipid mobilization and oxidation during exercise goes far beyond its relevance for endurance exercise performance. C.. 62(1). Evaluation of a diabetes education program for fifth-grade students.. W. F.. 386-392. H. (2001). Smith. & Eng. D. Trends in Endocrinology and Metabolism. and these reserves are an important source of fuel during prolonged endurance exercise. Y. H. J. . Chien.]. Therefore. An evaluation of Jump Into Action involved a quasi. (2005).004 premenopausal white women who participated in the Third National Health and Nutrition Examination Survey. W. S. H. K. J. J. Diabetes Res Clin Pract. Int.. and Hu. C. L. J. T.. Y. C. Jump Into Action is an instructional program on preventing noninsulin dependent diabetes mellitus (NIDDM). Q. Pt. K.. TX.. 73-84.. Horowitz. F. (1999). The effects of a 3-hydroxy-3-methylglutaryl coenzyme-A reductase inhibitor and moderate cardiorespiratory exercise on cholesterol metabolism in obese.experimental design with intervention and control groups including fifth-grade teachers (N=65) and students (N=1184) in predominately minority elementary schools in metropolitan Houston. 30(2).. D. A better understanding of the regulation of these processes will facilitate the development of more effective treatment modalities for obesity-related metabolic disorders.

Increasing evidence suggests that falling leptin concentrations observed during fasting act as a peripheral signal of starvation. N. and Saris. in turn. K. Silventoinen. W. dietary habits.. Eur Heart J. H. Overweight and obesity are associated with elevated mortality from all causes in both men and women. T. (2004). Obesity. Hukshorn. Journal of Women's Health. Overweight and obesity in women: health risks and consequences. Huang. is central to the metabolic syndrome and is strongly related to polycystic ovary syndrome (PCOS) in women. 25(24). body mass index. 52(2). Journal of American College Health. 771-776. C. especially postmenopausal breast cancer and endometrial cancer. this study enrolled 106 participants in a weight-reduction program and categorized them into a group of 51 who had been treated with orlistat 360 mg/day for one year and a group of 55 age and sex and body mass index (BMI) matched controls.. J. M.. puts women at dramatically increased risk of cardiovascular disease (CVD). and Jousilahti. overweight men. waist circumference.. . R. N. K. P. F. They used BMI (body mass index) >= 25 kg/msuperscript 2 or BMI >= 85th percentile and BMI >= 30 kg/msuperscript 2 or BMI >= 95th percentile to estimate overweight and obesity in those aged <= 19 years. 2212- 9. E. Harris. Nazir. H. Born.. obesity. Obesity. but its effect on other metabolic syndrome related parameters is not known. The evidence for the adverse effects of obesity on women's health is overwhelming and indisputable. W. which serves to conserve energy in the face of limited reserves. Hu. M. (2003). 163-172. G. The authors surveyed 738 college students aged 18 to 27 years to assess overweight. Joint effects of physical activity. To assess joint associations of physical activity and different indicators of obesity (body mass index. and waist-to-hip ratio) with the risk of cardiovascular disease (CVD). especially abdominal obesity. 83-86. Hu. Diet. Obesity substantially increases the risk of several major cancers in women. waist circumference and waist-to-hip ratio with the risk of cardiovascular disease among middle-aged Finnish men and women. (2003).. Westerterp-Plantenga. and physical activity.. Lee. and diabetes. Assessing Overweight.. K. S. Obese women are particularly susceptible to diabetes. To assess its influence on adiponectin.. B. and Kaur. 12(2). J. and the risk of death rises with increasing weight. T. 77(4). high sensitive C-reactive protein (hs-CRP) and other metabolic syndrome related parameters. Tuomilehto. 117 Orlistat lowers lipids and improves insulin sensitivity. J.. (2003). American Journal of Clinical Nutrition.. and Physical Activity in College Students. Pegylated human recombinant leptin (PEG-OB) causes additional weight loss in severely energy-restricted. Barengo. An extension of this hypothesis is that exogenous leptin should affect energy regulation during severe energy restriction.

P. stimulus control.. The purpose of this . P. Humphries. 1428-1435. and teamwork. and Wikas. and label reading. Gillentine. Weight Loss 101: A Healthy Weight Loss program for college students. Bogle. 17(1). (2004). (2004). C. portion control. Bariatric implications of critical care nursing. physical activity. These goals are particularly well suited to the needs of children and their families.. Measurements included LV structure/function with echocardiography. and Daughtrey. and hemodynamics in obese children. Dimensions of Critical Care Nursing. Relations of adiposity and effects of training on the left ventricle in obese youths. 34(9). and Owens. Boyle. visceral adipose tissue (VAT). H. M. S. and behavior therapy. and problem solving skills are behavior change techniques included in Weight Loss 101. B. A. Nurse-managed health centers offer holistic health care and patient-centered health promotion and disease prevention. Martin. however. Strengthening an academic nursing center through partnership. Correlation and regression at baseline showed that elevated LV mass was associated with excess general and visceral adiposity.. American Journal of Health Studies. L.. Hurst. a college student health center based program that is designed to facilitate college students exerting self-control over their nutritional habits as part of a healthy weight loss process.. D. have described such practices. Self-monitoring. Roberts. J. J. Douglass. academic health center providing primary care to pediatric and adolescent patients. Treatment should include a dietary regimen. The nutrition education covers such issues as a personal diet plan. K.. Medicine and Science in Sports and Exercise. and elevated cardiac output. A step-by-step program model is provided. and resting and exercising hemodynamics with a Dinamap monitor and Doppler-echocardiography. (2002). Few reports in the literature. total body composition with dual-energy x-ray absorptiometry. Blanco. a nurse-managed. B. 76-83. This manuscript describes Weight Loss 101: A Healthy Approach to Weight Loss. Gutin. V.. 52(4). The purpose of this paper is to describe one practice. Valencia Health Services (VHS). 197-202. 118 Humphreys. VAT with magnetic resonance imaging (MRI).. Allison. S. and Ferretti... Obesity and overweight are complex conditions that contribute to many chronic diseases. The delivery of optimum nursing care to morbidly obese patients in critical care presents unique challenges in critical thinking. S.. A. Hunt. B. 2) to determine the effects of 4-month of physical training (PT) on LV structure and function and hemodynamics. C. (2001).. Vemulapalli.... 23(2). The purpose of this study is: 1) To determine the relations of left ventricular (LV) structure and function to total body composition. C. Nursing Outlook. Barbeau. and 3) to explore determinants of individual variability in response to PT. planning. Youths were randomly assigned to engage in PT for the first or second 4-month periods of the 8-month intervention period.

Kanazawa. Irving.. This preliminary report suggests that the puppet . M.. 8(3). N. To students. Yamase. Igarashi. L. Fujita. This program includes an organized set of policies.." Figure Rating Scale data suggest that the program reduces negative stereotypes about large body shapes. food service. This paper describes integration of prevention and treatment strategies for adolescent obesity for each of the eight components of a CSHP. Okita. (2000). Sapporo Fitness Club Trial (SFCT)--design. A puppet program for elementary school children was implemented through early childhood education to promote size acceptance and prevent eating disorders and related problems. The 1997 Youth Risk Behavior Survey reports adolescents participate in behaviors that put them at risk for obesity. and the integration of school and community. now widely accessible in major cities. Journal of School Nursing. Promoting size acceptance in elementary school children: The EDAP puppet program. The prevalence of childhood and adolescent obesity has steadily increased over the past 20 years. The risk of developing health problems increases as the obese child becomes an obese adolescent and adult. The annual health check followed by lifestyle recommendations has long been the standard national strategy to improve cardiovascular disease (CVD) risk factors in Japan. procedures. Satake.. counseling and guidance. the program's most important message was "not to tease others" and "to be a good friend. School children (N = 152) completed an evaluation of the program and 45 fifth grade girls completed the Figure Rating Scale either before or after the program.. Eating Disorders: The Journal of Treatment and Prevention. The eight components of a Coordinated School Health Program (CSHP) include school health services. and activities intended to protect and promote the health and well-being of students and staff. K... K. a healthy school environment. (2004). The Sapporo Fitness Club Trial (SFCT) is a randomized controlled trial to compare the efficacy of the national standard alone (control) with the standard plus exercise at a fitness club (intervention) for the reduction of CVD risk factors. The recognition of these unhealthy behaviors among our youth has led to the need for early intervention. K. S. has a novel appeal as a strategy with the additive effect of CVD risk reduction. T. B. and Nishijima. comprehensive school health education. K. (2000). 221-232. and Cinelli. 119 article is to review the special needs of this patient population and to provide a template to guide proactive nursing care planning in critical care settings. Circ J. Obesity has become one of this country's most significant nutritional diseases. Exercise at fitness clubs. A coordinated school health program approach to adolescent obesity. physical education. 68(12). The Coodinated School Health Program is a mechanism to address adolescent obesity at the school-age level. 16(1). recruitment and implementation of a randomized controlled trial to test the efficacy of exercise at a fitness club for the reduction of cardiovascular risk factor. H. Illuzzi. worksite health promotion. 1199-204.. Morita. 12-19. N.

J. K.. R. Navarro. C. 120 program achieves its goal of promoting greater acceptance of diverse body shapes by discouraging teasing and encouraging students to treat everybody well.. Dissipating excess energy stored in the liver is a potential treatment strategy for diabetes associated with obesity. J.. M. Naja.... J.... Examined the effects of exercise on total and intra-abdominal body fat overall and by level of exercise in postmenopausal women. Aiello. 54... Isnard. the physical activity of youth should be increased. Gao. and reduced fat in the liver and adipose tissues. J. Falissard. 289(3). R. decreased body weight. T. uncoupling protein-1 (UCP1) was expressed in murine liver using adenoviral vectors in mice with high-fat diet-induced diabetes and obesity. Coleman. (2004). JAMA: Journal of the American Medical Association. Jakicic. 322-32. Yukawa. Imai. H.. and Mouren. and Baranowski. E.. P.. Uno. Hasegawa. S. To prevent obesity. diabetes and dyslipidemia. G. Y.. Non-curricular approaches for increasing physical activity in youth: a review. R. (2003). E. S. J. B. E. Foreyt. American College of Sports Medicine position stand: appropriate intervention strategies for weight loss and prevention of weight regain for adults. E. and McTiernan. Irwin. A... The authors describe binge eating and psychopathology in severely obese adolescents who are seeking treatment for obesity and search for specific psychological features that may be associated with binge eating. S. Y. Melanson. (2005). Yamada. H.. hepatic UCP1 expression increased energy expenditure. L. Ogihara. Medicine and Science in Sports and Exercise.. 173 sedentary. T. Clark.. and Oka. L.. Sakoda.. Katagiri. Bowen. Preventive Medicine. 2145-2156. Donnelly. 33(12). Ishihara. Ishigaki. Jago. Vila.. 39(1). Michel. J. 34(2). E. Once diabetes with obesity developed. Frelut. D.. W. G. and Volpe.... International Journal of Eating Disorders. alternative non-curriculum approaches need to be tested. Shimosegawa.. Schwartz. thus.. 235-243. D. Yasui. C. M.. M. Effect of exercise on total and intra- abdominal body fat in postmenopausal women: A randomized controlled trial. postmenopausal women (aged 50 to 75 yrs) participated in this study. Rudolph. Ulrich.. H. Diabetes. and in standard diet-fed lean mice. J. (2003). T.. 323-330. resulting in markedly improved insulin resistance and. T. T. Asano.. M. M. L.. overweight. Y. Potter. M. Volek. Since time for school physical education has declined and curricular interventions have had limited effects. Y. (2001). Examined whether dissipating excess energy in the liver is a possible therapeutic approach to high-fat diet-induced metabolic disorders. K. J... 157-163. Binge eating and psychopathology in severely obese adolescents. .

a multidisciplinary prevention program for overweight active duty service members. Melanson. A. Kellar.. the American College of Sports Medicine recommends that the combination of reductions in energy intake and increases in energy expenditure.9 kg x m(-2)) or obese (body mass index > or = 30 kg x m(-2)). Donnelly. 33(12). R. and Britton. Evidence Based Nursing.9 kgDTm-2) or obese (body mass index greater than or equal to 30 kgDTm-2). Military Medicine.. J. Appropriate intervention strategies for weight loss and prevention of weight regain for adults... . Edwards. E..... the American College of Sports Medicine recommends that the combination of reductions in energy intake and increases in energy expenditure. its major components and preliminary results are discussed. To address this significant public health problem. Volek. body image. Folen. (2001). 43. Teaching patients self-management techniques and cognitive coping strategies provides a common link for group and individual therapeutic interventions. E. M. S. C. S. D. A school based intervention to reduce television use decreased adiposity in children in grades 3 and 4. Williams. and emotions. which emphasizes healthy lifestyles. To address this significant public health problem. and Volpe. C. Folen. be a component of weight loss intervention programs. Spouse and family member participation is encouraged in group activities to provide support for the patients. 328- 332. Brown. K. 162(5). C... The Tripler LE3AN Program: A two-year follow-up report. 121 In excess of 55% of adults in the United States are classified as either overweight (body mass index = 25-29. Clark. H. D. 389-395. 3(2). E. and reduce subtle or unconscious sabotage. The philosophy behind the program. A. (2000). exercise and emotions. M.. be a component of weight loss intervention programs. The LEAN progam is a 3-wk intensive inpatient weight-loss program coupled with a 1-yr outpatient follow-up. The program utilizes a team of 6 psychologists to assist patients in evaluating the relationships among food.. Can a school based intervention aimed at reducing television and videotape viewing and use of video games decrease adiposity in children in grades 3 and 4? James.... M. L. and nutrition. through structured exercise and other forms of physical activity. Gohdes. Coleman. E. Garland. J. L. Provides an overview of the Tripler Army Medical Center LEAN Program. C.. L. through structured exercise and other forms of physical activity.. S. 2145-2156. Medicine and Science in Sports and Exercise. and Supplee. In excess of 55 % of adults in the United States are classified as either overweight (body mass index = 25-29. R. The Tripler Army Medical Center LEAN Program: A healthy lifestyle model for the treatment of obesity. F. J. Page. James. (1999).. Re-evaluation at 6-mo intervals for an additional year and 5-yr follow-up are planned. A. Noce. identify unhealthy family eating behaviors. attitudes. Jakicic. Bowles.. James. An energy deficit of 500- 1000 kcalDTd-1 achieved through reductions in total energy intake is recommended. N. Military Medicine. K.. Noce. M. J. Foreyt. (1997). 164(6).. J. their social environment.

83-85. (1999). James. such as regular physical activity. I. and healthy lifestyle principals to lose weight and maintain weight loss. and Nutrition) provides active duty service members a treatment strategy that involves a reasonable low-intensity exercise regimen.. Fitness and Lifestyle Appraisal. relapse prevention strategies. However. Cigarette smoking has a delayed onset among African-Americans compared to Whites. The LEsuperscript 3AN Program (emphasizing healthy Lifestyles. . Data from recent national health surveys on Black/White differences in major CVD risk factors like hypertension. social dancing and team sports) are not apparent until around age 40. R. (2002). and physical inactivity were reviewed for the purpose of identifying promising avenues for primordial prevention research among African-Americans. realistic Expectations.. A.. The overall health impact chiropractors have in caring for children can be enhanced through awareness and incorporation of health promotion activities. Jamison. dietary habits. cigarette smoking. 19-24. R. Application of simple anthropometry in the assessment of health risk: implications for the Canadian Physical Activity. 4(4). B. Canadian Journal of Applied Physiology. and Ross. obesity. behavior modification. Primordial prevention of cardiovascular disease among African-Americans: A social epidemiological perspective. S. 396-414. (1997). Childhood: a crucial age for health promotion. healthy meal planing. health-relevant cultural norms which could support primordial prevention programs. Topics in Clinical Chiropractic. These findings have relevance for primordial prevention work in Black communities since they suggest the existence of broad-based. S84-S89. 29(6. S. 27(4). across the life cycle. cholesterol. the potential relationships between body composition and health risk rely on the use of anthropometric tools. Three areas of behavioral choice in childhood are discussed: social drug use. because the use of these methods in large-scale studies and field settings is impractical. 122 This paper provides a review of 2-yr follow-up data on the Tripler Army Medical Center LEsuperscript 3AN Program for the treatment of obesity in active duty soldiers and sailors. and Attitudes. All may have an impact on later health status. and sexual conduct. Janssen. Emotions. Incremental improvements in our knowledge of the associations between human body composition and disease have been facilitated by advances in research technology. Black/white differences in "vigorous" leisure-time physical activity (e. Preventive Medicine. Heymsfield. intensive nutritional counseling. Part 2 of 2). J. cognitive coping strategies.g. Magnetic resonance imaging and computerized tomography are among the technological advances that have helped unravel the mechanisms that link body composition and disease. reasonable Exercise.

Jebb. F. S. This review studies the efficacy of yoga in the primary and secondary prevention of ischaemic heart disease and post-myocardial infarction patient rehabilitation. K. 25-7. (2002). 29.. Understanding the determinants of adiposity in young children may be particularly critical for preventing adult obesity since the age at which body fatness reaches a postinfancy low point (typically 4-6 years) is inversely associated with obesity later in life.. (2004).. leanness. and physical activity in 467 children (range 4-6 years). Eur J Cardiovasc Prev Rehabil. M. R. S. We examined cross-sectional associations among fatness. Willing. M. 563-571. Fatness. R. and Sritharan. The increasing incidence of obesity in the UK has prompted a range of initiatives to raise awareness of the problem. Burns. J. T. Physical Activity.. 20(7). Efficacy of very low-energy diets and meal replacements in the treatment of obesity. Benefits of yoga in the modification of cardiovascular risk factors and in the rehabilitation of the post- myocardial infarction patient are areas of significant importance. C. Very low-energy liquid diets (VLEDs) were developed to provide a safe alternative to starvation. 369-75. Yoga is an unconventional form of physical exercise that has been practised over a long period of time in the Indian sub-continent. which provide a maximum of 800 kcal/day. Activity was measured using accelerometry and parental report of children's TV viewing. Majority of the rehabilitation workers believes that incorporating nonconventional forms of physical exercise such as yoga definitely would enhance efficacy and add value. 11(5). 219-225. G. the focus is now on addressing the issue as part of patient care by advising adults and children on weight management and changes in diet and exercise. It is important to assess the practical significance and the suitability of incorporating yoga into the comprehensive cardiac rehabilitation programme. This article attempts to study the history and the science of yoga and evaluate its effects on cardiovascular health. J. This paper considers the evidence concerning the efficacy of both commercial and milk-based total liquid diets. S. L. A. 123 Janz. The nurse's role in promoting weight loss and encouraging healthier lifestyles. Torner. Low-energy diets. and Goldberg. Jebb. 35(6). and Warren.. Levy. (2005). (1998). It has gained immense popularity as a form of recreational activity all over the world. . with only a modest attenuation in the rate of weight loss. C. In view of the well-known links between obesity and chronic disease. Journal of Human Nutrition and Dietetics. Preventive Medicine.. N. Professional Nurse. are the mainstay of obesity treatment. and Television Viewing in Children during the Adiposity Rebound Period: The Iowa Bone Development Study. Its possible contributions to healthy living have been studied and many interesting revelations have been made.. Yoga in cardiac health. S. Jayasinghe. J. ideally in combination with increased energy expenditure through physical activity.

A. Ecological analyses imply that the increase in the prevalence of obesity is more strongly related to lower levels of physical activity than higher energy intakes. A randomized trial of counseling for fat restriction versus calorie restriction in the treatment of obesity. M. increase in nutrition knowledge. F. International Journal of Obesity. Medicine and Science in Sports and Exercise. The etiology of overweight and obesity is clearly multifactorial. N. To evaluate the effectiveness of dietary counseling focusing on fat reduction (20 g/day) compared to calorie reduction (1000 to 1200 kcal/day) in promoting long-term weight loss in moderately obese women. Sherwood.. Jeffery. One hundred seventy-seven men and women who had participated in an 18-month trial of behavioral interventions involving food provision and financial incentives were examined 12 months later. S.. but over 12 additional months of no-treatment follow-up. W.. all treated groups gained weight. 63(5). 78(4). R. . This review will consider the effects on body weight and the risk of obesity of sedentary lifestyles. and Baxter... E. and decrease in perceived barriers to adherence.. (2003). Journal of Consulting and Clinical Psychology. D. W. French. Jeffery. but not financial incentives. E. R. R. (1995). 793- 797. W. Socioeconomic status and weight control practices among 20. Long-term effects of interventions for weight-loss using food provision and monetary incentives. R. and prospective studies that have assessed physical activity and dietary intake and their relationship to body weight were reviewed. maintained only slightly better weight losses than a no-treatment control group. led to better weight loss than standard behavioral treatment during the 18-month trial. Hellerstedt. A. and did not differ from each other. S. and French. A. within the context of dietary habits. 124 Jebb.. S. (1999). (1996). 132-137. R. and Wing. Wing. Obesity treatment research should focus on developing better ways to maintain changes in the diet and exercise behaviors needed for sustained weight loss. cross-sectional. Food provision.. This study examined the relationship between socioeconomic status (SES) and weight control practices in women. and Tate. 31(11 Suppl). Physical activity and weight loss: does prescribing higher physical activity goals improve outcome? American Journal of Clinical Nutrition. American Journal of Public Health. R. but ultimately it is determined by the long-term balance between energy intake and expenditure. The data from ecological. S534-S541.to 45-year-old women. 684-689. decrease in percentage of energy from fat. S. 1005-1010. Jeffery. R. W. Jeffery. J. 86(7). Contribution of a sedentary lifestyle and inactivity to the etiology of overweight and obesity: current evidence and research issues. Weight loss success during both active treatment and maintenance was associated with increase in exercise. L.. and Moore. (1995).

L. Clinical Pediatrics. The purpose of this study was to survey physicians regarding their attitudes and practices related to the treatment of pediatric obesity in a primary care setting. S. and older healthy subjects. Curr Hypertens Rep. Recent studies suggest that water drinking elicits acute changes in human physiology. 17-20. and Saelens. 24(3). Empirically supported treatments in pediatric psychology: pediatric obesity. (2003). K. (2005). Health Promotion Practice. (2002). 223-249. 3(4). cardiac transplant recipients. (1999). N. Jelalian. Steven Jeffrey discusses how nurses can help patients/clients to maintain a healthy weight. Journal of Community Nursing. More recently. A comparison of instructional methods for weight loss in women. Seventy-four predominantly White participants at least 10 pounds over healthy weight began the program. and Burkett. and Rhode Island). 42(3). 235-245. water drinking was shown to increase energy expenditure.. 20. 26. Blood pressure does not change in healthy young subjects. Water drinking profoundly increases blood pressure in patients with autonomic failure. C. Surveys were sent to physicians who were members of the American Academy of Pediatrics and the American Academy of Family Physicians practicing in the Southern New England area (Connecticut. of physician attitudes and practices related to pediatric obesity. E. Water drinking also increases blood pressure in quadriplegic patients. Journal of Pediatric Psychology.. 501-506. E.. J. S. Massachusetts. Jeffrey. Boergers. . to effectively integrate the discussion of weight issues into the primary care setting. 22. The objective of the study was to evaluate the efficacy for long-term weight loss of recommendations for much higher physical activity than those normally used in behavioral treatments. J. Alday.. and Frank.. 125 Recommending increased physical activity facilitates long-term weight loss. additional training and education regarding safe and efficacious intervention strategies for pediatric obesity. 15(3). but to a lesser extent. B. E. S. To review the efficacy of existing interventions for pediatric obesity with reference to the Chambless criteria. Jelalian. The role of the nurse in obesity management. Jordan. This study tested effects of three methods for delivering a weight-loss education program for women. 7(1). Jones. Effect of water drinking on sympathetic nervous activity and blood pressure. but the optimal level of physical activity to recommend is unknown. (2001). R.

S. 72(3). Albala. (2005). A. These results suggest that programs to increase physical activity in obese children should structure the activity in short bouts and attempt to increase parental physical activity. however. Evaluation of an upper elementary school program to prevent body image. Evidence that sustainable weight loss is enhanced by means other than caloric restriction. B.9 bouts of MVPA that lasted 4. eating. 199-204. and Epstein. Katz. Fifty-one 8-12-year-old children seeking obesity treatment wore accelerometers for 3 or 4 days. Vio. H. L. Kalakanis...5 METs) and examine predictors of activity in obese children. 1268-1275.2 min. Annu Rev Public Health. Research Quarterly for Exercise and Sport. 61-88.. F. those touting carbohydrate restriction are currently most in vogue. Competing dietary claims for weight loss: finding the forest through truculent trees. W. Cerda. R. parameters of appetite and energy intake (El) at breakfast after weight loss. (2001). Lejeune. M. (2003). To study the effects of 13 weeks conjugated linoleic acid (CLA) supplementation in overweight subjects on bodyweight maintenance.2 min. (2004). J. 57(10). G. European Journal of Clinical Nutrition. M. Kater. S. L. In response to an accelerating obesity pandemic. Rohwer. 202-209. R... Paluch.. R. Preparing young students to resist the sociocultural pressures that contribute to body image and eating problems in American culture poses a monumental challenge. International Journal of Obesity. 483-493. 126 Kain. E... The purposes of this study were to measure the level and pattern of moderate-to-vigorous physical activity (MVPA = > 4. This project determined if the 11-lesson "Healthy Body Image: Teaching Kids to Eat and Love Their Bodies Too!" curriculum would have a positive effect when presented to upper elementary school children. 72(5). Effect of conjugated linoleic acid supplementation after weight loss on appetite and food intake in overweight subjects. To assess the impact of a 6 months nutrition education and physical activity intervention on primary school children through changes in adiposity and physical fitness. M.2 bouts of MVPA per day that lasted an average of 4. is lacking.. J. K. Journal of School Health. W.. H. Goldfield. G. M. Uauy. 26. K. 28(4). Saris. and Leyton. J. Hierarchical regression models showed parent activity improved the prediction of obese children's activity levels and the number of bouts of MVPA but not the duration of MVPA. and Westerterp-Plantega. competing weight-loss diets have propagated. while parents engaged in 3. M. Whereas short-term weight loss is consistently achieved by any dietary . J. School-based obesity prevention in Chilean primary school children: Methodology and evaluation of a controlled study.. L. (2002).. D. and Londre. Children averaged 12. and weight concerns. M. P. Parental Activity as a Determinant of Activity Level and Patterns of Activity in Obese Children. Kamphuis.

Kaukua.. Kawachi. E... Pekkarinen. and Poston. Katz. 375-389. A.. We evaluated the effects of 12-month treatment with sibutramine 15 mg daily compared with placebo on health-related quality of life (HRQL) in obese type II diabetes patients. K. (2003). 34(6). "Does skinny mean healthy?" . M. Abdulrahman. International Journal of Obesity. current. H. J. Defining obesity in children has been difficult as assessing body fat is expensive and impractical. M. D. D. lasting weight control is not. and Rissanen. and haemodynamic variables. L. T. an extensive literature belies this notion. L. W. Kelsey. M. Hyder. G. R.. J. We also explored the predictive value of HRQL and its changes early during treatment. 533-541. Katz. To qualitatively and quantitatively examine body image ideals and perceived weight- related health among African-American girls and their female caregivers to inform intervention development for Girls Rule! an obesity prevention pilot program.... . Chan. Bentley. A. Health-related quality of life in a randomised placebo-controlled trial of sibutramine in obese patients with type II diabetes. (2004). glycaemic control.. We examined the associations between the changes in HRQL and in weight. H.. K. 86(7). Competing dietary claims imply that fundamental knowledge of dietary pattern and human health is lacking. 600-605. Shields. M. Technical skills for weight loss: Preliminary data from a randomized trial.. L. C. P. 127 approach to the restriction of choice and thereby calories. (2002). A. (1996). 2(6). A. K. Kaur.. African- American girls and their female caregivers. Gonzalez. C.. M. 14(4). 75 overweight females (aged 30-65 yrs) who were the primary purchasers and preparers of household meals completed either a counseling-based (CBI) or a skill-building intervention (SBI). Coakley. Larson.. M.. Treatments in Endocrinology. and Colditz.Perceived ideal.. I. Preventive Medicine. Compared the effects of conventional dietary counseling with those of an intervention emphasizing technical food skills on weight loss among overweight females. Childhood overweight is a significant and growing health problem in the US and other parts of the world. M. 608-615. II. Nawaz.. L. E. W. Rotnitzky. S. and healthy body sizes among. 28(4). H. Can physical activity minimize weight gain in women after smoking cessation? American Journal of Public Health. Gordon. Troisi... 999-1004. G. and Yeh. Ethnicity and Disease. Secular trend data in the US suggest that children have become substantially heavier over the last several decades and that their risk for a number of health problems is increasing as a result. A.. (2004). and Ammerman. Childhood overweight: an expanding problem.

activity-related.. (2003). A. Fleury. Journal of Gerontological Nursing. concentrated carbohydrates.. J. such as smoking cessation. J... M. (1999). and large portion sizes. 18-23. To resolve the controversies surrounding obesity. Social Cognitive Theory (SCT) as presented by Bandura (1986. This article discusses some of the changes in our food environment that have encouraged overeating and some research that underlies successful weight loss and maintenance of weight loss. 231-235. Managing cardiovascular risk reduction in elderly adults. The ideal model of obesity treatment is a comprehensive intervention including dietary. 1997) appears to have strong promise as a guide to understanding physical activity behaviors and developing clinically relevant interventions to promote the initiation and maintenance of physical activity. sedentary lifestyle. in part by recognizing the contributions of fat. J. and Stern. 128 The purpose of this study was to examine prospectively whether exercise can modify weight gain after smoking cessation in women. A. Copyright (c) 2003 by Elsevier Science (USA Keller. Gregor Holt. Diabetes Spectrum. pharmacological. Primary care practitioners must explore the most effective techniques for promoting cardiovascular risk reduction in older adults. Primary Care: Clinics in Office Practice.. include managing . Obesity: food intake. The mechanisms that underlie successful initiation and adherence to physical activity regimens are not well understood. behavioral. Other risk factor modification efforts. (2003). and nutrition is discussed in this article. S. This critical systematic review of research using SCT was completed to determine the predictive ability of model constructs in explaining physical activity behavior and in identifying key intervention components found to enhance physical activity initiation and maintenance. 301-316. similar to the ideal treatment for diabetes. 6(2). and/or surgical components that is geared toward individual needs. Kazaks. Keller. The discussion of these topics will help in the guidance of patients to develop personalized eating plans and reduce energy intake. N. and Thompson. S. and Stern. T. we must invest much more in research into the prevention of obesity and to ascertain those lifestyle or medical approaches that will make it easier for anyone to maintain a healthful energy balance. often not highlighted. Online Journal of Knowledge Synthesis for Nursing. 16(4). 30(2). J.. Kazaks. C. Healthy People 2010. The main focus of any obesity intervention should be on health improvement instead of just body weight reduction. 29(6). Obesity treatments and controversies. C. Fleury. Managing lifestyle modification risk factors. Few theoretical models have used consistent explanatory variables that are theory-driven and many findings that use extant models are equivocal.. and Mujezinovic Womack. (2003). obesity. Predictive ability of social cognitive theory in exercise research: an integrated literature review.

and the relationship of obesity to coronary heart disease risks and discusses weight reduction issues in children. to prepare an evidence-based evaluation of the effects of physical activity on glucose intolerance in obesity. Keller. the measurement of obesity in children. K. and the baseline severity of glucose intolerance.. 129 homocysteinemia. Effects of physical activity on insulin action and glucose tolerance in obesity. 38. This literature review indicates that physical activity has favorable effects on reducing insulin resistance in obesity and among patients with type 2 diabetes mellitus. 31-32.. and the long-term efficacy of most approaches is poor. Behavioral treatments for overweight and obesity are as varied as the elements of behavior. with particular emphasis on randomized clinical trials. (1996). 34-36. S. Nurse Practitioner: American Journal of Primary Health Care. and sedentary behavior. together with anthropometric measurements. the interval between exercise and testing of glucose tolerance. Medicine and Science in Sports and Exercise. 31(11 Suppl). This paper evaluates selected behavior change theoretical models used in weight reduction interventions and presents recommendations for the use of theory in weight reduction research. D. R. C. . D. Improvement in glucose tolerance is less consistently observed and is related to intensity of exercise. and Goodpaster. Clinically useful definitions of obesity in children have not been established. requiring long-term behavioral change. although the body mass index. J. H. may provide the practitioner with useful assessment parameters. S619- S623. These factors are presented as equally important modifiable coronary heart disease risks.. etiology. B. This paper examines obesity in childhood. The purpose of this paper is to examine the effect of physical activity on glucose tolerance in relation to obesity. Discussions of weight In children must acknowledge the nutritional requirements of the normally occurring growth process. collateral changes in adiposity. 8(5). Kelley. and Allan. Evaluation of selected behavior change theoretical models used in weight management interventions. Online Journal of Knowledge Synthesis for Nursing. Obesity is a common nutritional disturbance of children and affects 25% to 30% of children and adolescents. A review of currently published clinical trial data supports the conclusion that physical activity can reduce insulin resistance and improve glucose intolerance in obesity. C. (2001). (1999). and Stevens. Keller. Overweight and obesity are complex problems. We reviewed current literature. investigations must target the development of cause-effect explanations. Assessment. E. 21(9). Because of the complexity of both the problem and its treatment. and intervention in obesity in children.

. Getting physical: the importance of physical activity in the prevention of overweight and obesity in youth. C. Government. (2000). This suggests a link between such foods and obesity prevention. (2000). Department of Agriculture (USDA) sponsored a round table in New Orleans to address behavioral nutrition. And yet. Education. and Offutt. nutrition. psychology. is obesity on the rise? There isn't an adult American with a pulse that doesn't know. 35(3). 17. medicine. is a mistake. J. Youth studies Australia. and increased activity may be involved. chaired by Dr. Y. (2004). T. Eileen Kennedy. Nonetheless. S. inadequate calories. H. Professor Kemper suggests possible causes of weight gain in the population and recommends measures to combat the trend. Communicating Food for Health. Kemper. are summarized in this article. the Research. we can't seem to convert increased nutrition information into changes in behavior. Kenney. representing such diverse fields as economics. High-lights of the discussions. (2004). S. (1995). The behavior and psychology of weight management. discussed the determinants of food choices and activity levels and identified research needs. Healthy lifestyles for healthy Americans: report on USDA's year 2000 behavioral nutrition roundtable. 17(4). J. In January 2000. 84-88. and Economics (REE) mission area of the U. neuroendocrinology. The impetus for the round table was a question recently asked by Agriculture Secretary Glickman: "Why. The research includes his own longitudinal studies conducted on young people in the Netherlands. K. when we have a greater base of understanding about diet and nutrition than ever before. and lack of exercise. although many other factors such as low fat content. fiber- . Increasing the fiber content of childrens' diets may help control childhood obesity. But skipping breakfast and snacking when you are not hungry. Obesity may be linked to genetic factors. Obesity is rare in developing countries where a large proportion of the diet is vegetable foods high in fiber. and priorities related to improving consumer eating behavior and activity levels. Kennedy. E. The prevalence of childhood obesity appears to be growing in the US. 130 Kelly." Participants. and marketing research. 96(5). Kimm. JAAPA: Journal of the American Academy of Physician Assistants. 23(1). The role of dietary fiber in the development and treatment of childhood obesity. 29-32. To snack or not to snack. Pediatrics. S. In this article Han C. Nutrition Today. more frequent meals is your best bet for lower cholesterol and weight control. 27-34. Eating smaller. Kemper presents an overview of recent research findings regarding the international epidemic of overweight and obesity in young people. Clinicians who know the multiple factors involved in achieving behavioral change can better assess a patient's true readiness for a major lifestyle adjustment.S. E.G. 1010-1015. public health. gaps. 13. about the dangers of high cholesterol. G. diet. for example.

and while evidence is inconclusive. Harvey. Nursing Standard. J. Kirk. and another recent review provide further documentation of the growing role of inflammation in cardiovascular risk. Proceedings of the Nutrition Society. (1999). E. Based on the available literature.. and subsequent cardiovascular disease risk. The author discusses the dietary management of obesity in adults and children. (2003). Obesity treatment is notoriously unsuccessful and one of the barriers to successful weight loss reported by patients is a lack of social support. Treatment of obesity: theory into practice. 58(1). The Internet offers a novel and fast approach to the delivery of health information. A. Increasing dietary fiber in children's diets could therefore be a preventative measure. Suggestions are made as to how health professionals involved in obesity treatment can address the growing problem. obesity. and hypertension. King... M.. J.. S. E. much of the health information available on the Internet is unregulated or not written by qualified health professionals to provide unbiased information. D. A randomised trial of an internet weight control resource: the UK weight control trial. some studies have shown modest benefits for using dietary fiber in treating childhood obesity. S. K. Pollard. L. F. Southern Medical Journal. knowledge of the role of such markers is extremely important for prevention and chronic disease management. A... Kirk. this article reviews the new guidelines. E. enabling 24-hour access to help and advice.. Kirk. G. The American Heart Association released guidelines in 2003 to help clinicians know when to use such markers. Clinical use of C-reactive protein for cardiovascular disease. such as C-reactive protein. Because inflammatory markers are associated with diabetes. more recent evidence since the guidelines. D. 47-55. C. 985-8. J. fiber-rich diets tend to be carbohydrate-rich and low in fat. 3(19). D. Mainous. A review outlining the current situation in the management of obesity in adults. Recent evidence supports an association between elevation of inflammatory markers. 3rd. Also. (2003). 131 rich foods generally supply fewer calories and speed transit time through the digestive tract. The prevalence of obesity has increased dramatically over recent years and the health risks associated with obesity are well known. and Taylor. L. and that health professionals need to recognise that obesity is a chronic condition requiring long-term intervention. and Ransley. Greenwood. Diet and weight management. and forms recommendations for primary care clinical practice. McConnon. S. BMC Health Services Journal. 97(10). 53-58. Thomas. and water-soluble fiber blunts the insulin response to carbohydrates. 17(49). Newer studies published after the guidelines. Continuing professional development: obesity. L. (2004). However. She suggests that nurses have a key role to play in obesity prevention and management. The .

Promotion of dietary carbohydrate as an approach to weight maintenance after initial weight loss: a pilot study. that the author teaches in a residential program for obesity. Klauer. Obesity Research. 10(1). The aims of this study were to describe the ambulatory management of childhood obesity by pediatricians (PDs) and family physicians (FPs) and to evaluate knowledge of and adherence to published recommendations. 45(4). This article describes a psycho-educational class. of healing. (2002). 277-285. Managing overweight and obesity in women. J. 13(4). 275-283. W. topiramate).. J. To test a novel approach to weight management based on positive advice to eat more carbohydrate-rich foods. Eating Disorders: The Journal of Treatment and Prevention. sibutramine. Concerns are raised regarding the increased incidence of obesity and overweight among women in the USA. and Cursiter. Childhood obesity is one of the most challenging issues facing healthcare providers today. M. Journal of Human Nutrition and Dietetics. behaviour and lifestyle modifications. a door is opened to the beginnings of psychic reconciliation. Obesity treatment involves proper evaluation and planning of treatment. L. T. 12(2). L. and/or surgical procedures. Ambulatory management of childhoos obesity. The overeater self and the healthy self within. (2004). (2000). N.. It is concluded that helping individuals with eating disorders to be on their own teams. Kirk. The health implications of obesity and corresponding issues in body image are discussed. is difficult. and Adams. and Aronne. The project aims to deliver high quality information to the patient and to evaluate the effectiveness of this information. called "The Overeater Self and the Healthy Self Within". (2002). . to make an about face and view behavior that they have ben despising for so long in a positive light. The author asserts that clients attempting to eliminate problematic eating behavior without understanding what their use of food has been doing to them is unworkable. 87-91. but that once they are able to turn that mental corner. Clinical Obstetrics and Gynecology. of compassion for themselves. (PsycINFO Database Record (c) 2004 APA. 132 proposed study aims to compare a web-based weight loss package with traditional dietary treatment of obesity in participants. Crombie.. pharmacological therapy (including orlistat. D. both in terms of weight loss outcomes and cost-effectiveness.. Klinger. 1080-1088. Guidelines in treating obesity are presented. all rights reserved) Kolagotla. encouraging increased physical activity and dietary.

. The best approach is to prevent obesity in children. O. (2004). Flachs. 1). M. P. Adults also need to become more physically active... J. 111(5). More likely. and its application as part of evidence-based clinical interventions. which make development of effective agents against single receptors impractical. nonpharmacological behaviour therapy. 133 Kopecky. Matejkova. Rossmeisl. exercise and energy restricted diets) and surgical treatment of obesity are discussed. The great expectation for new therapeutic agents has not been fulfilled in clinical practice. The US must develop a national obesity prevention strategy. investigation of potential neuroendocrine targets for appetite suppression suggests redundancy in the systems. and Dietz. Brauner. The emerging science of body weight regulation and its impact on obesity treatment. T. This review describes the regulation of energy homeostasis and the energetics of body weight regulation. Sponarova.. P. The number of overweight and obese Americans has increased dramatically and genes alone are not responsible. and Aronne.. L. S225-S232. Bardova. G. Respiratory uncoupling may. and Kuda. . 1579.. could lead to a more coherent approach to obesity treatment. More than half of US adults are overweight. The pharmacological (sibutramine.. J. Obesity treatment remains a `Cinderella' of all clinical management programmes. 65-72. In vitro studies indicated that lipogenesis as well as lipolysis depend on cellular ATP levels. orlistat and noradrenergic- releasing agents). Physiological Research. Body fat content is controlled. but this may involve re-designing communities so there are more walking and biking trails. Koplan. (2003). Journal of Clinical Investigation. whilst the restriction of eating through surgical division of the upper bowel seems strange in an age of advanced and sophisticated technology. J. through the depression of ATP synthesis. O. 53(Suppl.. P. and 22% are obese. 565-570. J. 282(16). H. by energy charge of adipocytes. but generally without a happy ending. Caloric imbalance and public health policy. J. Ruzickova. (2005). Clinical treatment of obesity: are drugs and surgery the answer? Obesity Research. Kopelman. Energy metabolism of adipose tissue - Physiological aspects and target in obesity treatment. control lipid metabolism of adipose cells. W. Nevertheless. Americans are simply eating more calories and exercising less. (1999). P. The best way to do this is to bring back physical education in the schools. 64(1). Prazak. Korner. J. K.. The better understanding of the neuro-regulation of appetite. Expression of some uncoupling proteins (UCP2 and UCP5) as well as other protonophoric transporters can be detected in the adipose tissue.. at least in part.. JAMA: Journal of the American Medical Association.

BMI. Freiburg intervention program for ambulatory therapy of obesity in childhood (FITOC). and Berg. The Freiburg Intervention Trial for Obesity in Chidren (FITOC).percentile are integrated in this program. Z Arztl Fortbild Qualitatssich. L. J. Aase. G. In FITOC children from the age of 8-11 years and over the 97.. J. The goals weight management.. and Kromhout. E. U. The program consists of regular physical training (3 times a week). A.. (2005). Rucker.. and Berg. and weight control strategies of a midwestern population. v.. K. K.. Baak. Saris.... P. J.. 54. and Thomas. J. Mayo Clinic Proceedings. their psychosocial as well as environmental determinants.. v. height. U. Korsten-Reck. Clark.. B. 134 Korsten-Reck. 677-81. objectives and strategies. C. Brug. S. M. C. Kottke. C. Visscher. Kromeyer- Hauschild. (2002). J.. S. M. E. and weight control strategies to aid in design of effective interventions to prevent and treat obesity. 114-121. Bonk.. 94(8). whether it is possible to make a successful treatment for obese children in an interdisciplinary program. In this study we first try to answer the question. after treatment and at all check-ups. Grupe. 77(2). To elicit from individuals in a population their current weight and height. 498- 507. F. Since 1990 data from 283 children coming out of 15 treatment groups (about 2 groups per year) were collected and analyzed. Kemper. Seidell.. D. A study was conducted to outline the rationale. W... Kayser. Design: The evidence for potential behavioural determinants and strategies to prevent weight gain was reviewed. A. a standardized cycle ergometry and a medical measurement at the beginning.. J. M.. Second it is asked whether a transfer of this program to further regions in Germany leads to comparable results. Esser. H... and the .. Paw. C... Self-reported weight. Mechelen. N. Keul. and the effects of interventions aimed at the prevention of weight gain. Schouten. R. Hayes. Kremers. C. M. J. M. P. weight goals. R. DeBoer. Versicherungsmedizin. J. European Journal of Clinical Nutrition. A... W. R. L. N. G. A. Hoffman. S. S. J. Obese children at the age of 8-11 are treated in an eight months intensive period and a follow-up period of 4 months or more. T. Menzel. Schuit. comprehensive nutrition and behaviour training (overall 7 parents evenings each 4 to 6 weeks and 7 cookery courses for the kids in the same time scale). M. B. (2000). G. fasting blood serum. L. M. A. M. U... (2002). Rudloff. Brekke.. Brandel. A. Netherlands Research programme weight gain prevention (NHF- NRG): rationale. J. 21-25... Kok... T. W. Brekke. H. M. 49(4). weight goals.. Wolfarth. Wolfarth. which is established in Freiburg since 1987. increased physical fitness and improvement of the cardiac risk profile are checked by weight.. Freiburg Intervention Trial for Obese Children (FITOC) is an interdisciplinary treatment program for obese children. objectives and strategies used in a systematically designed research programmme to study specific weight gain-inducing behaviours. L. S. Emunds. A.

J. and strategies for the population as a whole. M. (2000). Jeffery. dieting without exercise results in loss of both fat and fat-free mass (FFM).. J. Krempf. T. links between independent policies and processes in different settings and sectors. 3rd. H. C. . International Journal of Obesity. (2005). Ritenbaugh. Med Sci Sports Exerc. 27(5). A... To determine the effect of orlistat on weight reduction and the long-term maintenance of this weight loss when associated with a continuous mildly reduced energy diet. Physical activity is an integral part of weight control programs. Behavior therapy is considered the "treatment of choice" for mild to moderate obesity. P.. J... J. M. but recommended amounts vary.. Resting metabolic rate (RMR) is also lowered during dieting.. J. in conjunction with a reduced calorie diet is an important component of a weight reduction program. (2002). Kruger.. While calorie restricted diets are efficacious for weight loss. Targets for action. B. Serdula. 591-597. 135 methods applied within the Netherlands Research programme weight gain prevention (NHF-NRG) project were described... and the decline in RMR may be due in part to the loss of FFM. trends. 26(3). Evaluation of weight resistance training as a component of exercise in the behavioral treatment of obesity. intervention and commitment to action at all levels (from the individual to international players). Galuska. S. economic aspects and global burden of obesity. Exercise. W. Krinick. The objectives of this study were to describe the prevalence and characteristics of those who reported using exercise as a weight loss strategy and to determine the prevalence of meeting various institutionally recommended levels of physical activity (N=8538) among that population. Joubert. Miloradovich. This report analyses the prevalence.. Weight reduction and long-term maintenance after 18 months treatment with orlistat for obesity. and Attali. 61(02). Louvet. H.. as a result of the body adapting to periods of famine. M. potential solutions and surveillance outcomes are presented. and Kohl. (2003). Dissertation Abstracts International Part B: Science and Engineering. 364-8. V. International Journal of Obesity. Kumanyika. W. Vol. and Antipatis. Morabia. R. Obesity prevention: the case for action. 37(3). 425-436. Physical activity profiles of U.S. adults trying to lose weight: NHIS 1998. A.. D. R. G. Allanic. The action agenda presented highlights the need for correcting the societal causes of obesity. RMR correlates highly with FFM. K.

as well as mail. 293-308. and Obarzanek. . Soldiers failing or at risk of failing weight and fitness standards attend a wellness program one weekend per month for three consecutive months. 136 Kumanyika. International Journal of Obesity. Preventing obesity and type 2 diabetes in youth: call to action. A. M. The high and still increasing prevalence of obesity in children from the USA. LaFontaine. 204-207. Annual Review of Public Health. (2003). Presents a review of the literature on the epidemic trends of obesity and type 2 diabetes mellitus in the United States and discusses how National Strength and Conditioning Association members can help prevent and address this growing trend. nutrition.. (2001). (2001). The aim of this review paper was to survey and critically evaluate the descriptive and controlled trials of acupuncture for enhancing weight loss. S. Minisymposium on obesity: overview and some strategic considerations. Kumanyika. Pathways to obesity prevention: report of a National Institutes of Health workshop. 27(4). J. its usefulness in obesity management has not yet been fully evaluated. and Foster. 11(10). and adults poses a major economic and health threat to our society. This paper presents the Wisconsin Army National Guard's attempt to retain soldiers failing to meet weight and annual physical fitness test standards.. This article summarizes results of a workshop conducted by investigators funded under a National Institutes of Health initiative designed to stimulate novel research for obesity prevention. 22. (2003). (2) examining the multiple and complex environmental influences on eating and physical activity patterns. S. 419-427. and involved a mix of interventions. D. Although acupuncture is being utilized to treat a variety of important health problems. telephone. Acupuncture for the treatment of obesity: a review of the evidence. 24(6). but relatively little research has focused on obesity prevention. adolescents. Strength and Conditioning Journal.. There is an extensive research base on obesity treatment and on the health benefits of weight loss. including face-to-face group and individual counseling. and (3) considering how the development of obesity during childhood and adolescence can be prevented through interventions in school. Instruction includes topics in exercise training. 166(3). were conducted in a variety of natural and research settings. An initiative to retain reserve soldiers failing to meet weight and physical fitness standards: the Wisconsin Army National Guard experience. Military Medicine. T. and internet-based approaches. and primary care settings. E. K. (2002). A. 1263-1274. Lacey. R. G. Obesity Research. The three reviews in this minisymposium on obesity explore the health issues by: (1) describing the public health impact of obesity. 53-56. Lalich. M. Tershakovec. The 20 pilot studies funded under this initiative involved study populations that were diverse with respect to life stage and ethnicity. family.

International Journal of Obesity and Related Metabolism Disorders. in-between meals.. and Millstone. A dietary and behavioural programme for the treatment of obesity. International experience of Policy Councils on food and nutrition has developed over recent decades but they have not received the attention that is due to them. This program is cost effective and soldier caring. M. Public Health Nutrition. At 48 months. Journal of Internal Medicine. J. The data provide evidence for the idea that there is need for social stratification of future measures of health promotion within families. M... graduates of the program had a 55% retention rate. including a very low calorie diet (VLCD). G. and Muller. Nutritional status. (2005). 104(6). To evaluate weight loss maintenance after 4 years of nonpharmacological. A total of 52 overweight and 26 normal weight children were investigated.3 years (t1. M. Langnase.. 254(3). D. The result obtained indicate that a low SES may serve as a barrier against family-based intervention. The 1992 International Conference on Nutrition recommended that governments create Food Policy Councils but few have been created. S. Barling. A. parental education. H.. H. 11-9. Health Education. A 4-year clinical trial and a long-term posttreatment follow-up. Brenner. J. to assess weight development amongst completers and noncompleters beyond the active 4-year treatment period. Furthermore. Agren. K.. M.. 29(4).. nonsurgical obesity treatment. nutrition and physical activity: the UK as a case study. N... and obesity prevalence in a study of six-year-old children in Germany.. Lamerz. frequency of exercise and daily television viewing were measured before intervention (t0 and after a mean period of 1. Hebebrand. 272-279. Rayner.. Mast.. Peltonen. T.. intake of fruit. particularly in North America.. Wehle. To assess the association between socioeconomic status (SES) and childhood obesity. . L. Asbeck. There has been more experience in local and sub- national policy councils. Social class. Policy councils on food. (2003). C. Kuepper-Nybelen. and Herpertz-Dahlmann. 8(1). G. sports club membership. J. and Torgerson. 137 general wellness. J. Bruning. E. Rayner. 336-344. diet and behavioural support. Lang. vegetables and low fat foods. The influence of socio-economic status on the long-term effect of family-based obesity treatment intervention in prepubertal overweight children. A total of 324 soldiers who completed the program were evaluated for retention rates.. and motivational lectures. The objective of this paper is to assess the effect of the socio-economic status (SES) on long-term outcomes of a family-based obesity treatment intervention in prepubertal children. and which factor in particular stands out in relation to obesity. stress reduction. B.. I. Lantz. (2004). Trost-Brinkhues. (2005). 373-80.

Stimulation of energy expenditure (EE) with selective thermogenic beta -adrenergic agonists may be a promising approach for treating obesity. 98(1). E. W.3. A. Van Baak. and Mattsson. American Journal of Clinical Nutrition. the propensity of previously obese (postobese) individuals to regain weight after dieting. Ferraro. 735-739. Journal of Rehabilitation Medicine. perceived exertion and pain graded and oxygen cost calculated. S. Current Pharmaceutical Design..10.. in part... D. (1995). Vrang. Larson. K. 91-97. 9(17). A low metabolic rate for a given body size and body composition and a low ratio of fat to carbohydrate oxidation predict body weight gain. and Ravussin. T.. L. and Hooker. on energy expenditure and body composition in obese men. K. body mass index 37. and Astrup. American Journal of Clinical Nutrition. 19-22. H. R. Larson..7 years. Effect of a 28-d treatment with L-796568. Bowles. A.. M.. P. Energy metabolism in weight-stable postobese individuals. M. Southern Medical Journal.1 +/.4 kg x m(-2) performed an indoor walking test. Gottesdiener. (2002).= Larsen. P. H. Robertson. We analyzed the effects of the highly selective human beta sub(3)-adrenergic agonist L-796568 on 24-h EE.1 +/. S. T. D. This study determined the proportion of South Carolinians trying to maintain or lose .. Kirtland. METHODS: Fifty-seven obese women 44. 1373- 1382. (2003). Larsson. Influence of weight loss programmes on walking speed and relative oxygen cost (%VO2max) in obese women during walking. Modern societies have moved from famine to feast and obesity and its co-morbidities now sweep the world as a global epidemic. Self-reported physical activity among South Carolina adults trying to maintain or lose weight.. (2005). a novel beta sub(3)-adrenergic receptor agonist. and Tang-Christensen. A. E. U. N. 780-788. M. Speed. M. substrate oxidation. Toubro.. weight-stable men.. J. The obesity epidemic is related to widespread physical inactivity in the United States. E. 138 Larsen. S. Lattimore.. E. Numerous scientific laboratories and pharmaceutical companies have taken the challenge and are now exploiting novel molecular targets for treatment of obesity. oxygen consumption and heart rate were measured. The objective was to investigate effects of dieted weight reduction on walking ability in obese women.. Such metabolic traits could also explain. M. 76(4). D.. Central pre-proglucagon derived peptides: opportunities for treatment of obesity. Saris. Maximum oxygen uptake (VO2max/kg) was predicted from a submaximum bicycle ergometry test. 35(2). R. and body composition in obese. (2003). P.

(2001). A. Growth and maturation: the connection with physical activity to obese children.. J. SETTING: Multispecialty tertiary care center. Exercise capacity in adult African-Americans referred for exercise stress testing: is fitness affected by race? Chest. Childhood obesity is expected more serious in the 21st century. it is imperative to look into the nature and health-related effects of physical activity towards obesity management. J. 7(1). and address the contribution of growing rates of obesity. F.. 139 weight and within that subpopulation.. and Ventura. V. C. To determine the prevalence of achieving new recommended levels of physical activity. The recommendations are based on new scientific findings.. therefore. Prasad. Lavie. M. hypertension. SETTING: Two large teaching institutions. place a greater emphasis on the adoption of healthy eating patterns and behaviors rather than a singular focus on dietary fat intake. R. (2004).. Effects of cardiac rehabilitation and exercise training in obese patients with coronary artery disease. Lavie. The American Heart Association Dietary Guidelines for 2000: A summary report. the number who practiced a restricted diet and engaged in physical activity. DESIGN: We compared data before and after cardiac rehabilitation between obese and nonobese patients. the types of activity involved. D. Bedford. and diabetes to heart disease in the United States. Journal of Epidemiology and Community Health. and Sheard. and Ebrahim. Nutrition Reviews. 126(6).. S. To determine the effects of cardiac rehabilitation and exercise training in obese coronary patients. 42-48. A. 52-56. Taylor. 109(1). The etiology of obesity has been investigated for more than decades and nobody will argue that physical inactivity and high-energy intake are the two core factors. The objective of this chapter is to clarify the effects of physical activity participation on adolescents' body changes and avoid unrealistic expectations from it. Lau. H. Milani. Results from the British Women's Heart and Health Study. Lauber.. Is housework good for health? Levels of physical activity and factors associated with activity in elderly women.. To determine the factors associated with exercise capacity. Recently. P. (2001). V. Chest. 56(6). and Milani. R. 298. 59(9). and their determinants among elderly British women. The guidelines for the general public are similar to dietary recommendations made by other health-related groups and government agencies and. (1996). R. C. 1962-8. 473-478. (2002). Journal of Physical Education and Recreation. For the sake of prevention and treatment. DESIGN: Retrospective evaluation of large stress-testing database. N. O. Kuruvanka. P. the American Heart Association published a revision of its dietary guidelines. C. T. Lawlor.. .

S. Romanetz... S. Effects of a community-based prenatal nutrition program on the oral health of Aboriginal preschool children in northern Ontario. Lawrence. H. K. and Wodarski.. . Current research indicates that dental public health programs fail to prevent ECC because intervention often arrives too late. D. 184-186. (2002) provide answers to two fundamental questions regarding the role of PPAR gamma in the making of a fat cell. This manuscript outlines various applications of behavioural techniques and interventions utilized for smoking and obesity. The peroxisome proliferator activated receptor gamma (PPAR gamma).. and Coppack. Behavioral health: treatment and prevention of chronic disease and the implications for social work practices. 38(4). (2002). Aboriginal preschool children across Canada are at increased risk for Early Childhood Caries (ECC) when compared with their non-Aboriginal age cohorts. (2003). Cappel. (2004). 49-65... and function. The public health problems in the new millennium are largely related to lifestyle. Rosen et al. Although its exponential rise in prevalence undoubtedly represents a major threat to the health of the population. A. and rational intervention requires an understanding of adipocyte genes. 1-5. B. Probe. Wodarski. 17(2). Lazar. P. J... M. L. Binguis. Exclusive reliance on body mass index (BMI) alone to define management goals is not sufficient. V. 172-182. development. (2002) and Ren et al. Obesity is characterized by excess adipose tissue. Obesity and its complications pose one of the most important challenges to 21st century health care. 16(1). Despite this. A. M. Becoming fat. Most people do not wish to become fat. Rutherford. there is an international epidemic of obesity fueled by sedentary life-styles and high caloric consumption among people living in industrialized societies. (2002). as well in the pathogenesis and treatment of diabetes.benefits and risks with special reference to type 2 diabetes mellitus. Lawrence. for cosmetic as well as medical reasons. Prevention paradigms and implications for social workers are also outlined. treatment must be tailored to the individual concerned. J.. 140 Lawrence. 114-118. Practical Diabetes International. A. 188. Journal of Health and Social Policy. L. The field of behavioural medicine seeks to include individual responsibility in the prevention of chronic diseases. Obesity treatment -. a member of the large family of nuclear hormone receptors. and cancer. There are great possibilities for lifestyle change through behavioural interventions. Genes and Development. In this issue of Genes & Development. and Rogers. Zittel-Palmara. cardiovascular disease. has received enormous attention as its role has emerged in the formation of adipose tissue. L. M. The illness industry has seen a large growth in the USA with health care expenditure accounting for 14% of the gross national product. 19(4).

.. J. Thus. L. Lederman. Body mass index (BMI) has been recommended for use in adolescent screening programs to select subjects with excess body fat for appropriate interventions.. Alfasi. Lederman. N. 500-506.. Journal of the American Medical Women's Association. Weight gain during pregnancy may contribute to obesity development. and Blyth. A. Pregnancy weight gain and postpartum loss: avoiding obesity while optimizing the growth and development of the fetus. G.. restricting weight gain may be detrimental to the baby. Concerns about possible adverse effects of pregnancy weight gain on later maternal weight and on labor and delivery must be rigorously evaluated in light of possible benefits for fetal growth and development. A. H. To determine weight gain during pregnancy and weight changes postpartum in first-time mothers delivering at or near term. Influence of Methylphenidate on Eating in Obese Men. 224-232. increases brain synaptic dopamine and produces anorexia. Jaroni. (1996). L. F. J. Epstein. Obesity Research. Birth-weight rises with increased pregnancy weight gain. Methylphenidate. R. . and perinatal and neonatal mortality fall as birthweight increases in both preterm and term infants. and Lerman. Maternal and Child Health Journal. 37-42. C. A. 141 Lazarus. American Journal of Clinical Nutrition. We investigated the effects of two doses of short-acting methylphenidate on energy intake over one meal in obese adult males. J.. Body mass index in screening for adiposity in children and adolescents: systematic evaluation using receiver operating characteristic curves. (2004). Goldfield... 63(4). G. 53-58. Rapid synaptic dopamine transport or reduced brain dopamine receptor signaling may influence energy intake. Paluch. (2001). The lowest mortality is observed at 3500 to 4500 g in infants of white women. J. Leddy. Roemmich. 12(2). Although often thought to be at high risk. infants termed "macrosomic" include infants of the lowest mortality rate. R.. S. Webb. suggesting that it may reduce energy intake. R. 6(1). and Deckelbaum. a dopamine reuptake inhibitor. K. (2002).. Baur. 56(2). The purpose of this paper was to evaluate the screening performance of BMI using appropriate epidemiologic methods. L. J. S. Pregnancy-associated obesity in black women in New York City. S.. Weight gain that is optimal for the mother and the baby differs according to the mother's prepregnancy weight. No systematic evaluation of BMI in screening for high degrees of adiposity was available when these recommendations were formulated.

24(2). individual and group contingencies for exercise completion. 1275-1289. M. diet. 157-66. A. the guidelines for screening. Semin Reprod Med. . 13- 14. Jr. Shigaki. and Hoeger. T. neglecting the well-recognized nonhormonal aspects of cardiovascular health. (1999)..8 kg. P. which are essentially the same for men and women.. As with men. obesity. Examined the effects of two maintenance programs on exercise participation. 382-388. Simple lifestyle changes--exercise. 219-227.. who participated in a 10-week cognitive-behavioral inpatient treatment followed by either a weight maintenance program or a follow-up period without professional support. Edgar. E. many postmenopausal women and their physicians relied heavily on hormone therapy to prevent cardiovascular disease. 142 Leermakers. Diabetes Educator. R. and avoidance of tobacco--can significantly reduce the chance of heart disease and its major risk factors. Perri. 40(11). Anderson. K. Addictive Behaviors. (2002). A. C. This study examined outcome differences of 109 obese subjects. Leibbrand. (2000). Lewis. Following an initial 6-month treatment phase which produced a mean weight loss of 8. Effects of exercise- focused versus weight-focused maintenance programs on the management of obesity. 23(2).. This qualitative study was conducted to explore perceptions of body size and shape in a group of black women with Type 2 diabetes. (2005). Ss were assigned to an exercise- focused or to a weight-focused maintenance program. 25(3). L. Approaches to preventing an epidemic of obesity. 6(8). Adam Legge discovers how. energy consumption. L. hyperlipidemia. and a brief overview of treatment recommendations. and Fuller.. and weight change in 67 obese adults (mean age 50 yrs) undergoing behavioral weight-loss treatment. A new group. A. Liburd. Coronary heart disease (CHD) is a common and serious health problem facing women as they move beyond the reproductive years. M. Until recently. C. the National Obesity Forum. G. Both maintenance programs included 6 months of biweekly group sessions.. Body size and body shape: perceptions of Black women with diabetes. R. M. Community Nurse. hypertension. Maintenance of weight loss after obesity treatment: Is continuous support necessary? Behavior Research and Therapy. and Jack. (1999). energy expenditure. and Fichter. Legge. L.. weight control. is one of several initiatives aiming to help improve weight control in primary care.. V. The exercise-focused program included group walking sessions. This review discusses the epidemiologic studies linking these risk factors to CHD in women. and diabetes are the major risk factors for heart disease in women. L. and relapse prevention training targeted specifically at the maintenance of physical activity. Prevention of coronary heart disease: a nonhormonal approach..

Model of nonalcoholic steatohepatitis. Leo. M.. 143 Licence. (2004)... carried out to support the external working group on the 'Healthy Child' module of the Children's National Service Framework. Moore. S. Health promotion interventions that target children and young people can lay the foundations of a healthy lifestyle that may be sustained into adulthood. Dunnagan. (2004). K.. Y. and Torgerson. S. Pelican. K. However. 502-509. some features seem common to successful interventions... Cao. C. J. C. Dietary intake. Obesity and diabetes are frequently associated with nonalcoholic steatohepatitis (NASH). Paul. S. In spite of this. M. We are facing a rapid increase in the prevalence of obesity that is mainly related to behavioural changes in modern society. M. L. Holmes. and Haynes. and physical activity-related determinants of high body mass index in rural communities in Wyoming. Liebman. L. A.. A. eating behavior. mainly due to methodological shortcomings.. but studies have been hampered by the absence of a suitable experimental model. M.. American Journal of Clinical Nutrition.. Montana. is also discussed. Q. 45(1). International Journal of Obesity. especially fat and carbohydrates. obesity is a chronic disorder and long-term treatment improves weight loss and maintenance. This paper is based on a selective review of evidence relating to health promotion in childhood. Liddil. dietary changes are thus essential components in all obesity treatment programmes and in the present article an outline is given of different dietary treatment strategies. increased physical activity and behaviour therapy seems more efficient than treatment programmes using just one or two of these modalities.. Wardlaw. (2003). S. Promoting and protecting the health of children and young people. .. C... A. 30(6). knowledge about the design and implementation of dietary treatment programmes is rather limited. and above all. Ren. Melcher. Obesity treatment: an overview with a dietary perspective. To assess the relation between body mass index (BMI) levels and various lifestyle variables related to physical activity and specific characteristics of a healthy eating pattern. M. Child: Care. 2-7. (2001). 79(3). L. Lieber. The health-related behaviours adopted by children and young people can have both immediate and long-term health effects. Lifestyle changes. The role played by specific macronutrients. B. 684-692. Furthermore. K. G. W. Xu. C. T. K. A. A multicomponent strategy including a low energy diet. using baseline cross-sectional data from the Wellness IN the Rockies project. 27(6).. Many studies have been undertaken to evaluate the effects of different therapeutic approaches. Our objective was to create a rat model of NASH. 623-635. and Idaho. Lindroos. M. Scandanavian Journal of Nutrition. A.. Ponomarenko.. and DeCarli. Mak. Health and Development.

(2005). Linneman. F. The risk of type 2 diabetes. Rosner. J. 36(6). C. in many European countries more than half the adult population is overweight. 144 Lindstrom. (2002). S.. E. Most importantly.. 78(5).. The obesity thanks to increasing incidence becomes a significant socioeconomic and medical risk factor in Czech Republic. and that type 2 diabetes can be prevented. The presented project intends to extend the accredited methods of obesity therapy and to integrate in-patients care in spas. (2004). P. Hu. A. K. CVD. lifestyle changes do not have to be extreme. affecting more and more children and adolescents. Nanney. with no need to consume the energy through physical activity. S. B. 305-308.. International Journal of Obesity.to 5-year-old children's fruit and vegetable intake. and Haire Joshu. physical activity and body weight. The Finnish Diabetes Prevention Study was the first controlled randomised study to show that individualised lifestyle counselling of individuals with high risk of developing type 2 diabetes can influence diet. little is known about the relation of whole grains to body weight and long-term weight changes. Biological evolution has produced body-fat-regulating mechanisms that are more powerful in protecting against weight loss than against weight gain. Journal of Nutrition Education and Behavior. (2003). Huynh. diet and physical exercise intervention with follow-up methods focused on behavioral therapy. B. but it has been shown that the healthcare system can also have a role in preventing obesity-related morbidity. Hessler. W.. If the population would adopt a lifestyle in line with the official nutrition recommendations. Liskova. The 'obesogenic' environment is to some extent a political issue. K. J. Manson. Parents are accurate reporters of their preschoolers' fruit and vegetable consumption under limited conditions.. Steger May. Moravcova.. or at least postponed. C.. The current environment offers constant availability of affordable palatable energy-rich foods. Relation between changes in intakes of dietary fiber and grain products in weight and development of obesity among middle-aged women. Lifestyle strategies for weight control: experience from the Finnish Diabetes Prevention Study. M. and Tuomilehto. Peltonen. D. J. A. Long-term effectiveness of obesity intervention program in children.. directed on education. 81-8. We examined the associations between the intakes of dietary fiber and whole. it hass become 'abnormal' to be of 'normal weight'. American Journal of Clinical Nutrition.. Although increased consumption of dietary fiber and grain products is widely recommended to maintain healthy body weight. 920-928.or refined-grain products and weight gain over time. the obesity and diabetes trend could at least be stabilised. hypertension and certain forms of cancer increase with increasing weight. Kytnarova. G. 26(1). and Colditz. To assess the accuracy of parents as reporters of both their own and their 2.. Proceedings of the Nutrition Society.. J. Liu.. Currently.. 64(1). and Hosek. . Willett. S..

. 1. Action for healthy kids.. D. H. 145 Liu.. Tannic acid stimulates glucose transport and inhibits adipocyte differentiation in 3T3-L1 cells. (2003). is a major mechanism leading to weight gain and obesity. Y.. Gatorade sponsors: new kids' anti-obesity campaign. D. and Ko. the differentiation and proliferation of adipocytes. (2003). Y. Adipogenesis. Obesity is increasing in the American population in epidemic proportions. Socioeconomic characteristics of the population eligible for obesity surgery. Journal of Nutrition. 1. C. Briefly reports on results from recent United States surveys that indicate that more and more business are affording their employees opportunities for weight loss and physical fitness in order to combat the rising cost of health insurance.. However. K. Surgery. (2003). IDEA Health and Fitness Source. 135(2). J. X. Lofshult. designed to reduce and prevent childhood obesity. (2004).. Lofshult. Weight reduction surgery results in sustained weight loss for morbidly obese individuals-a group of patients refractory to nonsurgical obesity treatment. IDEA Health and Fitness Source. 1. "Get Kids in Action". Lofshult. Livingston. Li. (2005). D. J. most antidiabetic drugs that are hypoglycemic also promote weight gain. D. E. Discusses the Action for Healthy Kids (AFHK) which strives to combat health challenges facing youth. thus alleviating one symptom of T2D while aggravating a major risk factor that leads to T2D. (2004). 1. F. . 21(6). Briefly announces the partnership between the Gatorade Company and the University of North Carolina to create a new program. and Chen. It is highly desirable to develop pharmaceuticals and treatments for T2D that reduce blood glucose levels without inducing adipogenesis in patients. 21(8). Drinking milk can reduce childhood obesity. 288-296. Obesity is a major risk factor for Syndrome X and type II diabetes (T2D). What businesses are doing to fight obesity. Lofshult. 1(1). 165- 71. 21(10). IDEA Fitness Journal. Kim. IDEA Health and Fitness Source. Reports on a study linking milk consumption in children to a reduction in childhood obesity. Li. 135(3). Liu. X.

Journal of Orthopaedic Nursing. Annunziato. G. J. as well as a local overweight prevention initiative in Chicago (Illinois. Pathways. Cano. Overweight (M = 85.. 146 Lohman.. Chicago project uses ecological approach to obesity prevention. T. K. Ochner.. C. and McKinney. (2004).. Going. B.. Controlled trial of a nutrition-focused treatment for weight loss maintenance. S.. Lucks. S. and Plodkowski. International Journal of Obesity.4 kg) participants in all groups lost weight on identical low-calorie diets... The Enhanced Food Monitoring Accuracy (EFMA) group received CBT and techniques to improve the consistency and accuracy of their food diaries. Himes. It emphasizes the important and unique position of the orthopaedic nurse in its assessment and prevention. 104(8). Tested the hypothesis that high relapse rates found in obesity treatment programs are in part due to insufficient qualitative changes in dietary intake. Pediatric Annals. L. Indices of changes in adiposity in American Indian children. Guidance on best practice is given based on the present. 73-80. C. S. and Ring. St.. J. (2003). M. M. Crerand. An ecological model for obesity prevention that conceptualizes the relationships among overweight risk factors is also presented.. evidence. Preventive Medicine. D. The aim of this study was to verify whether changes in some dietary patterns over a 6-y follow-up period would be associated with weight changes. The current ranges of preventative measures are critically reviewed. 33(1). a randomized trial. Loredo. Norman.. The prevention programme is called the Consortium to Lower Obesity in Chicago Children. A physician extension model for diabetes/obesity treatment (DOTM). R. (2004). H. The immediate need for overweight prevention efforts to be developed and implemented on a large scale in the US is discussed. Butryn.. Jeor. Thompson. M. R. J. This article describes the natural history of deep vein thrombosis highlighting its prevalence in the orthopaedic patient. evaluated the effectiveness of a school-based obesity prevention program on body composition changes in American Indian children. Didie. 37(6 Part 2). Caballero. . USA) which was developed in a manner consistent with the ecological model. R. 26(1). Dietary patterns play an important role in the control of body weight. The control group received traditional cognitive-behavior therapy (CBT) treatment for 22 sessions.. 55-63. somewhat scanty. S91-S96. L. C. Longjohn. Riddell. A23. 3(2).. (1999). Several body composition methods were compared in intervention and control schools for assessing body composition changes. Lowe.. M.. A focused review of nursing and the effectiveness of preventative measures for deep vein thrombosis. (2002).. Love. Journal of the American Dietetic Association. S.

. Tested predictions from restraint theory and the 3-factor model of dieting using an eating regulation paradigm. Restrictive dieting vs. This counter-regulatory trend was observed in spite of a significant decrease in RDs' Disinhibition scale scores following treatment. 147 Lowe. Asia Pacific Journal of Clinical Nutrition. Lipids. (2003). obese. However. D. the potential relevance of the dietary glycemic index to obesity treatment has received comparatively little scientific notice. Foster. D. This review examines how the glycemic and insulinemic responses to diet may affect body weight regulation.. Addictive Behaviors. M. 253-266. a pattern most consistent with the predictions of restraint theory. 26(2). and 3) obesity prevalence has risen markedly since the 1970s in the US despite a significant decrease in fat consumption as a percent of total energy. the relationship between dietary fat and adiposity has been questioned for several reasons: 1) weight loss on low-fat diets is characteristically modest in nature. Ss took part in an ostensible ice cream taste test with or without a preload. for this reason. . carbohydrate consumption has increased in a compensatory fashion. Novel treatments for Obesity.. and most of this increase has been in the form of refined starchy food and concentrated sugar that are high in glycemic index (GI) and/or glycemic load (GL). A. Kerzhnerman. D. Excessive fat consumption is commonly believed to cause obesity and. Implications of these findings for restraint theory. despite comprehensive public health efforts to combat this problem. after 8 wks of the dieting interventions. G. R. Dietary glycemic index and the regulation of body weight. Ss were 42 female. RDs increased and UDs decreased their intake following a preload. 117-121. Ludwig. I. T. (2001). both before and after the weight control intervention. S. 38(2). Ludwig. and argues for the potential utility of low glycemic index diets in the prevention and treatment of obesity and related complications. "undieting": Effects on eating regulation in obese clinic attenders. the 3-factor model of dieting. Prevalence rates of overweight and obesity have risen precipitously in the United States and other developed countries since the 1960s. M. 2) prospective epidemiological studies have not consistently found that individuals eating the most fat are heavier than those eating the least fat. Although considerable attention has been focused on decreasing dietary fat and increasing physical activity level. 12 Suppl. At pretest. (2003). conventional approaches to weight loss have focused on decreasing dietary fat. restraint theory's prediction that participants would engage in counter-regulatory eating was not supported. R. S. S8.. At posttest. Swain. nonbinge eaters (aged 24-66 yrs) assigned to either a weight loss group (restrictive dieters [RDs]) or a group designed to eliminate dieting ("undieters" or [UDs]). and relapse in obesity treatment were discussed. and Wadden. As dietary fat has decreased.

Gnudi. C.. Mittenperger. associated with optimal fetal growth and birth weight in twins. R. Journal of Reproductive Medicine. D. Barilli. M.. a 3-yr community-based. Potvin.. Lynch. J. Glucagon- like peptide 1 (GLP-1) secretion and plasma dipeptidyl peptidase IV (DPP-IV) activity in morbidly obese patients undergoing biliopancreatic diversion. Paradis. (2003). 29-31. A. Desrosiers. N. If nurses are to prevent further health complications due to obesity. A. L. S. 2115-2117. C. B. Kirby. J. The physiological inhibitory control of glucagon-like Peptide 1 (GLP-1) on gastric emptying and the contribution of this peptide in the regulation of food intake as a satiety factor suggest that impaired secretion and/or activity of GLP-1 may be involved in the pathogenesis of obesity. C. Hormone and Metabolic Research. C. . A.. R... C. primary prevention program for non-insulin-dependent diabetes mellitus in a Mohawk community near Montreal. writes Grainne Lynch. by maternal pregravid body mass index (BMI) status. 148 Lugari. T. 9(7). 48(4). Mauldin. G. L.. American Family Physician. 63(11).. Salerni. 111-115.. Hediger. 779-790.. G. Obese proportions. Describes the Kahnawake Schools Diabetes Prevention Project. D.. B. R. A.. S. 26(6). and baseline results of a diabetes primary prevention program with a native community in Canada. D. Saad Haddad. L. they must take a look at preventative health. M. (2001). Lyznicki. evaluation. R. R. M. Obesity: assessment and management in primary care.. 217-224. E. Cas. Young. The Kahnawake Schools Diabetes Prevention Project: Intervention. and Davis. National data indicate that the prevalence of obesity in the United States is increasing in children and adults. and O'Sullivan.. B. D.. F. McComber. L.... 36(2)... Body mass index-specific weight gains associated with optimal birth weights in twin pregnancies. L. Ganzerla. Canada. To formulate maternal weight gain guidelines. Nugent.... Montour. Preventive Medicine. Cross. G. Obesity is a complex. R. J.. and Rivard. (1997). and Zandomeneghi. Riggs. Lamping. C.. F. Luciani. Objectives are to improve healthy eating and encourage more physical activity among elementary school children. Leduc.. Witter. Camellini. Ugolotti. A.. M. Macaulay. Nodari.. Luke.. G. multifactorial condition in which excess body fat may put a person at health risk. A.. (2004).. Newman. A. (2001). J. Reversing these trends requires changes in individual behavior and the elimination of societal barriers to healthy lifestyle choices. World of Irish Nursing. J. M.

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MacAulay, J., and Newsome, R. (2004). Solving the obesity conundrum. Food Technology,
58(6), 32-37.

The Research Summit of the Institute of Food Technologist(IFT) for identification of
actions for food-related solution to obesity epidemic was held on February 15-17, 2004 in
New Orleans. The keynote address by Claude Bouchard, executive director of
Pennington Biomedical Research Center, emphasized on several hypotheses for the
obesity epidemic including behavioral, physical environment and biological approaches.

MacKenzie, N. R. (2000). Childhood obesity: strategies for prevention. Pediatric Nursing, 26(5),
527-530.

The prevalence of childhood obesity has been steadily increasing over the past several
decades. Because obesity is not readily amenable to treatment, prevention is very
important. Children's growth should be monitored using the body mass index (BMI) and
risk factors assessed through a dietary and physical activity history. For children at risk,
developmentally-based prevention strategies include establishing a positive feeding
relationship, encouraging healthy eating habits, and maintaining physical activity.

Magnusson, M. B., Hulthen, L., and Kjellgren, K. I. (2005). Obesity, dietary pattern and physical
activity among children in a suburb with a high proportion of immigrants. Journal of Human
Nutrition and Dietetics, 18(3), 187-94.

Obesity among children is a growing problem. Interventions should be planned to meet
needs in different cultural settings. The objective of this study was to explore dietary
patterns, physical activity and perceptions of relationships between life-style and health
among children in a suburb with low socio-economic status and a high proportion of
immigrants and refugees.

Maki, K. C., Davidson, M. H., Tsushima, R., Matsuo, N., Tokimitsu, I., Umporowicz, D. M.,
Dicklin, M. R., Foster, G. S., Ingram, K. A., Anderson, B. D., Frost, S. D., and Bell, M. (2002).
Consumption of diacylglycerol oil as part of a reduced-energy diet enhances loss of body weight
and fat in comparison with consumption of a triacylglycerol control oil. American Journal of
Clinical Nutrition, 76(6), 1230-1236.

Diacylglycerol is a natural component of edible oils that has metabolic characteristics that
are distinct from those of triacylglycerol. We assessed the efficacy of an oil containing
mainly 1,3-diacylglycerol in reducing body weight and fat mass when incorporated into a
reduced-energy diet.

Marion, A. W., Baker, A. J., and Dhawan, A. (2004). Fatty liver disease in children. Archives of
Disease in Childhood, 89(7), 648-652.

NAFLD/NASH is now recognised as an increasing clinical problem in children and
adolescents. Risk factors include obesity, insulin resistance, and hypertriglyceridaemia.
Drug hepatoxicity and genetic or metabolic diseases that can cause hepatic steatosis must

150

be excluded. Affected children are usually asymptomatic although a few may complain
of malaise, fatigue, or vague recurrent abdominal pain. Liver biopsy is the gold standard
for diagnosis, and is important in determining disease severity and prognosis. The natural
history of childhood NASH may be progressive liver disease for a significant minority.

Marr, L. (2004). Viewpoint. Soft drinks, childhood overweight, and the role of nutrition
educators: let's base our solutions on reality and sound science. Journal of Nutrition Education
and Behavior, 36(5), 258-265.

The percentage of overweight children in the United States and other countries has now
reached epidemic proportions. Both physical activity and food intake contribute to the
energy equation, but research increasingly points to physical inactivity as the primary
culprit in weight gain. Singling out and restricting specific foods and beverages are
unlikely to be effective in reducing the prevalence of overweight children. Nutrition
educators need to emphasize overall lifestyle, including physical activity, as well as
caloric intake, in childhood overweight intervention efforts.

Martinez-Valls, J. F., Moreno, B., Formiguera, X., Genis, M., and Azpeitia, A. (2002). Effect of
weight loss with orlistat on cardiovascular risk prediction in clinical practice. The Obeso study.
Spain. International Journal of Obesity, 26(1).

Overweight and obesity are closely associated with coronary heart disease (CHD) risk
factors. We examine the effects of weight loss with orlistat on 10-year CHD risk in
clinical practice.

Matheson, D. M., Killen, J. D., Wang, Y., Varady, A., and Robinson, T. N. (2004). Children's
food consumption during television viewing. American Journal of Clinical Nutrition, 79(6),
1088-1094.

Television viewing is associated with childhood obesity. Eating during viewing and
eating highly advertised foods are 2 of the hypothesized mechanisms through which
television is thought to affect children's weight. Our objectives were to describe the
amounts and types of foods that children consume while watching television, compare
those types with the types consumed at other times of the day, and examine the
associations between children's body mass index (BMI) and the amounts and types of
foods consumed during television viewing.

Matheson, D. M., Varady, J., Varady, A., and Killen, J. D. (2002). Household food security and
nutritional status of Hispanic children in the fifth grade. American Journal of Clinical Nutrition,
76(1), 210-217.

Food insecurity is a critical variable for understanding the nutritional status of low-
income populations. However, limited research is available on the relation between
household food insecurity and children's nutritional status. Our objective was to examine
the relations among household food insecurity, household food supplies, and school-age
children's dietary intakes and body mass indexes (BMIs).

151

Maziekas, M. T., LeMura, L. M., Stoddard, N. M., Kaercher, S., and Martucci, T. (2003). Follow
up exercise studies in paediatric obesity: implications for long term effectiveness. British Journal
of Sports Medicine, 37(5), 425-429.

To examine the effects of exercise training on paediatric obesity immediately after
training and at a one year follow up and to provide recommendations for future research.

Mazur, R. E., Marquis, G. S., and Jensen, H. H. (2003). Diet and food insufficiency among
Hispanic youths: acculturation and socioeconomic factors in the third National Health and
Nutrition Examination Survey. American Journal of Clinical Nutrition, 78(6), 1120-1127.

Low socioeconomic status is associated with poor diet, food insufficiency, and poor child
health. Hispanic households have disproportionately low incomes. Acculturation-related
changes may augment the effects of poverty on children's diet and health. The goal was
to determine the associations that acculturation, measured by parents' language use, and
income have with dietary intakes and food insufficiency among Hispanic youths.

McCance, K. L., and Jones, R. E. (2003). Estrogen and insulin crosstalk: breast cancer risk
implications. Nurse Practitioner: American Journal of Primary Health Care, 28(5), 12-13, 16-18,
21-25.

The incidence of breast cancer may be running parallel to the high insulin levels that
occur with diabetes mellitus and atherosclerosis. Estrogens are known to increase the risk
of breast cancer, and there is increasing evidence for interactions between estrogen and
intracellular growth factor signaling pathways. This article includes recommendations to
lower bioavailable estrogen and insulin through lifestyle changes.

McCarter Spaulding, D. (2004). The importance of breastfeeding in improving the health of
African-Americans: a health policy perspective. Journal of Multicultural Nursing and Health,
10(3), 24-28.

The objective of this paper is to recommend health policy changes that will support
efforts to increase breastfeeding among African-Americans.

McCarty, M. F. (2005). Up-regulation of PPARgamma coactivator-1alpha as a strategy for
preventing and reversing insulin resistance and obesity. Medical Hypotheses, 64(2), 399-407.

Excessive accumulation of triglycerides and certain fatty acid derivatives in skeletal
muscle and other tissues appears to mediate many of the adverse effects of insulin
resistance syndrome. Although fatty diets and obesity can promote such accumulation,
deficient capacity for fatty acid oxidation can also contribute in this regard. Indeed, in
subjects who are insulin resistant, diabetic, and/or obese, fatty acid oxidation by skeletal
muscle tends to be inefficient, reflecting decreased expression of mitochondria and
mitochondrial enzymes in muscle. This phenomenon is not corrected by weight loss, is

152

not simply reflective of subnormal physical activity, and is also seen in lean first-degree
relatives of diabetics; thus, it appears to be primarily attributable to genetic factors.

McCrone, S., Dennis, K., Tomoyasu, N., and Carroll, J. (2000). A profile of early versus late
onset of obesity in postmenopausal women. Journal of Women's Health and Gender Based
Medicine, 9(9), 1007-1013.

Obesity is a serious health problem among women across the life span. Although people
can become obese at any age, there is a large proportion of older women who have been
obese since childhood. The purpose of this study was to determine whether
postmenopausal women with an early versus late onset of obesity manifested differences
in body habitus, eating behaviors, and mood. One hundred thirty-five postmenopausal
women with obesity responded to self-report questionnaires on weight history, weight
loss and maintenance expectancy, eating behaviors, and mood. Women with an early
onset of obesity had a significantly higher body mass index (BMI), waist circumference,
and highest attained adult body weight than women with a late onset of obesity. They had
attempted a significantly larger number of diets and had lost more weight on any single
diet. The groups also differed significantly on binge eating and overeating in response to
negative affect. There was a tendency for women with an early onset to have more
depressive and anxious symptoms. Postmenopausal women with an early onset of obesity
differed physiologically and psychologically from those with a late onset. Tailoring
dietary and behavioral interventions to profiles of postmenopausal women based on onset
of obesity may improve the overall efficacy of weight loss programs.

McCrory, M. A. (2000). Nutrition and the life cycle. The role of diet and exercise in postpartum
weight management. Nutrition Today, 35(5), 175-182.

This paper reviews the role of diet and exercise in postpartum weight management, citing
evidence from both observational and experimental studies in lactating and nonlactating
women. Issues regarding the safety of exercise during lactation will also be covered.
Finally, practical advice, including guidelines for weight loss in the postpartum period,
will be given. It should be noted that in this paper the terms "exercise" and "physical
activity" will be used interchangeably.

McDonald, P. W. (1995). A case for the treatment of obesity. Journal of the Canadian Dietetic
Association, 56(3), 131-136.

Although obesity increases the risk of some of the most prevalent diseases in the western
world, a growing number of practitioners have been led to believe that not only are
attempts to modify weight through exercise and dietary modifications doomed to failure,
but that repeated attempts to treat obesity may actually increase an individual's risk of
illness. This paper reviews the literature associated with most common arguments
espoused by critics of obesity treatment and demonstrates how these conclusions are
either invalid or premature. It is argued that given the clinical utility of professionally
monitored treatment programs and that even modest weight loss results in substantial net

153

benefits to physical, psychological and social health, it would be unethical to withhold
treatment.

McElroy, S. L., Arnold, L. M., Shapira, N. A., Keck, P. E., Jr., Rosenthal, N. R., Karim, M. R.,
Kamin, M., and Hudson, J. I. (2003). Topiramate in the Treatment of Binge Eating Disorder
Associated With Obesity: A Randomized, Placebo-Controlled Trial. American Journal of
Psychiatry, 160(2), 255-261.

Binge eating disorder is associated with obesity. Topiramate is an antiepileptic agent
associated with weight loss. The objective of this study was to evaluate topiramate in the
treatment of binge eating disorder associated with obesity.

McGarvey, E., Keller, A., Forrester, M., Williams, E., Seward, D., and Suttle, D. E. (2004).
Feasibility and benefits of a parent-focused preschool child obesity intervention. American
Journal of Public Health, 94(9), 1490-1495.

This field study tested the feasibility and benefits of a program to promote 6 targeted
parental behaviors to prevent obesity in children served by the Special Supplemental
Nutrition Program for Women, Infants, and Children (WIC).

McInnis, K. J. (2003). Diet, exercise, and the challenge of combating obesity in primary care.
Journal of Cardiovascular Nursing, 18(2), 93-102.

Obesity has reached epidemic proportions in the United States and in most industrialized
nations. More than 60% of US adults are now overweight or obese, predisposing over 97
million Americans to a host of chronic lifestyle diseases, particularly cardiovascular
disease. Despite the existence of explicit evidence-based consensus reports on the health
risks of obesity and the health benefits of even moderate amounts of weight loss, many
patients do not receive advice from their health care providers to lose weight or on how to
do so effectively. Even modest physical activity and small incremental healthy dietary
changes when incorporated into one's lifestyle have a positive effect on weight loss and
promote the maintenance of favorable body weight and body composition changes with
advancing age. This article describes elements of effective counseling and practical
guidelines for developing a healthy lifestyle approach for overweight and obese
individuals.

McInnis, K. J., Franklin, B. A., and Rippe, J. M. (2003). Counseling for physical activity in
overweight and obese patients. American Family Physician, 67(6), 1249-1256, 1266-1288, 1180-
1181.

Obesity has reached epidemic proportions in the United States. More than 60 percent of
U.S. adults are now overweight or obese (defined as at least 30 lb [13.6 kg] overweight),
predisposing more than 97 million Americans to a host of chronic diseases and
conditions. Physical activity has a positive effect on weight loss, total body fat, and body
fat distribution, as well as maintenance of favorable body weight and change in body
composition. Many of the protective aspects of exercise and activity appear to occur in

J.. all interventions related to the prevention and treatment of obesity have failed. which support how individuals present themselves and their condition (IS). weight maintenance and weight-loss interventions. Journal of Sports Sciences. Clinical practice. McLean. American Journal of Health Education. Griffin. Z. (2004). International Journal of Obesity and Related Metabolism Disorders. This article discusses the assessment and management of childhood and adolescent overweight and obesity. Obesity in children: tackling a growing problem. and cancer is estimated at $71 billion annually. McMahan. 27(9). How then can we best encourage people to make lower fat. 22(3). we explored IMC in overweight volunteers. Despite the well-known health and quality-of-life benefits of regular physical activity. the prevalence of obesity in the United States has reached epidemic proportions.. 329- 336. Y. We must find anew way to prevent this epidemic from spreading. A "fat" tax: knowledge and attitudes of snack food taxing among college students. 33. Toney. and (3) intentionality within the communicative act (ICA). The IMC model has three main features: (1) intentionality of symptoms. S. J.. K. Weight gain creates a strong medical concern and is a biomarker for differential medical treatment. J. (2003). Hampl. weight maintenance and weight-loss interventions: a systematic review of randomised trials. and York. To conduct a descriptive systematic review into the nature and effectiveness of family involvement in weight control. . Support from primary care for losing weight: The role of patient intentionality. S. (2) reflections on those symptoms (RS). These issues are rarely considered within exercise and health sciences. N.. (2003). Childhood and adolescent obesity has increased dramatically over the past 25 years in Australia. which is a hallmark of quality in contemporary public health. The economic cost for the United States from heart disease. In contrast. and how health professionals approach patients is seen as important in achieving these effects. (2004). 34(6). To date. Along with this trend. and Hardeman. McKenna. 154 overweight persons who gain fitness but remain overweight. Family involvement in weight control. Currently over 20% of Australian children are overweight or obese. The long-term success of this treatment hinges on sustaining changes in diet and physical activity.. McLennan. In this study. W. few Americans are routinely active. diabetes. yet they are central to delivering a patient-centred service. ethically approved by the North West Devon Health Trust. and Chikamoto. Australian Family Physician. the model of intentionality of medical consultations (IMC) shows that patients have different approaches towards these meetings. 33-36. 987-1005. The National Health and Medical Research Council has recently developed the 'Clinical practice guidelines for the management of overweight and obesity in children and adolescents'..

933-949. (1998)... T.. Stock. N. Gharbia. J.min-1)... physical activity (PA). The primary objective of this double-blind study was to compare the safety and tolerability of aripiprazole and olanzapine in patients with schizophrenia as evidenced by the percentage of patients exhibiting significant weight gain.S. M. (2003). N. T. 30(10). Nutrition Today.. Vanveggel. Carpenter. A.. neuronal. Melanson. Ainsworth. (2004). D. E. Annals of Internal Medicine. and cardiovascular disease (CVD) risk factors. R. O. and Lohr. 203-215. J. 39(5). B. Melanson.. This study determined the relationship between aerobic power (VO2max).. K. Preventive Services Task Force. In humans... S. R. The study also determined how increased VO2max and increased PA levels influence CVD risk factors of 576 low- fit adults (VO2max less than 30 mL. Marcus. Harrell. This review examines evidence for screening and treating obesity in adults. 20(10). R. . (2004). Is physical activity or aerobic power more influential on reducing cardiovascular disease risk factors? Medicine and Science in Sports and Exercise. R.. Dell'Olio. Weight gain is a side effect of therapy with many atypical antipsychotics and may have important clinical repercussions with respect to long-term health and treatment compliance. B. 1521-1529. E. K. Obesity poses a considerable and growing health burden. J. J.kg-1. D. G. Lux... and Carson. and the environment may promote overeating. L. 139(11). R. S. K. A comparison of weight change during treatment with olanzapine or aripiprazole: results from a randomized... 47-56. Sutton. J. D. Journal of Clinical Psychiatry. Griggs. R. Food intake regulation in body weight management: a primer.. McTigue. followed by 12 wk of observational monitoring.. Archibald. McMurray. S. Food intake regulation involves a complex integration of hormonal. 65 Suppl 18. Screening and interventions for obesity in adults: Summary of the evidence for the U. H. W. D. Harris. and Angelopoulos. K. Jody. A. fat-laden foods? Among those most affected by such a policy are college-age students.. Changes in multiple health outcomes at 12 and 24 weeks resulting from 12 weeks of exercise counseling with or without dietary counseling in obese adults. double-blind study. and metabolic controls. 849-856. We compared health outcomes in obese adults who underwent 12 wk of exercise counseling with or without dietary counseling. (2004). J. Hemphill. McQuade. and Williams. physiologic. Bunton. 155 more appropriate food choices? What if a tax was applied to unhealthy. M. Nutrition. such regulation is especially complex because many nonphysiologic factors may also influence it..

. Cardiology Clinics.. The Physical Activity and Nutrition (PAN) in Children program is one of the first large- scale efforts to focus on improving understanding of the roles of physical activity (PA) and nutrition in the health and well-being of children. J. A13. Law as a tool for preventing chronic diseases: expanding the range of effective public health strategies. obesity.. Narayan. Vinicor. Baranowski. . S. especially for state and local health department program managers and state and national policy makers. clinical. 156 Mendlein... Goodman. T. J. The authors writing in this issue of Preventive Medicine have advanced the PAN program's goals by cataloguing and describing state-of-the art tools for assessing PA and nutrition.Pt.. and Pratt. Law. A. These diseases are a consequence of several factors that include an aging population. and CVDs.. and population science research. Copyright (2004 by Elsevier Science (USA).. Pechacek. Kocher. 1(1). Dietz. (2004). T. P. which is a fundamental element of effective public health policy and practice. E. G. Ford. M. F.. and other chronic diseases and their risk factors. type 2 diabetes. is expected to increase dramatically. A. metabolic syndrome. stroke. R. A. Prev Chronic Dis. 31(2. 485-504. and an excess of contemporary lifestyle. L. W. the burden of chronic diseases. (2004). played a crucial role in many of public health's greatest achievements of the 20th century. P. S. and diabetes pose special challenges for clinical and public heath practice as well as for basic.. A.. heart disease. C. H. by reviewing intervention strategies among children and adolescents. H. H. metabolic syndrome. F. In an effort to expand the range of effective public health interventions. Physical activity and nutrition in children and youth: Opportunities for performing assessments and conducting interventions. 22(4). Zaza. A. V. This effort is especially needed to address the US nationwide epidemic of obesity that has emerged during the past 2 decades... and Deedwania. and type 2 diabetes: emerging epidemics and their cardiovascular implications. G.2). Still. Mensah. Preventive Medicine. Giles. the Centers for Disease Control and Prevention will work with its partners to explore the development of systematic legal frameworks as a tool for preventing chronic diseases and addressing the growing epidemic of obesity. As we enter the twenty-first century. and by recommending applied research to address gaps in knowledge and practice. M. (2000). Moulton. S150-S153. D. Obesity. and Marks. conceptual legal frameworks for the systematic application of law to chronic disease prevention and control have not been fully recognized and used to address public health needs. Mensah.changes in demographic composition. Mokdad.. The prevention and control of overweight. W. Development and implementation of legal frameworks could broaden the range of effective public health strategies and provide valuable tools for the public health workforce. such as obesity..

Khan. G.S. Repeated measures ANOVA and secondarily stepwise regressions were used to analyze the data. We studied the effect of two environmental factors. and environmental factors as well as advertising pressures influence the usage patterns of all 3. This book's 20 chapters. Jarosz. Western Journal of Nursing Research. J. Furthermore. D. and Vardi. G. W. 310-316. B. Dulmus.N.. are divided into five parts: introduction. and exercise). (2000). B.. Unlike tobacco. Mertens. C. S.. food and physical activity are essential to life. female. no current obesity treatment program results in consistent weight reductions. some of these same countries are reporting substantial reductions in tobacco use. (1998). written by contributors from the fields of social work. genetically obese (fa/fa) rats (n = 52) and their lean (Fa/fa) littermates (n = 24) were studied using an experimental 2 x 2 x 2 factorial design (diet type. substance abuse. C. J. R. 1073S-1082S. (2003). L. H. 286-287. W. The effect of a high-fat diet and exercise on the expression of genetic obesity. there are 300. Journal of Sports Medicine and Physical Fitness. 22(6). and J. health problems. The authors discovered that the effect of appetite on obesity expression is more limited . Kavanagh. Wodarski. Husten. diabetes. Possible lessons from the tobacco experience for obesity control. P. Rosenthal.. L. preventive intervention for emotional problems. K. public health. teen pregnancy. T. 38(4). 736- 748. L. Reviews the book Handbook of Preventive Interventions for Children and Adolescents edited by L. The editors have chosen to use the primary prevention model in which the focus is on interventions to prevent the onset of a disorder or problem.. high-fat diet and non- weight-bearing exercise.. R. To examine the effects of a 12-month daily walking program without dietary restriction on the metabolic rate. school violence and child abuse. These similarities suggest that there may be commonalities between factors involved in controlling obesity and tobacco. Metzger. S. Obesity is thought to be caused by complex genetic-environmental interactions.A. J. Campbell.. and psychology. 157 Mercer. Exercise without dietary restriction as a means to long-term fat loss in the obese cardiac patient. genetics... A.. (2004).000 obesity-related premature deaths each year. Young adult. International Journal of Adolescent Medicine and Health. Although obesity is increasing to epidemic proportions in many developed countries. and Shephard. C. body composition and blood lipid profile of overweight and moderately obese patients following myocardial infarction.. 77. L. and Noureddine. on obesity expression. and Dietz. Merrick. social. Morbidity in childhood and adolescence has changed and the new disease pattern is dominated by obesity. In the United States. Yet similar psychological. A. and conclusion. American Journal of Clinical Nutrition. 16(3). Rapp-Paglicci. Green. social problems. Handbook of preventive interventions for children and adolescents.

certain forms of cancer. peers. Effective Diet and Exercise Treatments for Overweight and Recommendations for Intervention. 407-411.. Obesity that starts in childhood has many physical and psychiatric morbidities. like the treatment of addiction. and Silverstein. It is increasing in prevalence and is associated with many comorbid conditions including cardiovascular disease. diabetes mellitus. These choices are often influenced by family. B. decreased exercise.. (1998). and there may be critical stages when obesity expression is amenable to environmental modification.. Obesity is a major health problem affecting more than one third of adult Americans. Sports Medicine. 94-99. and family history of obesity. Prevention and treatment of obesity. This article addresses typical problems and recommendations for normal adolescent nutrition as well as nutrient needs for special conditions such as obesity. J.. C. Toubro. W. (2001).. and individual nutrition beliefs. G. L. which may be relevant for the prevention and treatment of obesity if these effects can be maintained over 24 h. 33(2). 4(6). P. 72(5). Pediatric overeating and obesity: An epidemic. The effects of pork-meat protein. E. Effect of fat-reduced diets on 24-h energy expenditure: comparisons between animal protein. E. even though the long-term safety and efficacy of these drugs have not been completely examined. Miller. vegetable protein. (PsycINFO Database Record (c) 2004 APA.. S. Nutrient requirements increase to promote physical growth and development and adolescents begin to make lifelong diet choices. and Maropis. and Aronne. G. and Astrup. 193-210. and sleep apnea. Our improved understanding of the molecular mechanisms underlying obesity has encouraged the use of currently available antiobesity drugs. requires changes in daily lifestyle and in diet and exercise. C. Gold. 717-724. (2003). Pharmacotherapy of obesity. Pediatric obesity has become a problem of epidemic proportions. (1997). Miller. Primary Care: Clinics in Office Practice. 158 than expected. B121-B214. (2000). American Journal of Clinical Nutrition. and vegetarianism. athletics. 25(1). J. M. all rights reserved) Miller. and carbohydrate on 24-h energy expenditure were compared. C. S. Psychiatric Annals. Factors affecting the childhood and adolescent obesity epidemic include social and cultural changes involving food intake. 1135-1141. 31(10). Mikkelsen. J. S. Single-meal tests have shown that protein has greater thermogenic and satiating effects than does carbohydrate. and carbohydrate. A. Adolescence is a period of remarkable change. . degenerative disease of the weight-bearing joints. Current Opinion in Endocrinology and Diabetes. Nutrition and diet-related problems. Mezitis. soy protein.

Treatment outcomes for overweight can be measured in terms of physical parameters (e. Health-care professionals and consumers have criticized TWL treatments as being detrimental to the obese persons health. 2(1). D.g. mood state) and behavioural terms (e. Traditional weight loss (TWL) treatments have been unsuccessful at reducing the prevalence of obesity in the population. Uses and the scientific basis of guggul are provided. Commiphora mukul (CM). V.. eating patterns. and Dunstan. the health at any size (H@AS) paradigm. medical terms (e. B. has been proposed. frequency of exercise. (2004). blood pressure. D. Although evidence is limited. 52-59. blood lipid levels). self healthcare). bodyweight. Miller. The health at any size paradigm for obesity treatment: the scientific evidence. L. Topics in Clinical Chiropractic. and Jacob. Journal of Science and Medicine in Sport. 7(2). body mass index). Consequently. (2000). B. The HAS paradigm is based on the philosophy that once diet restrictions and barriers to activity have been removed. This paper reviews the philosophical foundation and the scientific data that support and oppose the H@AS paradigm and compares it with that of TWL treatments. psychological terms (e. (2001). Obesity Reviews. C. percentage body fat. A. W.g. has been used in the Ayurvedic System of Medicine as an active ingredient in dietary supplements for the management of musculoskeletal disorders. C. W. 51-56. Miller. 68-70. an alternative approach to obesity treatment. 7(1). Y. self-esteem. and Singh. blood glucose control. 37-46.g. The effectiveness of physical activity interventions for the treatment of overweight and obesity and type 2 diabetes. popularly known as guggul... Scientific basis for therapeutic uses of guggul (Commiphora mukul). and inflammation for thousands of years. 159 Traditional diet and exercise treatments for obesity have been ineffective in reducing the prevalence of overweight in the population. . obesity.g. strategies to reduce sedentary behaviours appear to have potential for reducing obesity among children and adolescents. skin diseases. the individual will develop healthier eating and activity patterns that lead to a naturally healthy body weight. This review summarises current evidence relating to the effectiveness of physical activity (PA) interventions for treating overweight and obesity and type 2 diabetes. eating pathology. serious wounds. Interventions to increase PA for the treatment of overweight and obesity in both children and adults have primarily consisted of health education and behaviour modification strategies in clinical settings or with selected families or individuals. Mishra.

and health who are working for change through Action for Healthy . Economist takes aim at "big fat" US lifestyle.. A. Tax credits or subsidies for engaging in physical activity may be more effective. Effects of a controlled trial of a school-based exercise program on the obesity indexes of preschool children. Moag Stahlberg. Pongprapai. 41- 44. JAMA: Journal of the American Medical Association. 253-7. Recent dietary guidelines for the prevention and treatment of hypertension emphasized a healthy eating pattern called the Dietary Approaches to Stop Hypertension (DASH) diet. The aim of the study was to evaluate the level of habitual physical activity in Croatian physical education (PE) teachers. (2004). sedentary lifestyles.. Mo suwan. Mitka. or in a high-risk population. 1006-1011. 14(3). 251-7. L. 68(5).. Z. S. high salt intake. Subjects were 292 second-year elementary school pupils from 2 kindergartens in Hat Yai municipality. Exercise has been found to be effective for prevention of weight gain and maintenance of a stable weight in adults. American Journal of Clinical Nutrition... Songkhla province. V. L. including the DASH diet. These problems make it vital for nutrition professionals to work in partnership with a multidisciplined team to find solutions and reverse this trend.. They can join representatives from education. The objective of this study was to evaluate the effect of a school-based aerobic exercise program on the obesity indexes of preschool children. and excessive alcohol intake. H. (2003). Junjana. and Nakagawa. Can dietary changes reduce blood pressure in the long term? Curr Opin Nephrol Hypertens. A. Durakovic. Coll Antropol. (2004). Taxes on food would make it more expensive but would affect mostly poor people. Nutrition professionals face a growing challenge: severe overweight and obesity among children and adolescents. M. 289(1). and Findak. and Puetpaiboon. 33-35. 28 Suppl 2. An economist at the University of Chicago believes that society must find economic ways of preventing obesity. southern Thailand. on blood pressure in the general population. and undernourishment in youth are entrenched in American culture. Ruzic. as well as the existence of some other risk factors for the development of cardiovascular diseases (CVD). in addition to avoidance of obesity. The problems of overweight.. physical activity. (1998). He believes the low cost of food and the sedentary nature of most jobs causes obesity. C. Action for Healthy Kids: focus on state teams: current initiatives for sound nutrition and physical activity programs in schools. Gender differences in cardiovascular diseases risk for physical education teachers. Our new challenge is to examine the long-term efficacy and effectiveness of dietary change. 160 Misigoj-Durakovic. Topics in Clinical Nutrition. 19(1). Miura. M. (2005). K.

Montgomery. and building levels. D. Excess weight and obesity are major public health challenges in this country. The present review. 161 Kids (AFHK). C.. Y. (2004). C. 15(1). J. and cardiovascular disorders. Socioeconomic status and obesity in adult populations of developing countries: a review. W. A. C. Mobley.. shows a different scenario for the relationship between SES and obesity. Although more studies are necessary to clarify the exact nature of this relationship. and Grant.. If taken cumulatively this syndrome may be referred to as "diabesity. 207-8. 591-596. C. Nutrition column.. Jackson. (2004). Obesity in the developing world can no longer be considered solely a disease of groups with higher SES. J.. New resource from the CDC to prevent obesity: perinatal implications. Health consequences of excess weight and obesity. A. 3. S.. C. quiz 220. Over 97 million adults are overweight or obese and it is rapidly reaching epidemic proportions among younger individuals. B. K. A. 58-60. S. published between 1989 and 2003. Lifestyle is an expression of individual choices and their interaction with the environment and is closely associated with risks for obesity. diabetes. 82(12). on studies conducted in adult populations from developing countries. (2004). C. 13(3). The burden of obesity in each developing country tends to shift towards the groups with lower SES as the country's gross national product (GNP) increases. three main conclusions emerge from the studies reviewed: 1. Compend Contin Educ Dent. and Broadnax. particularly among men. 211-2. Slater. which has mobilized 51 state teams to initiate and sustain action at the state. 24-31. American Journal of Clinical Nutrition. Conde. 940-946. Strategies for the prevention and treatment of childhood obesity require a better understanding of the relation between the pattern of free-living physical activity and total energy expenditure (TEE). Moura. .. Kelly. Montague. 2. Relation between physical activity and energy expenditure in a representative sample of young children. Bulletin of the World Health Organization. M. and Popkin." The escalating prevalence of obesity among both children and adults is one modifiable dominant risk factor in this triad. M. Monteiro. school district. The shift of obesity towards women with low SES apparently occurs at an earlier stage of economic development than it does for men. A landmark review of studies published prior to 1989 on socioeconomic status (SES) and obesity supported the view that obesity in the developing world would be essentially a disease of the socioeconomic elite. C. Reilly. 80(3). 214-8.. Paton. P. Journal of Perinatal Education. L. E. J. Lifestyle interventions for "diabesity": the state of the science. Journal of National Black Nurses' Association. M.. (2004). L. 25(3).. Montgomery. (2004).

JOGNN: Journal Obstetric Gynecologic and Neonatal Nursing. 6(2). 823-32. and Searing. and Searing. Almost 62% of women are overweight. Obesity is a complex disease with multifactorial origin. obesity has reached epidemic proportions in many developed and transition countries. therefore. if the specific goal is to approach expending 420 kJ/d (100 kcal/d) through walking. J. 33% are obese. Fifteen minutes per day of moderate or brisk walking. M. Health care providers should encourage women to consume a diet high in fruits and vegetables and low in total and saturated fats. 162 Research has identified pregnancy as a trigger to obesity among women. J. Weight loss is a complex trait that depends on many environmental. The prevalence of obesity is rising throughout the world. H. Marti. including an increased incidence of cardiovascular disease and breast and colon cancer. A. The Centers for Disease Control and Prevention recently published a guide on obesity that may serve as an excellent resource for both educators and their clients. A. 437-440. Morin. Geneva residents completed validated quantitative physical activity frequency questionnaires from 1997 to 2001.. Treatment or prevention of obesity is necessary to reverse or avoid the onset of type 2 diabetes and other obesity-related diseases. J. Small physical activity increases may prevent weight gain in most populations. and Martinez. the duration should be closer to 60 minutes for slow walking and 30 minutes for moderate or brisk walking. Obesity and nutrition in women throughout adulthood.. 33(6). C. 94(3). behavioural and genetic influences. (2004).. however.. of these women. 33(6). L. Nutritional challenges are particularly relevant to women. Moreno-Aliaga. Morin. A. which in many cases appears as a polygenic condition affected by environmental factors. M.. Morabia. (2004). A.. Does walking 15 minutes per day keep the obesity epidemic away? Simulation of the efficacy of a populationwide campaign. . K. Dietary patterns influence health outcomes. (2004). M. K. M.. JOGNN: Journal Obstetric Gynecologic and Neonatal Nursing. could increase physical activity at the population level. K. H. Clinical issues. Does weight loss prognosis depend on genetic make-up? Obesity Reviews.. 823-832. childbirth educators are encouraged to include the topic of weight gain in their classes. Stark. or 30 minutes per day of slow walking. 155-68. and Costanza. A. Women who are overweight or obese experience a greater number of adverse health outcomes. with a heart-healthy pattern having the most positive health outcomes. Indeed. Santos. Stark. K. (2005). The incidence of obesity is even greater in non-Hispanic Black and Mexican American women. Obesity and nutrition in women throughout adulthood. American Journal of Public Health.

However. Patients should be told that factors that increase the risk of cardiovascular disease seem to be associated with an increased risk of BPH or a greater severity of BPH. and other factors may significantly increase the risk of BPH. For example. less well known is the potential of these two compounds to reduce the risk of recurrence of a number of overall general health conditions. Obesity. 163 Nutritional challenges are particularly relevant to women. S44-S48. However. J. More research is needed. calcium may play a role in increasing levels of high-density lipoprotein. 69-74. Design: Representative cross-sectional survey using a postal questionnaire which included case stories as stimuli for questions about the GPs' nutrition guidance to overweight female patients. reducing blood pressure in some hypertensive individuals. Who gets what treatment for obesity? a survey of GPs in Scotland. 439-441. promoting weight loss. . and increases with age. 33% are obese. hypertension. Urologic Nursing. including an increased incidence of cardiovascular disease and breast and colon cancer. and Hunter. Basingstoke. C. diabetes. dyslipidemia. and phytotherapy tend to dominate the medical literature when discussing potential treatments for this condition. Lean. a lack of physical activity. M. Drug. Moyad. Women who are overweight or obese experience a greater number of adverse health outcomes.. (2003). reducing kidney stone recurrence. (1999). R. The potential benefits of dietary or supplemental calcium and vitamin D for osteoporosis prevention have been well reviewed. and reducing the symptoms of premenstrual syndrome. Eur j clin nutr. Benign prostatic hyperplasia (BPH) is one of the most prevalent conditions found in men. surgical.. S.not just for bone loss: potential benefits of calcium and vitamin D for overall general health. To describe the types and delivery of obesity treatment currently favoured by General Practitioners (GPs) working in Scotland. Complementary and preventive medicine. 23(1).. Urologic Nursing. Dietary patterns influence health outcomes. a heart unhealthy diet. Hankey. A. of these women. the potential for lifestyle changes to actually prevent this disease or reduce the severity of this condition when used as an adjunct to conventional treatment is not only intriguing but is strongly supported by past limited studies. Health care providers should encourage women to consume a diet high in fruits and vegetables and low in total and saturated fats. Moyad. The incidence of obesity is even greater in non-Hispanic Black and Mexican American women. Lifestyle changes to prevent BPH: heart healthy = prostate healthy. 23(6). M. These treatments have demonstrated remarkable effectiveness for the various degrees of BPH. (2003). preventing colon polyp formation. A. Osteoporosis part III -. Morris. M. but the time is ripe to discuss with patients the potential lifestyle changes that could influence risk. E. Almost 62% of women are overweight. C. E. with a heart-healthy pattern having the most positive health outcomes.

Asbeck. Regarding universal prevention little rigorous evaluation has been carried out in larger populations. 2(1). mostly Hispanic. Myers. 15-29. and Grund. and Grund. (2004). Prevention of obesity-- more than an intention. (2001). Munro... M. 10-13. Although all experts agree that obesity prevention has high priority there is almost no research in this area. Obesity prevention is necessary to address the steady rise in the prevalence of obesity. among its other actions on the body. (2000). Although all experts agree that obesity prevention has high priority there is almost no research in this area. and Vargas. The effectiveness of different intervention strategies is not well documented. The effectiveness of different intervention strategies is not well documented. Concept and first results of the Kiel Obesity Prevention Study (KOPS). Parental perceptions of the preschool obese child. Dr Charlie Murray examines whether this new peptide is the Holy Grail of anti-obesity research. . 98(41): 15. The purpose of this study was to increase staff understanding of parents' views so that interventions could be developed to achieve improved outcomes in attenuating the rate of weight gain in obese children. 98: 15 Driving children to school increases traffic congestion and hurts the health and fitness of pupils. The study revealed that 35% of parents did not believe their obese child was overweight and 53% had no problem controlling what their child eats. 2(5). J. 26(1). triggers eating through its effects on the brain. M. the peptide ghrelin is secreted from the sotmach and.. R. J. (2001). M. C. Discovered only five years ago. 164 Muller. I. How parents view their children's weight is an important consideration for nurses. Obesity prevention has been integrated into community-wide programmes preventing coronary heart disease. Nursing Times. S66-S74... (NURS-TIMES) 2002 Oct 8-14. (2002). Mast. 23-30. A. of obese children to determine the parents' perceptions of their child's obesity. International Journal of Obesity and Related Metabolism Disorders. A. A questionnaire was administered to 200 parents. Muller. Mast. There is also no structured framework for obesity prevention.. says Robert Munro. Murray.. Obesity prevention is necessary to address the steady rise in the prevalence of obesity. I. Ghrelin: hungry for more? Gastrointestinal Nursing.. Pediatric Nursing. K. K. Childhood obesity is a serious public health problem today with many potential complications and adverse outcomes for children. There is also no structured framework for obesity prevention. Z. Walking and cycling are options that could curb obesity and heart disease. S. Prevention of obesity - is it possible? Obesity Reviews. A walk on the healthy side. Langnase.. Langnase. M. Asbeck.

L... on the effects of catechins on body fat reduction in humans. 1101-1107. H. Nam. D. To briefly summarize the literature: there is conclusive evidence that obesity is associated with increased morbidity and mortality and imposes a substantial economic burden both at the individual and societal level. Lee. M... S. there is no convincing evidence for the consistent effectiveness of any single. I. On the basis of a review of the current literature and recommendations. C. T. . To evaluate the effects of low-dose growth hormone (GH) therapy combined with diet restriction on changes in body composition and the consequent change in insulin resistance in newly-diagnosed obese type 2 diabetic patients. 73-78. the major component of green tea extract. Tanaka. and Huh. There are few studies. K. Y. Komine. S. American Journal of Clinical Nutrition. 81(1). Nawaz. Nawaz. 89(5). H. 764-767. However.. Public health briefs. This study explores the pattern of weight loss counseling by health care providers in Connecticut and the associated weight loss efforts by patients. and Tokimitsu. We investigated the effect of catechins on body fat reduction and the relation between oxidized LDL and body fat variables. T. S.. S. 122-9. and Katz.. Meguro. Catechins. has been shown in small prospective cohort and randomized controlled trials to confer beneficial health effects. currently used weight- loss method. Weight loss counseling by health care providers. Hase. D. B. K. American College of Preventive Medicine practice policy statement: Weight management counseling of overweight adults. International Journal of Obesity. . L. S. Weight reduction. have various physiologic effects. Lim. Soga. D. at least in the short term. Cha. Song. and Katz.. (2001). It has been reported that the body mass index (BMI) correlates with the amount of malondialdehyde and thiobarbituric acid-reactive substances in the blood. 25(8).. H. Y. 165 Nagao. (1999). R. American Journal of Preventive Medicine. K.. Low-dose growth hormone treatment combined with diet restriction decreases insulin resistance by reducing visceral fat and increasing muscle mass in obese type 2 diabetic patients.. however. Ingestion of a tea rich in catechins leads to a reduction in body fat and malondialdehyde- modified LDL in men. Kim. (2001). the American College of Preventive Medicine presents a practice policy statement on weight management counseling of overweight adults. Y. 21(1).. B. Y... (2005). Adams. American Journal of Public Health..

(2004). D. To examine prospectively the short. Associations between Body Satisfaction and Physical Activity in Adolescents: Implications for Programs Aimed at Preventing a Broad Spectrum of Weight-Related Disorders. Research on the prevalence and consequences of obesity. A. Associations . and the longer-term effects of these weight-reduction interventions among children have not been elucidated. This study examined associations among body satisfaction and physical and sedentary activities in 4. However. In girls. but associations were not statistically significant.. D. the challenges inherent to developing such an approach. e443-9. (1996). Eating Disorders: The Journal of Treatment and Prevention. an overview of some of the questions and controversies currently facing the fields of eating disorder and obesity prevention. however. Kowen. only a minor fraction of obese children participate in weight reduction interventions. 64-71.and long-term effects of a 3-month. Barkan.. G. 115(4). (2003).. School-based programs for preventing eating disturbances. and suggestions for working toward integrated approaches aimed at preventing the broad spectrum of weight-related disorders are discussed. 66(2). S. M. Obesity and eating disorder prevention: an integrated approach? Adolescent Medicine. who. and Wall. Y. body composition. Goeden.. M. anorexia and bulimia nervosa. combined dietary-behavioral-physical activity intervention on anthropometric measures.and long-term beneficial effects of a combined dietary-behavioral-physical activity intervention for the treatment of childhood obesity. Story. O. dietary and leisure-time habits. (2005).. Short. Epstein. what. and behaviors such as binge eating and purging indicates why prevention is necessary.. D. 14(1). C. and Eliakim. 12(2). and a discussion of the potential for integrated prevention approaches that address the broad spectrum of weight- related disorders. Boys with lower body satisfaction reported significantly less physical activity and more TV viewing than boys with higher body satisfaction... Obesity has become the most common pediatric chronic disease in the modern era. Neumark Sztainer. D. This article provides a rationale for interventions aimed at the prevention of eating disorders and obesity. unhealthy dieting. Neumark Sztainer. Early prevention and treatment of childhood and adolescent obesity is mandated. 746 adolescents. Journal of School Health. 166 Nemet. Friedland. A rationale for utilizing an integrated approach. Surprisingly. and how are considered. research has not adequately addressed the question of who should be targeted for prevention and how the topic of prevention should be approached. This paper describes a framework for involving schools in primary and secondary prevention of eating disturbances. Research on the etiology of eating disturbances also provided a basis for determining what factors need to be addressed. fitness. 159-173. and lipid profiles among obese children. The issues of why. trends were similar. Pediatrics. 125-137. Neumark Sztainer.

803-810. were lower levels of body satisfaction significantly associated with higher physical activity levels. 167 were similar among overweight youth. M. Factors associated with changes in physical activity: a cohort study of inactive adolescent girls. and Rex. Because obesity is prevalent among youth of certain minority groups and low socioeconomic backgrounds.. 157(8). and analyzed.. D. L. This study aimed to assess the prevalence of weight-control behaviors and their associations with overall dietary intake among adults and adolescents.. M. J. Story. Weight-control behaviors among adults and adolescents: associations with dietary intake.. and since few programs address the needs of these youth. 67(10). Sixty-one overweight adolescents participated in semi-structured. Archives of Pediatrics and Adolescent Medicine. (2000). 428-433. 41-51. Cheskin. Recommendations comprised the areas of program activities. D. and Rex. and situations to avoid. to determine their level of interest in participation.. (2003). exercise. Neumark Sztainer. program structure. coded. L. J. environment. Martin. J. which were audiotaped. M. 14(4). 37(1). New Moves: a school-based obesity prevention program for adolescent girls.. 30(5).. and Story. Neumark Sztainer. (1997).. Journal of School Health. L. D. possible barriers. Examined student recommendations for school-based obesity prevention programs. This study tests the feasibility of an innovative school-based program for obesity prevention among adolescent girls. J. S. M. P. and to learn about the outcomes they desired from such a program. 203 adolescents in 7th-12th grades participated in gender-segregated focus groups discussing development of a program comprising healthy eating. J. Rock. the study population was selected from inner city public schools with high percentages of youth from minority groups and low socioeconomic backgrounds. In no instances. School-based programs for obesity prevention: What do adolescents recommend? American Journal of Health Promotion. Preventive Medicine. high-school physical education class. leader qualities. New Moves was implemented as a multicomponent. Thornquist. Neuhouser.. M. and Story. Neumark Sztainer. and Barnett. This study aimed to obtain recommendations from overweight youth on the development of school-based weight control programs.. Preventive Medicine. 381-391. L. Hannan. D. in-depth individual interviews.. P. D. M. Hannan.. and weight control. D.. Recommendations from overweight youth regarding school-based weight control programs.. C. Story. transcribed. Neumark Sztainer. . T.. J. (2003). Tharp. 232-235. girls-only. M. (2000). Neumark Sztainer.

168

To identify factors associated with changes in physical activity in adolescent girls at risk
for sedentary lifestyles and obesity.

Neumark Sztainer, D., Story, M., and Harris, T. (1999). Beliefs and attitudes about obesity
among teachers and school health care providers working with adolescents. Journal of Nutrition
Education, 3-9.

The aim of the present study was to assess and describe obesity-related beliefs and
attitudes among school staff. Mailed surveys were completed by 115 science, health,
home economics, and physical education teachers, school nurses, and school social
workers from all junior and senior high schools (n = 17) within a large urban school
district (response rate = 66%).

Neumark Sztainer, D., Story, M., Resnick, M. D., and Blum, R. W. (1997). Psychosocial
concerns and weight control behaviors among overweight and nonoverweight Native American
adolescents. Journal of the American Dietetic Association, 598-604.

To compare the psychosocial and weight-related concerns and weight control, eating, and
exercise behaviors of overweight and nonoverweight Native American adolescents living
on or near reservations. A cross-sectional survey assessed psychosocial, health, and
weight-specific concerns; disordered eating; and health-promoting behaviors. The study
population included 11,868 Native American youth in grades 7 through 12.

Nicklas, B. J., Ambrosius, W., Messier, S. P., Miller, G. D., Penninx, B., Loeser, R. F., Palla, S.,
Bleecker, E., and Pahor, M. (2004). Diet-induced weight loss, exercise, and chronic
inflammation in older, obese adults: a randomized controlled clinical trial. American Journal of
Clinical Nutrition, 79(4), 544-551.

Persistent, low-grade inflammation is an independent predictor of several chronic
diseases and all-cause mortality. Objective: The intention of this study was to determine
the independent and combined effects of diet-induced weight loss and exercise on
markers of chronic inflammation.

Nicklas, T. A., Yang, S. J., Baranowski, T., Zakeri, I., and Berenson, G. (2003). Eating patterns
and obesity in children: The Bogalusa Heart Study. American Journal of Preventive Medicine,
25(1), 9-16.

Childhood obesity is a growing public health problem. This study examined the
association between eating patterns and overweight status in children who participated in
the Bogalusa Heart Study. A single 24-hour dietary recall was collected on a cross-
sectional sample of 1562 children aged 10 years (65% Euro-American [EA], 35%
African American [AA]) over a 21-year period.

Nies, M. A., Artinian, N. T., Schim, S. M., Vander Wal, J. S., and Sherrick Escamilla, S. (2004).
Health risk assessment in an urban Hispanic community. Clinical Nurse Specialist, 18(6), 302-
307.

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This study describes the health risks of urban Hispanic adults and compares the health
risks of persons who identified themselves as "not overweight" with those who identified
themselves as "overweight."

Nonas, C. A. (1998). A model for chronic care of obesity through dietary treatment. Journal of
the American Dietetic Association, S16-S22.

Obesity is rapidly increasing to epidemic proportions. At the same time, obesity is not
well accepted us a disease among health professionals or insurance companies. The
primary care physician is often forced to ignore the obesity and treat the associated risks,
and the dietitian is often compelled to treat the disease for only short periods and for little
reimbursement. Therefore, to treat obesity more effectively both clinically and
economically, it is necessary to create a health care team. This can be done by joining the
dietitian and the primary care physician, even if each health professional sees patients at a
different site.

Norton, D. E., Froelicher, E. S., Waters, C. M., and Carrieri Kohlman, V. (2003). Parental
influence on models of primary prevention of cardiovascular disease in children. European
Journal of Cardiovascular Nursing, 2(4), 311-322.

Lifestyle behaviors such as overeating and physical inactivity contribute significantly to
CVD, the leading cause of morbidity and mortality among adults globally. CVD risk
factors that begin in children often track into adulthood. Parents are believed to influence
the health behaviors of their children. To review the literature on parental influence on
children's health beliefs and behaviors, particularly eating and exercise behaviors as
indicators of CV health, school-based CVD risk reduction programs, and racial/ethnic,
gender and socioeconomic considerations for models of primary prevention of CVD in
children.

Nothwehr, F., and Stump, T. (2002). Weight control behaviors of low-income, African American
women. Health Promotion Practice, 3(2), 207-216.

Obesity is extremely common among African American women, and many women
express interest in losing weight. To better understand current weight management
practices in this population, this study measured behaviors and attitudes believed
important to successful weight management. Data were obtained via telephone survey.
The study involved 155 low-income African American women aged 30 to 69 identified
through an urban primary care clinic. Results were compared between those women
currently trying to lose weight (n = 80) and those who were not (n = 75). Those women
trying to lose weight were more likely to engage in goal setting and dieting strategies
categorized as planning and preparation, communication about diet, and cognitive
strategies. Among those currently trying to lose weight, considerable room for
improvement in the degree to which the women used the various strategies remained.
Public health communications and health care provider interactions may need to deliver a

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broader, stronger message about healthy and successful weight management for this
population.

Nowicki, E. M., Billington, C. J., Levine, A. S., Hoover, H., Must, A., and Naumova, E. (2003).
Overweight, obesity, and associated disease burden in the Veterans Affairs ambulatory care
population. Military Medicine, 168(3), 252-256.

This report describes the prevalence of overweight and obesity and estimates the disease
burden associated with excess weight in ambulatory Veterans Affairs (VA) patients.

Nupponen, R., and Laukkanen, R. (1998). How to develop a group curriculum: developing an
exercise programme for overweight adults. Patient Education and Counseling, 33, S77-S85.

This paper reports on work to develop introductory exercise courses for sedentary,
moderately overweight adults. The aim is to offer a safe and motivating programme of
physical exercise and, through experiential learning, to encourage and facilitate increased
physical activity. The core of the programme is a course of 10-20 weekly exercise
classes. The classes include a variety of physical exercises adapted to the special needs of
overweight adults (BMI 28-34 kg/m2) and a number of health-related fitness tests. We
outline the underlying principles of the exercise courses, their structure and contents, the
guidelines of instruction, and the use of formative evaluation. In addition, we report on
the implementation of five weight-reduction courses and six exercise courses involving a
total of 209 participants. A fairly high level of programme acceptability (in terms of
attendance rates and personal commitment) and programme feasibility (in terms of
acceptability, changes in personal orientation towards health and weight reduction, and
satisfaction among participants) was achieved. (c) 1998 Elsevier Science Ireland Ltd.

O'Donnell, M. (2004). Health-promotion behaviors that promote self-healing. Journal of
Alternative and Complementary Medicine, 10, S49-S60.

A large body of evidence has shown that health-promotion programs in smoking
cessation, stress management, fitness, nutrition, weight control, and medical self care
have been successful in helping people improve their health practices and related health
conditions. However, the impact of these programs on promoting self-healing among
people with acute and chronic diseases is mixed. The purpose of this paper is to identify
research opportunities important to fostering a better understanding of health promotion
behaviors that promote self healing. To provide context, the health-promotion concept is
discussed, as is the literature on workplace health-promotion programs provided to
overtly healthy people.

O'Meara, S., and Glenny, A. (1997). Practice. What are the best ways of tackling obesity?
Nursing Times, 93(22), 50-51.

A systematic review of the literature on the treatment and prevention of obesity carried
out by the NHS Centre for Reviews and Dissemination (CRD) demonstrates that the
prevalence of excess weight and obesity are on the increase. The review indicated that

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certain interventions in primary care can be effective, while surgery appears to be most
effective in severe obesity. It highlights limitations in the available research in the area.

O'Toole, M. L., Sawicki, M. A., and Artal, R. (2003). Structured diet and physical activity
prevent postpartum weight retention. Journal of Women's Health, 12(10), 991-998.

Postpregnancy weight retention contributes to the near-epidemic prevalence of obesity in
the United States. This study examines the impact of an individualized, structured diet
and physical activity intervention on weight loss in overweight women during the first
year postpartum.

Obarzanek, E., and Pratt, C. A. (2003). Girls health Enrichment Multi-site Studies (GEMS): New
approaches to obesity prevention among young African-American girls. Ethnicity and Disease,
13(Supplement 1), S1-5.

The Girls health Enrichment Multi-site Studies (GEMS) is an obesity prevention research
program sponsored by the National Heart, Lung, and Blood Institute (NHLBI), targeting
young African-American girls. Expert groups have suggested that the high prevalence of
obesity in African-American women could be a contributing factor to their excess
morbidity and mortality from cardiovascular disease compared to women from other
ethnic groups. To address the issue of obesity and its origins in African-American
women, the NHLBI Growth and Health Study (NGHS) was initiated to investigate
factors related to the development of obesity and associated cardiovascular disease risk
factors in a cohort of young African-American and White girls, aged 9 and 10 years.

Onis, M. d. (2004). The use of anthropometry in the prevention of childhood overweight and
obesity. SCN News, (29), 27-32.

This paper reviews concepts and proposes measures related to the use of anthropometry
for the early identification of excessive weight gain. Potential measures involve:
monitoring anthropometric indicators; monitoring the growth of all children up to 18
years of age; use of prescriptive reference data to interpret growth measurements; and
obesity prevention and early intervention.

Orbach, P., and Lowenthal, D. T. (1998). Evaluation and treatment of hypertension in active
individuals. Medicine and Science in Sports and Exercise, 30(10 Suppl), S354-S366.

Hypertension is a very common vascular disease. It is seen in adolescents, obese persons,
postmenopausal women, and the elderly. A nonpharmacologic approach to treatment is a
critical first step in management. The modalities include a diet low in salt and saturated
fat, exercise, less than 2 ounces of alcohol daily, and abstinence from smoking. Dynamic
(aerobic) exercise is effective in lowering blood pressure (BP) only if performed
regularly.

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Oshiro, C., Maskarinec, G., Petitpain, D., Hebshi, S., and Novotny, R. (2004). Soy intervention
in adolescent girls: design and implementation. Journal of Nutrition Education and Behavior,
36(4), 204-208.

The purpose of this study was to explore the feasibility of implementing a soy
intervention in female adolescents. Twenty girls, ages 8 to 14, were recruited to consume
1 daily serving of soymilk or soy nuts. They also provided 9 weekly urine samples over a
2-month period. Information about the study foods and procedures was collected through
post-study questionnaires. Adherence to the intervention was successful using strategies
that addressed both girls' and mothers' needs. The use of conveniently packaged soy
foods, activities to maintain motivation, and frequent contact maintained participation.

Ottley, C. (2003). Clinical practice. Health and fitness series -- 4. Getting children to develop a
healthy relationship with food: helping parents, empowering children. Journal of Family Health
Care, 13(4), 95-96.

The author, a dietitian, discusses the trend in the UK towards children developing
unhealthy relationships with food. This is manifested as overeating leading to overweight
or obesity, or a desire, even among younger children, to follow slimming diets that can
adversely affect growth and development. Rather than food restriction, a healthy
relationship with food involves young people being able to self-regulate their intake and
enjoy all the components of a balanced diet..

Ottley, C. (2004). What do we know about. childhood obesity? Journal of Family Health Care,
14(1), 8-10.

The incidence of obesity among children in the UK has been increasing since the 1980s
and is a "hot topic" among health professionals, Government, the media and some
parents. It is an emotive subject which often attracts instant opinions and hasty solutions.
To provide sound, balanced advice it is important that health professionals are aware of
current evidence about the prevention and management of obesity in children, and
differences between child and adult obesity. This article summarises the evidence and
offers some practical tips. It also considers child obesity in the context of the family.

Owens, S., Gutin, B., Allison, J., Riggs, S., Ferguson, M., Litaker, M., and Thompson, W.
(1999). Effect of physical training on total and visceral fat in obese children. Medicine and
Science in Sports and Exercise, 31(1), 143-148.

Children with high levels of total body fat mass (TFM) and visceral adipose tissue (VAT)
have elevated levels of certain risk factors for coronary artery disease and non-insulin-
dependent diabetes mellitus. We tested the hypothesis that controlled physical training,
without dietary intervention, would have a favorable impact on VAT and percent body fat
(%BF) in obese children.

2(1). 173 Padden. A. 1-14. E. (1998). and Kravitz. According to the National Institutes of Health. Despite evidence of the benefits of physical activity -. APNs can inspire patients to adopt positive attitudes about the value of physical activity and exercise -.both physiological and psychological -. but also in children and adolescents. L. other research on exercise as a weight loss method suggests that the latter ACSM statement was based upon studies that do not effectively compare caloric-restriction programs to increased energy-expenditure programs. National Heart. Exercise Vs. Lung and Blood Institute (1998). Two statements are of particular interest to the applied exercise professional: 1. 2. mental and social well- being. Diet in Weight Loss. Following the meeting. (2003). The Surgeon General has reported that regular participation in moderate physical activity is an essential component of a healthy lifestyle. is assumed to be the right of each individual. MacDougall. J. without caloric restriction. J. type.. beginning as early as the prenatal period. Paez. the American College of Sports Medicine (ACSM) held a scientific roundtable. fitness. a status of full physical. 1(1). The prevalence of obesity has become a global epidemic not only in the adult population. However. Papamandjaris.attitudes that will ultimately translate into health benefits across the life span. 13(3). (2002). minimally affects fat loss. P.few Americans engage in regular exercise. J. (2002).. 1203- 1215. It is essential that all healthcare providers routinely assess and counsel patients about the frequency. The achievement of positive health. In an attempt to define the role of exercise in the treatment and prevention of obesity. A. if at all. ACSM released several consensus statements regarding physical activity and public health. C. The role of the advanced practice nurse in the promotion of exercise and physical activity. Parizkova. and Chin. The addition of exercise to a diet with restricted caloric intake promotes fat loss and helps maintain fat-free mass... Life Sciences. 15-17. Journal of Exercise Science and Fitness. M. Topics in Advanced Practice Nursing. coronary artery disease and diabetes. 62(14). IDEA Personal Trainer. Potential environmental strategies and . 6. Physical activity. 55 percent of the adult population in the United States are either obese or overweight. Obesity prevention and health promotion during early periods of growth and development. and quality of life through daily activity. K. and intensity of their physical activity. D. Advanced practice nurses (APNs) can take an active role in meeting the nation's goals of Healthy People 2010 to improve health. Obesity substantially increases an individual's risk of suffering from chronic diseases such as hyper-tension. L. H. Medium chain fatty acid metabolism and energy expenditure: obesity treatment implications. D. This review examines medium chain fatty acid (MCFA) intermediary metabolism and the effects of MCFA on thermogenesis and total energy expenditure. and Jones. duration.

Paschal. Indicators for obesity were identified using anthropometric data that included weight. Bernstein.. Journal of Community Health: The Publication for Health Promotion and Disease Prevention. R... in part through their effects on insulin sensitivity. The alarming aspect of it is that it is affecting people at a much earlier age. It was shown that even the recommended dietary allowances of World Health Organizations for first three years of life are higher by 10-15 % than required. This study longitudinally examined specific indicators of obesity among a group of female nursing students who incorporated an exercise program into their normal weekly routine. since the very beginning of life are considered to have an important impact on obesity prevention. A. positive energy balance which lead to an increased accumulation of fat.. diabetes. M. A. and risk of pancreatic cancer in a large U. 14(2). (2005). E. Thun. M. Obesity is a serious problem in the United States and is associated with hypertension. Patel. D. K.S. Nurse Education in Practice. and Calle. young children are becoming morbidly obese and are experiencing the same health problems as middle-aged adults. 305- 318. Super-Sized Kids: Using the Law to Combat Morbid Obesity in Children. thus. Cohort. and percentage of body fat. J. D. S. and other health problems. and a . 155-162. Although nursing students are educated about the importance of healthy diets and the benefits of exercise. E. Cancer Epidemiol Biomarkers Prev. A. may be modifiable risk factors for pancreatic cancer. 164-177. Obesity and physical activity. Pawloski. Chao. Family Court Review. Morbid obesity is an unfortunate problem that is only becoming worse everyday. 174 modified lifestyle. V. Martin. body mass index (BMI). cholesterol and blood sugar levels) of African Americans participating in a community-based health education and physical fitness program. M. L. Baseline Assessment of the Health Status and Health Behaviors of African Americans Participating in the Activities-for-Life Program: A Community-Based Health Intervention Program. (2005). R. 3(3). Dennis Shipp. Physical activity and body composition analysis of female baccalaureate nursing students. and Davidson. body mass indices. L. 29(4). recreational physical activity. 459-66. A. many do not engage in health promotion behaviors. There is a higher prevalence of being overweight among African American adults than among their Caucasian counterparts.. pulse data. 43(1).. (2003). including balanced diet and physical activity.. Obesity. (2004).. This implication applied especially to children and adolescents who reported spontaneously high levels of physical activity during the period of development followed by. R. Rodriguez. Lewis. and Simpson. The objective of this study was to assess baseline health behaviors and health status (hypertension.. D. Patel. C.. Blood pressure.

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physical activity level assessment were performed at the beginning and at the conclusion
of the study period.

Peach, H. G. (2002). Obesity, smoking and hazardous drinking among men admitted to the
surgical wards of a regional hospital. Australian Journal of Rural Health, 10(6), 273-277.

The purpose of the study was to determine the prevalence of obesity, smoking and
hazardous drinking, and identify opportunities for their reduction, among men admitted
to the surgical wards of a regional hospital.

Pearce, L. C. (2003). Metabolic syndrome & obesity: co-epidemics could overwhelm home
health care. Caring, 22(6), 24-26, 28, 30.

Our nation's battle with the bulge has contributed to the current co-epidemics of obesity
and metabolic syndrome. The US Surgeon General's office reports that these disease risks
may soon cause as much disease and death as cigarette smoking (HHS, 2001). In the
United States, one in four adults has metabolic syndrome, which includes about 15
million persons with type 2 diabetes (Ford, 2002).

Pearson, D. (2003). Continuing professional development: weight management. Primary Health
Care, 13(10), 43-50.

Obesity has a major impact on individual health and wellbeing. This article describes
how nurses can assist patients in weight management.

Pearson, D. (2003). Tackling obesity in the community. Journal of Community Nursing, 17(6),
19-20, 22.

Dympna Pearson outlines the health benefits of reducing levels of obesity in the general
population.

Peate, I. (2005). Male obesity: a gender-specific approach to nurse management. British Journal
of Nursing, 14(3), 134-8.

Android or male obesity is increasing. With greater understanding of the causes,
development and outcomes of being obese and overweight, the nurse can begin to help
men by using a gender-specific approach towards challenging this increasing global
epidemic. This article provides a definition of overweight and obesity using the World
Health Organization classification. The prevalence of obesity among men in the UK is
outlined, and inequalities are highlighted and discussed. Some men from certain social,
economic and ethnic groups are predisposed to developing obesity or becoming
overweight. The human and financial implications of obesity and overweight are
described and the healthy outcomes associated with the disease are discussed.

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Peltonen, M., Lindroos, A. K., and Torgerson, J. S. (2003). Musculoskeletal pain in the obese: A
comparison with a general population and long-term changes after conventional and surgical
obesity treatment. Pain, 104(3), 549-557.

Obesity is associated with musculoskeletal pain and osteoarthritis. This study compares
the prevalence of work-restricting musculoskeletal pain in an obese and a general
population and investigates changes in the incidence of and recovery from
musculoskeletal pain after bariatric surgery or conventional obesity treatment. A random
sample of 1135 subjects from a general population was compared with 6328 obese
subjects in the Swedish obese subjects (SOS) study.

Pennington, J. A. T., Obarzanek, E., Silsbee, L. M., Harris, T., Starke Reed, P. E., Kusek, J.,
Kurinij, N., and Garfield, S. A. (2000). Clinical trials. Update: diet-related trials and
observational studies supported by the National Institutes of Health. Nutrition Today, 35(4), 158-
160.

The following are brief descriptions of current or recently completed NIH trials that
include nutrition-related measures of various population groups.

Pereira, M. A., Swain, J., Goldfine, A. B., Rifai, N., and Ludwig, D. S. (2004). Effects of a Low-
Glycemic Load Diet on Resting Energy Expenditure and Heart Disease Risk Factors During
Weight Loss. JAMA: Journal of the American Medical Association, 292(20), 2482-2490.

Weight loss elicits physiological adaptations relating to energy intake and expenditure
that antagonize ongoing weight loss. To test whether dietary composition affects the
physiological adaptations to weight loss, as assessed by resting energy expenditure.

Perna, F., Bryner, R., Donley, D., Kolar, M., Hornsby, G., Sauers, J., Ullrich, I., and Yeater, R.
(1999). Effect of diet and exercise on quality of life and fitness parameters among obese
individuals. Journal of Exercise Physiology, 2(2).

Use of very-low-calorie-diets (VLCD) for treatment of obesity has been adversely related
to quality of life (QOL). Because exercise is known to alter mood and self-beliefs in a
positive direction, it may offset the negative impact of dieting. The present investigation
evaluated the physical and QOL effects of a 12-week VLCD and exercise program.

Perri, M. G. (1998). The maintenance of treatment effects in the long-term management of
obesity. Clinical Psychology: Science and Practice, 5(4), 526-543.

Reviews the efficacy of strategies designed to improve the maintenance of treatment
effects in the long-term management of obesity. Included are the results from controlled
trials that evaluated strategies such as extended therapy, relapse prevention training,
monetary incentives, food provision, and peer support as well as the use of very-low-
calorie diets and pharmacotherapy. Improved maintenance of weight loss was observed in
behavior therapy extended beyond 6 months and in long-term pharmacotherapy

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(dexfenfluramine or the combination of fenfluramine plus phentermine) used in
conjunction with behavior therapy or dietary counseling.

Perri, M. G., Nezu, A. M., McKelvey, W. F., Shermer, R. L., Renjilian, D. A., and Viegener, B.
J. (2001). Relapse prevention training and problem-solving therapy in the long-term management
of obesity. Journal of Consulting and Clinical Psychology, 69(4), 722-726.

This study compared 2 extended therapy programs for weight management with standard
behavioral treatment (BT) without additional therapy contacts.

Perrin, E. M., Flower, K. B., Garrett, J., and Ammerman, A. S. (2005). Preventing and Treating
Obesity: Pediatricians' Self-Efficacy, Barriers, Resources, and Advocacy. Ambul Pediatr, 5(3),
150-156.

With respect to obesity prevention and treatment, to determine pediatricians' 1) treatment
self-efficacy; 2) perceived barriers and relationships to management self-efficacy; 3)
desired resources; and 4) willingness to be involved in advocacy.

Pescatello, L. S., Volpe, S. L., and Clark, N. (2004). Which is more effective for maintaining a
healthy body weight: diet or exercise? ACSM's Health and Fitness Journal, 8(5), 35-37.

As a nation, America continues to get heavier. While both diet and exercise are important
strategies for maintaining a health body weight, the authors address the debate over
which strategy is more important.

Peters, J. C. (2004). Social change and obesity prevention: where do we begin? Nutrition Today,
39(3), 112-117.

Obesity in the United States has reached epidemic proportions in both adults and
children. Multi-factorial causes are responsible, including social, economic, and other
environmental forces acting on a susceptible genetic heritage. Halting and reversing the
epidemic will require multi-factorial solutions, including implementing cognitive coping
strategies and mounting an effective social change movement.

Peterson, J. A. (2003). 10 constructive ways to help fight the obesity epidemic in America.
ACSM's Health and Fitness Journal, 7(6), 1.

Describes ways in which obesity in the United States can be prevented such as
encouraging people to be physically active, change public attitudes concerning exercise
and encourage support of physical education in the school system.

Petty, R. G. (2004). Obesity, diabetes, and hyperlipidemia: exploring the link to antipsychotic
medications. includes discussion. Advanced Studies in Nursing, 2(3), 81-92, 123-125.

The rates of overweight and obesity in the general population are of epidemic
proportions. Only 39% of the US population is deemed to have a normal weight. An

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association between obesity and an array of illnesses is extremely well recognized.
Featured prominently among these illnesses are the metabolic or insulin resistance
syndrome and type 2 diabetes. People with major mental illness are at an increased risk
for physical ill health and premature mortality.

Pietrobelli, A. (2004). Outcome measurements in paediatric obesity prevention trials.
International Journal of Obesity, 28(Supplement 3), S86-S89.

OObesity in children impacts on their health in both the short and long term. Having an
accurate and precise body composition assessment, it may be possible to control growth
process and predict adult status in order to reduce the risk factors for various diseases.

Pimentel, D., and Pimentel, M. (2003). Sustainability of meat-based and plant-based diets and
the environment. Fourth International Congress on Vegetarian Nutrition: proceedings of a
symposium held in Loma Linda, CA, April 8-11, 2002. American Journal of Clinical Nutrition,
78(3S), 660S-663S.

Worldwide, an estimated 2 billion people live primarily on a meat-based diet, while an
estimated 4 billion live primarily on a plant-based diet. The US food production system
uses about 50% of the total US land area, 80% of the fresh water, and 17% of the fossil
energy used in the country. The heavy dependence on fossil energy suggests that the US
food system, whether meat-based or plant-based, is not sustainable. The use of land and
energy resources devoted to an average meat-based diet compared with a
lactoovovegetarian (plant-based) diet is analyzed in this report. In both diets, the daily
quantity of calories consumed are kept constant at about 3533 kcal per person. The meat-
based food system requires more energy, land, and water resources than the
lactoovovegetarian diet.

Pinkowish, M. D. (1998). Obesity -- a chronic disease. Patient Care for the Nurse Practitioner,
1(8), 33-43.

Extra body weight is a risk factor for diabetes, cancer, and heart disease among other
conditions, and obesity itself is now considered a chronic disease. Help your patients
make the most of their hard-fought battles to lose weight and keep it off.

Plaza, C. I. (2004). State policy watch. States' public health initiatives address nutrition, obesity,
and physical education. Healthcare Financial Management, 58(9), 16, 18.

Over the past three years, the media, food and beverage industry, public health advocates,
and federal and state policymakers have devoted significant attention to the growing
American obesity epidemic.

Ponto, M. (1995). The relationship between obesity, dieting and eating disorders. Professional
Nurse, 10(7), 422-425.

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Western society seems preoccupied with weight and dieting. The issues surrounding
obesity and eating disorders are examined and the question is raised whether knowledge
of psychology can help when dealing with clients with obesity or anorexia. Current
thinking on behavioral programmes for such clients is also explored.

Popkin, B. M. (2001). Nutrition in transition: the changing global nutrition challenge. Asia
Pacific Journal of Clinical Nutrition, 10 Suppl, S13-8.

The rapid shift in the stage of nutrition towards a pattern of degenerative disease is
accelerating in the developing world. Data from China, as shown by the China Health and
Nutrition Survey, between 1989 and 1993, are illustrative of these shifts. For example, an
increase from 22.8 to 66.6% in the proportion of adults consuming a higher-fat diet, rapid
shifts in the structure of diet as income changes, and important price relationships are
examples that are presented. There appears to reflect a basic shift in eating preferences,
induced mainly by shifts in income, prices and food availability, but also by the modern
food industry and the mass media.

Poston, W. S. C., II, Foreyt, J. P., Borrell, L., and Haddock, C. K. (1998). Challenges in obesity
management. Southern Medical Journal, 91(8), 710-720.

Current and emerging therapies and outcome data from a large clinical practice are
reviewed, and the challenges for physicians and researchers involved in obesity treatment
are discussed. It is concluded that therapies that combine psychosocial interventions,
drugs and extended maintenance appear to have the most promising long-term benefits.
Broader definitions of treatment outcome and success, including improvements in
comorbid conditions, physical activity and quality of life are needed.

Poston, W. S. C., II, Haddock, C. K., Olvera, N. E., Suminski, R. R., Reeves, R. S., Dunn, J. K.,
Hanis, C. L., and Foreyt, J. P. (2001). Evaluation of culturally appropriate intervention to
increase physical activity. American Journal of Health Behavior, 25(4), 396-406.

To evaluate a culturally appropriate intervention to increase activity in overweight
Mexican American women.

Poston, W. S. C., Reeves, R. S., Haddock, C. K., Stormer, S., Balasubramanyam, A., Satterwhite,
O., Taylor, J. E., and Foreyt, J. P. (2003). Weight loss in obese Mexican Americans treated for 1-
year with orlistat and lifestyle modification. International Journal of Obesity, 27(12), 1486-1493.

To evaluate the effectiveness of a culturally appropriate lifestyle intervention combined
with orlistat in producing weight loss with obese Mexican-American women.

Pratt, C. A., Nosiri, I., and Pratt, C. B. (1997). Michigan physicians' perceptions of their role in
managing obesity. Perceptual and Motor Skills, 84(3), 848-851.

Journal of Abnormal Psychology. Obesity is one of the fastest-developing public health problems. this hypothesis has not been tested in a randomized experiment. (2003). Nursing Times. NT clinical. cancer and obesity. Perceived barriers to prevention of obesity were inadequate time to educate patients. 30-31. Understanding the importance to health of a balanced diet. the aetiology of obesity is complex and multifactorial in nature. Presnell. 166-170. S. Although it is widely accepted that dieting increases the risk for bulimic pathology. the authors conducted an experimental test of the dietary restraint model by randomly assigning nonobese women (N = 82) to either a 6-week. E. 112(1). K. Accordingly. J. 5(2). 30-1. about 33% (n = 70) perceived their role in the prevention of obesity as coordinating and 39% (n = 82) as cooperative and of equal importance to that of other professionals. Price. 180 In a random sample of 211 primary-care physicians in Michigan. 101(1). Although there is little doubt that promoting physical activity in children and adolescents can have an important role in preventing obesity.. low-calorie diet or a waitlist control condition. (2005). healthy diet as it provides the energy and nutrients required to survive and stay healthy. Obesity is increasing in children and adolescents globally. The research shows that many gaps exist. healthy diet as it provides the energy and nutrients required to survive and stay healthy. Combining a healthy diet with an active lifestyle has huge health benefits and helps reduce the risk of major health problems such as heart disease. The general population needs to have a balanced. cancer and obesity. International Journal of Sports Medicine. Childhood obesity: the role of physical activity. . The general population needs to have a balanced. These results suggest that physicians' involvement in managing obesity can improve if they work closely with other health professionals. particularly in the establishment of guidelines for appropriate levels of physical activity in children and adolescents. method of reimbursement. (2001). Combining a healthy diet with an active lifestyle has huge health benefits and helps reduce the risk of major health problems such as heart disease. S. Nursing Times. Understanding the importance to health of a balanced diet. confirming that dieting was successfully manipulated. The diet intervention resulted in significant weight loss. Price. Obesity is one of the fastest-developing public health problems. and inadequate training in management of obesity. An experimental test of the effect of weight-loss dieting on bulimic pathology: Tipping the scales in a different direction. Proimos. and Stice. (2005). 101(1).

R. Given the plethora of eating behaviour techniques that obese individuals might adopt for weight loss. L. (2003). Therefore. 23-32. B. B. attitude and practice regarding obesity among patients. and to distinguish those that were deemed beneficial from the ones that were not. 1509-1516.. and Azam. 181 Pucher. Qidwai. Type 2 diabetes mellitus in youth. Obesity is a major public health problem and responsible for significant morbidity and mortality among our patients. 32-4... it is not likely that they could. In the United States. Jumbosize Europe? European Union conference on obesity calls for immediate action. at Aga Khan University Hospital.. Copenhafer. Evans. and Kerrigan. 19(4). (2003). School nurses have an essential role in implementing the American Diabetes Association (ADA) recommended screening guidelines to identify youth at high risk for type 2 DM and in implementing student health programs that focus positively on the importance of physical activity and healthy eating habits. (2000). Raben. S. L. American Journal of Public Health. It is important to study the knowledge. Quatromoni. The adoption of eating behaviors conducive to weight loss. D'Agostino. 29-38. B. Qi. B. Jo Ayub Med Coll Abbottabad. or would be willing to. Knowledge. W. and Dijkstra. A. L.. . K. To investigate relationships between dietary patterns and the development of overweight. Scandinavian Journal of Nutrition. and Millen.. Quarry Horn. J. (2002). 16(3). Promoting safe walking and cycling to improve public health: lessons from the Netherlands and Germany. 102(9). E. adopt all of them. (2004). D. attitude and practices with regard to obesity among patients. 1240-1246. I. Karachi. (2003).. Dietary patterns predict the development of overweight in women: the Framingham nutrition studies. 93(9). J. J. Journal of the American Dietetic Association. B. A. We examined the public health consequences of unsafe and inconvenient walking and bicycling conditions in American cities to suggest improvements based on successful policies in The Netherlands and Germany. 1(1).. Eating Behavior. Early recognition and intervention can delay the onset of type 2 DM and prevent the long-term complications. Journal of School Nursing. R. the incidence of type 2 diabetes mellitus (DM) in children and adolescents has been increasing at an alarming rate. E. 195-203. J. P. Public health matters. in order to devise interventional strategies. the purpose of this study was to identify the specific eating behaviours conducive to weight loss adopted during the behavioural treatment of obesity. 47(1). and Dennis.

and childhood obesity is also increasing at an alarming pace. Campos. 21(2). C. alpha- melanocyte-stimulating hormone. with increasing rates in most countries.. and monoamines in food intake regulation. Medicine and Science in Sports and Exercise. To evaluate the impact of regular physical activity on thrombogenic profile in obese individuals. Ramey.. S. 2) activation of coagulation leading to a thrombin generation. Redegeld. The focus was on the impact of physical activity on platelet aggregation. S. (2005). M. The epidemic has been followed by a simultaneous rise in type II diabetes. (2004). Franke.. M. 52(3). J. and 3) simultaneous activation of fibrinolysis. Ramos. The study was planned to investigate the effect of obesity and obesity treatment on quality of life in children.. and ethnicity: focus on a law enforcement cohort. and Shelley.. Meguid. Nutrition. 116-121. The prevalence of both overweight and obesity is as high as 50-65%. 182 The average prevalence of obesity in Europe is now 15-20%. (1999). B. 269-79. cardiovascular disease. L. including the possible effect of ethnicity. International Journal of Obesity and Related Metabolism Disorders. and plasminogen activator inhibitor-1 (PAI-1) in overweight and obese subjects.. (2001). R. Neuropeptide Y. No effective pharmacologic treatment leading to sustained weight loss currently exists. U. Treating obesity concerns not only medical concomitants and future complications but also quality of life. A. M.. fibrinogen. S631-S634. and Coelho. This cross-sectional study determined the prevalence of nephrolithiasis and common cardiovascular disease (CVD) risk factors in a law enforcement officer (LEO) cohort and evaluated the relationship of nephrolithiasis with several CVD risk factors. W.. M. 31(11 Suppl). Physical activity in the prevention and treatment of a thrombogenic profile in the obese: current evidence and research issues. The growing interest in the regulation of food intake stems from the current drug treatments for obesity. D. and Bullinger. Rauramaa. C. Medline-based literature search with emphasis on controlled randomized clinical trials.. Quality of life after in-patient rehabilitation in children with obesity. . almost all of which interfere with the monoamine system. Obesity is increasing in severity and prevalence in the United States and represents a major public health issue. Action is therefore urgently needed. II. Ravens-Sieberer. AAOHN-Journal. S63-S65. and Vaisanen. C. M. E. J. Physical activity increases acutely 1) platelet number and activity. Relationship among risk factors for nephrolithiasis.

H. Aitchison. W.. S. 645-650. and McDowell. 28(6). Newell. and Henry. Interventions for prevention and treatment of childhood obesity typically target increases in physical activity and. J. (2002).. D. the evidence base for such strategies is extremely limited. Ventham.. To describe health and lifestyle indices in obese children and adolescents and compare with control subjects and a reference group. Kilanowski. 183 Raynor... H. Reducing variety in energy-dense food groups may decrease energy and dietary fat intake. Jochens. International Journal of Obesity and Related Metabolism Disorders. and weight during obesity treatment. International Journal of Obesity.. K.. and weight. reductions in physical inactivity (sedentary behaviour such as television viewing). P.. M. H. The main aim of the present review was to update the systematic review and critical appraisal of evidence in the light of the recent rapid expansion of research in this area.. 813-820. Reilly.. Journal of Nutrition Education and Behavior. 13-19. J. Reicks. H. and Epstein. Reilly.. Relationship between changes in food group variety. (2004). . To assess dietary costs during a family-based pediatric obesity intervention. dietary intake. To test whether excess weight gain in patients treated for childhood acute lymphoblastic leukaemia (ALL) was predictable using patient characteristics at diagnosis. J. The purpose of this qualitative study was to examine how spirituality affects intrapersonal characteristics associated with a weight loss program.. J. B. W. 611-619. R. Risk factors for excess weight gain in children treated for acute lymphoblastic leukaemia. (2003). I. Physical activity interventions in the prevention and treatment of pediatric obesity: systematic review and critical appraisal. and Marild. Mills. Raynor. Grufman. S. This study examined changes in food group variety during obesity treatment and the relation between changes in food group variety. C. International Journal of Obesity.. J. M. and Gibson. L. Proceedings of the Nutrition Society. Jeffery. dietary intake. Z. 1537-1541. J. (2000). Qualitative study of spirituality in a weight loss program: contribution to self-efficacy and locus of control. H. R. more recently. Wallace.. Journal of the American Dietetic Association. S. Esterlis. Regber. E. Experimental studies show diets with greater variety in energy-dense foods increase consumption and body weight. However. C. Gender-related coping strategies in obese children and adolescents.. A cost-analysis of adopting a healthful diet in a family-based obesity treatment program. promoting weight loss. Tate. (2004). and Wing. F. 26(1).. J. C. A. (2002). B.. R. T. A. 36(1). 62(3).

Delzenne. P. A. 95(3). Brighenti. insulin sensitivity and diabetes risk. and McCarron.. N. K. Miller. Confronting the epidemic: the need for global solutions. 43. Journal of Public Health Policy. D. Riccardi. Nieuwenhuizen.. Theis. the composition of the habitual diet is clearly an important regulator of this function. D. N. reduced insulin sensitivity is strongly associated with the metabolic syndrome. Cardiovascular disease kills nearly as many Americans each year as the next seven leading causes of death combined. Reusser. C. We address the prevalence of overweight and obesity: the cope and size of the epidemic. B. Insulin sensitivity is a key function in human metabolism because it has a crucial role in the development of disease that are increasingly common in modern society. The epidemic of obesity is global and legal actions to stem the epidemic must become global. 188-193. F. Frayn. Tuijtelaars. Process for the Assessment of Scientific Support for Claims on Foods. Aggett. S. and Vessby.. D. Thus. D. impairs insulin-sensitivity while physical activity can improve it. Valid knowledge concerning structure and contents of an ambulant training program for obese children and adolescents suggested by experts is still missing.body weight regulation. 184 Reinehr. Wollenhaupt. Economic costs of . P. Improving these statistics may be simply a matter of improving diet quality. European Journal of Clinical Nutrition. The prevalence of cardiovascular disease and most of its associated risk factors is markedly higher and increasing more rapidly among African Americans than in any other racial or ethnic group. and James.. Journal of the National Medical Association. Ambulant training programs for obese children.. and how food marketing has aggravated the problem. Insulin sensitivity can be modulated by different environmental factors.. W. M.. A. we assessed a survey based on defined criterions in the "Arbeitsgemeinschaft fur padiatrische Diathetik (APD)" and investigated the literature to cover and to compare based on defined criterions the spectrum of ambulant treatment models in Germany to advance guidelines for therapy in obese children. W. A.. G. Rigby.. Government subsidies contribute to excessive consumption.. Criterions of comparison for the development of valid therapy recommendations.. 56 Suppl 2. and Andler. (2003). J. however. a new feature of the epidemic now threatens health in the US and other industrial countries. PASSCLAIM -. (2004). Klinische Padiatrie. The metabolic syndrome. E. M. 83-88. In 1999/2000. Pannemans. Chahda. 214. Impaired insulin sensitivity is an important determinant of type 2 diabetes. S. moreover. S. it has been proposed as an independent risk factor for cardiovascular disease.... B. including dietary habits. Kumanyika. 418-34. Obesity. T. G. especially if associated with abdominal adiposity... DiRienzo.. (2004). Kersting. (2002).. Adequate nutrient intake can reduce cardiovascular disease risk in African Americans. 25(3-4). which represents a cluster of metabolic abnormalities and cardiovascular risk factor.

The prevalence of obesity increased by 40% between 1980 and 1990. Physical activity is important for achieving proper energy balance. 9(Supplement 4). Obesity as a chronic disease: modern medical and lifestyle management. McInnis. Multiple interactions exist between lack of physical activity and obesity.Numerous studies have shown that the combination of proper nutrition and regular physical activity is the most effective intervention for weight loss and maintenance of weight loss. and behavioral components. K. Obesity Research. counselling and coordination of multidisciplinary obesity treatment. S. which is needed to prevent or reverse obesity. Rippe. The United States is facing 2 major lifestyle-related epidemics that are intricately linked: an epidemic of obesity and an epidemic of inactivity. Obese patients who receive counselling and weight management from physicians are significantly more likely . increasing numbers of patients present with serious comorbidities related to excess body weight. and Hess. K. Effective treatment of obesity has been shown to reduce cardiovascular risk factors and comorbid conditions. but endorsement by WHO of national policies may not be sufficient to turn the tide globally.. Physician involvement in the management of obesity as a primary medical condition. Increased physical activity lowers the risk of obesity. Rippe. and behavior therapists offers the best chance for effective obesity treatment. Journal of the American Dietetic Association.. Not only is energy expended during physical activity. Obesity is a chronic disease with a multifactorial etiology including genetics. may favorably influence distribution of body weight. and Melanson.. Regular physical activity can improve body composition. We note that lawsuits in the US and regulation elsewhere are alerting people to the epidemic. 185 obesity are enormous. environment. As the obesity epidemic escalates. Physical activity plays multiple roles in the prevention and treatment of obesity. Journal of the American Dietetic Association. and Ringer. when appropriate.. A chronic disease treatment model involving both lifestyle interventions and. Crossley. physical activity. S9-S15. J. R. M. and changes in eating behaviors should be coordinated by this team. (2001). dietitians. and health. (1998). The role of physical activity in the prevention and management of obesity. Physician involvement is necessary for medical assessment. S. lifestyle. management. physical activity also has a positive effect on resting metabolic rate. M. J. J. Walking is the most convenient and logical way most obese persons can increase their physical activity. and routinely understated. The United States is in the midst of an epidemic of obesity involving more than one third of the adult population. S31-S38. 302S-311S. and confers a variety of health-related benefits even in the absence of weight loss. J. exercise specialists. Rippe. metabolism. regular physical activity. M. The IOTF has encouraged the new WHO strategy on diet.. (1998). chronic and relapsing. Obesity should be recognized and treated as a primary medical condition that is progressive. J. Lifestyle factors such as proper nutrition. additional medical therapies delivered by an interdisciplinary team including physicians.

Obesity treatment guidelines and materials are available from various health organizations. S. Lean. Rissanen. J.. K. by studying whether weight loss greater than or equal to 2. A comprehensive weight management programme must include dietary adjustments. J. Pediatric Nursing. To assess the clinical usefulness of published guidelines for the use of orlistat. (1999). T. S635-S645.. high protein diet as an alternative dietary treatment for overweight patients with type 2 diabetes.. 26(1). 103-109. 33-36. Robinson. and excessive television produce obese children. Only studies with some measure of weight and a description of the type of physical activity were included. reproductive abnormalities. and Fogelholm. M. Broom. (2002). and prostate. and MacLennan. Obesity is epidemic in the United States today and on the rise in children. Lack of regular physical exercise contributes to a child's likelihood to be obese. gallstones. 39-43. uterus. Physical activity in the prevention and treatment of other morbid conditions and impairments associated with obesity: current evidence and research issues. and weight losses of greater than or equal to 5% after 12 weeks and greater than or equal to 10% after 6 months of drug therapy predict weight loss and risk factor changes after 2 years. including cancers of the colon. Medicine and Science in Sports and Exercise. M. (2000). Rissanen.. (2003). sleep apnea. No controlled randomized trails of exercise in the treatment of any of the studied conditions in obese patients were identified. To assess the efficacy of a low carbohydrate (<40g day). N.. McRobbie. O. G. A Medline literature search on the effects of physical activity in the above conditions was conducted. S. poor diet. M. 1561-1567. To evaluate the current status of knowledge concerning the effects of physical activity in the treatment and prevention of obesity-related problems. (1999). Roberts. International Journal of Obesity. L.. A. The consequences of physical inactivity.. 31(11 Suppl). osteoarthritis. R. back pain. 186 to undertake weight management programmes than those who do not. JAMA: Journal of the American Medical Association. The role of physical activity in the prevention and treatment of childhood obesity.. and impaired health-related quality of life. S. Robertson. Segal. 27(1). increased physical activity and behavioural modification.5 kg during a 4 week dietary lead- in period. . 26(1). International Journal of Obesity. Roessner. breast. A. L. Reducing children's television viewing to prevent obesity: A randomized controlled trial. Low carbohydrate diets in overweight patients with type 2 diabetes. and Sjoestroem. while a program of exercise can reverse an unhealthy lifestyle. A. Predictive value of early weight loss in obesity management with orlistat: an evidence-based assessment of prescribing guidelines. 282(16).

Lamas. 88-95. Weight. The thematic consisted of nutritional education. Minicucci. For optimal developmental . S. Preventing childhood obesity: a solution-oriented research paradigm. Robinson. Roizen. T. Body Mass Index above 95%. (2002). This study was done to evaluating the effect of the treatment of a group of obese adolescents through a multidisciplinary team (physicians. R... (2005). males and females. and dietary intake. J. Severino. 45-69. physical activity. health. and Sirard. Therefore. S. nutritionist. Past research has identified social and environmental causes and correlates of behaviors thought to be associated with obesity and weight gain among children and adolescents. R.. often results in weight cycling (repeated bouts of weight loss and regain) with the potential for serious physical and psychological health risks and contributes to a growing epidemic of dangerous eating disorders. The authors hypothesized that intervention-group (IG) children would significantly decrease their adiposity levels.. without endocrinopathy and neurological diseases. E.and 4th-grade (mean age 8. Robison. 26(1). W. 28(2 Suppl 2). during a eight month period. This work is a prospective and descriptive research conducted in a Obesity Adolescents Ambulatory. M. providing interventionists with experience with this population of children. Infants and children with Down syndrome have an increased incidence of a variety of medical problems. Infants and young children with Down syndrome are frequently among the youngest children enrolled in early intervention programs. J.. ages 11 trough 17. The early interventionist and the medical problems of the child with Down syndrome. Promoting weight loss through dietary restriction and behavior modification rarely succeeds. videotape. N. Much less research has documented the efficacy of interventions designed to manipulate those presumed causes and correlates. and video game) use to assess the effects on adiposity. emphasizing reductionist approaches to understanding etiologic mechanisms of diseases and risk factors. J. 16(1). L. 10 patients were object of study. (Must e col. There was the participation of at least one of the parents. American Journal of Preventive Medicine. continuing to promote such approaches for the purpose of improving health is scientifically indefensible and ethically unacceptable. stimulus to physical activity and psychological aspects related to obesity. Alternative Health Practitioner. and Mueller. Infants and Young Children. International Journal of Obesity.). Results of the treatment of obese adolescents: A multidiscipline approach. C. J. T. nurses and social worker). M. These latter efforts have been inhibited by the predominant biomedical and social science problem-oriented research paradigm.9 yrs) children's media (TV. 194-201. J. 187 Conducted a school-based trial of reducing 192 3rd. (2003). Martins. 5(1).. F. (1999). and culture: shifting the paradigm for alternative health care. N. Rodrigues. I. L.

. Roos. 38-39. Deheeger. Early intervention providers who are knowledgeable about the particular medical problems that occur more frequently in children with Down syndrome can be of great assistance to families.. Bellisle. Leibel. L. Several possible strategies for adjusting portions to bring intake back in line with energy requirements are discussed. Scandanavian Journal of Nutrition. (2005). and treatment of obesity by lifestyle modification.. J. M. intake and expenditure. P. Although we are just beginning to understand how environmental factors such as portion size affect eating behavior.. 'obesity. the child with Down syndrome must have any such problems identified early. B. chemical mediators of energy homeostasis. 28(4). F. 188 progress and participation in early intervention. G. M. the available data suggest that large portions of energy-dense foods are contributing to the obesity epidemic. 42-54. New England Journal of Medicine. the neurophysiology of feeding. Internet versions of one of the main newspapers in both countries were selected as data sources. 38(2). The preliminary search of 'The Guardian' (UK publication) resulted in 810 news articles. drug therapy and surgical therapy. C. Thibault. Roinsol.. International Journal of Obesity. Media debate on obesity prevention in the UK and Sweden. Soulie. The internet archives of the newspapers over one year (September 2003 to August 2004) were searched for articles using the keyword. D. Nutrition Today. H.. energy balance regulation by metabolic cycles. P. the 'Dagens Nyheter' (Swedish publication) had 24 news articles. (2003). R.. and Serog. of which 199 fulfilled the selection criteria. genetic factors in obesity. Rolls. (1997). and managed appropriately. Obesity. To compare the influence of weight-reducing diets containing different amounts of protein and CHO on body composition in obese adolescents and to examine dietary and physical activity behaviours during follow-up. . and Hirsch.. Souberbielle. prevention strategy and key actors in the prevention programmes were included. Rosenbaum. Rolland Cachera.' All articles that had information on causes. 396-407. Carbonel. (2004). 49(1). This paper reviews the pathogenesis of obesity as well as other important aspects of this topic. The supersizing of America: portion size and the obesity epidemic. F. D. 337(6). J. The continuing rise in the rates of obesity calls for urgent action. all fulfilling the criteria. M. Topics include regulation of energy storage. 514-519. Current media debates in UK and Sweden on obesity and its prevention were analysed. J.. E. Obesity seems currently to be a bigger media topic in the UK than in Sweden. Longueville. Massive obesity in adolescents: Dietary interventions and behaviours associated with weight regain at 2y follow-up... metabolic effects of weight perturbation.

K. Since such programs can be carried out with limited medical resources. S. A literature search (Medline. The purpose of this study was to examine the evidence in the literature for a relationship between physical activity and weight development during and after pregnancy. The participants were exposed either to no model. Carte. Sixty-nine female undergraduates completed the restraint scale. the influence of exercise-induced weight loss on abdominal fat is unclear. mainly based on an extended MEDLINE search and the Pregnancy and Childbirth Database (Cochrane). Rotenberg. (1999). 189 Ross. a peer model who behaviorally demonstrated dietary restraint. The findings revealed that attribution style. L... Intermittent vs continuous VLCD therapy in obesity treatment. 75- 84. S560-S563. (1998). The effects of modeling dietary restraint on food consumption: do restrained models promote restrained eating? Eating Behavior. but not restraint or current dieting status. It is known that a preferential deposition of fat in the abdominal region is the obesity phenotype that conveys the greatest health risk. 190-192. International Journal of Obesity and Related Metabolism Disorders. or a peer model who behaviorally and verbally demonstrated dietary restraint. (1999). and the Eating Attribution Style Questionnaire (EASQ). with physical activity being one important determinant of weight outcome and eventually also overweight and obesity. 6(1). The role of intermittent very low calorie diet (VLCD) in obesity treatment has received little attention. The participants had an opportunity to consume food as part of a taste test. R. 31(11 Suppl). and Speirs. Rossner. Is abdominal fat preferentially reduced in response to exercise- induced weight loss? Medicine and Science in Sports and Exercise. Medicine and Science in Sports and Exercise. J. Although physical activity is commonly prescribed to reduce obesity. S568-S572. 31(11 Suppl). A retrospective analysis of the literature. 1966-1998) was performed using appropriate keywords to identify studies reporting changes in both whole body and abdominal fat in response to exercise. S. Physical activity and prevention and treatment of weight gain associated with pregnancy: current evidence and research issues. and Janssen. they may offer an additional therapeutic tool. A. Rossner. Weight development during pregnancy is the result of numerous interacting factors. I. Females who had an internal attribution style for indulgent food consumption decreased their consumption of food as a function of the dietary restraint of the models. whereas females who had an external attribution style for .. This review was undertaken to clarify whether abdominal fat is preferentially reduced consequent to weight loss induced by regular exercise. was conducted. (2005). At present there are no randomized controlled trials (RCT) wherein it was clear that exercise alone induced weight loss. a dieting checklist. moderated the effects of exposure to the peer models.

Of 420 subjects. 28-30. smoking and purging. D. 1999. H. M. otherwise the use of harmful slimming strategies may be further increased as teenage girls frantically try to lose weight and to avoid the stigma associated with female fatness. Sibutramine can be a useful tool in the obesity treatment toolbox if used by knowledgeable practitioners. fatness phobia is common during female adolescence. Gibney. T. International Journal of Obesity and Related Metabolism Disorders. Y. . Despite increasing trends in the prevalence of overweight and obesity. (1998). 405-426. M. The Department Of Health has identified that prevention must be aimed at children to address its rise in future generations (DoH. This article provides a treatment algorithm to help physicians measure meaningful weight loss and proposes conservative blood pressure limits to guide the long-term prescription of sibutramine. Obesity prevention programmes which target adolescent girls at risk of overweight and obesity. 1997). Whitaker et al. 190 indulgent food consumption increased their consumption of food as a function of the dietary restraint of the models. and who are motivated and ready to undertake dietary and physical activity changes. Childhood obesity is recognised as a predictor of adolescent and adult obesity (Smith. (2003). 1998). 59% reported that they wanted to be slimmer and 68% had previously tried to lose weight. J.. who have a body mass index greater than or equal to 30 kg/m2 or greater than or equal to 27 kg/m2 with comorbidity. Ryan. Copyright (c) 2003 by Elsevier Scien (USA). consequences and prevention. 30(2). Ryan. The pursuit of thinness: a study of Dublin schoolgirls aged 15 y. Childhood obesity: its incidence. fasting. Parseons et al. Contrary to expectations. in their pursuit of the 'perfect' female figure. K. This study has demonstrated a high level of dissatisfaction with body weight in a sample of Dublin schoolgirls aged 15 y. (2004). Pharmacologic approaches are indicated in those patients who have had prior weight-loss attempts. Medications are useful adjuncts to diet and exercise and may help patients lose weight and maintain significant weight loss (5%-10% from baseline).. Nursing Times. Primary Care: Clinics in Office Practice. must take cognizance of their profound fear of fatness. Use of sibutramine to treat obesity. In 1998 the World Health Organization declared childhood obesity a 'global epidemic' (WHO. and Flynn. 2002. 100(3). Rugg. 485-487. A. 2002). M. Normal weight and even underweight girls also expressed a desire to be thinner and reported using unhealthy weight control practices including random avoidance of staple foods. overweight girls were not found to hold the monopoly on such dissatisfactions.

3-5. blood pressure and number of steps in 2 min). physical activity and nutrition education.. T. . Flaten. Secondary outcomes were body mass index (BMI). 21(7). (2002). Sabin. K. 191 Ryttig. Also. M. 27 patients (group A) were randomized to a balanced diet of 6720 kJ/day during the whole treatment period. raising concerns of an epidemic of diabetes and cardiovascular disease. 49-50. Journal of Human Nutrition and Dietetics. E. The other patients were randomized to VLCD (Nutrilett(R)) 1764 kJ/day diet during the first 2 months. An uncontrolled.. However. 81 obese patients of both genders with a body mass index more than or equal to 30 kg/m<sup>2</sup> were recruited from the Swedish University's out-patient obesity clinic. Weight loss on a balanced hypoenergetic diet was compared to that on a very low energy diet [very low energy diet] (VLCD) after 2 months of treatment. The primary outcome measure was waist circumference. (2005). C. (2003). P. A prospective. R.. legumes and nuts. Crowne. Bristol doctors have identified the first cases of type 2 diabetes in Caucasian children with obesity. 56. namely the reduction of risk for many chronic diseases and the increase in longevity. Long-term effects of a very low calorie diet (Nutrilett(R)) in obesity treatment. Numerous studies show important and quantifiable benefits of the different components of vegetarian diets. Nursing Times. whole grain cereals. twice-weekly. Sacher. and Shield. (1997). 18(1). 574-579.. cardiovascular fitness (heart rate.. Chadwick. H.. exercise. and Lawson. and Rössner. nutrition and diet (MEND) programme was held at a sports centre. The mind. randomized... The programme consists of behaviour modification. NTplus. Childhood obesity and type 2 diabetes. M. K. Cole. E. J. S. Elizabeth Crowne and Julian Shield explain what they found and what must be done to combat obesity.. Forum Nutrition. fruits. 26 months of weight maintenance with or without VLCD assistance was examined in obese patients. J. J. Our knowledge is far from complete regarding the relationship between vegetarian diets and human health. M. scientific advances in the last decades have considerably changed the role that vegetarian diets may play in human nutrition. Sabate. P. Williams. 218-20. S. Wells. Components of a healthy vegetarian diet include a variety of vegetables. self-esteem and body composition. Assessing the acceptability and feasibility of the MEND Programme in a small group of obese 7-11-year-old children. Matt Sabin. comparison between VLCD and a hypocaloric diet+behavior modification and their combination. 98(19). International Journal of Obesity. J. pilot study to evaluate feasibility and acceptability of a new community based childhood obesity treatment programme. J. The contribution of vegetarian diets to human health. for 3 months.

Advanced Studies in Nursing. Director of H. Most. The recent sharp rise in childhood obesity has been overshadowed to some extent by growing concern over the comparatively low number of young people with eating disorders like anorexia. M. Community Practitioner. (2004). changing lifestyle patterns and the impact of healthy school initiatives. 74(8).. Kamimoto. respiratory quotient at AT (P =.1 plus or minus 4. (2001).6 plus or minus 3.005). atypical antipsychotic drugs lead to clinically significant weight gain. Neither the mechanisms behind the metabolic changes with antipsychotic agents nor the complex feedback mechanisms to control weight and satiety are completely defined. responsible for two million deaths each year in people below the age of 75. Diet and heart health symposium II. The pharmacology of metabolic complications due to weight gain.10 kg/m super(2)).0 v 37.E.003). T. 43-46. (2001). Sato. includes discussion. Saiki.5 plus or minus 2. S. M. 11. P <.002) than the control group. Sadler. Salisbury. Catharine Sadler examines the issues of childhood obesity. but not all.001). and Yosida. R. .. the obese group had lower anaerobic threshold (AT) values (P <. Furthermore. There is strong evidence to show that patients with severe mental illness are at increased risk for overweight/obesity and diabetes. 21..T UK. M. (2004). Cardiovascular disease is still the leading cause of death across Europe. To study on effect of obesity on changes in serum hypoxanthine with exercise. S. 2(3). C. Nursing Standard.. 192 Sadler.A. This article examines the part health psychology has to play in underpinning care strategies and supporting professional practice during the process of rehabilitation following a myocardial infarction.7 mL/kg/min. 30. T. The role of health psychology post-myocardial infarction. 93-100. Weight watchers.1 plus or minus 4. (1996). 286-288. and exercise capacity reserve (P =. C. 627-630.2 kg/m super(2)) and 16 healthy volunteers (BMI. Expiratory gas analysis during exercise showed that peak Vo sub(2) was significantly lower in the obese group than in the control group (28. Michael Livingston. Metabolism. 50(6). Saklad. Changes in serum hypoxanthine levels by exercise in obese subjects. British Journal of Cardiology. S1-S8 Suppl 1.R. 10(39). exercise stress testing with treadmill was performed on 7 obese subjects (body mass index [BMI]. Kohzuki. introduced the symposium by saying that diet plays an important role in the causation of cardiovascular disease even though we have drugs that effectively lower plasma cholesterol.

The aims of this paper are to describe a randomized controlled trial ('Switch-Play') developed to prevent unhealthy weight gain among 10-year-old children and to report the findings of the process evaluation. Caries Research. Saper. Sanders. K. C. Dietary guidelines are designed to maintain an adequate intake of nutrients and to protect against diet-related disease. particularly saturated fat intake. and quality of these supplements are critical when counseling patients regarding weight loss. Hume. Booth. R. H. 193 Salisbury. D. 7-17. R.. Telford.. Reducing sedentary behaviour and increasing physical activity among 10-year-old children: overview and process evaluation of the 'Switch-Play' intervention. Diet and general health: dietary counselling. (1995). Maintaining lifestyle change after myocardial infarction: part 2.. D. 172-176. safety. or discourage use of a particular weight-loss supplement is presented in this article. P. 3-8 Suppl 1. Nutrition and Dietetics: Journal of the Dietitians Association of Australia. Common dietary supplements for weight loss. and Eccleston. Over-the-counter dietary supplements to treat obesity appeal to many patients who desire a "magic bullet" for weight loss. A. B. L.. J. Overweight and obesity has doubled among children in Australia. Cooke. (2005). and Phillips. Eisenberg. D. Current population dietary guidelines advocate a reduction in total fat intake.. HELEN SALISBURY examines the factors which influence the rehabilitation process and how clients can be helped to adopt and maintain preventive health behaviours. 38. T.. 460-463. S. In the second of two articles on the role of health visitors in myocardial infarction rehabilitation. A. There is an urgent need to develop primary prevention strategies to prevent current and future unhealthy weight gain. Ball. caution. Asking overweight patients about their use of weight- loss supplements and understanding the evidence for the efficacy. 61(3). which should mainly be derived from starch. J. B. Salmon. (2004).. (2004). American Family Physician. . 'What's to eat?' -. M. M. 70(9). Crawford... (2004). Health Promotion International. particularly cardiovascular disease and obesity. Health Visitor. 68(11). and Worsley.. 1731-1738. 20(1). Sangster.Nutrition and food safety needs in and out-of-school hours care. There is a positive relationship between total sugar intake and the incidence of dental caries where dental hygiene is poor and exposure to fluoride is low. Jolley. Investigate the nutrition and food safety needs of out-of-school hours care (OSHC) services.. A schema for whether physicians should recommend. A. to 25-35% of the energy intake and an increased intake of carbohydrate to more than 55% of the dietary energy intake.

Help overweight patients with the new NHLBI guidelines on treating obesity. 26(1). (2001). by the subjects about their obesity experiences. interactive Internet food diaries. 18. However. International Journal of Obesity and Related Metabolism Disorders. C. (1995). Obesity is currently a well-recognised medical and social problem. Saunders. interactive Internet food diaries. to a diet-induced weight loss programme induces small improvements in the change in FFM/FM and possible RMR after a relatively long period. 35(15). S. Relapse stories in obesity. 26(1). 4(8). (1998). seeing obesity as a problem is also connected to cultural norms of beauty. Abdominal obesity and cardiovascular risk markers in type 2 diabetic patients: The Belgian OCAPI study. Patient Care for the Nurse Practitioner. normality and acceptable behaviour. it is clear that exercise does not give any success. 194 Saris. S. 16. Intervening in the obesity epidemic. F. Sarlio Lahteenkorva. In modern societies. 92-94. Patient Care for the Nurse Practitioner. Diet and nutrition in your practice. Exercise treatment alone is an option for longterm treatment with relatively small changes in body weight and body composition. Intervening in the obesity epidemic. C. 203-209. and multipatient weight-loss sessions. The society's view on obesity and the quality of life among the obese. and Van Gaal. and multipatient weight-loss sessions. The present study is an attempt to analyse obesity narratives to characterize the complex interrelationship between relapses and sociocultural factors. (2001). S. 103-107. J. negative attitudes toward obesity have been documented in several studies. Adding exercise and especially weight training. If short term weight loss is the main treatment objective. The social constructionist version and application of grounded theory was used to analyse the stories told. L. Exercise with or without dietary restriction and obesity treatment. (2002). 12-14. S. Scheen. In-depth interviews were obtained from 90 obese subjects who were applying for weight loss programmes or seeking help for obesity-related problems. International Journal of Obesity. . Dietary restriction can potentially induce much faster rates of weight loss. 99. Preferred body shapes may vary within population groups and attitudes towards overweight have changed many times throughout the history. Help overweight patients with the new NHLBI guidelines on treating obesity. Sarlio Laehteenkorva. (2002). S113-S116. M. International Journal of Obesity. however. 8(3). The tendency for obese people to relapse and regain the weight they have lost constitutes a serious problem in obesity treatment. European Journal of Public Health. W. Saunders.. A. H.

Schupp. While undernutrition and wasting are reported. HbA sub(1e) and fasting lipids (central lab) were determined. M. C. D.. C. (2003). determine . arterial blood pressure. and visual function in adult cystic fibrosis patients. K. Covas. E. The primary goal of this study was to assess whether increases in fat-free mass (FFM) and decreases in total and percentage fat mass from 15 weeks of twice weekly supervised strength training would be maintained over 6 months of unsupervised exercise in a randomized controlled trial. 195 The OCAPI (Optimize CArdiovascular Prevention in dIabetics) study aimed at determining the global cardiovascular (CV) risk of 1001 consecutive type 2 diabetic patients. LDL cholesterol was calculated using the Friedewald formula. M.. C. J. Because the macular pigment of the retina is largely derived from 2 carotenoids. as well as growth stunting. C. Lutein.. and Leon. worldwide. B. and Werner. The purpose of this study was to assess the relation between BMI and obesity and the level of adherence to the traditional Mediterranean diet. these conditions. J. 79(6). Schneider.. and the 10-year CV risk was estimated using the Framingham formula. lutein and zeaxanthin. International Journal of Obesity. macular pigment. (2004). Pancreatic insufficiency in cystic fibrosis (CF). Olano Martin.. E.. and Elosua. D.. Adherence to the traditional mediterranean diet is inversely associated with body mass index and obesity in a spanish population. Journal of Nutrition. 51(6). I. (2000). seem to be on the decline. H. Jeffery. Information is presented by geographic region and by nation within region. zeaxanthin. J.. (2004). S. The literature shows that malnutrition remains a significant problem for adolescents. the decreased serum concentrations seen in CF may have consequences for ocular and retinal health Our aims were to determine plasma carotenoid concentrations. Soc Sci Med. H. S. R. is often associated with decreased carotenoid absorption.. American Journal of Clinical Nutrition. 955-67. but that the types of nutritional problems impacting this group have changed significantly over the past two decades. Marrugat. 3355-61. This paper addresses international trends in adolescent nutrition by reviewing the literature from English-language indexed journals and online sources from around the world. Kugler. Cross. Morrissey.. 134(12). Body mass index (BMI).. Schmitz.. waist circumference (WC). Vila.. R. 1045-1052. 27(3). even with replacement pancreatic enzyme therapy. A. M. Strength training for obesity prevention in midlife women. K. The Mediterranean diet is a healthy eating pattern with protective effects on chronic diseases. Schroder. 326- 333. Jensen. Gerth. W. International trends in adolescent nutrition.

Type 2 diabetes mellitus is a familial disorder that is fast becoming epidemic in the USA. 819-827. (2004). Gregory. a family systems variable. Some have argued that energy homeostasis operates primarily to defend against weight loss and that. M. . S. This paper brings together several literatures to provide a comprehensive examination of the major challenges facing obese children and their families. L. In the context of this system. and assess retinal health and visual function in CF patients. M. R. (2003). (2004).. Schwartz.. Schwartz. Childhood obesity: a societal problem to solve.. and Puhl. In contrast to other threats to American children's health. biological defense against weight gain was not selected for. 89(12). the treatment and prevention of childhood obesity are considered the responsibility of individual children and their parents.. G. D. and Niswender. J. Obesity Reviews. Parents of overweight children are left in the difficult position of fearing the social and health consequences of their child's obesity.. Nursing and Health Sciences. D. Primary care physicians see a substantial portion of the obese population. has been correlated with self-management and glycemic outcomes. Scollan Koliopoulos. M. B.. K. 57-71.. P. It is possible that nurses will care for entire families with diabetes in the near future. An abundant and compelling literature supports the existence of a homeostatic system that dynamically adjusts energy intake and energy expenditure to promote stability of body fat mass. Preventive Medicine. A. B. and fighting a losing battle against the omnipotent presence of the media and constant exposure to unhealthy foods. 38(6). Most persons with diabetes live with family members who might facilitate or inhibit self-management tasks or skills. Orzano. yet rarely counsel patients to lose weight. 4(1). the ease with which many individuals gain weight is difficult to explain. Consideration for legacies about diabetes and self-care for the family with a multigenerational occurrence of type 2 diabetes. family functioning. Obesity is epidemic in the US and other industrialized countries and contributes significantly to population morbidity and mortality. Scott. 6(3). over the course of evolution. In multiple studies. 196 absorption and distribution of macular pigment.. Maxwell. DiCicco Bloom. (2004). Adiposity signaling and biological defense against weight gain: absence of protection or central hormone resistance? Jo Clin Endocrinol Metab. A. Speaking of weight: how patients and primary care clinicians initiate weight loss counseling. B. J. and Crabtree. This pressure exists in the context of the societal stigmatization of overweight children and the powerful environmental inducements aimed directly at children to eat nutritionally poor foods.. W. Flocke. Cohen. 5889-97. 223-227.

R. M. Leptin is a hormone that is made in the adipocytes.. J. comprising either or both aerobic and strength training of 30-60 minutes per day for 3-7 days per week. The association has not been examined in a Chinese population. J. 88(428). Evidence from studies using experimental diets have shortcomings because of their short duration and selection of highly-motivated subjects and because the outcomes can be easily influenced by the choice of foods to be used in the intervention. 58-61. E. 6(4). C. Selig. Acta Paediatr Suppl. and Visser. however. exercise has been shown to prevent the progression of coronary atherosclerosis and even promote plaque regression. 197 Sea. Groenewald. 99(10). 1-5. J.. E.. L. and Schwartz. Tong. A. Albertse.. For .. 64(1). Chow. C. C.. Cost-effective prevention strategies to prevent weight gain and the development of obesity should be based on appropriate knowledge of the determinants of weight gain.-Y. Journal of the American College of Nutrition. J. fragmentary at best. Seeley. and Visscher. Achieving such 'energy balance' is a product of complex interactions of peripheral hormones with effector systems in the central nervous system (CNS) that regulate food intake and energy expenditure. (1999). J. Exercise as primary treatment modality in the prevention and rehabilitation of cardiac disease. M. C. and Chan. Seidell. (2004). Exercise training. Cost-effective measures to prevent obesity: epidemiological basis and appropriate target groups. P. is effective in primary and secondary prevention. 23(5). S. (2003).-N. J. A multidimensional weight-management program for women. M. Neuroendocrine regulation of food intake. Momberg.-M.. Nooyens. Journal of the American Dietetic Association. M. J.. 1257-64. These receptors can be found in two different types of systems. C. Physical inactivity is now a stand-alone risk factor for cardiovascular disease. are associated with the development of a variety of health problems and eating disorders. D. Woo. Food variety is reported to be closely associated with body fatness in Caucasians. C. Maintenance of appropriate stores of metabolic fuels depends on carefully matching caloric intake to caloric expenditure. partly because inappropriate research methods are used to study the determinants of obesity under normal circumstances. Real and imagined overweight and obesity.-C. M. (1999). W. OBJECTIVE: To examine the association between food variety and body fatness in Hong Kong Chinese adults. Associations between Food Variety and Body Fatness in Hong Kong Chinese Adults. (2005).. The body of evidence on the dietary determinants of weight gain is. Journal of Science and Medicine in Sport. T. Proceedings of the Nutrition Society. circulates in the blood and interacts with receptors in the CNS.. In the age of re- vascularisation therapy. Senekal. 404-413. and resulting weight-reduction efforts..

A. Olive oik and the Mediterranean diet: beyond the rhetoric. K. HCPJ. 4(4).. K. The purpose of this study was to analyze the association of food. (4) Assist in establishing appropriate intervention. With obesity a growing public health problem and pressure on PCTs to do something about it. L. Serdula. 14-16. and Tur.. and Moravej. J. 24(7). Weight loss counseling revisited. Ngo de la Cruz. Physician and Sports Medicine. JAMA: Journal of the American Medical Association. The core philosophy of the course is self-empowerment.. a practical tool for organizing information around weight loss counseling was developed. (3) Advise in designing a weight-control program. There's no better time than the years surrounding menopause for a woman to start or renew an exercise program. (2) Ask about readiness to lose weight. (1996). L. and Dietz. The exercise prescription includes aerobic exercise.. counsellors could become more involved with weight loss programmes. Serra Majem. 198 many years. 289(14). M. In the UK. Sharman. H. and management of weight-related problems. 30-32. M. 17 per cent of men and 20 per cent of women are currently obese and over half . treatment. weight-loss paradigm. and stretching components. and (5) Arrange for follow-up. (2003). research and practice in the field of weight management have been based largely on a unidimensional. resistance training. L. and obesity. An active menopause: using exercise to combat symptoms. European Journal of Clinical Nutrition. and listening to her clients' stories. Obesity is one of the largest and fastest growing public health problems in the world. 19-22. This weight- loss counseling tool uses the 5 A's: (1) Assess obesity risk. Shangold. Ribas. H. (2003). K. 57(9). K. nutrient and energy intakes with olive oil consumption in Spain. Patient empowerment: an innovative approach to weight loss. Khan. S2-S8. osteoporosis. HCPJ. 3(1). and it decreases the long-term risk of cardiovascular disease. and should be individualized according to the woman's exercise history. (2003). M. (2004). The long-term success rate for persons using this paradigm has been low. From compliance to concordance: a psychological approach to weight management. This article presents a multidimensional paradigm that focuses on all aspects of the prevention. 1747-1750. Exercise may reduce the immediate symptoms of menopause. W. simplistic.. Learning from her own experiences. Sharman. J. By adapting the treatment model used for smoking cessation into National Health Institutes of Health evidence-based guidelines for obesity management. Each of these steps is discussed.. Kath Sharman has developed an innovative approach to weight management which mainly focuses on psychological interventions.

Neumark. Zhou. L. B... Sheehan. J. 200-207. J. Shephard. 14(3). (2003). possibly in excess of C3. DuBrava. DeChello. A. Klesges. Rates of weight change for black and white Americans over a twenty year period... Reliability and validity were established for weight concern measures completed by 8- 10-year-old African-American girls participating in a pilot obesity prevention program. C.. Sherwood. with obesity treatment estimated to account for six to eight per cent of the nation's direct health care costs. The prevalence rates appear to be increasing. N. Robinson. 66: 62. 64.5 billion to the wider economy (National Audit Office Report. S50-S59.. S. American Baby: For Expectant and New Parents. and what does this imply for prevention and treatment? Data Sources: Relevant articles in Medline and personal files. Fighting childhood obesity. Pratt. (2004). 199 the adult population are overweight. (2003). Girls in Minneapolis/St. D. Story. A. Beech. 13(2). T. (2004). J. (2004).. J. Paul were more likely than Memphis girls to . Paul. E. K. Measurement characteristics of weight concern and dieting measures in 8-10-year-old African-American girls from GEMS pilot studies. However. and Davis. This has serious financial consequences for the NHS. 66. B. Klesges. 161-168. J.to 10-year-old AA girls and 179 parents/caregivers of AA girls from 2 urban areas. M. 2001) Sheehan. S). To examine the rate of weight gain over time among Americans by age. it is expected that more than 25 per cent of British adults will be obese... The rates are soaring. and race. L. M. N. M.. Prenatal Ed. R. or did not think about it at all. T. 27(4). S. M. Memphis and Minneapolis/St. Sherwood. L.. Cullen.. and 50% would like to be smaller. Ethnicity and Disease... gender. Body image perceptions and dieting among African-American pre-adolescent girls and parents/caregivers. This study describes body image and weight concern attitudes of pre-adolescent African- American (AA) girls and their parent/caregivers. and by the year 2010. 498-504. Beech. E. McDonald. Z. N. But you can get baby on the right track from the beginning. and Fang. Results demonstrated that most AA girls were either happy with their weight. Cross-sectional survey data were collected from 189 low-income 8. Mellin. To suggest the role of the practicing physician in examining and treating childhood obesity. Role of the Physician in Childhood Obesity. International Journal of Obesity. 20% of girls would like to be larger than their current size.. Killen. Story.. M. 38(Suppl. M.. and Baranowski. How should obesity be determined at clinical examination? Is there an obesity epidemic? What is the likely influence of obesity upon current and future health? What are the causes of obesity. Clinical Journal of Sport Medicine.. Preventive Medicine.. T.

Sidney. S. and Grey. and Yarnell. 103(11).. A. The purpose of this analysis was to evaluate the 7- yr change in physical fitness in a biracial (black and white) population of young men and women. 30(3). and Davis. A... An estimated 64% of the US population is classified as overweight or obese. S. W. Past research has surveyed primary care physicians (PCP) about their attitudes and practices towards obese patients. (2004). This research describes the family context of eating and mealtime patterns in young adolescents at high risk for type 2 diabetes and the implications for preventing this disease. P. and lacking in women and nonwhites... C. J. 1069-1076. Shortt.. OBESITY NOW IS recognized as a national epidemic.. Development and implementation of a visual card-sorting technique for assessing food and activity preferences and patterns in African American girls.. Crow. R. E. Boraz. 1473-1479. 80(6). Siebold. S. L. activity preference and frequency. and Thomas. M. (1998). Simkin Silverman. M. 29(6).a public health dilemma. One third of parents reported concerns that their daughters were too heavy. Sherwood. AORN Journal. Journal of the American Dietetic Association. L. Predictors of weight control advice in primary care practices: patient health and psychosocial characteristics. Seven-year change in graded exercise treadmill test performance in young adults in the CARDIA study. Gleason. Skidmore. Weissfeld. and implications for obesity prevention programs.. King. N. A. 997-1004. P. Adkins. not population-based. Preventive Medicine. R.. Knal. have contributed to this epidemic. such as increased food portions and sedentary lifestyles.. Seventy-two percent of parents reported that they were trying to lose weight. Most studies of physical fitness change have been relatively small. S. (2003). and body mass index were examined. (2003). yet less is known about the patients receiving advice. Buhari.. Haskell.. 97(12). A. Story. K.. W. Neumark-Sztainer. 427-433. . Sternfeld. Card-sorting tasks for assessing food and activity preferences and patterns among African American girls were developed. 817-25. E. 200 report weight dissatisfaction. W. K. J. Quesenberry. Environmental factors. R.. Qjm. R. 71-82. Diabetes Educator. D. B. M. (2005). (2004).. Obesity -. R. C. Discussions include possible regional differences in weight concern among AA girls. Associations among food preference and intake frequency. The obesity epidemic: prospects for prevention. The family context of an intervention to prevent type 2 diabetes in high-risk teens. L. 1078.. M. J. M. and Wing. 40(1).. Medicine and Science in Sports and Exercise.

if strategies for the prevention and treatment of this epidemic are to be developed. D.. and parental participation. and national public and private organizations met in Rochester. (2004). M. Thomas. sedentary lifestyle. increasingly recognized as a major complication of overweight and obesity. 34(4).05) in their knowledge of healthy lifestyles. 223-229. 239-252. state. These results indicate that focused instruction on important health issues may be preferable to a broad approach. Slattery. hypertension. Jensen. and Ryan Wenger. Pediatric Nursing. Minn. exposure to cigarette smoke. Thus obesity is increasingly seen as a public health problem requiring concerted action by both governmental and non-governmental organizations. M. 80(4).. D. M. A. Modest improvements in hypertension and exposure to tobacco smoke were observed. M. obesity. in Europe. 235-257. Physical activity has been shown to reduce risk of colon cancer. Mayo Clinic Proceedings. R. HeartPower! to the standard health education curriculum. is beginning to appear in UK adolescents. D. hypercholesterolemia. and even in many developing countries. J. Epidemiological data indicate that the prevalence of overweight and obesity has doubled or tripled in the past few decades in the US. A school-based intervention to teach third grade children about the prevention of heart disease. 201 Some 20-25% of UK adults are obese according to the WHO criterion (BMI >/=30 kg/m(2)). early intervention is an attractive strategy for this disease. N. Variables examined included knowledge. Physical activity and colorectal cancer. four of these studies detected statistically significant inverse associations. The inverse association between physical activity and colon cancer is consistent although only 7 of 13 studies that have collected both colon and rectal cancer data in the same manner report reduced risk for rectal cancer. for the Action on Obesity Summit hosted by Mayo Clinic. Wellik. representatives from local. A. quasi-experimental study to compare a school-based educational program.. McMahon. 28(3). (2002). Lopez-Jimenez. However. difficulties in estimating the exact amount of activity needed and frequency and intensity of activity result in only crude estimates of dose needed for a protective effect. The overall goal of this summit was to identify creative and effective strategies to . F.. Some studies have shown site-specific associations while others have not. 527-32. The frequency. (2005). M. The students who participated in the HeartPower! Program showed improvement (p < 0. Coronary heart disease continues to be a leading cause of death in adults... Smith. duration and intensity of activity are important components of a public health message to reduce risk of colon cancer through performance of physical activity. Skybo. A. following the trends in the US. Sports Medicine. Action on obesity: report of a mayo clinic national summit.. A sound understanding of the root causes is crucial. M. Because many risk factors for heart disease make their first appearance in childhood. T. In May 2004. A convenience sample of 58 third grade children participated in a year-long. and Hensrud. Type 2 diabetes. L.

Ideas generated from selected abstract presentations and breakout sessions were prioritized and incorporated into an action model (available at www. (2002). The effective management of obesity remains elusive. 5(4). Smith. remains barely effective short- term success is unlikely longer term. The huge societal. Sothern. 704-708. M. in the long-term..actiononobesity. not gaining for a while may be all that's needed. Sondike. Obesity: treating an American epidemic. B. M. M. Snelling. which lead to hyperglycaemia. and clinical costs of diabetes could be alleviated by the adoption of lifestyle measures. 132-134. 28. (2004). behavioral change. Both are a direct result of insulin resistance and "insulin deficiency. commercial weight loss programs. and. M. hopeful people than in the treatment of overweight and obesity. 202 Increase the US population's physical activity and improve nutrition to reverse the increasing prevalence of obesity. O. Sedentary lifestyles and poor nutrition challenge children who are predisposed to metabolic disorders. Solomon. by draconian "lifestyle change" or medication. the effective treatment of this problem. to neuropathy and vascular diabetic complications. M. 143-144. S. Obesity is on the rise and hard to treat.you may get patients to lose weight and keep it off. you. S. N. Obesity prevention in children: physical activity and nutrition. 123-127. Journal of Diabetes Nursing.org) deemed feasible for implementation into most communities. S. S. Weight loss: New medications. JAAPA: Journal of the American Academy of Physician Assistants. and Jacobson. M. and managing the health of the overweight woman. Journal of Women's Health & Gender Based Medicine.dietary intervention. Bringing a formidable opponent down to size. Cooperman. 17(5). 20(7/8). and the family should face the problem and deal with it before it assumes awesome proportions. and Stevenson. and increased activity -. 11(3). your patient. Whenever possible. 12(9). 23-24. In the current medical economic climate. Contemporary Pediatrics. (2000). so we turn to dieticians. In no other area of health promotion do we see more exploitation of frustrated. The current environmental experience of young children includes few opportunities for physical activity and an overabundance of high calorie foods. 30. As Americans become heavier. For a moderately obese child. A. 136-140. physicians are especially ill-suited to the task of behavioral modification. because they have so little time to give.. Nutrition.. Obesity is a logical response to this challenge. (2001). Pathogenesis of type 2 diabetes and effect of lifestyle changes. To prevent clinically significant obesity and later . H. financial. By focusing on three primary areas of weight management -. (1999). This article gives an overview of the pathogenesis of impaired glucose tolerance and type 2 diabetes.

Journal of the American Medical Women's Association.. 7-15. High-protein diets typically offer wide latitude in protein food choices. This commentary presents the basic tenets and early voices in the movement. V. quality. and Eckel. but they have benefits that extend beyond their basic nutritional properties. and nuts: potential functional foods for weight control? American Journal of Clinical Nutrition.. dairy. M. Canter. are restrictive in other food choices (mainly carbohydrates). normalizing eating behavior. and increasing physical activity independent of body weight. R. B. variations of these diets have been popular since the 1960s. Bazzarre. teas. Goals of the size-acceptance nondiet movement include improving self-image. Functional foods are similar to conventional foods in appearance. and cardiovascular disease. 1869-74. Onge. P. and fat burning as mechanisms of action for weight loss. and price had on meal selection behavior within an Army cafeteria. Physical Activity. 104(15). 56(2). They have yet to be related to the prevention of obesity. Howard. and provide structured eating plans. and Schmidt. High-protein diets have recently been proposed as a "new" strategy for successful weight loss. (2005). Spark. However. S. J. T. H. This study assessed the effectiveness of nutrition labeling on sales of targeted entrees and measured the perceived influence that factors such as taste. D. ketosis. Circulation. all sectors of society must work together to support strategies to change public opinion and behavior across the life span. Dietary fats. appearance. reviews government weight recommendations.. 203 metabolic disease in predisposed youth. functional foods have been studied for the prevention of osteoporosis. They also often promote misconceptions about carbohydrates. and suggests strategies for the size- sensitive physician. and Metabolism of the American Heart Association. T. Health at any size: the size-acceptance nondiet movement. (2003). A. St Jeor. D. 69-71. Bovee. 168(7). (2001). D. Dietary protein and weight reduction: a statement for healthcare professionals from the Nutrition Committee of the Council on Nutrition. cancer. A controversial new approach to obesity treatment has emerged during the last two decades in response to traditional programs that do not result in sustained reductions in weight. Prewitt. Sproul. E. V. calorie content. 556- 560. Does point-of-purchase nutrition labeling influence meal selections? A test in an Army cafeteria. (2001). Military Medicine. 81(1). St. fat content.. A. insulin resistance.. .. T. For example.. B. although obesity is one of the major health problems today.

... M. both animal and human trials suggest a greater satiating effect of medium-chain triglycelides (MCT) compared with long-chain triglycerides (LCT). Ortega. 95-102. and Lebowitz. C. P. E. H. Developed in 2000 by the Centers for Disease Control and Prevention. Regular physical activity helps avoid weight gain and plays a part in increasing wellbeing by reducing stress.. P. Flores. J. 10-11. N. The increase in childhood obesity and prevalence of chronic disease risk factors demonstrate the importance of creating healthy school environments. Onge. M. 204 St.. S. Stear. common and preventable risk factor for heart disease. I. 2(1). Animal and human studies have shown that the fast rate of oxidation of MCFA leads to greater energy expenditure (EE). H. D.. The aim of this review is to evaluate existing data describing the effects of MCT on EE and satiety and determine their potential efficacy as agents in the treatment of human obesity. V. (2005). J.. P. International Journal of Obesity. The importance of physical activity for health. obesity.. Jones. To determine the effects of long-term consumption of medium chain (MCT) versus long chain triglycerides (LCT) on energy expenditure (EE). MCT consumption will not result in greater EE. N.1. Ross. The author outlines some of the specific health effects of exercise . Physiological effects of medium-chain triglycerides: potential agents in the prevention of obesity. R. The school health index as an impetus for change. Most animal studies have also demonstrated that the greater EE with MCFA relative to long-chain fatty acids (LCFA) results in less body weight gain and decreased size of fat depots after several months of consumption. 132(12). United States-Sonora. the School Health Index was implemented in public schools in two counties along the Arizona. Prev Chronic Dis. Onge. Staten. As part of the Border Health Strategic Initiative. Journal of Nutrition. Between 2000 and 2003. Medium chain fatty acids (MCFA) are readily oxidized in the liver. K. a total of 13 schools from five school districts in two counties participated in the School Health Index project despite academic pressures and limited resources. L.. A19. Halverson. Bourque. St. (2003). P. C. W. the School Health Index offers a guide to assist schools in evaluating and improving opportunities for physical activity and good nutrition for their students. Furthermore. Exercise and health. anxiety and feelings of depression. Mexico border. M. K. type II diabetes and osteoporosis. Medium- versus long-chain triglycerides for 27 days increases fat oxidation and energy expenditure without resulting in changes in body composition in overweight women. (2002). and Parsons. 13(1).. (2003). Health and fitness series -. Journal of Family Health Care. and body weight loss compared with LCT consumption. 13. Physical inactivity is recognised as a significant. 329-333. substrate oxidation and body composition. and Jones. Steinfelt.. 27(1). substrate oxidation. E. Teufel-Shone.

e. food intake. and high total and LDL-cholesterol (TC and LDL-C)) in adult men and women. this does not mean that the other side of the energy balance equation. M. Gittelsohn.. is not important.the importance of physical activity. Obesity in children -. Obesity Reviews. with exercise intervention programs of at least 4 months' duration. The clinical trial data were reviewed on effects of physical activity on obesity-related dyslipoproteinemias (specifically low HDL-cholesterol (HDL-C). fourth.. Fenn. proceedings of the Kellogg's Nutrition Symposium 2000. L. S. especially carbohydrates. 205 and explains the significance of diet. in the prevention and management of childhood obesity. and.. 31(11 Suppl). students' perceived exposure to the Pathways interventions. Many childhood leisure activities. The article includes some practical health education tips. multisite. lack of suitable environments and lack of family time. Stewart. i. Steckler. M. 8 August 2000. and Vu. Smyth. Sydney. and fifth grade students. 2(2). Steinbeck. Active time may be limited by safety concerns. (2001). Steinbeck. Stone. K. At the 21 intervention schools process evaluation data were collected for training of school personnel. 37(6. M. D. Physical activity is the discretionary . J.. S80-S90.. D. Stefanick. as well as cardiovascular risk factors. 117-131. However. and that this decline is a major factor in the increasing prevalence of obesity. Effort was made to identify all randomized clinical trials (RCT). S28-S32 Suppl 1. adult participation in the family events. increase sedentariness. Pardilla. C. The focus of this paper is the role of energy output.. Pathways was a large-scale. Ethelbah. In addition. E. The importance of physical activity in the prevention of overweight and obesity in childhood: a review and an opinion. There are certain risk times for the development of obesity in childhood. physical activity. J. 3-year.. at least in later childhood. including children. which provide a basis for targeted intervention. tracking data supports the persistence of obesity. Medicine and Science in Sports and Exercise. An excess fat gain is the result of an imbalance between energy intake (food) and energy output (physical activity). S609-S618. M. The prevalence of childhood obesity is increasing and there are a number of theoretical reasons as to why intervention may be more effective in childhood. A. Martin. There is evidence that physical activity is declining for the whole population. Pathways process evaluation results: A school-based prevention trial to promote healthful diet and physical activity in American Indian third. Preventive Medicine. K. including viewing television. implementation of the project's food service guidelines in the school cafeterias. (2003). study testing a school-based intervention designed to lower percent body fat in American Indian children. Pt 2). Australian Journal of Nutrition and Dietetics. which had lipoprotein outcomes. B. Physical activity for preventing and treating obesity-related dyslipoproteinemias. (1999).. (2001). elevated triglycerides (TG). implementation of the classroom and physical activity curricula..

V. S. S. Rapid infancy weight gain is associated with childhood obesity. Kerry. L. Stallings. S. Journal of Nutrition. 265-269. it is imperative not only to gain a better understanding of the molecular. R. This trend is partly due to the alarming rise in the incidence of type 2 diabetes over the same period. A. N. Future and implications of reimbursement for obesity treatment. A. and cigarette smoking in adults at increased risk of coronary heart disease. 206 component of energy expenditure and there is evidence that falling levels of physical activity are contributing to the obesity epidemic. 913S-917S. M.. Therefore. If these trends continue. Obesity has been defined as a distinct disease by the World Health Organization. and Strom. This study assessed stages of change in fat intake. S. 111(15). The incidence of end-stage renal disease (ESRD) has risen considerably in the past two decades. but does not treat obesity as the underlying cause... E. and the American Dietetic Association. but also to uncover treatment modalities. E. The United States health care system is focused on treating individual obesity-related diseases. (2005). A. American Journal of Public Health.. whereas low infancy weight is associated with coronary heart disease. T.. National Institutes of Health. Journal of the American Dietetic Association.. 105(5 Pt 2). Schinnar.. and cigarette smoking during a randomized controlled trial of behavioral counseling. but also to become an increasing financial as well as logistical burden on the health care system. Centers for Disease Control and Prevention. Successful prevention of obesity and related cardiovascular risk factors requires a clear understanding of its determinants over the life course. physical activity. 1897-903. cellular and metabolic mechanisms involved in renal pathology. Zhao. including lifestyle changes. ESRD can be expected not only to cause suffering of ever growing numbers of patients. J. a major reimbursement challenge is to promote acceptance of obesity as a chronic disease and acceptance of its treatment by health management organizations. Gades. that can help prevent and/or slow the progression of kidney pathogenesis. Weight gain in the first week of life and overweight in adulthood: a cohort study of European American subjects fed infant formula. (2001). Stern. B.. and the government. In the United States. S. and Downey. Calorie restriction in obesity: prevention of kidney disease in rodents. Stern... (2001)... C. Circulation. E. Our aim was to identify during which periods in infancy weight gain is associated with adult obesity. A. The impact of behavioral counseling on stage of change in fat intake. M. J. J. private insurers. M. Stettler.. 91(2). A. 104-9. which in turn might be linked to the staggering increase in overweight and obesity. B. Nelson. Kazaks. Wheeldon. physical activity. (2005). Troxel. Ziegler. E. and Borchers. Steptoe. and Hilton. Rink.. D. ..

and Schiffer. 24(2). K. 36(3). Obesity is highly related to CVD risk. J. E. low-cholesterol diet and increasing activity. J. Juhaeri. R. Horn. M. J. Ring.. K. M. Preventive Medicine. Cardiovascular disease (CVD) is the number one cause of death in the United States. Cornell. Evans.. M. aetiology and health affects of obesity in American Indian populations is discussed with reference to strategies for treatment and prevention. and Gittelsohn. Dyer. M. Preventive Medicine. B. D. Stolley.. The purpose of this study was to examine the impact of the Pathways intervention on pychosocial variables related to physical activity and diet in American Indian children. (1999). E. E.. Health Education and Behavior. J. Stone. the program addressed the importance of eating a low-fat. The epidemic of obesity in American Indian communities and the need for childhood obesity- prevention programs. Hip-Hop to Health Jr. B.. Given the recalcitrant nature of weight loss interventions for adults. prevention of overweight and obesity has become a high priority. The study's primary endpoint was percent body fat. M. The prevalence of obesity in the United States is a significant public health problem. an obesity prevention program for minority preschool children: baseline characteristics of participants. especially in African American women. B. S13-S23. R. 152-164. M.704 third graders at baseline). This study explored the efficacy of a culturally specific obesity prevention program. 37. G. Caballero. 747S-754S.. 69(Supplement 4). (1997).. implementation. D. Stewart. Many obesity-related risk factors are more prevalent in minority populations. Methods: Pathways employed a nested cohort design in which 41 schools were randomized to intervention or control conditions and students within these schools were followed as a cohort (1. Davis. Pathways was the first multicenter American-Indian school-based study to test the effectiveness of an obesity prevention program promoting healthy eating and physical activity. 37(6 Part 2). 207 Stevens.. Designed for low-income. L. (2003). and quality control in the Pathways American-Indian multicenter trial. The epidemiology. D.. Story. T. 320-329. and Murray. M. L. S70-S79.. M.. E. and Broussard. Fitzgibbon.... Fabsitz. American Journal of Clinical Nutrition. M.. Clay... Murray.. T.. inner-city African American girls and their mothers. especially in children. v. M. Rock.. . Stolley. The impact of the Pathways intervention on psychosocial variables related to diet and physical activity in American Indian schoolchildren. T. Clay. E.. R... A. L. C. and Fitzgibbon. Kaufer Christoffel. (2003). Effects of an obesity prevention program on the eating behavior of African American mothers and daughters.. H. S. R. Preventive Medicine. The present study reports baseline data from an obesity prevention intervention developed for minority preschool children. Design. Lohman. Story. (2003). L. Norman.

13(Supplement 1). F. a generation later. Obesity in American-Indian children: Prevalence.. barriers. H. (1998). and psychosocial factors related to the disorder. S. N. and Barlow. The nutritional health of American Indian and Alaska Native children has changed dramatically over the past 30 years. perceived skill level and training needs in the management of child and adolescent obesity. D.. J. created to test interventions designed to reduce excess weight gain in African-American girls. E. F. D. S... Smyth.. Neumark-Stzainer. M. K. and Dorman.. E... This study was part of the GEMS project.... perceived barriers. (2003).. Ethelbah.. A. Zephier. International Electronic Journal of Health Education. Recommendations are presented for health educators to approach this problem from a holistic perspective involving assistance from parents and teachers and . E. This paper describes the development of an after-school obesity-prevention program for African-American girls. B. Pediatrics. high-calorie foods and the rapid change from active to sedentary lifestyles. J. An after-school obesity prevention program for African-American girls: The Minnesota GEMS pilot study. Preventive Medicine. and Rochon. Strauss. energy expenditure. and Davis. J. K. The primary aim of this study was to evaluate among health care professionals their attitudes.. S. Davis. T. Ethnicity and Disease. Sherwood.. (2002). R. Sherwood.. 37(6 Part 2). Holt. and prevention. The health risks associated with obesity are numerous and include Type 2 diabetes mellitus. Management of child and adolescent obesity: attitudes. J.. Jacobs. Y. Now. Story. M.. B. Sofka. Jr. S1-64. This paper presents a multifaceted etiology of childhood obesity regarding energy consumption. 66-72. H. S3-S12. D. N. and presents findings from a 12-week pilot trial conducted by the University of Minnesota. 2(2). E. Himes.. 208 Story. M. skills. (2003). Himes. and training needs among health care professionals. E. Stone. Nutritional concerns in American Indian and Alaska Native children: transitions and future directions. and Broussard.. M. obesity in American Indian and Alaska Native children is a major health threat. Journal of the American Dietetic Association. 170-176. consequences. behavioral factors. Trowbridge. dyslipidemia. (1999). Childhood obesity: a multifaceted etiology. Stevens. M. K.. 210-214. Story. Obesity has become a major health problem in American Indians only in the past few generations and it is believed to be associated with the relative abundance of high-fat.. 110(1 part2). M. B. Rock. M.. Stouffer. and respiratory problems. American Indians of all ages and both sexes have a high prevalence of obesity. L. The prevention and treatment of malnutrition (primarily undernutrition) was a major health issue until the mid to late 1970s.. Story. hypertension. R. Cartwright.

gene-by- environment interactions and childhood experiences. daily energy intake (EI). A. largely prescriptive and generally of limited success. A. specify for whom and under what conditions effects of agents occur. repeated measures design. (2001). C. Increases in fat. in two ways:.. and Blundell. Stubbs. Considering physical inactivity in relation to obesity. G. Stubbs. N. International Journal of Obesity. Interactions between diet and physical activity in the development and treatment of obesity. Johnstone. It is now widely accepted that diet composition effects energy intake (EI) and energy balance (EB). Although diet and exercise have been linked to health since antiquity.. Faith. Depression and obesity.. The effect of graded levels of exercise on energy intake and balance in free-living women. Physical inactivity and obesity contribute enormously to the current burden of disease in Australia. Current AWM are remarkably rudimentary.. Struber. R. using aspects of diet and physical activity. Biological Psychiatry. R. the connection has recently experienced a revival of interest. (2002). Sepp. C. (2003).. M. and Blundell. Investigated the functional relationship between depression and obesity. The study investigated whether weight loss interventions put children at risk for the development of disordered eating. Horgan.. 866-869.. K. Stunkard. J. The results of a study on obesity treatment are discussed. A. International Journal of Obesity. J. socioeconomic status (SES). disordered eating and stress. Also. Specific nutrients involved and mechanisms by which they operate are more controversial. 54(3). teasing. 330-337. total daily EE and body weight in six lean women using a within-subject. A.. J. (2002). Hughes. J. D. and Allison. such as severity of depression. King. 139(1). H. 2(1). A. 26(6). N. such as eating and physical activity. Moderators.. Mazlan. G. 209 assisting children in making lifestyle changes. (2004). E. Striegel Moore.. M. Hughes.. Horgan. energy density and the sugar content of foods appear to facilitate excess EI. 1-11. N. challenges and future directions for research are given. D.. J. gender. . King.weight control (preventing the development of obesity) and sustained weight reduction (in order to treat obesity). J. 26(1). S. Internet Journal of Allied Health Sciences and Practice. R. S. The impact of pediatric obesity treatment on eating behavior and psychologic adjustment. There is an urgent need to develop new approaches to weight management (AWM). as in all Western Countries. This report used the moderator/mediator distinction to approach this question. identify why and how they exert these effects. Journal of Pediatrics. Johnstone.... Whybrow. severity of obesity. We assessed the effect of graded increases in exercised-induced energy expenditure (EE) on appetite. 13-14. Mediators.

they may be very important in terms of their impact on body weight and health. B. Worth quoting: Instant 'cures' . Makes the point that obesity can only be cured with lifestyle changes. teachers and health professionals support school-based obesity prevention? Nutrition & Dietetics. with prevention of childhood obesity providing a particularly compelling mandate for action. Hudak. sugar substitutes and weight loss drugs only treat the symptoms. (2004). (2005). T. Criteria for NES are evolving but at present do not require distress or functional impairment.. (2004). E. 28(3). R. such as walking more. E. Data suggest that BED fulfills criteria for a mental disorder.. 6(1). 23-33. Suzuki. R. and Logue. 210 Major depression among adolescents predicted a greater body mass index in adult life than for persons who had not been depressed. We propose that a distinction be made between "eating disorders" and "non-normative" eating patterns without associated distress or impairment. 1361-6. Z. Obesity Research. Sutherland.. D. Although non-normative eating patterns may not be considered mental disorders. and Binns. S. 1. Swinburn. M. Gill. The prevalence of overweight and obesity was also assessed to compare to current national figures. . E. This study aimed to investigate the attitudes of parents.. (2004).or solutions? Active living. 61(3). Obesity Reviews.. S. Gill.. While policy and programme funding decisions are inevitably subject to a variety of historical. This paper describes the development of an evidence-based. S. a framework for defining their evidence base is needed. American Journal of Health Behavior. and political influences. It remains unclear whether BED and NES. Missik.. (2004). 137-144. Taylor. Tanofsky Kraff. C. that it should be comprehensive and sustained. and Kumanyika. Hurley. as they are currently defined. Obesity as a major public health and economic problem has risen to the top of policy and programme agendas in many countries. teachers and health professionals on factors contributing to childhood obesity and the role of the school in preventing childhood obesity. and Yanovski. Obesity treatment: broadening our perspective. 12(9). social.. T. decision-making framework that is particularly relevant to obesity prevention.. There is widespread agreement that action is needed urgently. Eating disorder or disordered eating? Non- normative eating patterns in obese individuals. Do parents. are optimally useful for characterizing distinct patient subgroups. 242-249. Obesity prevention: a proposed framework for translating evidence into action. Binge eating disorder (BED) and night eating syndrome (NES) are putative eating disorders frequently seen in obese individuals. and that it should be evidence-based. and that treatment options such as stomach stapling. 13(6).

L. (2004).. S69-S77. weight loss or development of the insulin resistance syndrome. Dowda. Rochon. This study investigated the relationships among optimism. 1525- 1531. B.. The impact of calcium intake on weight loss or prevention of weight gain has been demonstrated in a wide age range of Caucasian and African-Americans of both genders. Obesity is a growing epidemic with subsequent health consequences leading not only to reduced quality of life but also to increased medical costs.. Teegarden. Taylor. (2003).. T. Preventive Medicine. Teixeira. J.. C. B. Teachman. Klesges.. W. Calcium intake and reduction in weight or fat mass... Implicit anti-fat bias among health professionals: is anyone immune.. G. K. many studies have attempted to predict weight outcomes from information collected from participants before they start the programme. S. and Lohman. 418-431. D. To investigate whether negative implicit attitudes and beliefs toward overweight persons exist among health professionals who specialize in obesity treatment. A review of psychosocial pre-treatment predictors of weight control. Taylor. Since the first observations in rats >10 y ago.to 10-year-old African-American girls in the Girls' Health Enrichment Multisite Studies (GEMS). Pediatric Exercise Science. Psychometric properties of optimism and pessimism: results from the Girls' Health Enrichment Multisite Studies. This review focuses on the results of clinical trials that have investigated the impact of calcium and dairy products on prevention of weight gain.. Obesity Reviews. S. (2005). 6(1). and Brownell. 249S-252S. T. International Journal of Obesity and Related Metabolism Disorders.. Identifying significant predictors of weight .. F. Going. (2001). J. Baranowski. and Pate. S. Sardinha. B. 211 To selectively review the dietary literature to broaden perspectives on energy restriction as the primary determinant of successful obesity treatment. and dietary behaviors among 8. physical activity. Activity patterns and correlates among youth: differences by weight status. and Zhou. C. Journal of Nutrition. A. P. P. and to compare these findings to the implicit anti-fat bias evident in the general population. D. Pratt. 43-65. W. J. Eason. A. (2002). M. Prompted by the large heterogeneity of individual results in obesity treatment. pessimism. Freedson. The purposes of the study were to assess differences in physical activity levels and correlates of physical activity among overweight (greater than or equal to 85th percentile of body mass index for their sex and age) and non-overweight (< 85th percentile) youth. 133(1). 14(4).. 38. Growing evidence supports a relationship between increased calcium intakes and reductions in body weight specific to fat mass. R. Sallis.. K. Ey. R. several recently published clinical studies support this relationship as well. M.. C. L.

J. (2004). (2000). N.. E.. and physical activity components of this school-based obesity prevention intervention. Berlan. Thalamas. 26-27.. 49-52. L. C. 23 Hispanic mothers (aged 31-63 yrs) mainly born in Mexico participated. 24(1). Hispanic Journal of Behavioral Sciences. K. S. M. H. M. 695-700. Family behaviours regarding food choices and physical activity were identified and ranked according to priority by using formative assessment and a literature review of school-based programmes that included a family component. To determine the effect of an alpha2-adrenoceptor antagonist.. M. Davis. for example. American idle. M. cultural and familial dynamics.. and their relation to eating habits. as it could help professionals focus efforts on those most likely to benefit. J. J. Story.. and Barbe. The authors examine. Teufel. C. and Pablo. on the sympathetic nervous system and on energy expenditure responses after an oral glucose load. Poor lifestyle choices are causing childhood obesity to surge. P. Altaha. M. D. Levin. Montastruc. 69(Supplement 4). J. (2002). International Journal of Obesity and Related Metabolism Disorders. T. body mass index (BMI) and general well-being. S. J. Thomas.. Hispanic women.. J. Senard. C. L. M. Belkic. The goal of the feasibility phase of the Pathways family intervention was to work with families of third-grade American Indian children to reinforce health behaviours being promoted by the curriculum. Perry. Obesity.. 212 loss outcomes is central to improving treatments for obesity. Flint-Wagner. J. Clay. paid and unpaid work. Galitzky. Thew. An exploration of psychosocial determinants of obesity among Hispanic women. L. idazoxan. Pathways family intervention for third-grade American Indian children. American Journal of Clinical Nutrition.. which the authors explore through quantitative and qualitative methods. Managing obesity: the nutritional aspects. Nursing Standard. L. Glucose-induced sympathetic activity and energy expenditure during acute alpha2- adrenergic antagonism in obese subjects. food service. and help in matching individuals to different treatments. Teran.. 54-55. 16(16). 92-103.. .. (1999).. suggest supplementary or alternative treatments for those less likely to succeed. and Johnson. I. in obese patients.. (idazoxan acts as an indirect sympathomimetic drug through blockade of presynaptic alpha2-adrenoceptors). Nursing Spectrum.. G. L. has a psychosocial cultural context. (1998). a major public health problem among US. but it's not too late to teach kids healthy living.. 12(18). Gittelsohn. RCN continuing education. Lafontan. 803S- 809S.

. (2002). (2004). K. resources are decreasing. Gittelsohn.. Teachers have responded to recommendations by including lifetime activities. supports. The research goal. Approximately half the recommended minutes per week are provided in schools where there is any PE. African-American caretakers of preschool children. T. 407-421.. 14(1). 213 This article discusses the nutritional aspects of obesity and the role of the nurse in helping patients to achieve optimum weight levels. Thomas. and. Going. Metcalfe. Fighting childhood obesity with university-community partnerships. 26(6). Few resources have been allocated to support the schools and in the presence of budget and high stakes testing pressure. congruent with the concept of cultural humility. and teachers of urban. M.. health related fitness. Riding to the rescue while holding on by a thread: physical activity in the schools. this study investigated patterns. and Story. Becenti.. Leadership lessons learned are provided for nurses interested in leading efforts to improve the health status of communities. S.. A. (2003). and Grey. L. 7(1). A model of University-Community partnership is proposed which incorporated the core leadership competencies of the RWJ program--interpersonal and communication effectiveness. Journal of Community Health: The Publication for Health Promotion and Disease Prevention. The public health burden of obesity. many (5- 33%) schools have no PE for their students. L. government. 28-37. Thompson. Journal of National Black Nurses' Association. Focus groups were conducted with parents. African American preschool children attending Head Start. 150-170. coalitions/foundations) often criticize schools and teachers while providing erroneous information and no support.. Schools were challenged to take action by the Surgeon General in 2001. L. Sources of support (research. E. K. S.. was to elicit target population members' . professional organizations. Stone. L. S.. other caretakers. strategic vision. self- knowledge. Thompson. and physical inactivity suggests schools be actively involved in prevention and treatment. and increasing MVPA. and Ring. Harnack. S. Nursing Leadership Forum. (2001). M.. overweight. 56(1). Davis. J. skills in creating change. Patterns of physical activity among American Indian children: An assessment of barriers and support. Thompson. L. M. Quest. As part of an initiative to develop and test a school-based obesity prevention program. This article describes how two Robert Wood Johnson (RWJ) Executive Nurse Fellows used their leadership competencies to inspire and lead change within the community to fight the growing problem of childhood obesity. J. risk-taking and creativity. 20-24. and barriers to physical activity in a sample of American Indian children. Perceptions of overweight and obesity in their community: findings from focus groups with urban. Nine schools from communities representing 6 different tribal groups participated in this study.

(2002). J. Moreover. 35(3). physical activity. W. International Journal of Obesity and Related Metabolism Disorders. Baranowski.. V. A. and Dietz. Tilghman. L. T. F. W. A. G.. 193-199. Cullen. H. 282-289. M. The aim of this study is to assess the relationship between eating food purchased away from home (FAH) and longitudinal change in body mass index (BMI) z-score among girls. C. developing strategies for use in practice and providing education to the public about the potentially deadly consequences of obesity. 66-68. T. importance. The risk of diabetes is significantly related to obesity. Hellers.. Obesity has reached near epidemic proportions in the United States... Thompson. these participants tended to offer suggestions for health professionals and those designing nutrition education interventions. Cyr.. K. K. C... Ballew. The risks of morbidity and mortality associated with diabetes poses serious problems for the African American community.to 10-year old girls at risk of becoming obese. (2003).. L. Lonnqvist. A pilot study of long- term effects of a novel obesity treatment: omentectomy in connection with adjustable gastric banding. Journal of Nutrition Education and Behavior. (2004).. and Nicklas. Baranowski. 214 perspectives on the nature. J. Must.. W. 115-123.. Thompson. 14(3). ABNF-Journal. Thorne. H. Design: Interviews and group qualitative discussions were conducted separately with 8. International Journal of Obesity and Related Metabolism Disorders. Apelman. and to assess the longitudinal tracking of eating FAH from childhood through adolescence. particularly African American women. P. and inactivity influences among preadolescent African American girls at risk of becoming obese. these same participants had a complex view of the relationships of weight and health. Obesity and diabetes in African American women. The prevalence of obesity is high among African Americans. 28(2).to 10-year-old African American girls and their parents.. and causes of overweight and obesity in their community. O.. J. To determine whether visceral fat reduction in connection with bariatric surgery could improve weight loss and metabolic profile of obese subjects. Food purchased away from home as a predictor of change in BMI z-score among girls.. prevalence.. and Arner. Taylor. Bandini. . (2003). with an emphasis on childhood obesity. J. stressed numerous environmental factors contributing to obesity. To understand diet. Themes that emerged revealed that participants defined obesity as a more extreme state than the medical definition. Resnicow. G. It is vital that nurses be at the forefront in initiating research studies. Influences on diet and physical activity among middle-class African- American 8. Rittenberry.

. Caloric and fat intake were not significantly related to perceived deprivation. 39(1). A prospective study using 14-day food diaries was conducted to determine whether perceived deprivation and preoccupation with food correspond to actual caloric and fat intake. This column looks at whether there is a practical solution yet. McBride. Pandemic obesity: what is the solution? Nutrition Today. G. and. (2003). (2001). J. Albright. Dieting. Tillotson. if there is.. and 70% expressed willingness to participate in health promotion for the entire family. 37(3). J. 71(10). Attitudes toward smoking and family-based health promotion among rural mothers and other primary caregivers who smoke. most did not want their children to smoke. E. what is it? Here goes! Tilson. and Sargent. Western Journal of Nursing Research. The family milieu provides a potential context for integrating smoking cessation and prevention activities to complement school-based efforts. and Gregg. These findings support the contention that psychological deprivation occurs regardless of caloric intake.. These findings suggest the feasibility of a program in which adults and children work together at home on smoking cessation and prevention activities that might increase the effectiveness of school-based smoking prevention messages. E. . C. M. Only weight cycling and Revised Restraint Scale was significantly correlated with perceived deprivation with 11% of the variation explained by the Revised Restraint Scale scores. E. Journal of School Nursing. J. K. and preoccupation with food. 405-418.. and receptivity to and preferred format for health promotion programs. perceived deprivation. 215 Tillotson. Written materials either mailed home or brought home from school were the preferred program formats. For preoccupation with food. B. Is the food business to blame for the fattening of America? Can nutrition professionals play the blame game and get themselves off the hook? Some perspectives on the strategy and tactics of the war against obesity. "What is the practical solution to the obesity problem?" is the perceptive question I was recently asked by Linda Hirsh. 6-9. (2002). In this study. 489-494. only fat intake and Revised Restraint Scale scores were significantly correlated with 15% of the variance explained by the Revised Restraint Scale scores. J. Fifty-three percent (n = 276) of 501 caregivers responded. using a sample of 121 adult women who were binge eating without purging or were currently dieting. smoking characteristics and attitudes. Field Producer for the Peter Jennings' Show. 136-138. E. We're fat and getting fatter! What is the food industry's role? Nutrition Today. surveys were mailed to caregivers of elementary school children to assess demographics. She was preparing a television show on the American obesity problem for fall viewing on ABC. and they wanted to quit themselves. M. (2004). 25(4). Timmerman. Among smokers. D. 91% considered it important to involve their children in their smoking cessation attempts. C.

(2004). Journal of the American Academy of Nurse Practitioners. and that their effects might be attributed. International Journal of Obesity and Related Metabolism Disorders. Long-term feeding of tea catechins suppressed body fat accumulation in high-fat diet- induced obesity in mice. These results demonstrate that intake of tea catechins is beneficial for body fat accumulation. S. 22(1-4). 38-40... Burns. S. 12(4). K.. 3(4). Practice patterns between gender. P. 48.. and Graff-Iversen.. Cameron-Smith. J. The public's response to the obesity epidemic in Australia: weight concerns and weight control practices of men and women. A. weight concerns and weight control behaviours and related beliefs in a representative sample of adults from the state of Victoria. at least in part.. (1997). Australia. especially abdominal fat in humans. Reifsnider. (2001). D. We asked whether most men and women targeted in obesity guidelines would already be included in existing clinical recommendations for the prevention of coronary heart disease (CHD) or whether a new group of patients would be added to current workloads. 141-3. S. C. and Todd. and Allan. What is a realistic approach to weight loss? What are the best methods to use? This article identifies the probably causes of obesity and provides new insights for treatment. The survey was conducted between October and December 1997. A convenience sample of 17 nurse practitioners and 15 physicians were surveyed about assessments and interventions used in practice for weight management along with perceived barriers to providing effective weight management. an important component of primary care. 45- 46. Gross. Guidelines for treating overweight and obesity have been suggested by the World Health Organization and other expert groups. 10(10). D. Biofactors. Obesity: manage as chronic disease or behavioral problem? JAAPA: Journal of the American Academy of Physician Assistants. Timperio. D. Tokimitsu. This pilot study examined how primary care providers manage patients with weight problems. G. (2000). Weight management practices among primary care providers.. to the activation of hepatic lipid metabolism. and Crawford. E. Topping. I. Action levels for obesity treatment in 40 to 42-y-old men and women compared with action levels for prevention of coronary heart disease. 417-424.. To assess weight perceptions. Public Health Nutrition. 113-116. (2000). Tonstad. Consecutive intake of tea catechins (588 mg/day) reduced body fat. 216 Timmerman. . Effects of tea catechins on lipid metabolism and body fat accumulation. M. profession and practice setting of the nurse practitioners were compared. 1698-1704.

C. 13 cohort studies were conducted in the US and internationally. Between 1989 and 2001... even in the obese. and prevalence of gallstones. Torgerson. nine showed an association between exercise and decreased prostate cancer risk. Obesity and weight loss have been associated with gallstone disease. J. L. 2-yr incidences of these disorders were examined in relation to changes in weight and body fat distribution after surgical and conventional obesity treatment. T. S. International Journal of Obesity and Related Metabolism Disorders. Torgerson. body fat distribution. Low-carbohydrate dieting: what's going on? Scandinavian Journal of Nutrition. O. T. Naslund. and pancreatitis in men and women. Lindroos. A review of available clinical trials indicates that there is not enough information on efficacy and safety to make clear recommendations for or against the use of such diets in obesity treatment. 167-169.. This review summarises the literature that examines the association between exercise and prostate cancer risk. making interpretation of data difficult. 98(5). The Swedish Obese Subjects (SOS) study--rationale and results. Exercise and prostate cancer. 47(4). is also related to an increased mortality. and Peltonen. gallbladder disease. E. M. 31(11 Suppl). The purpose was to review studies that have examined the effect of aerobic (AEX) or resistance exercise (REX) on body composition in older individuals (> 55 yr). A. In addition to improved treatments. The Swedish Obese Subjects (SOS) study was initiated in 1987 as an attempt to elucidate this paradox. 217 Torgerson.. Beckett. There is also an association between gallstones and pancreatitis. J. and Poehlman. Of these. (2004). too many published studies have methodological shortcomings. Physical activity and the progressive change in body composition with aging: current evidence and research issues. J. Our goal . Obesity is associated with increased morbidity and mortality.. 363-369. K. and pancreatitis: Cross-sectional and 2-year data from the Swedish Obese Subjects (SOS) and SOS reference studies.. and Matheson. strategies to reduce disease risk are urgently required. D. Unfortunately. Torti. 34(6). Furthermore. S. and Sjostrom. We investigated cross-sectional relationships between body mass index (BMI). (2003). Sports Medicine. gallbladder disease. 1032-1041. I. S590-S596. (2001). J. Gallstones. Toth. American Journal of Gastroenterology. Low-carbohydrate diets have become increasingly popular in recent years. S. (1999). Medicine and Science in Sports and Exercise. M. G.. Prostate cancer is a leading cause of cancer morbidity and mortality in men. Several observational epidemiological studies have indicated that weight gain and weight loss. (2003). S2-S4.

Effects of chromium picolinate on body composition. 57(3). on macronutrient selection. and Popkin. sertraline) in a wide range of disorders like headache due to stress and tension. The impact of physical exercise on macronutrient preferences was examined with a perspective to improve preventive and therapeutic strategies of obesity. 38(2). fluvoxamine. Journal of Psychosomatic Research. Tremblay. 31(5). one observation stands out and that is the fact that dietary fat intake needs to be controlled in order for exercise to produce a negative energy and fat balance. Physical activity and preference for selected macronutrients. Various studies. and Biondi. Tseng. L. To investigate the characteristics and prevalence of binge eating among overweight Taiwanese and to determine the effect of binge eating on outcome of weight loss treatment.. S584-S589.. Chen. Some atypical therapeutic effects of SSRI / Alcuni effetti terapeutici atipici degli SSRI. M. K. C. S. M. Ainsworth.. 59-70. (1999). propose that SSRI could be useful in pathologies different from psychiatric disorders. B. This study explored the efficacy of chromium picolinate as a fat-reduction aid for obese individuals enrolled in a physical exercise program. it is important to provide nutritional guidelines in a context where physical activity aims at reducing or better controlling body weight. and Drapeau. S. Because active individuals do not systematically choose foods that are low in fat content. D. The presently available literature does not permit to establish a consensus regarding the impact of physical activity. K. Tudor Locke. put emphasis on the advantage of using several SSRI (paroxetine. A.. However. Y. The literature was reviewed pertaining to the acute effects of physical activity and the short-term and chronic effects of exercise training on macronutrient preferences. M. Trent. J.. (2001).. 218 was to examine the effect of these two exercise paradigms on fat mass and fat-free mass and to consider those factors that may explain variability in findings among studies. Y. Lin. V. R. Active commuting to school: an overlooked source of childrens'(sic) physical activity? Sports Medicine. V. . H. Medicine and Science in Sports and Exercise. 309-313. be it acute or long-term. B. C.. E. Several studies published in the recent years.. (2003).. treatment of pain. 35(4). P. Trincia.. Lee. migraine prevention. Lee. in which the majority of the cases have been conducted in a controlled manner with random double-blind selection. 273-278. 31(11 Suppl). and Thieding Cancel. B. Rivista di Psichiatria. (2004). Chen. 279-285.. premenstrual syndrome and premature ejaculation. (1995). Response of Taiwanese obese binge eaters to a hospital-based weight reduction program. and Lai. M. Journal of Sports Medicine and Physical Fitness. fluoxetine. J.

Shakib. (2004). to a lesser extent. Previous studies have implicated acculturation to the US as a risk factor for unhealthy behaviors among Hispanic and Asian-American adolescents.Objective: This paper analyses how supplementary feeding programmes may contribute to rising obesity trends. violence. J. R. P. 285-292. D. The epidemiological transition: need to incorporate obesity prevention into nutrition programmes. Uauy. It also explored the participants' interest in making lifestyle changes to promote a healthy weight. (2004). This study examined the association between acculturation and . and unsafe sex.. A medical records review indicated that of the Hispanic children between the ages of 7 and 12 years. and continual professional development. debunk nutrition and health information. 186-191. Acculturation. Public Health Nutrition. Journal of Community Health. and Tagtow. S. Overweight and perceived health in Mexican American children: a pilot study in a central Texas community.. This study assessed actual and perceived health status of overweight Mexican American clients at a central Texas school-based health center in a predominantly Hispanic school district. Reynolds... R. A. and fast-food consumption among Asian-American and Hispanic adolescents. 20(5). what factors may explain this phenomenon. out-of-school structured exercise. field-based training. The primary focus of both assessment and promotion efforts has been on in- school physical education classes and. K. (2003). A new vision for health promotion and nutrition education. Tuttle. 29(6). Spruijt-Metz.. and (ii) to establish an early habit of lifestyle physical activity that can be sustained into adolescence and adulthood. 38% had a weight status at or above the 85th percentile. B. Recommendations for strengthening the role of health promotion in settings where nutrition educators work are provided and include the need for strong academic preparation. D. including substance use. and Johnson. and potential strategies to avoid obesity in malnutrition prevention efforts. O. J.. C. 467-81. and mitigate the effect of chronic diseases is the vision presented for success in the future. Sun. Current and optimal roles of educators are discussed in relation to societal trends and their inherent opportunities and barriers. 18(2). American Journal of Health Promotion. sport and play. physical activity. B. (2002). Derrick... and Kain. 219 The assessment and promotion of children's healthful physical activity is important: (i) to combat the international obesity epidemic that extends to childhood. A. 5(1). Journal of School Nursing. C. 223-230. Unger. Trends in the nutritional status for developing countries that are undergoing rapid economic growth indicate a decrease in protein-energy malnutrition (PEM) with an associated rise in obesity prevalence. Tyler. Increased integration and collaboration of health promotion and nutrition education professionals to effectively engage consumers.

. L. Maximal aerobic power and body composition were measured in all subjects before and after a 12-week diet intervention period. I. Leisure-time activity is an important determinant of long-term weight maintenance after weight loss in the Sibutramine Trial on Obesity Reduction and Maintenance (STORM trial). To improve the success rate. and Saris. S. and controls (C). W. Hilsted. Early lifestyle intervention in patients with non-insulin-dependent diabetes mellitus and impaired glucose tolerance.. 78(2). but in a former study we could show that this led to an increase in fibrinogen with a possible alteration in coagulation. A. Uusitupa.. exercise (E) (five 45-min sessions at 78. and Nieman. P.. P.. D. Astrup. . G. A. Influence of diet and/or exercise on body composition and cardiorespiratory fitness in obese women. Roecker. 28(5). Finer. J. The success rate of long-term maintenance of weight loss in obese patients is usually low.5 percent maximum heart rate). Van Gaal. C.. 445-449. J. The purpose of this study was to measure the influence of diet.. determinants of long-term weight maintenance must be identified. Nieman. M. (2003). Mueller. V.5 plus/minus 0. James. One-year dietary and exercise intervention on 86 40-64 yr old obese patients with newly diagnosed noninsulin-dependent diabetes mellitus (NIDDM) in Kuopio. Body weight reduction and physical activity is generally recommended in obese hypertensives. Kopelman. C. Shannonhouse... J.. 209-214. E.. exercise. 220 obesity-related behaviors-physical activity and fast-food consumption-among 619 Asian- American and 1385 Hispanic adolescents in Southern California. (2002). Van Baak. Van der Meyden. Annals of Medicine. U.. W.300 kcal/day).. D. W. I.19-5. E. M. (1998). J. Finland resulted in a better metabolic control and a moderate reduction in cardiovascular risk factors as compared to the conventional treatment group. M. Ninety-one obese subjects were randomized into one of four groups: diet (D) (4. Van Mil.200-1. M.. N.. Butterworth. International Journal of Sport Nutrition. A. and Franz. H. Roessner. Toennesmann. 213-222.. C. L.. exercise and diet (ED). 23(2). (1996). Does body weight reduction and physical activity alone and in combination with ACE-inhibition influence the disturbed balance between coagulation and fibrinolysis in obese hypertensives? International Journal of Sports Medicine. F. Utter.44 MJ or 1. or both on body composition and cardiorespiratory fitness in obese women. 8(3). E. N. a multicenter European study of weight loss and weight maintenance in obesity that combines sibutramine treatment with dietary restriction and advice on exercise and behavior. The objective of the study was to identify determinants of long-term success in weight maintenance in obese subjects who completed the Sibutramine Trial on Obesity Reduction and Maintenance (n = 261). American Journal of Clinical Nutrition.

International Journal of Obesity. Ziegler. (2002). 560-568. and Rossner. Rissanen. M. Lancet. van den Borne. H. To evaluate the effects of a 3-mo moderately intense exercise program. To examine whether a family history of high-risk groups for major noncommunicable diseases (NCDs) was a significant risk factor for these conditions among family members in a study population in the Gambia. O.. G. 221 Van der Sande.. J. W. B. J. Anthropometry. (BULL-WORLD- HEALTH-ORGAN) 2001... Widdershoven.. G. and Muls. S. and 6-min walk test were assessed. . and McAdam. 79(4): 321-8 (30 ref). E. W. A. M. cognitive-behavioral conceptualization of obesity treatment (Master Questionnaire). Milligan. Lysens. low back and knee pain. Ceesay. S. We assessed the effect of rimonabant.. K. 1389-97.. and Curfs. (2002). Scheen.. The aim of care is to optimize quality of life and promote self-determination. S. In animal models. Vansant. 46 obese women (21-68 yr. Beck Depression Inventory. A. on bodyweight and cardiovascular risk factors in overweight or obese patients. a selective CB1 blocker. Journal of Multicultural Nursing and Health. M... Today. people with ID are seen as citizens who need to be supported to achieve a normal role in society. Van Gaal.. G. 365(9468). Caregivers are regularly confronted with situations in which there is a conflict between providing good care and respecting the client's autonomy. assertiveness (Interpersonal Behavior Scale). G. The promotion of autonomy for people with ID is not easy and gives rise to ethical dilemmas. exercise capacity (VO sub(2)peak using graded maximal ergometer bicycle). cannabinoid-1 receptor (CB1) blockade produces a lean phenotype. physical activity (Baecke questionnaire). M. Effects of the cannabinoid-1 receptor blocker rimonabant on weight reduction and cardiovascular risk factors in overweight patients: 1-year experience from the RIO-Europe study. R. van Hooren. W. M. Family history: an opportunity for early interventions and improved control of hypertension. A. M. (2005). Banya.. (2001).. The policy concerning care for people with intellectual disability (ID) has developed from segregation via normalization towards integration and autonomy. E. with resistance to diet-induced obesity and associated dyslipidaemia. 46(7).. 26(1). where strong community and family coherence are important determinants that have to be taken into consideration in promoting lifestyle changes. L. L. Moderate training improves physical fitness and quality of life in obese women. H. A. P. Autonomy and intellectual disability: the case of prevention of obesity in Prader-Willi syndrome. A. A. R. F. P. Hulens.. L. BMI >30 kg/m super(2)) received multidisciplinary treatment for 6 mo. body image (Body Attitude Scale). Nyan. O. obesity and diabetes. M.. Walraven.

L. A. K. and Lustig. and mitochondrial metabolism. A.. could promote weight loss and alter food intake and preference in obese adults.. A.. cognitive. 95(3). H. P. Effects of television viewing on children's development. K. A. pediatric nurses need to be aware of the effects of inappropriate television viewing. we studied the effects of school programs in regard to preventing excess body weight. without dietary or exercise intervention. 222 Veech. J. 27(2). G. . E. and psychological effects associated with inappropriate television viewing and suggests assessment procedures and interventions that can be used with families who want to change their pattern of television viewing. Effectiveness of school programs in preventing childhood obesity: a multilevel comparison. and MacKenzie. Buffington. The effects of ketone body metabolism suggests that mild ketosis may offer therapeutic potential in a variety of different common and rare disease states. Veugelers. Dietary intake and risk factors for poor diet quality among children in Nova Scotia.. The therapeutic implications of ketone bodies: The effects of ketone bodies in pathological conditions: Ketosis. P.. K. B. R. W. (2005). Prostaglandins Leukotrienes and Essential Fatty Acids. We investigated whether suppression of insulin secretion... E. 309- 319. 96(3). ketogenic diet. Cowan. Hyperinsulinemia is a common feature of many obesity syndromes. Pediatric Nursing.. (1998). K. (2003).. and Johnston. Fitzgerald. Yim Chiplis. International Journal of Obesity. L. Suppression of insulin secretion is associated with weight loss and altered macronutrient intake and preference in a subset of obese adults. Connelly.. Arheart. A. Primary care approaches. R. Vessey. Am J Public Health. L. (2004). the normal mitochondrial fuel produced by glycolysis leading to an increase in the DELTAG' of ATP hydrolysis. 24(5). L. P. A. C. Canadian Journal of Public Health. Spencer. 212- 6. Here we examine dietary intake and risk factors for poor diet quality among children in Nova Scotia to provide direction for health policies and prevention initiatives. redox states. 432-5. (2005). J. R. Cowan. 483-486. P. Veugelers. 70(3). Because television and its explicit and implicit messages are ubiquitous in our society. Velasquez Mieyer. P.. despite the importance of diet for the temporal increase in the prevalence of childhood obesity.. In light of the alarming increase in childhood obesity and lack of evidence for the effectiveness of school programs. and Fitzgerald. insulin resistance. Public health policies promote healthy nutrition but evaluations of children's adherence to dietary recommendations and studies of risk factors of poor nutrition are scarce. This article reviews physical. N. 219-226. J. These inferences follow directly from the metabolic effects of ketosis and the higher inherent energy present in D- beta-hydroxybutyrate relative to pyruvate.

213-230. Frances Vickers reports. its effectiveness in manifesting body composition changes has been an area of intense debate in the last decade.. most studies have focused on the use of chromium picolinate [Cr(pic)(3)]. Scavron. The health risks associated with being overweight are poorly understood by the public... Sports Medicine. Seven components of the concept of hope were described in the context of the women's weight-loss experiences. Obesity is a fast growing epidemic that is primarily due to environmental influences. there remains continued debate regarding the energy content and the optimal macronutrient distribution for promoting healthy and effective weight loss. Obesity bodes ill for the future. K. 174-187. hoping to maintain a balance. Because the supplement is absorbed better than dietary chromium. J. 34-35. The potential value and toxicity of chromium picolinate as a nutritional supplement. and Forsythe. A unique pattern of hope. K. Diet and exercise for weight loss: a review of current issues. Diabetes Educator. M. and De Torrijos. The secondary analysis of transcripts from a study of 9 women who used prescription anorexiant medications described in this article was conducted to discover the role that hope played in the women's weight-loss initiatives. chromium dietary supplementation has been postulated to potentially have effects on body composition. however. J. 10(11). It was found that hope grew throughout the women's weight-loss initiative but peaked once the medications were discontinued. 1-9.. Rosal. Despite considerable research. Characteristics of hope in women who have discontinued anorexiant medications are different than those associated with hope in other contexts. (2005). Nutrition and exercise represent modifiable factors with a major impact on energy balance. 33(3). 663-672. weight loss agent and muscle development agent. (2002). especially with athletes who may have exercise-induced increased urinary chromium loss. describes the women's experiences as they strove to maintain the weight they had lost.. Cr(pic)(3) has been amazingly popular with the general public. Sports Medicine. 10(2). Volume. . and Farris. F. C. L. Vanheest. J. Von Goeler. Ockene. S. C. B. D. J. (2000). 223 Vickers. (2003).. C. Self- management of type 2 diabetes: a survey of low-income urban Puerto Ricans. J. S. Low-fat diets have been advised for many years to reduce obesity. Hoping to maintain a balance: the concept of hope and the discontinuation of anorexiant medications. Vincent. The element chromium apparently has a role in maintaining proper carbohydrate and lipid metabolism in mammals. World of Irish Nursing. E. (2003). As this role probably involves potentiation of insulin signalling.. including reducing fat mass and increasing lean body mass. 29(4). B. F. Volek. I. Qualitative Health Research. 35(1).

T. 510-526. and Byrne. (1998). (2004). S.. This paper provides the justification of physical activity promotion for health by critically reviewing the recent US Surgeon General's Report. Management of the obesity epidemic will require a two-pronged approach. A. Evidence is summarized of the effects of physical activity on physiological responses. Obesity has reached epidemic proportions in the United States and other developed nations. M. Foster.. .. I. including the Diabetes Prevention Program. and Brownell. 560-568. Sanderson. Dieting and the development of eating disorders in obese women: results of a randomized controlled trial. Berkowitz. K. S95-S103.. D. and mental health and quality of life. 151S-62S. (2002). the great number of health conditions being affected by physical activity. A comprehensive program of lifestyle modification induces loss of approximately 10% of initial weight in 16 to 26 weeks. High levels of physical activity and the consumption of low-calorie. including liquid meal replacements.. appears to be attributable to a toxic environment that implicitly discourages physical activity while explicitly encouraging the consumption of supersized portions of high-fat. as revealed by a review of recent randomized controlled trials. overall functional capacity. Does physical activity enhance health? Patient Education and Counseling. or e-mail. can also help maintain weight loss. L. Wadden. Foster. (2004). D. A. T. Sarwer.. In the United States. low-income Puerto Rican individuals. portion- controlled meals. and Phelan. A. American Journal of Clinical Nutrition. R. Letchak.. Efficacy of lifestyle modification for long-term weight control. The marked increase in prevalence.. high-sugar foods. D... Research in the past decade has shown that genetic influences clearly predispose some individuals to obesity. 33. D. Wadden.. 12 Suppl. mail. It is concluded that the health potential of physical activity is substantial due to the high prevalence of inactive lifestyle in the populations. 224 This study explored self-reported barriers to diabetes self-management in a population of urban. Cumulating evidence suggests that the effects be applicable to both genders and to a wide age range. D. Wadden. Vuori. and the feasibility arid safety of physical activity as a health measure. V. K. a number of diseases and disabilities. A. overall mortality. G. G.. B. 70(3). however. Obesity: responding to the global epidemic. whether provided in person or by telephone. I. Journal of Consulting and Clinical Psychology. Long-term weight control is facilitated by continued patient-therapist contact. It is emphasized that substantial health effects can be gained by moderate daily physical activity which does not require high skill level nor specialized equipment or facilities. J. R. Obesity Research. T. R. The adverse effects of physical activity on health are shown to be small and mostly preventable. 80(3). M. 27% of adults are obese and an additional 34% are overweight. Butryn. Gladis. Anderson. S.

treatment of the overweight patient. 93-107. 73-9. Where once the goal was a reduction to ideal weight. Developing effective strategies for treatment and prevention is therefore a priority for clinical medicine and public health. The objective of the study was to examine whether dieting would elicit binge eating and mood disturbance in individuals free of these complications before treatment. combining behavioural and pharmacological interventions. I. this means losing as little as 5-15% of their initial weight.. ACSM's Health and Fitness Journal. and Griffith.. (2005). 64(1). This process is taking place at a time of unprecedented change in the understanding of the role of genetic factors in human health and disease. Socioeconomic status and weight control practices in British adults. decreased physical activity. and Berkowitz. The importance of helping obese individuals adopt realistic treatment expectations is also discussed. B. J. and Bollier. Reports on studies and statistics on childhood obesity are also included. Wadden. Understanding the aetiology of childhood obesity: implications for treatment. The goal of obesity treatment has changed significantly in the past decade. Childhood obesity: causes and treatment. 225 Some investigators fear that dieting may precipitate binge eating and other adverse behavioral consequences. (2003). M. Holloman.. Clinical Endocrinology and Metabolism. Proceedings of the Nutrition Society. L. H. without further treatment. maintain a loss of 5% one year later. 17-22. Journal of Epidemiology and Community Health. 7(1). Includes the role parents have in the prevention and treatment of obesity in children. and genetic research into obesity has challenged assumptions about causal processes. Wardle. J. (2001). Describes treatment suggestions such as early intervention.. (1999). Methods of improving the maintenance of weight loss include increasing physical activity. P. Walters. T. Childhood obesity poses one of the greatest challenges to paediatric health in the 21st century. Blomquist. extending the length of behavioural treatment and. D. with appropriately selected individuals. physical activity and helping children to eat in response to hunger.. Discusses how genetic predisposition. R. J. A. A review of recent studies shows that patients treated by a comprehensive group behavioural programme lose approximately 9% of their initial weight in 20 weeks and. 13(1). the current objective is the achievement of a healthier weight. For many obese individuals. Attitudes and practices concerning weight control in British adults were examined to test the hypothesis that variation in concern about weight and deliberate weight control might . Sarwer. A. poor dietary choices and the environment play a role in childhood obesity. Wardle. 55(3). 185-190. This article briefly describes behavioural methods to help obese individuals modify their eating and activity habits in order to achieve these new goals..

S. A. Mass education for obesity prevention: the penetration of the BBC's 'Fighting Fat. Demographic factors associated with awareness of the campaign were analysed. This paper describes the development. Awareness of the campaign was high in all socio-economic groups. Waller. implementation and evaluation of a school.. but memory for the healthy lifestyle message was significantly poorer in those with lower levels of education an from ethnic minority groups. J. 287-296.. J. Data collected were part of the monthly Omnibus Survey of the Office of the National Statistics in March 1999. H. but not men. and ethnicity. and combined nutrition and physical activity group. Fighting Fit" Campaign's success in achieving public awareness of the need for obesity prevention.. marital status... T. M.. (2001). Questions included weight and height. 16(3). Higher SES groups were hypothesised to show more weight concern and higher levels of dieting. Warren. M. but suggest that different approaches might be needed to maximize participation from groups most in need of lifestyle change. Children aged 5- 7 years (n = 213) were recruited from three primary schools in Oxford and randomly allocated to a control group or one of three intervention groups: nutrition group. and 2 economic markers after controlling for age. Implications of these findings for understanding causes and prevention of obesity are discussed. J. healthy eating habits and increased physical activity.. J. Health Education Research. recognition of the campaign name. 226 partly explain the socioeconomic status (SES) gradient in obesity. 343-355. Fighting Fit' campaign. Miles. The results strongly support the effectiveness of the campaign in publicizing the issue of increasing prevalence of obesity and the need for lifestyle change. More than half of the respondents had heard of the campaign and 30% recalled the healthy lifestyle messages. J. Awareness was also not higher in overweight than normal weight respondents. S. 92(8). and participation in the campaign registration scheme.. whereas higher occupational status was associated with a lower risk only for women. K. M. Sex differences in the association of socioeconomic status with obesity. Health Promotion International. Fewer than 1% registered to participate in the scheme. and Perwaiz. Investigated socioeconomic predictors of obesity in 15. Wardle.. and Duman. Obesity risk was greater among men and women with fewer years of education and poorer economic circumstances and among women. J. Rapoport. Afuape. and Jarvis. (2003). Wardle. physical activity group.and family-based intervention to prevent obesity in children aged 5-7 years. Data from the 1996 Health Survey for England were used to compare odds ratios for obesity by education. Higher educational attainment and higher socioeconomic status were associated with a lower risk of obesity in both men and women.061 men and women (aged 16- 75+ yrs). occupation. L.. J. 1299-1304. of lower occupational status. Evaluation of a pilot school programme aimed at the prevention of obesity in children. 18(4). M. Lightowler. The study aimed to evaluate the BBC's "Fighting Fat. American Journal of Public Health. Bradshaw. The setting for the . (2002). C. Henry.

. M. Waterhouse. (2005). 276-277.. 227 interventions was lunchtime clubs. 6(4). Exercise training in obese children and adolescents: current concepts. . and Green.. L. Evidence suggests that non-physically active children are more likely to become non-physically active adults and that encouraging the development of physical activity habits in children helps establish patterns that continue into adulthood. D. K. S. Pediatrics. A. diet and physical activity were assessed at baseline and at the end of the intervention. Honein. A. M. C. Atherosclerosis begins in childhood and vascular endothelial dysfunction its earliest detectable manifestation. Several studies have shown an increased risk for neural tube defects associated with prepregnancy maternal obesity. O'Driscoll. Davis.. W.. Watts. (1995). 35(5). while women lose weight slowly and gain it back? Or why a woman's hip and thigh fat seems resistant to dieting and even exercising? The answer lies in the mystery of the female fat cell. The increase in fat mass in children and adolescents has occurred concomitantly with a decline in reported time for exercise. L. (2003). (2003). Watts.. Jones. D. Davis. K. Children's growth. Botto. we explored the relation for several birth defects and compared our findings with those of previous studies. particularly as obesity and inactivity in adolescents are increasing. A. Sports Medicine... Obesity is epidemic in western societies but treatment of established obesity in adults is relatively ineffective and primary prevention should be emphasised. Maternal obesity and risk for birth defects. Because few recent studies have examined the relation between maternal prepregnancy obesity and overweight and other birth defects. A. E. Few studies have examined the effect of exercise training in obese adolescents and none have specifically determined its effect on vascular function. 1(4). Outsmarting the female fat cell. 1152-1158. Watkins. 111(5). Rasmussen. Women's Health Digest. Exercise training normalises vascular function and improves body composition in obese adolescents. D. T.. Have you ever wondered why men lose weight quickly and keep it off. Childhood obesity has reached epidemic proportions worldwide and is associated with increased cardiovascular mortality and morbidity in adult life. and Green. 375-92. G.. where an interactive and age-appropriate nutrition and/or physical activity curriculum was delivered. Dietary treatment of obesity is relatively ineffective in adults and it has been suggested that prevention of obesity in childhood and adolescence should emphasise increased physical activity rather than diet because of fears relating to the adverse effects of inappropriate eating patterns. D. E. and Moore. Jones. Journal of Science and Medicine in Sport. T. A.. Siafarikas. nutrition knowledge..

130. and Leopold. That part of the equation deals with energy expended in daily physical activity. 369-374. We aimed to estimate the prevalence of 'clinically significant' knee pain. Langenbeck's Archives of Surgery. More than half of US adults are overweight and a quarter are obese. Long-term success rates are not convincing. School-based education about nutrition and healthy lifestyles provides an opportunity for intervention with all children. Journal of Public Health Management and Practice. J. M. so it is important that those involved in the food world be involved. (2003).. identify and assess the population impact of independent risk factors. A healthy lifestyle program: promoting child health in schools. A. Webb. K. 18(6). M. Wechsler. 26(3). 388(6). Many children today consume diets that are high in fat. A. G.. the other side of the equation for energy balance has been neglected. carbohydrate-rich diets. Many different treatment modalities are available. D. lack regular physical activity. Opportunities for prevention of 'clinically significant' knee pain: results from a population-based cross sectional survey. especially body fat use very low calorie diets followed by a fat-reduced. The problem of overweight children is an increasing public health concern in the United States. Urwin. The 2000 version of the Dietary Guidelines for Americans emphasizes daily physical activity. 322-328. and estimate levels of healthcare need. C. Research focus: Overweight and obesity should be treated in an interdisciplinary and multimodal approach. . Allison. K.. 228 Weaver. After implementation of the program. there was a significant increase in student knowledge of nutrition and healthy lifestyles as determined by a pretest and posttest evaluation. and receive minimal amounts of nutrition education at school. (2004). Nutritionists outnumber exercise physiologists 10 to 1. and McCarthy. and Symmons.and 5th-grade students was designed to increase the student's knowledge about nutrition and healthy lifestyles. Those in the foodservice industry could work on controlling portion sizes and cutting out unlimited free refills. Lunt. Dietary guidelines take obesity to task. The results have implications for school nurses because childhood behaviors have such a profound impact on future adult lifestyle choices.. 54(7). Weepie. W. The percentage of obese persons is increasing worldwide. with emphasis on dietary guidelines to prevent or correct obesity. Up to now. There is little UK-based evidence on the prevalence and predictors of knee pain associated with disability across all adult ages. The best results in loosing body weight. Brammah. M. (2000). Food Technology.. T... Medical management of obesity. T. The World Health Organization defines obesity as a chronic disease. Obesity is associated with elevated morbidity and death rates. Journal of School Nursing. 277-284. (2002). A program for 4th. M. R.

Treatment and prevention of childhood obesity: seeking quality interventions in the public schools. Weng. Discusses the prevention and treatment of childhood obesity in the United States including the use of physical therapists and physical educators in public schools. Taylor. (2001). To review psychosocial research with respect to relevance for the development of nutritional education strategies for optimal weight control during childhood and the longer term. The 24 Ss (mean age 37 yrs) consumed 3 times .. (2004). (2002). H. Guidelines for childhood obesity prevention programs: promoting healthy weight in children. D. M. S. Jr. and Kovacs.. 26(6). we tested the association between increasing number of children and obesity (body mass index [BMI] >or= 30) in 9046 middle-aged women and men (4523 couples). Bastian. Public Health Nutrition. Number of children associated with obesity in middle-aged women and men: results from the Health and Retirement Study.. 24(1). Journal of Nutrition Education and Behavior. J. This article presents recommendations for childhood obesity prevention programmes. 1-4. Westenhoefer. 870-872. a national survey of households. D. 229 Weight Realities Division of the Society for Nutrition Education. To review the psycho-social research with respect to relevance for the development of nutritional education strategies. J. 35(1). 13(1). Ann Nutr Metab. J. R. 46 Suppl 1.. M. 125-9. J. Moser. The effect of (--)-hydroxycitrate on energy intake and satiety in overweight humans.. Konin.capturing the minds of children. (2002). Westererp Plantenga.. Virginia journal. and Ostbye. Westenhoefer. Journal of Women's Health. (2002).. L. A. Establishing dietary habits during childhood for long-term weight control. Wenos. The recommendations focus on living actively. To study associations between number of children and obesity in middle-aged women and men. Assessed the effects of 2 wks of daily administration of (--)-hydroxycitrate (HCA) on energy intake and satiety in overweight men and women in a 6-wk randomized placebo- controlled single-blinded cross-over trial. K. 14-15. International Journal of Obesity and Related Metabolism Disorders. B. H. T. and Wenos. 4(1A). Establishing good dietary habits -. E. H.. 85-91. eating in normal and healthful ways and creating a nurturing environment that helps children recognize their own worth and respects cultural foodways and family traditions. (2003). 18-23. METHODS: In the Health and Retirement Study.

(2002). Child nutrition advocates have called for reducing access to soft drinks in schools as an important step in optimizing healthful environments for children. 230 daily for 2 wks 100 ml tomato juice (placebo) and. evidence-based concerns.. 24-25. 17(12). C. Mayer. and Grey. (2002). 36(5). soft drink manufacturers must acknowledge the problem of rising rates of overweight in children and work within their spheres of influence to limit access to soft drinks in schools. Pediatrics. Obesity and Type 2 diabetes have become major public health problems in the United States. 21(2). 13(9).. The purposes of this article are to identify current challenges related to obesity and Type 2 diabetes and to present the social ecological theory as a framework for the expansion of the reach of diabetes prevention and management that is relevant to community health nurses. Viewpoint. Misinformation must be dispelled so that resources can be directed to real. Applying the social ecological theory to type 2 diabetes prevention and management. Knowing risk factors at birth for the development of childhood obesity could help to identify children who are in need of early obesity prevention efforts. We asked our readers panel what they would do about the increasing incidence of overweight school children developing diabetes. have the potential to play a vital role in addressing these significant health issues. S. R. Journal of Nutrition Education and Behavior. White. Today's lesson: a healthy diet. M. R.. E29-E36. with expertise in preventive health care. Community health nurses. E. Briefly describes a program recently launched called "VERB: It's What You Do" to promote physical and social activity in children between the ages of 9 and 13 to encourage them to adopt a health lifestyle and prevent overweight and obesity. White. The objective of this study was to determine whether children whose mothers were obese in early pregnancy were more likely to be obese at 2 to 4 years of age. (2004). and Peterson. Nursing Standard. 1. S. Nitzke. The viewpoint presented in this article is that soft drink consumption is a contributing factor in the rising incidence of overweight among school-aged children. Along with other stakeholders. Hullatt. A. and Drake. L. 266-271. and local levels. 114(1). Whitaker. C. I. G. A. state. School nutrition policies are being revised at national. White. (2004). 87-99. IDEA Personal Trainer. separated by a 2 wk wash-out period. Predicting preschooler obesity at birth: The role of maternal obesity in early pregnancy. (2004). 100 ml tomato juice with 300 mg HCA. D'Eramo Melkus. Whittemore. Are soft drinks getting a bum rap? We don't think so... . F. K. Verb: it's about action.. Journal of Community Health Nursing..

We review current findings in obesity and weight loss lifestyle modification research. (2004). J.. or corticotropin is the cornerstone of acute care. Obesity among sexually abused women: an adaptive function for some? Women and Health. its practical implications. Wiese. L. E.. The alarming increase in the prevalence of obesity in the United States is associated with many chronic health problems. Gout: effective strategies for acute and long-term control. S. and sustainability of Planet Health. acceptability. . S. Carter. In an attempt to explore the possibly adaptive function obesity may serve for some women with histories of sexual trauma. gout is increasingly being observed in post-menopausal women. 37(2). L. Individuals need to learn how to modify their eating behaviors to control their weight and improve their health.. and Gortmaker. and Oldham. W. K. The incidence of gout increases with advancing age and elevations in serum urate levels.. Programs that include a combination of diet. we examined relationships among sexual abuse history. Weight control: a lifestyle-modification model for improving health. (2004). F. B. R. Methods Workshops on Planet Health implementation were attended by 129 teachers (language arts.. 518-519. 231 Wiecha. Body Mass Index < 27.. science. 514-516. Fuemmeler. The Lifestyle Modification Model. S. and cognitive-behavioral strategies are effective in helping mild to moderately obese individuals modify their eating patterns. Body Mass Index >/= 27. and implementation ideas for practitioners are presented along with suggestions for considering cultural differences. 467-475. Wiederman. and Wortmann. and Sansone.. L. N. Johnson. Prompt therapy with colchicine. exercise. History of sexual abuse was unrelated to current body weight within the entire sample. and maximum weight fluctuation among obese (n = 38. A. D. body dissatisfaction. an interdisciplinary. Assessed the feasibility.. Nursing Clinics of North America.. Korzec-Ramirez.. is monarticular. Journal of Pediatric Psychology. exquisite pain and inflammation are characteristic. 29(6). 510-512. The initial attack begins suddenly and. L. M.3) and nonobese (n = 112.. A. J. W. 89-100. NSAIDs. Journal of Musculoskeletal Medicine. Strunk. E. Sansone. Diffusion of an integrated health education program in an urban school system: Planet Health. (1999). R. L. M. K. and social studies) over three school years (1999-2000. math. Sanders. Response to colchicine supports the presumptive clinical diagnosis. E. M. Wierenga.. 29(1). 21(10). integrated health education curriculum implemented in six public middle schools.. A. Handler. S. Although still much more common in men than in women. Ayadi. as well as the nonobese and the obese subsamples. (2002). but confirmation of the diagnosis depends on identification of urate crystals in synovial fluid or tophaceous material. typically. 303-313.3) women sampled from a primary care medical setting. and 2001-2002). 2000-2001.

D. Houston. effective and safe treatments for obese people. D. The methodology included developing checklists for each of the intervention sessions. M. There are no long-term studies that directly compare the weight loss potential of low versus higher carbohydrate diets. (1999). 2(2). Ladelund. Williamson. Health Promotion Practice. Williams.. Is there an optimal macronutrient mix for weight loss and weight maintenance? Best Pract Res Clin Gastroenterol. (1997). G. audiotaping randomly selected sessions.. and Auslander. 135-142. Live Well (EWLW) Nutrition Pro-gram was a community-based. which they claim are responsible for obesity. F. and independently rating the audiotapes. 513-20. a process evaluation was conducted to determine the extent to which the content was accurate and comprehensive. L. however there is no clear consensus regarding their safety and efficacy for weight loss. Obesity treatment.. This article reviews the mechanisms that control body weight and then discusses how an understanding of these mechanisms may lead to the development of new.. 315(7114). and McCargar. Willaing. Belle. (2001). Jorgensen. 1140-1142. New England Journal of Medicine.. T. and should be achieved through a combination of exercise and a nutritionally balanced and varied diet. W. Proponents of these diet plans advocate dramatic reductions in carbohydrate intake to combat insulin resistance and hyperinsulinaemia. S. L. F. Haire Joshu. 11(6). . A. 341(15).. Evidence from randomized controlled trials suggests that low carbohydrate diets may enable short-term weight loss by facilitating reduced energy intakes. C. 18(6).. The prevention of obesity. Successful weight loss occurs through the creation of a sustained energy deficit. Nutritional counselling in primary health care: a randomized comparison of an intervention by general practitioner or dietician.. The Eat Well. L. however poor dietary compliance may prevent long-term success. 232 Wilding. I. T.. 997-1000. H. Eur J Cardiovasc Prev Rehabil. AIMS: To compare health effects and risk reduction in two different strategies of nutritional counselling in primary health care for patients at high risk of ischaemic heart disease. 1031-47. Process evaluation methods of a peer-delivered health promotion program for African American women. D. (2004). Wilkinson. To ensure that the program was delivered as intended. Unbalanced nutrient profiles may increase the risk of adverse health consequences in adherents. Low carbohydrate diets should not be recommended at this time due to a lack of adequate long-term follow up data. Simonsen. dietary change program delivered by peer educators to low income African American women. British Medical Journal (Clinical Research edition). Low carbohydrate diets are gaining popularity. J. and Nielsen. J. (2004).

J.. many women and girls view thinness as a requirement for feeling acceptable to themselves and to others.. L. such as self-starvation. Responding to mainstream ideals of female beauty. African American females have been largely excluded from studies. F. 31(11 Suppl). anorexia and bulimia nervosa. symptoms of the eating disorders. (1999). 310. cancers. J. R. Physical activity in the treatment of the adulthood overweight and obesity: current evidence and research issues. S. obesity. 456S-461S. The number of overweight or obese children has increased markedly over the past 20 years in the UK. How can health-care staff best tackle sedentary lifestyles and poor eating habits? Winett. Long-term weight gain prevention: A theoretically based Internet approach. A 1999 study of over 1 million American adults showed that obese people were twice as likely to die from any cause as people of normal weight. due to the assumption that the Black community's acceptance of women with fuller shapes protects its women from eating problems. diabetes. I provide an overview of the role of physical activity in the prevention of overweight and obesity and in the treatment of overweight and obese individuals. (1998). The drive to be thin can lead to problematic eating patterns. binge-eating. R. D. Tate.. 233 Doctors need to do more to encourage their obese patients to lose weight. 629-41. (1996). R. (American Health Foundation Roundtable on Healthy Weight). (2005). not limited to formal exercise regimes. Wilson. Preventive Medicine. Professional Nurse. and a sedentary lifestyle are strongly associated with risk for heart disease and stroke. 41(2). S547-S552. A secondary focus of this paper is on the potential mechanisms responsible for changes in body composition consequent to physical activity. Diabetes is one such complication of obesity.. Williamson. G. and purging. Most current literature on eating disorders and the drive for thinness focuses only on White middle-class women and girls. Anderson. American Journal of Clinical Nutrition. . S. R. and Winett. Medicine and Science in Sports and Exercise. The use of the term "physical activity" is preferred to the term "exercise" to better reflect a broader scope of movement. E. and premature death. P. 61-73. Increasing physical activity: alterations in body mass and composition. As the mortality rate from heart disease drops. H. Wing. 18(6). A major focus of Healthy People 2010 is promoting weight management and physical activity because overweight. Wojcik. 63(3). A. Eating disorders and the cultural forces behind the drive for thinness: are African American women really protected? Social Work in Health Care. Tackling childhood obesity. more effort should be placed on preventing other diseases related to obesity. Wilmore. (2003). 28(1).

Weight management in childhood: Canadian dietitians' practices. Canadian Journal of Dietetic Practice and Research. It was concluded that both a modified program and marketing approach are needed if the clinical community is to help overweight men. 234 The purpose of this paper is to review the evidence on the role of physical activity in the treatment of adult overweight and obesity. S.. and underlines the importance of targeting preventive strategies at this age group. R. L. Canadian dietitians specializing in pediatric practice were surveyed to provide a preliminary profile of the strategies they use to manage overweight youth. Obesity is an increasing problem in the UK. 130-133. E. Health Visitor. both for adults and children. and Levy Milne. and which treatment characteristics might appeal to them. "Why?" Seventy-two overweight males were surveyed regarding what might motivate them to seek treatment. Different strokes for different folks: Why overweight men do not seek weight loss treatment. J.. B. and Smith. Eating Disorders: The Journal of Treatment and Prevention. Respondents indicated that health problems and the desire to improve appearance are primary motivators. 63(3). Three specific questions are addressed: (1) Does exercise alone produce weight loss? (2) Does exercise in combination with diet produce greater weight loss than diet only? And (3) Does exercise in combination with diet produce better maintenance of weight loss than diet alone? Wolfe. Wood. 10(2). respondents preferred individualized. (2002). 115-124. 70(4). Strikingly missing from the literature are studies that ask. 151-152. Obesity in childhood tends to track into adulthood. (1997). Prevalence of overweight in Shropshire infant school children. (2002). 65 reported that they provide an intervention program to overweight youth. few men utilize weight management programs. In contrast to the programs most widely available. T. Wray. Of the 164 respondents. . Despite health risks associated with male-pattern obesity. TINA WOOD describes the findings of a study of infant school children which found increasing levels of obesity over the past decade. athletics-based programs that allow autonomy in food selection. It was also posted on the DC website and sent by electronic mail. The survey was mailed to 298 dietitians belonging to the Dietitians of Canada's (DC) Pediatric Nutrition and Consulting Dietitians' Networks and to the head dietitians in Canadian pediatric hospitals across the country.

. Family-based behavioral weight control treatment involves the parent in the modification of child and parent eating and activity change. T.. J. Wu. S. An activity calendar program for children who are overweight. Obesity is considered as the major public health crisis in the country. The importance of leading a healthy lifestyle for preventing obesity is also discussed. E. (2003). Pediatric Nursing. such as computer use and television viewing. To compare results of a conventional obesity treatment program with those of an obesity treatment program that included education of owners of obese dogs. none of the research describes an instrument to achieve this goal. M. Wei. Yadrick. E. Evaluation of owner education as a component of obesity treatment programs for dogs. Med Sci Sports Exerc. 342-347. are modifiable causes of overweight among children.. . J.. O. C. Yu. J. 17-24. 19-30. Reed. Weight-control behavior among obese children: association with family-related factors. (2005). however. 158(4). To assess if parent standardized body mass index (z-BMI) change predicts child z-BMI change. L. Holloway. Epstein. J. K. An analysis is presented on the obesity related problems in the United States. and Buffington... E. C. 11(1).. N. Peters. 8-13. (2003). 724-30. an obesity prevention program using electronic pedometers. A. J. A Colorado statewide survey of walking and its relation to excessive weight. 97(2). R. 235 Wrotniak. 29(1). Wyatt. G.. H. R. Archives of Pediatrics and Adolescent Medicine. Journal of Nursing Research. There is an urgent need to increase the physical activity in the population.. 37(5). C. T. F. (2004). Journal of the American Veterinary Medical Association. There are many recommendations in the literature that suggest the number of children who are overweight must be decreased. The purpose of this study was to investigate the weight-control behavior of obese children... (2004).. Small-scale success has been achieved in programs like Colorado on the Move (COM). B. Barry. 224(12). I. Journal of Family and Consumer Sciences. Yackel. Sedentary lifestyle activities. Supporting healthy lifestyle choices. H. This article describes the use of a home-based physical activity calendar and its successes and failures. and Hill. (2005). C. to understand parents' supervision and to explore related factors that influenced the weight-control behavior. A. Paluch. W. and Yin. 1932-1935. Parent weight change as a predictor of child weight change in family-based behavioral obesity treatment. Yaissle. H. and Roemmich.

but one in five men and women is defined as overweight with a BMI greater than 25. W. 236 Yamada. (2003). In the current study.. W. was developed and implemented. C. J.. J. Leading by example: a local health department-community collaboration to incorporate physical activity into organizational practice. Community organizations serving targeted areas of the county participated in one or more interventions incorporating physical activity into routine organizational practice. M. M. J. D. shift or night work and sedentary work. J. Diamant. education.. However. Lewis. Journal of Occupational Health. Bradford. as reflected in the extent of organizational commitment associated with each intervention. Prevention of weight gain and obesity in occupational populations: A new target of health promotion services at worksites. Relatively high-risk residents were recruited.. 116-123. and McCarthy. job stress. J. Engaging high-risk populations in community-level fitness promotion: ROCK! Richmond. and were more likely to report a family history of chronic disease. J. Today in Japan. The purpose of this study was to determine whether ROCK! Richmond.. L. 44(6). Journal of Public Health Management and Practice. T. Jordan. Yancey. Different recruitment methods may need to be used to recruit more from among the lowest socioeconomic strata... L. B. Ishizaki. level of organizational support for physical activity integration was assessed. . participant demographic and health status characteristics were compared with those of respondents to a random sample survey conducted 18 months earlier. L.. California. and thus the prevention of obesity should be targeted in health promotion services at worksites. Vigorous research is required in workplaces because a few work- related factors. Y. (2004). A. have been suggested in the literature to promote weight gain and abdominal fat accumulation. I. Yancey. extended work including overtime. Buzzard. K. J.. (2002). K. A. and McCarthy. Obesity has been recognized as a global epidemic threatening health and life. 180-188. A. such as socioeconomic status including job and position.. 10(5). Nascimento. M. Eller. Welch. Health Promotion Practice.. Guinyard.. 4(2). Voas.. a healthy nutrition and physical activity promotion initiative of the Richmond (Virginia) City Department of Public Health was effectively recruiting the high-risk individuals for whom this lifestyle change intervention was intended. Sloane. obesity defined as a body mass index (BMI) greater than 30 kg/m2 is found in 2- 3% of adults. ROCK! Richmond participants were disproportionately African American and female. A multisectoral model promoting sociocultural environmental change to increase physical activity levels among African Americans in Los Angeles County. and income levels were higher than those of the citywide sample. which centered around modeling the behaviors promoted ("walking the talk"). and Tsuritani.. Certain high-risk segments of the population were successfully reached and involved in community fitness activities. had significantly higher body mass indices (BMIs). their employment.. This model represents a true collaboration between a local health department and a community lead agency. The effectiveness of recruitment. 373-384. M. A.

Behavioral therapy for obesity that is. Z. The purpose of this paper is to explore the relationship between binge eating disorder (BED) and obesity.. (1999). S.. A workshop was convened in 1997 by the National Institutes of Health and the Centers for Disease Control and Prevention to consider the need for and feasibility of conducting a randomized clinical trial to estimate the long-term health effects of intentional weight loss in obese persons. M. and Williamson. most patients have regained much or all of their lost weight at long-term follow-up.. little information is available showing that intentional weight loss improves long-term health outcomes. G. Yao. 340-5. nutrition education. H. percent body fat. Relative influence of diet and physical activity on cardiovascular risk factors in urban Chinese adults. and McCrory. S. cognitive restructuring. M. A.. S. L. P. Z. and whose physical activity levels (PALs) vary widely. and physical activity are also emphasized. 237 Yanovski. Gao. Bain. 69(3). A total of 1 30 weight stable adults aged 35-49 y living in urban Beijing. International Journal of Obesity and Related Metabolism Disorders. F. (2003).. One approach to this problem has been to supplement behavioral treatment with other modalities such as very-low-calorie diets. . We investigated these factors in a population whose traditional diet may have both positive and negative aspects. Yanovski. and Devlin. Although the benefits of weight loss in obese individuals may seem obvious. and central adiposity were assessed. blood pressure and presence of the metabolic syndrome were also examined. R. 920- 932. J. Yanovski. Lichtenstein. Report of a National Institutes of Health--Centers for Disease Control and Prevention workshop on the feasibility of conducting a randomized clinical trial to estimate the long-term health effects of intentional weight loss in obese persons. self-reward. S. American Journal of Clinical Nutrition. and medication. A.. S117-S120. (2003). Binge eating disorder and obesity in 2003: Could treating an eating disorder have a positive effect on the obesity epidemic? International Journal of Eating Disorders. 1(5). Role of behavioral therapy in the management of obesity. 366-372. The relative influence of dietary factors vs physical activity on cardiovascular risk factors are poorly understood. (1995). D. 27(8). Although behavioral treatment programs that incorporate lengthier and more intensive regimens are often successful in producing short-term weight loss. S.. The hallmark of behavioral therapy for obesity is self-monitoring of eating behavior. Roberts. 34(Supplement). Ma. Endocrine Practice. China. but techniques of stimulus control. M.. Dietary intake. Biochemical parameters. Tucker. K. the application of learning theory to obesity treatment is now a standard component of weight-loss programs.. surgical procedures. B. Z.

B. M. and Nestle... (2005).. school-based after-school physical activity intervention in elementary schools. Yoshinaga. Spanu. The intervention consists of (a) academic enrichment. International Journal of Obesity. Significant differences between the groups would provide evidence that a fitogenic environment after school has positive health benefits. Agagliati. Z. M.. P. Maffeis. Preventive Medicine. and Gutin. S. 38(2). and Imamura. D. L. identify historical changes in the sizes of those foods. Purpose: The objective is to assess the mediating effect of PA on relations between stress and adiposity in youth. F. Eighteen schools were randomized to the control (obesogenic) or intervention (fitogenic) group. Hashiguchi. The contribution of expanding portion sizes to the US obesity epidemic.. and Treiber. J. Saber. This article describes the process of setting up a 3-year. A. D. M. (b) a healthy snack. L. Yin.. Sameshima. 26(1).. Barbeau. Severe obesity: Multidimensional treatment. this study was designed to weigh samples of marketplace foods. Then we determined the effect of programs for the screening and treatment of overweight elementary school children whether the programs prevented mildly overweight children from development of more overweight condition. (2005).. 67-89. K. Young. The moderating effect of physical activity (PA) on relations between chronic stress and adiposity is unknown in youth.. J. American Journal of Public Health. Jr.. Moore. Miyata.. J. and (c) physical activity in a mastery-oriented environment. . Moore. Hanes.. Successful implementation would show the feasibility of schools' being able to provide a fitogenic environment. A follow-up study has reported that not only highly obese but also mildly obese children are becoming heavier during the elementary school children. 246-249. B. 28(1).. G. K. M.. Physical Activity Buffers the Effects of Chronic Stress on Adiposity in Youth.. Eval Health Prof. The primary aim of the study is to determine whether adiposity and fitness will improve in children who are exposed to a fitogenic versus an obesogenic environment.. Bauducco. M. B. L.. Labate. 172-174.. B. and Rovera. and compare current portions with federal standards. Ferrari. Humbles. The study design. P.. M. (2002). Martignone. Annals of Behavioral Medicine. (2004). 29-36. Because larger food portions could be contributing to the increasing prevalence of overweight and obesity.. C. program components. J. R... 238 Yin. P. Zago.. E. Prevention of mildly overweight children from development of more overweight condition. (2002). and evaluation of the intervention are described in detail. Davis. 92(2). Z. 29(1). An after- school physical activity program for obesity prevention in children: the Medical College of Georgia FitKid Project.

Zhou. Zuppa. L. G. P. have been shown to have hypocholesterolemic effects that reduce the risk of cardiovascular disease.. Journal of Nutrition. Morton. 239 Aim of the study is to develop multidimensional approach for severe obesity (BMI>40) and to assess the use of obesity surgery. J. Walking to school: incidental physical activity in the daily occupations of Australian children. D. J. The aim of this pilot study was to examine the extent to which Australian children walked to and from primary school. placebo-controlled. and Mulligan.S. It has been shown to be a risk factor for cardiovascular disease. fluoxetine.. and Blackburn. Scott. (2004). We evaluated from January 1999 to January 2002 363 patients (104 male. To investigate the effect of orlistat on the pharmacokinetics of three highly lipophilic drugs (amiodarone. 428-435. fluoxetine. P. Takebe. on the pharmacokinetics of three highly lipophilic drugs (amiodarone. H.. (2003). and Wadley. To undertake a content analysis of the types of foods advertised during programs. and to survey parents to identify factors influencing this behaviour. which have particular appeal to children and in timeslots where children are likely to be watching television and to assess conformity with the recommendations of the Australian Guide to Healthy Eating (AGHE). L. adult population. Children's participation in physical activity is declining. A. R. type 2 diabetes mellitus. 132(3). K.. and simvastatin) in healthy volunteers. (2003). Television food advertising: counterproductive to children's health? A content analysis using the Australian Guide to Healthy Eating. 11(1). J. W. 78-84. a lipase inhibitor. and nowhere is this more apparent than in the incidental activity of walking to school. T.. J. Journal of Clinical Pharmacology.. Zhi.. 1-11. 60(2). such as soy protein and soy isoflavones. Moore. which now affects up to 35% of the U. . is the most common nutritional disorder in affluent societies and is becoming an increasingly important health problem in developing countries.. Nutrition and Dietetics: Journal of the Dietitians Association of Australia. and simvastatin). Occupational Therapy International. Obesity. and certain types of cancer. (2002). Effects of orlistat.. Kanitra. 259 female) through our Clinical Nutrition Department. Contain soybean components. randomized two-period crossover (for fluoxetine and simvastatin) or parallel (for amiodarone) studies in healthy volunteers ages 18 to 65 years of a body mass index between 18 and 30 kg/m2. J. Effects of isoflavone aglycone on the prevention of obesity in a diet-induced-obesity mouse model. 601S- 603S. E. the authors performed double-blind. hypertension. stroke. 43(4). Ziviani. M. and Mehta.

169. 68. 219. 33. 93. 169. 152. 224. 29. 75. 52. 183. 102. 92. 66. 203. 205. 130. 160. 144. 64. 200. 155. 128. 199. 62. 124. 45. 64. 79. 55. 164. 199. 162. 223. 88. 164. 39. 153. 105. 78. 170. 53. 59. 109. 136. 88. 36. 185. 30. 28. 110. 38. 147. 128. 37. 93. 150. 175. 224. 71. 147. 114. 93. 40. 71. 112. 153. 57. 85. 155. 57. 221. 108. 216. 234. 37. 55. 250. 167. 199. 45. 231. 85. 174. 240. 212. 229. 42. 253. 76. 74. BOYS. 20. 247. 38. 84. 245 CANCER. 17. 83. 78. 239. 183 206. 208. 232. 91. 150. 121. 72. 221. 252 236. 68. 44. 71. 89. 183. CHARACTERISTICS. 90. 39. 61. 59. 232. 76. 195. 37. 103. 119 BREASTFEEDING. 128. 111. 72. 155. 39. 117. 40. 172. 160. 68. 177. 210. 171. 83. 64. 126. ATHLETICS. 94. 174. 174. 220. 139. BEHAVIOR MODIFICATION. 204. 176. 149. 180. 42. 204. 85. 246. 214. 200. 158. 66. 64. 222. 111. 70. 78. 184. 28. 90. 149. 244. 183. 214. 90. 209. 37. 256 194. 254 201. 201. 141. 174. 204. 157. 88. 57. 53. 30. 208. ACTIVITIES. 157. 124. 60. 203. 204. 103. 130. 59. 151. 159. 108. 113. 241. 166. 107. 181. 64. 180. 98. 234. 203. 229. 46. 256 170. 231. 206. 94. 139. 55. 142. 132. 110. 164. 149. 217. 134 127. 163. 114. 162. 25. 121. 162. 219. 92. 223. 82. 167. 61. 35. 205. 132. CARDIOVASCULAR. 75. 60. 193. 62. 206. 100. 86. 152. 197. 36. 29. 214 105. 75. ASSESSMENT. 214. 33. 53. 208. 56. 101. 67. 32. 103. 173. ALCOHOL. 56. 215. 154. 159. 224. 158. 177. 30. 95. 230 45. 128. 78. 37. 223. 205. 130. 115. 45. 246. 63. 231. 139 ADOLESCENT HEALTH. 232. 53. 78. 90. 36. 109. 52. 109. 36. ACCELEROMETERS. 207. 254. 244. 111. 211. 57. 38. 234. 100. 57. 147. 224. 196. 123. 105. 252. 177 244 BREAKFAST. 103. 244. 128. 105. 33. 36. 222. 120. 239. 239. ANIMAL. 110. 186. 255 CHILD. 169. 194. 128. 36. 109. 112. 125. 53. 238. 173. 28. 161. 209. 128. 32 73. 82. 164. 152. 238. 211. 65. 49. 32. 167. 86. 83. 85. 40. 24. 162. 57. 244. 144. 208. 257 226. 33. 55. 93. 257 69. 23. 23. 105. 165. 121. 160. 223. 68. 123. 52. 236. 36. 84. 123. 210. 152. 154. 213. 71. 49. 97. 220. 179. 42. 43. 192. 108. 224. ATTITUDES AND PRACTICE. 78. 86. 64. 235. 90. 152. 235. 245. 91. 186. 96. 226. 46. 17. 146. 175. 194. 52. 165. 95. 60. 203. 68. 60. 179. 157. 38. 39. 183. BEVERAGE. 176. 30. 134. 164. 138. 127. 210. 59. BEHAVIOR CHANGE. 55. 23. 255 204. 228. 62. 127. 98. 49. PREVENTION. 126. 217. 145. 79. 166. 192. 91. 78. 74. 109. 33. 166. 60. 162. 183. 186. 234. 210. 42. 234. 37. 158. 186. 148. 123. 197. 78. 51. 85. 204. 25. 51. 76. 181. 63. 231 100. 57. 152. 138. 79. 46. 253 256 CHILDHOOD OBESITY. 189. 161. 213. 199. 240 INDEX 186. 188. 28. 71. 254 246. 141. 170. 49. 138. 120. 51. 228. 164. 108. 245. 169. 159. 221. 43. 170. 124. 124. 213. 122. 17. BODY IMAGE. 135. 17. 106. 108. 238 220. CHILDREN. 225. 123. 98. 158. 256 BEHAVIOR. 105. 56. 149. 52. 171. 117. 73. 183. 246. 104. 257 A BODY MASS INDEX. 207. 98. 52. 223. 98. 23. 84. 229. 131. 191. 181. 142. 23. 22. 218. 156. 185. 206. 170. 145. 226. 72. 93. 220. 49. 21. 61. 28. CONSUMPTION. 215. 104. 108. 163. 68. 109 256. 56. 203. 109. BLOOD PRESSURE. 93. 60. 214. 97. 236. 256 ATTITUDES. 151. 82. 83. 115. 49. 49. CARDIOVASCULAR DISEASE. 111. 140. 196. 203. . 135. 214. 122. 213. 181. 235. 190 142. 209. 140. 26. 103. 164. 126. 23. 105. 221. 190. 45. 167. 257 ADOLESCENCE. 125. 78. 200. 162. 253 200. 60. 219. 122. 119. 73. 130. 172. 169. 119. 126. 57. 210. 217. 254. 184. 137. AMERICAN. 205. 55. 167. 166. 176. 32. 215. 121. 177. 71. 88. 219. 164. 205. 242. 161. 253. 164. 225. 125. 204. 46. 196. 194. 24. 33. 84. 64. 204. 55. 208. 252. 143. 205. 90. 217. 101. BINGE EATING. 241. 65. 45. 21. 236. 169. 64. 43. BEHAVIORS. 157. BODY MASS. 257 ALCOHOL CONSUMPTION. 159. 35. 157. 17. 27. 45. 91. 88. 179. 25. 108. 252. 89. 30. 82. 246. 75. 114. 43. 23. 26. BODY FAT. 110. 75. 125. 72. 37. 229. 98. 247. 53. 195. 56. 94. 97. 39. 32. 219. 213. 40. 138. 91. AFTER SCHOOL. 167. 36. 193. 86. 204 CHILDHOOD. 49. 220. 176. 211. 138 89. 111. 245. 173. 92. 166. 130. 178. 138. 140. 205. 167. 89. 121. 111. 109 127. 200. 76. 216. 145. 218. 117. 70. 89. 178. 78. 226. 109. 57. 72. 46. 224. 238. 110. 63. 44. 109 DISEASE. 25. 252 82. 28. 29. 186. 214. 30. 46. 145. C 178. 161. 74. 57. 253. 73. 238 RISK FACTORS. 169. 86. 113. 196. 137. 93. 43. 68. 195. 228. 73. 175. 62. 33. 123. 130. 230. 194. 138. 75. 90. 68. 157. 85. 85. 91. 159. 173. 56. 179. 88. 111. 101. 241. 171. 33. 217. 62. 137. 229. 25. 140. 233. 253. ADULTS. 124. 149. 236 117. 225. 197. 119. 219. 35. 151. 40. 160. 32. 197. 146. 185. 23. 149. 257 B CARDIOVASCULAR RISK FACTORS. 127. 144. 189. 201. 39. 204. 151. 139. 126. 82. 197. 256 128. 30. 117. 30. 250. 235. 175. 41. 154. 39. 89. 109. 73. 169. 190. 117. 108. 136. 68. 56. 209. 35. 254. 75. 37. 72. 160 ADOLESCENTS. 111. 82. 130. 219. 81. 228. 220. 218. 102. 179. 25. 200. 230. 18. 54. 36. 195. 125.

142. 177. 103. 145. 79. 70. 231 EVALUATION. 163. 71. 204. 217 146. 36. 41. 68. 244 FOOD CHOICE. 122. 207. 245 FOOD AVAILABILITY. 110. 254 COMMUNITY. 20. 155. 234. EDUCATORS. 187. 153. 41. 75. 96. 192. 33. 148. 103. 20. 171. 215. 199. 32. 166. 57. 245 CORONARY HEART DISEASE. 170. 153. 43. 150. 110. 69. 116. 205. 149. 46. 162. 79. 150. 88. 126. DIETARY. 165. 96. 38. 101. 18. 230. 29. 93. 60. 68. 179. 60. 186. 64. 64. 169. 43. 246. 32. 151. 20. 52. 235. 114. 219. 175. 200 211. 190. 29. 63. 103. 132. 241 69. 256 247. 28. 190. 256 254. 179. 221. 42. 123. 41. 137. 138. 210. 17. 131. 194. 163. 181. 99. 169. 62. 153. 30. 230. 81. 216. 170. 242. 61. 113. 86. 97. 218. 174. 113. 159. 176. 149. 84. 188. 92. 79. 220. 147. 74. 63. 183. 209. 65. 232. 257 FAMILY. 97. 96. 32. 75. 235. 41. 26. CHOLESTEROL. FOOD BEHAVIOR CHECKLIST (FBC). 112. 153. 29. 223. 126. 186. 139. 149. 125. 173. 197. 199. 60. 203. 126. 252. 171. 137. 200. 43. 70. 218. 139. 96. 163. 127. 115. 54. 226 107. 230. DOSE. 111. 106. 83. 183. 179. 22. 80. 180. 62. 202. 220. 107. 140. 246. 42. 73. 33. 158. 244. 43. 166. 218. 255 ENERGY BALANCE. 130. 91. 165. 230. 185. 238. 253. 103. 136. 26. 85. FISH. 236. 101. 157. 167. 41. 104. 113. 114. 79. 78. 52. 116. 23. 39. 171. 65. 206. 148. 84. 177. 228 158. 66. 128. 172. 210. 187. 182. 83. 98. 98. 144. 188. 28. 241. 38. 195. 40. 89. 34. 183. 74. 248. 39. 239. 228. 138. 70. 39. 176. 196. 47. 27. 155. 151. 247. 135. 28. 188. 249 EPIDEMIOLOGIC. 234. 128. 162. 143. 88. 103. 246. 42. 235. 244. 77. 82. 215 91. 108. 167. 63. 93. 146. 173. 256. 37. 146. 139. 72. 126. 204. 226. 186. 207. 178. 66. 111. 198. COMMUNITY-BASED. 226. 175. 100. 196. 37. 175. 146. CULTURAL. 162. 138. 110. 121. 128. 145. 30. 57. 92. 172. 247. 191. 102. 32. 174. 135. 122. 206. 61. 158. 247. ENERGY EXPENDITURE. 88. 131. F 223. 92. 91. 25. 70. 52. 157. 156. 134. 252 161. 250 246. 29. 127. 169. 248. 250 196. 76. 41. 123. 113. 145. 80. 246. 197. 113. 148. 86. 195 236. 171. 83. 189. 106. 236. 238. 160. 184. 244. 208. 205. 183. 63. 91. 73. 239. 246. 117. 112. 44. 151. 220. 174. 112. 91. 99. 229. 69. 41. 76. 105. 151. 117. 68. 165. 239. 128. 252. 142. 236. 148. 240. 122. 30. 145. 193. 236. 242 DEPRIVATION. 140. 115. 111. 126. 214. 68. 223. 159. 148. 90 170. 138. 242. CULTURALLY APPROPRIATE. 67. 85. 106. 199. 102. 221 228. 213. 174. 107. 123. EATING DISORDERS. 230. 130. FITNESS. 64. 159. 24. 196. 28. CULTURE. 40. 38. 151. 78. 185. 49. 94. 208. 67. 205. 249. 130. 180. 217. 38. 230. 82. 42. 174. 94. 206. 170. 102. 101. 204. 60. 219. 185. 120. 70. 44. 247. 216. 145. 145. 209. 40. 249. 224 ETHNICITY. 34. 252. 27. 202 180. 124. FATS. 160. 34. 172. 119. 92. 111. 224. 124. 248. 181. 152. 136. 225. 90. 160. 105. 214. 218. 44. 111. 76. 177. 148. 119. 169. 83. 211. 192. 231. 150. 111. 154. 245. 40. DIET. 82. 46. 109. 100. 49. 228. DISEASES. 103. 132. 27. 105. 163. 52. 245. 70. 108. 74. 30. 120. 231. 98. 34. 95. 147. 178. 107. 218. 75. 79. 56. 36. 204. 77. 158. 72. 102. 141. 105. 112. E 148. 23. 26. 188. 174. 35. 69. 100. 107. 180. 219. 200. 57. 45. 240. 131. 56. 132. 258 EDUCATION. 203. 160. 220. 98. 139. 69. 22. 226. 176. 236. 190. 200. 170. 74. 184. 148. 46. 167. 169. 184. 232 56. 205. 122. 248. 141. 106. 162. 161. 97. 192. 257 150. 110. 219. 75. 164. 111. EATING PATTERN. 188. 32. 238. 97. 201. 249. 112. 110. 116. 126. 103. 207. 181. 256 72. 190. 115. 119. 241. 225. 83 165. 41. 135. 144. 128. 150. 153. 216. 85. 73. 169. 27. 208. 39. 108. 74. 148. 206. 176. 99. 234. 72. 167. 33. 88. 57. 250 FOOD INSECURITY. 116. 81. 190. 88. 136. 200. 44. 101. 44. 127. 90. 222. 131. 254 121. 148. 27. 156. 39. 178. 166. 201. 149. 193. 236. 155. 24. 250. 40. 72. 192. 242 DEPRESSION. 194. 222. 54. 256. 23. 44. 234. 185. 85. 120. 206. 151 EPIDEMIOLOGY. 125. 202. 75. 229. 39. 203. 246. 46. 71. 158. 184. 141. 229. 153. 28. 244. 72. 77. 195. 179. 105. 180. 134. 189. 57. 99. 210. 211. 179. 163. 158. 31. 219. 117. 191 DIETING. 229 DIETARY GUIDELINES. 35. 146. 135. 229. 184. 125. 156. 100. 210. 219. 88. 37. 89. 185. 189. 207. 111. 78. 195. 46. 244. 86. 174. ELEMENTARY SCHOOL. 25. 250. 102. 134. 209. 83. 205. 29. 121. 116. 149. 21. 191 110. 161. 143. 223. 41. 142. 137. 47. 248. 214. EXERCISE. 195. 169. 44. 89. 105. 239. 64. 106. 53. 105. 196. 164. 250 93. 100. 53. 163. 221. 149. FOOD GROUPS. 188. 244. 44. 82. 172. 136. 139. 160. 199. 209. 73. 200. 116. 38. 81. 49. 223. 37. 250. 233. 184. 99. 159. 104. 172. 235. 219. 140. 122. 40. 250 ENERGY INTAKE. 120. 111. 89. 202. 75. 174. 219. 152. 47. 33. 98. 158. 61. 254. 125. 208. 199. 126. 171. 122. 127. 54. 46. 233. 216. 84. 131. 65. 189. 138. 126. 86. 253. 32. 80. 204. 223. 79. 188. 52. 250. 105. 146. 239. 131. 202. 103. 158. 68. 256 FOCUS GROUPS. 241. 190. 224. 176. 204. 54. 119. 249. 193. 151. 90. 93. 185. 171. 247. 66. 108. 167. FOOD FREQUENCY. 204. 249. 102. 57. 65. 27. 222 D ETHNIC. 127. 21. 81. 208. 111. 184. 122. 183. 93. 152. 185. DIABETES. 70. 159. 18. 136. 101. 160 . 77. 225. 54. 250 185. 45. 152. 135. 95. 125. 93. 241. 197. 128. 82. 95. 68. 74. 57. 29. 166. 234. 152. 74. 42. 96. 126. 257. 214. 158. 28. 74. 209. 181. 206. 112. 35. 203. 210. 96. 185. 194. 238. 134. 39. 252. 80. 105. 75. 43. 122. 126. 144. 179. 66. 81. 235.

190. 41. 40. 121. 53. 36. 257 METABOLIC SYNDROME. HEALTH. 206. 29. 70. 87. 193. INTERVENTION. 244. 28. 94. 72. 82. 98. 76. 63. 41. 51. 244. 34. 67. 250. 240 197. 108. 28. 94. 182. 98. 190. 184. 229 114. 201. 38. 108. 146. 91. 184. LOW-FAT. 238. 152. 120. 224. 73. 230. 18. 105. 91. 18. 185. 23. 245 68. 32. 223. 41. 217. 71. 180. 246 GENDER. 242 INNER CITY. 87. 53. 123. 85. 98. 169. 172. 83. 101. 95. 36. 248 MANAGEMENT. 199. 196. 165. 79 I MINORITIES. 80. 37. 255. 91. 24. 60. 187. 143. 105. 56. 126. 165. 160 199. 211. 252. 71. 85. 28. 57. 89. 52. 105. LOW INCOME. 83. 71. 186. 42. 40. 90. 47. 111. 229. 167. HEALTH PROMOTION. 233. 27. 29. 105. 254. 121. 214. 126. 98. 200. 173. 222. 105 MINORITY. 41. 109. 78. 35. 92. 255. 240. 254 128. 57. 221. LUNCH. 110. 150 MINORITY GROUPS. 88. 29. 239. 213. 130. 68. 153. 107. 113. 143. 32. LONGITUDINAL. 242. 180. 86. 22. 30. 185. 37. 74 235. 105. LEISURE. 131 152. 79. 145. 75. 28. 28. 196. 126. 221 167. 229. 92. 204. 63. HEALTH STATUS. 130. 249. 176. 209. 60. 189. 185. 84. 191. 177. 99. 229 99. 183. HUNGER. 73. 135. 128. 41. 62. 56. 154. 192. 59. 95. 220. 153. 30. 139. 181. 193. 67. 105. 72. 51. 159. 113. 135. 78. 231. 156. 42. 127. 17. 199. 230. 140. 65. 181. 175. 163. 119. 75. 114. 195. 25. 103. 242. 83. 90. 220 FRUIT. 119. 222. 120. 54. H 137. 55. 233. 162. 37. 246. 85. 183. 88. 177. 215. 112. 82. 66. 174. 114. 84. 30. 256. 130. 187. 249. 149. 183. 157. 256 FORMULA. 231 GENETIC. 85. 33. 34. 229. 113. 221. 41. 70. 29. 173. 152. 145. 139. 71. 43. 33. 138. 228. 77. 255 HEART RATE. 140. 65. 214. 186. 107. 234. 219. 151. 226. 163 MEDITERRANEAN. 25. 198. 140. 205. 119. 187. 76. 157. 137. 253. 38. 121. 92. 254 157. 166. 59. 147. 49. 71. 201. 25. 85. 246. 91. 59. 84. 210. 185. 164. 150. 72. 40. 77. 178. 99. 20. 130. 215. 208. 232. LIPIDS. 146. 225. 27. 199. 20. 67. 242 MEDIA. 81. 183. 134. 250 128. 220. LIFE CYCLE. 115. 73. 46. 254 245. 88. 153 FRUITS. 96. 100. 215. 216. 24. 219. 184. 138. 21. 110. 179. 56. 107. 148. 115. 30. 104. 209. 193. 169. 77. 92. 125. 230. 89. 161. 23. 27. 257. 111. 65. 233. 83. 92. 195. 66. 161 250 LIFESTYLE. 66. 32. 232. 183. 165. 209. 188. 162. 244. 160. 148. 98. 110. 44. 235. 33. 49. 218. 46. 61. 102. 42. 242. 65. 69. 200. 204. 191. 19. 204 K KNOWLEDGE. 181. 189. 93. 91. 34. 197. 115. 148. 176. 32. 244. 208. 52. 142. 26. 181. 17. 90. FOOD PATTERNS. 135. 170. 240. 121. 34. LONGITUDINAL STUDY. 253. 185. 101. 189. 39. 29. 216. 250 174. 88. 178. 186. 205. 40. 149. 85. 139. 78. 44. 174. 192. 44. 216. 109. 219. 236. 33. 111. 100. 151. 33. 159. 241. 131. 213. 122. 229. 38. 230. 115. 171. 107. 28. 176. 74. 57. 234. 231. 41. 147. 149. 93. 215. 221. 139. 94. 93. 181. 258 M HEALTH EDUCATION. 100. 232. 124. 89. 185. 246. 49. 67. 209 HOST. 211. 66. 143 HEIGHT. 219. 74. 186. 190. 98. 192. 131. 44. 72. 250. 120. 44. 179. 99. 162. 126. 193. 72. 209. 112. 52. 210. 213. 46. 179. 205 236. 158. 240. 122. 181. 215. 246. 93. 234. 242 GIRLS. 46. 104. 152. 252. 146. 75. 153. 85. 34. 42. LOW-INCOME. 60. 208 81. 123. 196. 104. 128. 103. 241. 256 MIDDLE AGE. 183. 129. 226. 34. 108. 146. 151. 208 HOSTILITY. 211. 242 INFANTS. 173. 75. 175. 177 MORBIDITY. 119. 164. 43. 177. 33. 197. 214. 83. 28. 202. 23. 249. 254 62. 160. 126. 176. 213. 140. 24. 33. 88. 241 121. 93. 203. 136. 24. 103. LOW-ENERGY. 57. 254. 180. 157. 56. 131. 115. 95. 38. 45. 199. 220. 64. 46. 17. 36. 92. 191. 210. 82. 150. 141. 193. 215. 103. 172. 160. 64. 43. 63. 159. 223. 72. 181. 117. 85. 136. 161. 25. 93. 30. 122. 99. 164. 98. 92. 115. 136. MOTIVATION. 123. 132. 68. 189. 189. 144. 183 . 221. 63. 162. 106. 84. 108. 250. 253. 179. 107. 46. MORTALITY. 109. 123. 136. 108. 214. MENTAL ILLNESS. 170. 46. 68. 155. 206. 104. 98. 173. 219 177. 46. 28. 115. 170. 55. 27. 49. 39. 128. 225. 191. 113 212. 80. 84. 35. 65. 60. 71. 42. 79. 210. 111. 240. 116. 199. 166. 140. 169. 228. 98. 125. 234. 244. 132. 76. 111. 23. 72. 166. 24. 123. 64. 78. 49. 216. 235 MEASUREMENT. 77. 248. 195. 201. 224. 204. 43. 40. 151. 43. 166. 64. 35. 60. 105. 247. 88. 52. 116. 223. 89. 36. 128. 75. 242 FOOD INSUFFICIENCY. 125. 41. 124. 65. 176. 70. 178. 187. HYPERTENSION. 92. 176. 105. 149. 122. 89. 197. G 110. 252. 248. 248. 57. 34. 153. 141. 206. 142. 25. 117. 90. 24. 224. L 173. 222. 67. 45. 90. 249. 159. 41. 52. 124. 160. 113. 105 MEN. 82. 66. 90. 95. 27. 216. 35. 122.

179. 20. 134. 219. 208. 117. 180. 188. 111. 182. 161. PRENATAL. 219. 191. 77. 137. 243 65. 163. 30. 93. 178. NUTRITION. 111. 123. 221. 181. 196. 234 O PHYSICAL FITNESS. 177. 23. 117. 145. 26. 159. 27. 38. 221. 100. 171. 90. 38. 176. 194. 216. 35. 139. 213. 51. 239. 135. 203. 191. 156. 172. 120. 204. 63. 67. 43. 214. 121. 257 250. 97. N 86. 127. 152. 247. 98. 63. 149. 96. 167. 56. 53. 72. 99. 178. 61. 224. 173. 100. 206. 97. 174. 224. 238 OBESITY. 132. 175. 178. 113. 242 127. 92. 241. 51. 111. 53. 90. 66. 67. 125. 184. 78. 108. 49. 24. 162. 77. 229. 175. 35. 210. 103. 60. 136. 43. 23. 45. 236. 128. 145. 183. 26. 254 138. NUTRITION EDUCATION. 94. 18. 49. 106. 162. 179. 59. 102 RECALL. 202. 60. 248. 142. 204. 229. 22. 163. OVERWEIGHT. 145. 77. 190. 126. 130. 155. 250. 26. 94. 169. 206. 201. 217. 71. 35. 72. 109. 160 RACISM. 195. 66. 100. 245 65. 223. 94. 103. 219. 199. 91. 105. 256. 169. 142. 162. 184. 176. 54. 170. 256. 215. 226. 151. 96. 199 PUBLIC HEALTH. 255. 104. 156. 245. 70. 229. 174. 89. 75. 224. 95. 166. 177. 28. 186. 26. 19. 215. 22. 164. 210. 210. 33. 246. 80. 162. 125. 203. 140. 72. 201. 117. 65. 130. 165. 37. 223. 127. 202. 136. 23. 56. 76. 76. 193. 220. 139. 42. 69. 59. 248. 148. 44. 246. 153. 151. 35. 20. 196. 193. 68. 113. 78. 108. 81. 96. 101. 39. 256. 29. 209. 131. 122. 106. 235. 45. 25. 24. 230. 246. 66. 157. 230. 176. 119. 56. 39. 34. 185. 62. 246. 242. 42. 160 30. 28. 75. 59. 229. 97. 134. 117. 187. 64. 209. 75. 111. 190. 241. 45. 20. . 38. 36. 161. 110. 59. 254. 166. 162. 156. 110. 85. 131. 185. 73. 79. 165. 216. 64. 33. 89. 192. 52. 221. 112. 213. 53. 32. 204. 145. 124. 226. 120. 79. 89. 114. 35. 226. PRESCHOOL. 179. 206. 114. 235. 179. 252. 70. 221. 84. 85. 172. 84. 115. 26. 235. 252. 244. 73. 172. 47. 166. 203. 76. 29. 71. Q 203. 92. 149. 101. 18. 177. 234. 55. ODDS RATIO. 99. 144. 36. 36. 159. 100. 120. 229 46. 113. 226. 127. 33. 47. 39. 136. 185. 212. 57. 197. 39. 92. 238 OSTEOARTHRITIS. 61. 98. 211. 181. 27. 99. 103. 25. 101. 21. 241. 252. 240. 97. 184. 134. 27. 194. 113. 244. 85. 114. 185. 80. 83. 22. 145. 146. 220. 171. 26. 57. 137. 51. 56. 133. 211. 28. 247 81. 57. 216. 176. 218. 41 PATHWAYS STUDY. 218. 184. 78. 112. 254. 188. 59. 175. 202. 208. 146. 169 PHYSICAL EDUCATION. 100. 184. 233. 24. 46. 216. 193. 38. 171. 253. 207. 56. 206. 192. 197. 103. 196. 140. 42. 26. 246. 245. 91. 44. 155. 166. 164. 153. 170. 256 PSYCHOLOGICAL. 184. 105. 95. 145. 226. 189. 181. 124. 156. 71. 134. 185. 215. 84. 254. 36. 46. 188. 246. 114. 254. 143. 57. 254. 244. 159. 17. 257 125. 211. 141. 161. 200. 138. 200. 239. 221. 144. 115. 16. 181. 231. 79. 139. 228. 189. 42. 125. 202. 197. 246. 151. 242. 17. 150. 53. 134. 242. 183. 218. 85. 127. 95. 94. 68. 136. 144. 247. 228. 215. 234. 51. 171. 190. 199. 93. 81. 23. 135. 19. 171. 156. 20. 196 128. 170. 212. 221. 93. 114. 109. 67. 195. 205. 139. 173. 149. 172. 148. 196. 67. 143. 39. 110. 42. 33. 158. 76. 34. 248. 257 OBESITY PREVENTION. 155. 217. 77. 102. 32. 214. 71. 127. 193. 80. 102. 97. 104. 134. 238. 145. 242. 181. 174. 142. 18. 247. 107. 83. 230. 88. 61. 155. 248. 232. 71. 62. 242. 119. 107. 43. 238. 42. 88. 215. 234. 208. 164. 245. 149. 228. 102. 126. 37. 216. 93. 55. 49. 188. 189. 26. 207. 175. 70. 88. 170. 155. 239. 181. 194. 154. 225. 97. 69. 57. 225. 255. 139. 111. 117. 224. 128. 81. 258 224. 92. 229 257 QUESTIONNAIRE. 217. 62. PREGNANCY. 238 P R PATHWAYS. 250. 81. 38. 178. 37. 108. 108. 222. 201. 68. 75. 234. 111. 197. 91. 255 PHYSICAL ACTIVITY INTERVENTIONS. 187. 113. 19. 40. 179. 232. 126. 74. 70. 112. 101. 226. 225. 138. 104. 217. 149. POVERTY. 17. 47. 224. 221. 143. 235. 106. 27. 73. 88. 111. 52. 102. 163. 181. 46. 239. 174. 252. 151. 178. 68. 165. 74. 47. PROGRAMS. 21. 214. 99. 122. 180. 120. PREVENTION. 250. 104. 53. 25. 243. 69. 236. 193. 44. 27. 64. 162. 217. 184. 256. 83. 154. 185. 236. 116. 222. 65. 84. 199. 195. 44. 213. 30. 190. 200. 114. 247. 234. QUALITATIVE. 52. 126. 229 120. 140. 98. 235. 189. 127. 155. 171. 252. 55. 119. 244. 56. 147. 105. 75. 155. 238. 60. 253. 146. 64. 230. 158. 139. 253. 116. 105. 218. 102. 149. 166. 144. 191. 92. 148. 190. 211. 49. 200. 28. 186. 228. 75. 214. 62. 80. 232. 214. 46. 158. 112. 242. 57. 99. 185 96. 218. 220. 96. 18. 255. 34. 171. 69. 254. 95. 102. 177. 73. 28. 87. 64. 142. 166. 124. 39. 63. 222. 84. 35. 92. 153. 40. 204. 173. 173. 23. 100. NUTRIENT INTAKE. 32. 179 PHYSICAL ACTIVITY. 69. 202. 73. 72. 100. 187. 56. 241. 141. 99. 233. 242. 229. 150. 176. 57. 136. 104. 253. 122. 165. 112. 231. 27. 108. 191. 199. 97. 141. 205. 132. 167. 180. 100. 143. 23. 195. 98. 86. 226. 167. 147. 72. 84. 239. 149. 59. 40. 166. 85. 209. 74. 87. 82. PREDICTORS. 183. 206. 134. 107. 66. 41. 163. 171. 191. 165. 74. 175. 19. 128. 63. 169. 246. 253. 98. 160. 182. 95. 202. 216. 228. 150. 146. 61. 113. 128. 220. 207. 110. 151. 139. 36. 134. 137. PREADOLESCENT. 63. 121. 194. 37. 82. 249. 194. 255 228. 112. 176. 177. 245. 130. 116. 124. 41. 159. 32. 152. 85. 192. 142. 105. 43. 125. 234. 88. 37. 113. 198. 28. 103. 219. 131. 129. 115. 66. 79. 19. 244. 153. 97. 169. 222. 99. 219. 121. 131. 68. 70. 201. 84. 32. 236. 193. 38. 127. 213. 86.

210 174. 99. 128. 75. 29. 208 SEDENTARY. 33. 127. 96. 84. 101. 162. 206. 136. 82. 30. 134. 239. 214. 159. 110. 80. 228. 96. 128. 143. 104. 195. 159. 149. 95. 61. 71. 27. 102. 113. 92. 143. 35. 159. 203 RISK FACTORS. 236. 193. 117. 105. 35. 67. 216. 257 119. 163. 137. 169. 19. 115. 132. 166. 113. 83. 76. 95. 45. SURVEY. 38. 41. 105. 142. 80. 145. SOCIAL CLASS. 165. 232 126. 194. 28. 91. 189. 102. 123. 175. 35. SNACK. 20. 128. 171. 83. 218. 224. 217. 164. 256 204 SCHOOL FOOD SERVICE. 115. 127. 114. 128. 57. 204. 157. 71. 150. 33. 62. 125. 226. 121. 160. 102. 123. 31. 71. 93. 51. 177. 34. 24. 224. 84. 244 RECOMMENDATIONS. 46. 78. 232. SMOKING. 131. 178. 92. VIDEO GAMES. 183. 37. 68. 20. 95. 170. 107. 69 221. 246. 85. 179. 247. 171. 229. 100. 215. 244. 98. 90. 226. 49. 184. 115. 143. 79. 30. 165. 180. 202 206. 70. 78. 32. 98. 89. 164. 176. 171. 247 RURAL. 153. 199 107. 46. 177. 199. 101. 138. 103. 126. 55. 39. 140. 178. 239. SODIUM. 18. 92. 112. 256 SCHOOL-BASED PROGRAMS. 54. 86. 128. WEIGHT. 145. 37. 42. 53. 215. 221. 134. 230 U S UNDERNUTRITION. 151. 104. 145. 125. 80. 222. 69. 178. 221. 193. 44. 138. 203. 18. T 184. 230. 121. 155. 98. 186. 125. 70. 137. 75. 217. 97. 56. 252. 232. 110. 148. 205. 85. 62. US. 43. 40. 222. 174. 228. 102. 124. 42. 98. 117. 63. 71. 79. 105. 55. 32. 177. 146. 27. 33. 200. 181. 242. 201. 222. 103. 39. 246. 207. 116. 76. 108. 235. 176. THEORIES. 20. 30. 185. TELEPHONE. 69. 79. 66. 124. 110. 86. 36. 252. 80. 52. 220. 39. 69. 253. 33. 59. 192. 113. 87. 136. REGRESSION. 125. 246. 178. 215. 173. 65. 24. 97. 215. 199. 39. 34. 164. 55 SCHOOL-BASED. 202. 229. 35. 117. 144. 73. 195. 35. 149. 239. 178. 25. 195. 47. 18. 208. 55. 102. 41. 191. 89. 26. 242. 199. 233. 25. 216. 169. 171. 149. 202. 158. 39. 210. 44. 218. 65. 132. 84. 33. 196. 72. 75. 245. 213. 178. 205. 238. 116. 38. 230 139. 153. 178. 165. 252. 89. 196. 230. 228. 105. 110. 170. 157. 250. 199. 196. 210. 177. 180. 150. 125. 46. 258 STRATEGIES. 132. 133. 171. 113. 128 224. 219. 38. 156. 193. 179. 174. 152. 258 179. 155. 186. 161. 94. 154. 75. 101. 30. 200. 100. 190. 254. 24. 74. 253 49. 83. 88. 66. 29. 20. 63. 230. SOCIOECONOMIC. 107. 131. 209. 128. 166. 169. 213. 21. 72. 137. 32. 204. 218. 57. 109. 68. 102. 71. 140. 74. 65. VIDEO. 178. 84. 170. 91. 128. 73. 90. 161. 139. 56. 71. 181. 256 WAIST CIRCUMFERENCE. 137. 64. 256 63. 75 VENDING. 20. 91. 167. 221. 26. 92. 169. 224. 230. RECREATION. 234. 120. 120. RISK. 35. 91. 146. 186. 43. 149. 28. 213. 160. 152. 144. 203. 245. 248. 101. 87. 219. 109. 110. 248 206. 117. 141. 69. 120. 228. 214. 136. 111. 103 TEENAGE. 122. 219. 107. 43. 162. 137 . 253. 182. 37. V 221. 187. VEGETABLES. 30. 199. 211. 192. 80. 207. 161. 249. 177. 35. 87. 179. 111. 178. 29. 81. 97. 132. 207. 120. 156. 117. 126. 47. 23. 167. 155. 70. 110. 180. 158. 224. 147. 17. 257 TECHNIQUES. 60. 100. 234. 179. 180. 112. 173. 142. REFERENCE. 99. 208. 28. 55. 145. 154. 75. 111. 248 244. 221. 128. 223. 74. 73. W 215. 169. 57. 54. 230. 225. 188. RESTRAINED EATING. 150. 59. 105. 229. 155. 176. 68. 188. 194. 200. 137. 134. 183. 107. 256. 162. 53. 105. 110. 75. 88. 64. 146. 167 SCHOOL CHILDREN. 54. 103. SOCIAL COGNITIVE THEORY. 228. 111. 28. 100. 240 108. 247. 186. 28. 151. 134. 257 VEGETABLE. 56. 59. 27. 121. 247. 224. 46. 137. 149. 102. 247. 240. 197. 254 73. 240 73. 242. 17. 66. 100. 97. 77. 158. 235. 22. 35. 47. 54. 139. 196. 70. 131. 222. 177. 76. 73. 193. 142. 72. 53. 72. 231. 230. 211. 160. 255 RISK BEHAVIOR. 82. 62. 67. 44. SELF-ESTEEM. 125. 224. 72. 171. 164. 146. 76 239. 172. 256 151. 65. 195. 189. 209. 219. SELF-REPORT. 230. 189. 113. 201. 137. 159. 205. 22. 108. 179. 215. 249. 98. 122. 184. 74. 211. 203. 246. 64. 196. 61 51. 92. 127. 113. 160. 179. 222. 152. 119. 197. 130. 46. 254. 149. 102. 153. 115. 54. 29. 57. 215. 245. 145. 67. 205. 60. 122. 146. 64. 94. 125. 199. 177. 53. 60. 84. 252. 85. 55. 17. 170. 135. 114. 203. 102. 36. 55. 153. 91. 248. 42. 86. 90. 105. 25. 42. 238. 101. 223. 233. 189. 206. 82. 89. 153. 250. 97. SOCIAL. 102. 103. 101. 240. 141. 158. 171. 181. 140. 30. 104. 126. 210. 40. 200. 64. 40. 88. 112. 17. 97. 37. 155. 218. 204 93. SCHOOL. TEACHERS. 66. 254 151. 121. 190. 189. 217. 45. 128. 71. 130. 228. 30. 187. 253. 115. 219. 180. 72. 71 246. 226. 132. 248. 190. 95. 195. 252. 61. 179 100. 220. 155. 231. 220. 65. 223. 229. 226. 148. 181. TELEVISION. 114. 62. 55. 70. 124. 153. 185. 204. 66. 222 URBAN. 174. 37. 101. 127. 178. 128. 234. 57. 194. 214. 180.

27. 131. 256 211. 77. 242. 24. 248. 126. 165. 147. 39. 235. 247. 255. 249. 231. 206. 99. 231. 30. 88. 176. 91. 181. 250. 188. 126. 153. 238. 135. 242. 140. 183. 83. 37. 97. 103. 254 94. 253. 210. 24. 108. 111. 105. 84. 124. 103. 43. 239. 90. 18. 28. 154. 120. 86. 72. 141. 216. 238. 128. 17. 61. 107. 70. 176. 172. 126 164. 136. 171. 247. 252. 225. 192. 139. 34. 249. 127. 43. 245. 141. 236. 246. 216. 192. 35. 193. 123. 191. 161. 70. 139. 101. 145. 246. 214. 218. 16. 101. 117. 122. 70. 97. 63. 151. 151. 253. 96. 64. 45. 241. 193. 46. 252 WEIGHT-LOSS. 96. 27. 221. 100. 99. 245 233. WEIGHT MANAGEMENT. 211. 131. 254. 256 126. 248. 33. 96. 232. 66. 241. 173. 208. 239. . 185. 244. 180. 33. 76. 150. 197. 235. 223. 35. 148. 213. 203. 165. 43. 132. 65. 81. YOUTH. 223. 177. 134. 95. 187. 69. WORKSITE. 214 WOMEN. 57. 211. 19. 128. 163. 122. 226. 207. 131. 26. 37. 230. 255 Y WELL-BEING. 62. 46. 214 YOUNG ADULTS. 226 WHITE. 138. 121. 122. 44. 240. 134. 219. 113. 150. 53. 234. 90. 178. 110. 250. 143. 70. 92. 240. 54. 45. 60. 244. 161. 119. 180. 81.

about-face.org/afp/20000615/3615. 246 Web-Based Resources ASSOCIATIONS AND ORGANIZATIONS ABOUT-FACE Promotes positive self-esteem in women and girls of all ages. undernourished and sedentary youth by focusing on changes at school. http://www.americaonthemove.org/mc/empower/ Facts about body image.org/r/facts/bi. http://www. http://www.org/WActiveLiving.aafp.org/ 10 Ways to Empower Yourself http://www. http://www.aafp.html .org/ Tips for active living.org/ AMERICA ON THE MOVE America On the Move is a national initiative dedicated to helping individuals and communities across our nation make positive changes to improve health and quality of life.about-face.americaonthemove.actionforhealthykids.org/ Successful Management of the Obese Patient.about-face. http://www.shtml ACTION FOR HEALTHY KIDS The only nonprofit organization formed specifically to address the epidemic of overweight. http://www.asp?PageID=8 AMERICAN ACADEMY OF FAMILY PHYSICIANS Information on overall health. http://www. By focusing on individuals and communities AOM strives to support healthy eating and active living habits in our society.

and certifications are available from this website.htm How to purchase proper exercise equipment. http://www.org/health%2Bfitness/productpurchase.org/health%2Bfitness/comments. 247 AMERICAN ALLIANCE FOR HEALTH.cfm?template=nclb.healthology. AND DANCE AAHPERD is an alliance of six national associations and six district associations and is designed to provide members with a comprehensive and coordinated array of resources.aahperd.htm Links to topics in exercise.org/advocacy/ Information on the No Child Left Behind Legislation. http://acsm.org/aahperd/template. http://www. support. http://aahperd.com/focus_index. http://acsm.html Information on how to eat better.asp?b=aahperd&f=nutrition AMERICAN COLLEGE OF SPORTS MEDICINE MISSION STATEMENT: ACSM advances and integrates scientific research to provide educational and practical applications of exercise science and sports medicine. http://acsm.htm . research. RECREATION. http://member.org/health%2Bfitness/fit_society.org/ General health and fitness information and tips for beginning an exercise program are available. http://acsm.aahperd.org/health%2Bfitness/index. and programs to help practitioners improve their skills and so further the health and well-being of the American public. Information on health and fitness.htm Links to current comments on various exercise related factors. http://acsm.org/ Issues and legislation regarding improving physical activity.aahperd. PHYSICAL EDUCATION.

org/news/030105/ Links to helpful articles on increasing physical activity and eating better. As the nation’s “workout watchdog.acfn. http://www. http://www. You can submit your own questions as well.acfn.org/fitfacts/fitbits_list.org/fitfacts/fitbits_display. http://www. http://www. America’s Authority on Fitness.aspx?itemid=241 Ten tips to stay healthy during the holidays. http://www. .org/fitfacts/fitbits_display.org/resources-ask/ How to improve the eating habits of your family. http://www.org/ Quick tips for nutrition and physical activity.org/media-news/ AMERICAN COUNCIL ON EXERCISE The American Council on Exercise (ACE).aspx Links to specific exercise tips.” ACE sponsors university-based exercise science research and testing that targets fitness products and trends.acefitness.org/resources-quick/ One on one questions with a nutrition expert.acefitness. http://www. 248 AMERICAN COUNCIL FOR FITNESS AND NUTRITION The American Council for Fitness and Nutrition works with partners to raise awareness of the nutrition education and physical activity programs designed to improve community health and to demonstrate the commitment of public. http://www. is a nonprofit organization dedicated to promoting the benefits of physical activity and protecting consumers against unsafe and ineffective fitness products and instruction.acefitness.acefitness.aspx?itemid=192 Top seven healthiest foods.acfn.acfn.aspx Six fitness myths.org/default. private and non-profit sectors to finding effective obesity solutions. ACE sets standards for fitness professionals and is the world’s largest nonprofit fitness certifying organization. http://www.acfn.

http://americanheart. http://americanheart. dietary fiber.org/presenter. http://www. http://americanheart.org/presenter.aspx?itemid=227 AMERICAN DIETETIC ASSOCIATION With nearly 65.org/Member/PolicyInitiatives/index_21009.jhtml?identifier=3030527 Top ten ways to help children develop healthy habits.eatright.jhtml?identifier=3007590 .cfm Information on weight management.org/presenter. http://www.jhtml?identifier=1200000 Information on childhood obesity.org/fitfacts/fitbits_display.000 members.cfm AMERICAN HEART ASSOCIATION Information on heart health and conditions.org/presenter.acefitness.jhtml?identifier=3030485 Information on exercise for children. 249 http://www. ADA serves the public by promoting optimal nutrition. functional foods. http://americanheart.org/fitfacts/fitbits_display. Information about eating healthy is available at this website. http://www. http://www.aspx?itemid=123 How to choose the type of fats that you eat wisely.eatright. health and well-being.acefitness.org/Member/PolicyInitiatives/index_21054. total diet approach.jhtml?identifier=3007589 Information on diet for children.cfm Information on food misinformation.org/Member/PolicyInitiatives/index_21044.org/Public/ Information about food fortification and dietary supplements.eatright. http://americanheart. and vegetarian diets is available here. http://www. the American Dietetic Association is the nation’s largest organization of food and nutrition professionals.eatright.org/presenter.

org/education/profile. gender. http://obesity. news reports. and updates. research.org/prevention/programs. http://www.shtml Information on preventative and wellness programs.shtml Weight and wellness profile assessment. Obesity is not a simple condition of eating too much. ethnicity or disease state — compares to obesity in prevalence and prejudice.org/treatment/guidelines.ama-assn. and a goal weight calculator.shtml Information on maintaining weight loss. No human condition — not race. http://obesity.shtml Information on weight loss strategies.html AMERICAN OBESITY ASSOCIATION Here you will find what we think is the most comprehensive site on obesity and overweight on the Internet.ama-assn. http://obesity. http://obesity. treatment. It is now recognized that obesity is a serious.shtml . sickness and stigma.org/ Information on how to prevent weight gain. Links are separated by the chapter titles.org/prevention/maintaining. religion. http://obesity. mortality and morbidity.html Links to ten chapters of the Obesity Primer. chronic disease. consumer protection and discrimination are on this site. 250 AMERICAN MEDICAL ASSOCIATION Information on most if not all aspects of health. prevention.org/treatment/weight.org/ Nutrition and physical fitness information for youth.org/ama/pub/category/10931.ama-assn. Links to information on education. http://obesity. http://www.org/prevention/preventing. treatment options.shtml Links to information on treatment programs. http://www. links to specific information.org/ama/pub/category/2282. http://obesity.

org/ 10 Nutrition Tips http://www.html Obesity Prevention and the Role of Schools http://www.org/nutrition_tips.html . and supporting public policies to prevent overweight and obesity.canfit. http://www.canfit. http://www.htm CALIFORNIA ADOLESCENT NUTRITION AND FITNESS PROGRAM The California Adolescent Nutrition and Fitness (CANFit) Program is a statewide.asbp. Formed in 1950.shtml AMERICAN SOCIETY OF BARIATRIC PATIENTS The American Society of Bariatric Physicians (ASBP) is a professional medical society of licensed physicians who specialize in the medical treatment of obesity (Bariatrics) and its associated conditions. Asian American.canfit.htm Links to stories on obesity in the news. American Indian. non-profit organization whose mission is to engage communities and build their capacity to improve the nutrition and physical activity status of California’s low-income African American.org/treatment/cost.org/ Frequently asked questions about obesity.asbp.canfit.asbp. Latino.org/fitness. http://www.html Nutrition Activities http://www.org/nutrition_activities.html 3-week healthy snack plan http://www.html Links to fitness information http://www.org/news. http://obesity.org/nutrition_snackplan. 251 Cost of obesity.org/faq. ASBP has been instrumental in offering practical information that doctors can use in their bariatric practices. http://www.canfit.org/nutrition_obesity. and Pacific Islander youth 10-14 years old.canfit.

htm Information on milk and dairy products.ctfphc.org/DD/Home .ctfphc. using the evidence-based recommendations of the Canadian Task Force on Preventive Health Care (CTFPHC). http://www.ctfphc.org/to_cmaj_obesity.org/ Summary Table of Recommendations about obesity.html DRUGDIGEST DrugDigest is a non-commercial.org/ The Importance of Breakfast http://www.org/edu/edu_prog_bhm_brea. content and frequency of a wide variety of preventive health interventions.htm Screening for Childhood Obesity http://ctfphc.htm DAIRY COUNCIL OF CALIFORNIA Information on dairy products and health.dairycouncilofca. and treatment of obesity http://www.org/Full_Text/Ch4full.dairycouncilofca.htm Prevention of Obesity in Adults http://www. prevention. http://www.ctfphc.org/dairy/index. http://www. consumer health and drug information site dedicated to empowering consumers to make informed choices about drugs and treatment options. evidence-based.drugdigest.htm Detection.org/Full_Text/Ch30full. http://www. http://www. 252 CANADIAN TASK FORCE ON PREVENTIVE HEALTH CARE This website is designed to serve as a practical guide to health care providers.dairycouncilofca. planners and consumers for determining the inclusion or exclusion.org/Tables/Obesity_tab.

550266.00.drugdigest.org/DD/HC/Treatment/0. http://gssiweb. http://www.drugdigest.html Symptoms of Obesity http://www.00.550266.00.org/DD/HC/Causes/0. The sports science library contains information on obesity and weight loss.00.drugdigest.drugdigest.org/DD/HC/HCIntro/0.org/DD/HC/WhatIs/0.00.00. athletic performance. Information on obesity is available in this list. http://gssiweb.html Current research underway on obesity. http://www. 253 Introduction on Obesity http://www.4048.4043.drugdigest.4046.4049.org/DD/HC/Symptoms/0.html GATORADE SPORTS SCIENCE INSTITUTE Information on nutrition.550266. http://www.org/ A compilation of articles dealing with athletic performance and weight loss.550266.html Treatment options for obesity.html Obesity defined http://www.drugdigest.4045.org/DD/HC/Horizon/0.cfm?id=96&type=research GET FIT FRESNO Access to quality fitness programs for every Fresno Citizen in every neighborhood .org/sportssciencecenter/topic.00.550266. hydration.550266.550266.4044.org/DD/HC/RiskFactors/0.org/DD/HC/WhoHas/0.html RISK FACTORS OF OBESITY.drugdigest.4047.drugdigest.html Who is obese? http://www. and weight loss are available at this site.html Causes of obesity http://www.550266.4050.00.

org/kid/stay_healthy/ Food and fitness info for teens. http://www. peer-reviewed policy guidance and resources to support advocacy and decision-making at the state and local levels.kidshealth.org/ Popular types of exercise.org/ Locations for free aerobics classes in Fresno.healthpolicycoach.html Staying healthy links for kids.org/doc. http://www.asp?id=6457 Links to information on obesity prevention. http://www.kidshealth. http://www.org/teen/food_fitness/ .healthpolicycoach.html Nutrition and fitness articles for parents. http://www.org/ Childhood Obesity: Using School Programs to Encourage Increased Physical Activity among Youth.org/parent/nutrition_fit/index.getfitfresno. http://www.asp?id=6651 KIDSHEALTH KidsHealth is the largest and most visited site on the Web providing doctor-approved health information about children from before birth through adolescence.org/parent/nutrition_fit/fitness/exercise. 254 http://www.asp HEALTH POLICY GUIDE Health Policy Guide provides evidence-based.getfitfresno. http://www.healthpolicycoach. http://www. http://www.org/doc.kidshealth.kidshealth.org/pages/CurrentEvents.kidshealth.

physicalfitness.org/outreach/get_in_shape_tips_suggestions.org/naspe/template.physicalfitness. http://www. http://www. http://www.org/ Information on exercise and fitness activities.melpomene.melpomene.cfm NATIONAL CENTER ON PHYSICAL ACTIVITY AND DISABILITY Information on physical activity for disabled people.org/exercise/ .aahperd. http://www.html NATIONAL ASSOCIATION FOR SPORT AND PHYSICAL EDUCATION The National Association for Sport and Physical Education seeks to enhance knowledge and professional practice in sport and physical activity through scientific study and dissemination of research-based and experiential knowledge to members and the public.asp NATIONAL ASSOCIATION FOR HEALTH AND FITNESS The National Association for Health and Fitness (NAHF) is a non-profit organization that exists to improve the quality of life for individuals in the United States through the promotion of physical fitness.org/ Benefits of fitness for worksites and employees.ncpad. http://www. publication and education. sports and healthy lifestyles and by the fostering and supporting of Governor’s and State Councils and coalitions that promote and encourages regular physical activity. founded in 1982. http://www. 255 MELPOMENE Melpomene Institute.melpomene.asp Tips and suggestions to get in shape.org/ Information about physical activity http://www. http://www.ncpad. helps girls & women of all ages’ link physical activity and health through research.org/nehf.org/research/about_physical_activity.

http://www.asp Landmark reports on physical activity.ncpad. http://www.php?sheet=91 Food Guide Pyramid http://www.org/nutrition/fact_sheet. and industry efforts into collaborative partnerships that inspire and empower all Americans to lead more physically active lifestyles.org/nutrition/fact_sheet.org/nutrition/fact_sheet.php?sheet=263 Information on low fat dairy meals.asp .org/ FAQ’s about physical activity.php?sheet=92 Eating Breakfast as a Weight Management Tool http://www.ncppa. http://www.org/nutrition/fact_sheet.org/nutrition/fact_sheet.org/nutrition/fact_sheet.ncpad.ncpad. http://www.ncppa.ncpad.php?sheet=93 Information on food labels.php?sheet=94 Information on low carbohydrate fad diets. and sleep. 256 Combating fatigue via diet.org/faqs. exercise. http://www. http://www.org/landmarkreports. private. http://www.ncpad.ncpad.ncppa.org/nutrition/fact_sheet.ncpad.php?sheet=292 NATIONAL COALITION FOR PROMOTING PHYSICAL ACTIVITY The National Coalition for Promoting Physical Activity's mission is to unite the strengths of public. http://www.php?sheet=276 Information on serving sizes.

org/ NC’s Obesity Prevention Initiative Unveils New Campaign http://www. NCDA has over 1500 members.eatrightnc.org/newsandpress.html NORTH CAROLINA DIETETIC ASSOCIATION The North Carolina Dietetic Association (NCDA) is one of 50 state associations affiliated with the American Dietetic Association.shtml#StrengthFemale Health Aspects of Resistance Exercise and Training http://www. http://www.eatrightnc.org/ Strength Training for Female Athletes http://www. The North Carolina Dietetic Association is the advocate of the dietetic profession serving the public through the promotion of optimal nutrition.nsca-lift.org/Publications/posstatements. http://www. all of whom are Registered Dietitians.htm OBESITY RESEARCH Research on obesity.org/ Obesity Newsletter http://www. health and well being.shtml#HealthAspects NORTH AMERICAN ASSOCIATION FOR THE STUDY OF OBESITY Information on obesity.obesityresearch. research-based.org/newsletter/nl200403. 257 NATIONAL STRENGTH AND CONDITIONING ASSOCIATION The National Strength and Conditioning Association (NSCA) is the world's leading authority on strength and conditioning.org/Publications/posstatements. We provide reliable.nsca-lift. strength and conditioning information to our members and the general public.org/ .naaso. http://www. http://www.naaso.nsca-lift.

http://www.aahperd. http://www.org/ 99 Tips for Family Fitness Fun. 258 PALO ALTO MEDICAL FOUNDATION We commit to excellence.pe4life. We are community based and not for profit.pecentral.org/ SCHOOL NUTRITION ASSOCIATION Information on nutrition in schools. education and research. healthy living by advancing the development of quality.schoolnutrition. innovation and caring in health care.org/news_links.html PE 4 LIFE PE4Life inspires active. http://www.org/ Childhood Obesity: A New Epidemic http://www.org/health/toyourhealth/child_obesity.php PE CENTRAL Our goal is to provide the latest information about developmentally appropriate physical education programs for children and youth.schoolnutrition.org/naspe/template. http://www.pamf. http://www.pamf.pe4life. daily physical education programs for children. http://www. http://www.pe4life.org/Index.php Message boards where you can post information and ask questions about improving health through physical activity and nutrition.cfm?template=tips-spanish.aspx?id=1219 . Database with information on various level of physical education.org/ Comprehensive Childhood Obesity Bill Introduced in Senate http://www.org/forum/index.html Links to articles on physical activity.

academics and students. http://www. researchers. food.aspx?id=1078 Nutrition tips and education. and health. A comprehensive clearinghouse of information and resources to support decision-making that produces and sustains good results for children.hormone. treatment and cure of hormone-related conditions. http://www. http://www. founded in 1970. SNE provides forums for sharing innovative strategies for nutrition education.aspx?id=1138 Information available on programs. http://www.org/ THE HORMONE FOUNDATION The Hormone Foundation is dedicated to serving as a resource for the public by promoting the prevention. and communities. program administrators.org/obesity_resources. and fitness. http://www.org/ THE COMMUNITY NUTRITION INSTITUTE The Community Nutrition Institute (CNI) is a national non-profit organization.schoolnutrition. 259 Frequently asked questions about school nutrition programs. service providers.sne. education.communitynutrition. expressing a range of views on important issues.htm THE FINANCE PROJECT Resources for policy makers. Reviews on nutrition and exercise books are also available. and disseminating research findings.org/Index.financeprojectinfo. and others.org/content/home. nutrition.communitynutrition. and training on domestic and international food and nutrition concerns.org/ Obesity Resource Section of the Community Nutrition Institute http://www. http://wellness. families. sustainable food choices and has a vision of healthy people in healthy communities. families. which provides information.aspx SOCIETY FOR NUTRITION EDUCATION The Society for Nutrition Education (SNE) represents the unique professional interests of nutrition educators in the United States and worldwide. and students.org/Index. and influence policy makers about nutrition. fellow professionals. http://www. SNE is dedicated to promoting healthy.org/ .schoolnutrition.schoolnutrition. Members of SNE educate individuals.

http://www.org/tools_to_help/bmi.hormone.hormone. http://www. http://www.teenshealth.org/learn/obesity_4. http://www.org/tools_to_help/ten_ideas.org/learn/obesity.org/learn/obesity_3.hormone.org/ .org/learn/obesity_2. http://www.html Treatment options for obesity.html Symptoms of obesity.hormone.presidentschallenge. Information on activities to improve health is included on this website. http://www. http://www.org/the_challenge/active_lifestyle.org/learn/obesity_1.presidentschallenge. http://www.aspx# Ten ideas to get active.hormone. the President's Challenge can help motivate you to improve.html Lifestyle issues of obesity and prevention.aspx TEENSHEALTH Information on teen health http://www.html THE PRESIDENT’S CHALLENGE The President's Challenge is a program that encourages all Americans to make being active part of their everyday lives. No matter what your activity and fitness level.presidentschallenge. http://www.org/ A list of lifestyle activities for improving health.html Overview of obesity including causes.presidentschallenge.aspx BMI calculator. 260 Homepage for obesity information with useful links and information.

tvturnoff.org/teen/food_fitness/ TV TURNOFF NETWORK TV-Turnoff Network encourages children and adults to watch much less television in order to promote healthier lives and communities.htm .teenshealth. http://www.htm Tips to TV-Proof Your Home http://www. http://www.org/brock10.org/ Tips for turning off the TV. 261 Links to information on food and fitness http://www.org/proof.tvturnoff.tvturnoff.

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COM Information on fitness.com/features/daily-excercise-suggestions. http://www.healthology.com/articles/11506-2. http://healthfitnesstips.com/nip_v2.drmirkin. http://www. heart health.html Links to reports on fitness written by Dr. http://www.asp?f=nip_default&c=general Daily Exercise Suggestions.asp Methods to treat obesity.com/articles/11506-5.com/nutrition/index. men's health. 264 DRMIRKIN.drmirkin.emedicinehealth.com/ Links to reports on nutrition topics written by Dr.asp Obesity Causes http://www.html E-MEDICINE CONSUMER HEALTH Online site for health.asp HEALTH AND FITNESS TIPS Information on health and wellness in the 'Features' section. women's health.com/ Obesity Overview http://www.emedicinehealth.htm .com/fitness/index. Mirkin http://www. etc.com/articles/11506-1.emedicinehealth.com/articles/11506-6.drmirkin.health-fitness-tips. Mirkin http://www. http://www. nutrition.emedicinehealth. http://www.asp Prevention and outlook about obesity.emedicinehealth.

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com/cda/article/0.00.com/nutrition/26 MEN’S HEALTH Information on the health of men including fitness. http://www.menshealth.s1-6-0-0-2474.menshealth. 267 Best and Worst Foods a Man Can Eat http://www. the safe way to get an extra boost. http://www.com/cda/home/0.com/nutrition/25 . protection from the restaurant saboteurs. http://www. weight loss.muscleandfitness.com/cda/article/0. We've got the power foods. http://forums. lifestyle. how to cook for yourself. and nutrition.html Healthy Eating Guide.2823.s1-6-0-0-2087. and fat you should ingest.muscleandfitness. and even though this is about food.menshealth.00.s1-0-0-0-0. the special brew that can keep you disease free (no.menshealth.00. you still need to work out.mensfitness.html MUSCLE AND FITNESS ONLINE Information on fitness and nutrition that is easy to understand.html 21 Ways to Stick to a Workout http://www.com/cda/article/0. and read about motivating success stories. "Five a day the color way" is one way to go about it.2823.s1-1-0-0-2121. ask questions.2823. http://www.com/training/32 Information on the amount of protein.00.html Information on how food manufacturers confuse the public.muscleandfitness.com/cda/article/0.2823.com/ 17 Common Training and Nutrition Questions http://www. http://www.com/forum. not beer).menshealth.menshealth.s1-6-0-0-2482.html Weight loss message board where you can post comments. carbohydrates.jspa?forumID=5 Eat Right Every Time http://www. but we're here to keep you from sliding off that food pyramid.00. sex.

com/ChildhoodObesityRisks. http://www.com/ChildhoodObesityHow.com/home/0.ci OBESITYHELP A support site for obese people with information on treatment issues.obesityhelp. http://www.com/main-info-losingweight.com/ChildhoodObesityTreatment.com/main-info-eatingout.obesityhelp.php PREVENTION MAGAZINE Information on smart ways to live well.php Tips for losing weight.php Prevention options for childhood obesity.obesityhelp.html .obesityhelp.obesityhelp.com/ChildhoodObesityPrevention.php Main causes for childhood obesity.com/ Tips for eating out. http://www. http://www.obesityhelp.s1-21-0-0-0-0.obesityhelp. 268 Message Board where you can post information and ask questions about fitness and nutrition.php Low-fat food alternatives. http://boards. http://www.com/ChildhoodObesityCauses. http://www.com/ib/ikonboard.php Treatment options for childhood obesity.php How to know if you child is overweight or obese.php Risks involved in childhood obesity.muscleandfitness. http://www. http://www. http://www.com/main-info-alternatives.obesityhelp. http://www.00.prevention.obesityhelp.

html Information on walking basics and how to take advantage of this very popular type of cardio. and walking.com/body-fat-understanding.com/category/0. http://www. London. Remarks prepared for a National Obesity Forum debate.5775. http://www. http://www.prevention. Pilates.prevention.virilplant.com/ 10 Propositions on obesity and rationing treatment for it. spinning.virilplant. NORTH Information on a wide variety of topics including obesity.00.html RICHARD D.prevention. spinning.html Information on getting started in your workout program.richarddnorth.htm SIMPLANT .com/10_propositions/obesity.virilplant.00. http://www.s1-2-67-0-0-0.htm What is obesity and how is it measured? http://www. http://www.prevention.5775.com/category/0.THE EASY WEIGHT LOSS Information on understanding adult obesity. and yoga.htm Understanding Your Body Fat Percentage http://www.com/category/0.com/body-mass-index.htm Obesity and body mass index.5775. running.5775.s1-2-69-0-0-0. http://www.com/obesity-tratment.htm . swimming.richarddnorth.virilplant.00. 269 Information on fitness programs including: aerobics.com/obesity.s1-2-92-0-0-0. 2004 http://www.s1-2-56-0-0-0. cycling.com/category/0.html Information on cardiovascular exercise including: aerobics. http://www. 14 October.00.

sizewise.html STANFORD HOSPITAL AND CLINICS http://www. http://www.virilplant. and other causes of obesity.com/articles/health.stanfordhospital.stanfordhospital.virilplant.html Overview of Obesity http://www. and social effects of obesity.com/index.htm Consequences.virilplant.com/healthLib/greystone/heartCenter/heartDiseasePrevention/obesityTreatmen tOverview. 270 Genetic. psychological.stanfordhospital.com/ Information on health and fitness http://www.htm How obesity is treated and who should lose weight.com/healthLib/greystone/heartCenter/heartDiseasePrevention/overviewofObes ity.html Maintaining Weight Loss http://www. health risks. and more complete.html . http://www.html Obesity Treatment Overview http://www. http://www.stanfordhospital. psychological.com/healthLib/greystone/heartCenter/heartDiseasePrevention/preventingObesi ty. environmental.htm SIZE WISE We are here to provide you with information and resources designed to make your life healthier.stanfordhospital.com/obesity-tratment. more comfortable. http://www.html Preventing Obesity http://www.com/obesity-causes.com/healthLib/greystone/heartCenter/heartDiseasePrevention/maintainingWei ghtLoss.sizewise.com/obesity-consequences.

html Designing an Exercise Program http://www.webmd.html Risks of Physical Inactivity http://www. http://www.com/healthLib/greystone/heartCenter/heartDiseasePrevention/exerciseBeforeS tartinganExerciseProgram. https://diet. and mental strategies for success. A calorie counter. tips for success. https://diet.com/healthLib/greystone/heartCenter/heartDiseasePrevention/risksofPhysicalI nactivity.asp . obesity.com/index.html TESTOSTERONE NATION Mostly information for bodybuilders.com/webmddiet/default_home.COM Information on obesity including causes. via the search label at the top of the webpage. and treatment options are available on this website.aspx?referrer=1111_013_0000_0005&secure=1 Information on how to get fit including how to overcome five common excuses.com/WebMDDiet/default_getfit.weight.com/WebMDDiet/default_staymotivated. frequently asked questions.webmd.asp Definition of obesity. http://www. how to find the right activity and workouts that work.aspx?secure=1 Information on how to stay motivated to lose weight including how to set proper goals.com/ WEBMD WEIGHT LOSS CLINIC Information on food and recipes and how to stay fit and stay motivated.t-nation. http://www. You can search for information on weight loss. target heart rate calculator. https://diet. 271 Exercise: Before Starting an Exercise Program http://www.aspx?secure=1 WEIGHT.com/healthLib/greystone/heartCenter/heartDiseasePrevention/designinganExer ciseProgram. Information on fitness and nutrition can be found here as well.stanfordhospital.weight.stanfordhospital.webmd. etc.com/definition. trends. and dessert wizard are included at the lower right portion of the webpage.stanfordhospital.

http://www.com/weight-loss-programs.weight. http://www.weight-loss-i.asp WEIGHT LOSS INFORMATION Information on how to lose weight and eat a healthy diet.asp Years of life loss due to obesity.com/gimmick.htm Dietary guidelines for Americans.asp Complications of Obesity. http://www.com/complications.com/weight-loss. http://www. Various types of weight management strategies are discussed.weight.asp Information on weight loss gimmicks.htm Balanced Healthy Diet http://www.com/psychosocial. http://www.com/balanced-healthy-diet.htm Calorie needs to lose weight.weight.weight-loss-i. http://www.com/whyworry.htm .weight-loss-i.weight-loss-i.asp Psycho-social factors of obesity. http://www.com/calorie-needs-to-lose-weight.weight-loss-i. 272 Causes of obesity.weight.weight-loss-i.com/causes.weight.htm Information about weight loss. http://www.com/dietary-guidelines. http://www. http://www.com/ Types of weight loss programs.

weightwatchers.com/health/wko/men_workouts. http://www.weightwatchers.weight-loss-i. http://www. http://www.weightwatchers. 273 Practical guidelines to lose weight.weight-loss-i.aspx Fitness questions and answers.com/health/wko/women_workouts.com/index.aspx?tabnum=4&sc=128 Topics to help you stay motivated.aspx?newcategory=introduction .com/lose-weight.weightwatchers.com/how-to-lose-weight.weight-loss-i.com/weight-loss-for-adolescents. http://www. http://www.htm Perspectives on How to Lose Weight http://www. http://www. http://www.com/util/art/archive. http://www.weight-loss-i.com/weight-management.com/weight-reduction.weightwatchers.htm Weight Loss for Adolescents Teenagers & Children http://www.htm Weight reduction tips.htm WEIGHT WATCHERS Information on eating right and living an active lifestyle to lose weight.com/util/art/archive.weightwatchers.aspx?tabnum=4&sc=113 Workout tips for women.aspx?tabnum=4&sc=119 Fitness ideas http://www.com/util/art/archive.htm Exercise and weight management.weight-loss-i.aspx?newcategory=introduction Workout tips for men.

com/health/centers/fitness/ Archive of daily fitness tips. http://health. and a guide to getting fit.com/centers/fitness/10002 Calorie burning calculator http://health. http://health. the benefits of exercise. http://health. http://health. http://health.com/util/art/archive. http://www.yahoo.yahoo.com/centers/fitness/10001 Tips for achieving weight loss.com/health/asm/index.com/centers/weight_loss/ .com/centers/fitness/2 The key role of exercise in achieving weight loss.com/nutrition_fitness/miavita/fitnesstip=all Body fat percentage calculator. http://www. obesity.aspx?tabnum=4&sc=3 Health assessments.yahoo.com/util/qzs/index.weightwatchers.weightwatchers.aspx?tabnum=4 YAHOO! HEALTH Yahoo! Fitness Center with information on getting started with exercise.yahoo.aspx Health quizzes.com/centers/fitness/10003 A tool to help you pick the best type of activity for you to get more active.yahoo. 274 Topics in living a healthier lifestyle.yahoo.yahoo. and weight loss. http://health. http://www.weightwatchers. http://health.com/centers/fitness/20031158 Yahoo! Weight Loss Center with information on overweight.yahoo.

com/centers/weight_loss/101 .yahoo. http://health. http://health.yahoo.yahoo. http://health.yahoo. 275 Getting started in weight loss.com/centers/weight_loss/103 Weight loss strategies.com/centers/weight_loss/30003 Choosing the right weight loss program.com/centers/weight_loss/102 Achieving weight loss for life. http://health.

aspx?CatID=7584&SelectCatI D=7584&section=yourhealth GENERAL MILLS Information on Energy ways to lose weight including diet and activity modification. http://www.com/ GENERAL MILLS Corporate and health and wellness information.aspx?CatID=7782&SelectCatI D=7782&section=yourhealth Recommendations for adolescence to get more active. http://www.generalmills.generalmills.aspx?section=yourhealth 10 Simple Strategies to Increase Activity. 276 CORPORATIONS DOLE A site dedicated to helping people teach children how to eat better. http://www.com/corporate/health_wellness/your_health_detail. http://www.aspx?CatID=7846&SelectCatI D=7846&section=yourhealth Five steps to help you eat better.aspx?section=fitnut&sub=fit .com/corporate/index.generalmills.com/corporate/health_wellness/index.generalmills. http://www. http://www. and fitness.generalmills. http://www.generalmills.com/corporate/health_wellness/your_health_detail.generalmills. http://www.aspx Health information including BMI calculator and nutrition.com/corporate/health_wellness/exercise_fitness.dole5aday.com/corporate/health_wellness/your_health.aspx Health and wellness main page with links to information on health.com/corporate/health_wellness/your_health_detail. nutrition.

kraftfoods. http://www. and healthy living are available.kelloggs.kraftfoods. http://www.htm Healthy eating tips for Hispanic Americans.com/nutrition/nutritioncamp/learning/index.kraftfoods.com/nutrition/nutritioncamp/learning/index.com/kf/HealthyLiving/MealPlanner/MealPlanner.html KRAFT FOODS Information on products. http://www.html Information about food labels and how to read them.com/kf/HealthyLiving/NutritionUpdate/ConsumerEducation/consumerEd2.htm .aspx?s=health&m=plans/tools/weight/control Overview of the Institute of Medicine’s new recommendations for preventing childhood obesity.com/us/ Nutritional benefits of whole grain and fiber. http://www.com/kf/HealthyLiving/NutritionUpdate/PracticalPractice/knuSepr04PP.com/nutrition/nutritioncamp/learning/index. food and family.com/nutrition/wholegrain/benefits. http://www. http://www.kelloggwholegrain.htm Healthy weight range calculator. http://www.shtml A calisthenics calculator game.kelloggs.kelloggs.kraftfoods.kraftfoods.com/kf/HealthyLiving/NutritionUpdate/ConsumerEducation/consumerEdMay. http://www. 277 KELLOGG'S Product and nutrition information.com/main.kraftfoods. recipes. http://www.kelloggs.com/kf/ Meal and fitness planner. http://www.htm Healthy eating tips for African Americans.html Information about calories and four myths about nutrition and calories. http://www.

http://www.com/sensiblesnacking/ Sensible snacking quiz.kraftfoods.kraftfoods.com/kf/FoodandFamily/Spring_2004/healthyliving/10SnacksUnder150Calories.nabisco. http://www.nabisco.com/kf/HealthyLiving/articles/rulesofthumb.com/sensiblesnacking/ss_trivia.nabisco. Other dietary information is available as well.com/100caloriepacks/100cp_burn. http://www.htm Ten snacks less than 150 calories.kraftfoods. http://www. http://www.com/ Criteria for a snack to be considered a sensible snack. 278 Information on how to count calories in foods.htm Eight tips for beginning an exercise program.com/kf/HealthyLiving/WeightManagement/countingcalories.kraftfoods. http://www.com/kf/HealthyLiving/articles/beginanexercise.htm Portion size tips.com/sensiblesnacking/recipes/ss_recipemain. http://www. http://www.aspx 100 ways to burn 100 calories.nabisco. http://www.nabisco.htm NABISCO Product information available with a link to sensible snacking.aspx Sensible snack recipes.aspx .

htm Information on the Obesity Problem http://www.gov/nccdphp/dnpa/obesity/consequences.gov/nccdphp/dnpa/obesity/ Overweight and obesity defined. 279 Government Websites CALIFORNIA DEPARTMENT OF HEALTH SERVICES Protecting and Improving the Health of All Californians" http://www.cdc.ca. http://www.gov/ California Obesity Prevention Initiative http://www.htm CENTER FOR DISEASE CONTROL AND PREVENTION Information on health.htm Factors that contribute to obesity. http://www. http://www.cdc. and environmental influences on obesity.htm Health consequences of obesity. technological.cdc.cdc. http://www.dhs. and statistics on health related topics. Includes publications. data.ca.cdc.cdc.gov/nccdphp/dnpa/obesity/defining.gov/ps/cdic/copi/default.gov/ps/cdic/copi/html/problem.gov/nccdphp/dnpa/obesity/contributing_factors. safety.htm Current obesity trends.dhs. and products.dhs.htm .ca. http://www. http://www.htm The mission of the California Obesity Prevention Initiative (COPI) is to reduce the prevalence of obesity and its associated health risks in Californians through promotion of physical activity and healthy eating as well as address the societal.gov/ps/cdic/copi/html/Taking%20Action.gov/ Information on obesity and treatment.gov/nccdphp/dnpa/obesity/defining. http://www.ca.dhs.

htm State-based programs to prevent obesity and other chronic diseases.consumer. 280 Economic consequences of obesity. http://www.cdc. http://www.gov/weightloss/bmi. http://www.htm FAQ’s about overweight and obesity.us/ps/bestpractices/topicsubpages/obesity. http://www. http://www.gov/nccdphp/dnpa/obesity/resources. http://www.cdc.htm BMI Chart http://www.gov/nccdphp/dnpa/obesity/state_programs/index.gov/nccdphp/dnpa/obesity/faq.cdphe.gov/weightloss/guidelines.htm Recommendations for obesity treatment.cdphe.consumer.asp Best Practices: Obesity Prevention for Children and Youth http://www.htm Voluntary Guidelines for Providers of Weight Loss Products or Services http://www.state.co.cdc.html CONSUMER.consumer.cdc.us/cdphehom.co.gov/weightloss/setgoals.htm COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT The Colorado Department of Public Health and Environment is committed to protecting and preserving the health and environment of the people of Colorado.htm .GOV Resource for consumer information from the federal government.consumer.gov/nccdphp/dnpa/obesity/economic_consequences.htm General resources for overweight and obesity.state.cdc. http://www.gov/nccdphp/dnpa/obesity/recommendations.gov/ Setting Goals for Weight Loss http://www.

usda.ftc.gov/bcp/conline/edcams/waistline/index.nal.gov/ Weighing the Evidence in Diet Ads http://www.nal.gov/fnic/etext/000020.html Consumer Corner contains information about the food and nutrition topics the public most frequently asks about.usda. http://www.usda.gov/fnic/Fpyr/pyramid. 281 FEDERAL TRADE COMMISSION Information for consumers.html Information on food composition http://www.html .gov/bcp/conline/pubs/health/evidence.usda.gov/fnic/dga/index.htm Project Waistline Campaign http://www.ftc.ftc.gov/fnic/pubs_and_db.gov/fnic/consumersite/index. Much of the information is presented in full-text documents for your convenience.html Information on dietary guidelines http://www.nal.usda. http://www.html FOOD AND NUTRITION INFORMATION CENTER Information on food and nutrition http://www.html Food guide pyramid information http://www.nal.nal.

scientific adviser.cfm .healthypeople. http://www. 282 HEALTHY PEOPLE 2010 Healthy People 2010 challenges individuals. the Institute of Medicine strives to provide advice that is unbiased. document the statistical basis for the initiative.edu/focuson. and grounded in science. http://www. The primary goal is to increase the quality of your life. http://www.niehs. nutrition. The mission of the Institute of Medicine embraces the health of people everywhere. all of us— to take specific steps to ensure that good health. http://www.healthypeople.gov/Implementation/ The publications that set out the goals and objectives of Healthy People 2010.iom. http://www. based on evidence.gov/ Healthfinder® provides information on many topics related to the 28 focus areas of Healthy People 2010. and disease are available at this website.healthypeople.nih.healthypeople. and professionals—indeed. http://www. fitness. as well as long life.asp?id=22593 NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES Causes for childhood obesity. As an independent.iom. http://www-apps.gov/LHI/ Health objectives that enable groups to work together as a team.gov/conferences/drcpt/oe2005/index. is enjoyed by all.edu/ Information on obesity and steps that can be taken to prevent and treat obesity.healthypeople. http://www.gov/Publications/ INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES The Institute of Medicine serves as adviser to the nation to improve health.gov/healthfinder/ The Leading Health Indicators (LHIs) established by Healthy People 2010 will be used to measure the health of the Nation over the next 10 years. Information on the relationship between health. communities. and provide guidance for its implementation are available online and in print.

nih. minerals.nih. and school and community support for healthy eating and physical activity. nutrition education for children and their caregivers.gov/ Physical activity fact sheet. view our publications.gov/result. fitness and sports information website of the President's Council on Physical Fitness and Sports.asp/476/29 Links to information on vitamins. and link to the resources of other government agencies as well as to health and fitness organizations.nih.htm .health. http://www.gov/ Links to information on nutrition. physical activity. You can find out about the Council and its work.asp/725/29 Links to information on obesity. http://www.asp/474/29 Links to information on weight loss and dieting.nih. 283 NATIONAL INSTITUTES OF HEALTH U.S.gov/result. http://www.gov/result. http://www. and diet supplementation.gov/tn/ THE PRESIDENT’S COUNCIL ON PHYSICAL FITNESS AND SPORTS The President’s Council on Physical Fitness and Sports is the health.nih.usda. Department of Health and Human Services Website on health. http://health.gov/result.fns.asp/719/29 NSW HEALTH Health Information http://www.fitness. http://health.gov/resources_factsheet.gov.nsw. http://health. http://health.au/ TEAM NUTRITION Team Nutrition is an initiative of the USDA Food and Nutrition Service to support the Child Nutrition Programs through training and technical assistance for foodservice.fitness.

surgeongeneral.S. http://www. 284 Fitness topics. FOOD AND DRUG ADMINISTRATION Information on the regulated products of the FDA. http://www.gov/publications/over_child.fda.gov/publichealthpriorities.gov/council_pubs.hhs.fitness.nih. http://www.htm U.html#overweight Information on methods to increase physical activity.niddk.html U.gov/ Links to overweight and obesity information. SURGEON GENERAL America's chief health educator.gov/publichealthpriorities.htm .shtml WEIGHT-CONTROL INFORMATION NETWORK Information on helping your overweight child.gov/safety/index.gov/hearthealth/lifestyles/lifestyles.gov/ Losing Weight: Start By Counting Calories http://www. http://www. and eating right.surgeongeneral. http://www.html#increasing Database containing useful information on diet.S. giving Americans the best scientific information available on how to improve their health and reduce the risk of illness and injury. http://win. http://www. nutrition.surgeongeneral. as well as information on hot topics and the food industry.html Choose a heart healthy lifestyle http://www.fda.fda.gov/fdac/features/2002/102_fat.

niddk.htm Resources for information on overweight and obesity.gov/resources/index. 285 Statistics Related to Overweight and Obesity http://win.nih.htm#obesity .niddk.nih. http://win.gov/statistics/index.

the hope is that you will be able to find something of use.oznet.ksu.ksu. http://www.edu/humannutrition/nutLink/pages/RES.HTM Vegetarianism http://www.oznet.ksu.HTM Newsgroups for health related information. Always remember to exercise good judgment as you surf from site to site.htm Links to information on lifespan nutrition.edu/humannutrition/nutLink/pages/VEG.ksu. http://www.edu/humannutrition/nutLink/pages/FOOD.oznet.HTM .oznet. and fitness. http://www.oznet. health.ksu. Although it is not all-inclusive by any means. http://www.HTM Links to government health sites. 286 UNIVERSITIES KANASAS STATE UNIVERSITY The purpose of this page is to provide links to various sites that focus on nutrition and nutrition-related areas.oznet.edu/humannutrition/nutLink/pages/PROFILE.edu/humannutrition/nutLink/pages/EXERCISE.ksu.edu/humannutrition/nutLink/n2.HTM Nutrition related resources. http://www.oznet. http://www.ksu.oznet. exercise. http://www.edu/humannutrition/nutLink/pages/GOV.ksu.htm Links to information on exercise and fitness.edu/humannutrition/nutLink/life.HTM Nutrition Profiles http://www.edu/humannutrition/nutLink/pages/NEWS. http://www.oznet.HTM Information on food nutrients.ksu.edu/humannutrition/nutLink/pages/ORG.oznet.ksu.HTM Links to information on nutrition.

berkeley.shtml Fit WIC http://www.ces.berkeley.html UNIVERSITY OF CALIFORNIA.edu/cwh/activities/child_weight2. http://www.edu/cwh/resources/progs_overwt.edu/cwh/ Project on Reversing Childhood Obesity Trends http://www.berkeley.shtml Nutrition and Food Security Programs http://nature.cnr.ncsu.edu/cwh/activities/fitwic.html Publications on nutrition.ncsu.berkeley.ces.edu/depts/fcs/food/hhb/index.ncsu.shtml .cnr.html This program provides you with research-based information that you can use to help you make healthful changes in your eating and exercise habits designed to help prevent cardiovascular disease. 287 NORTH CAROLINA STATE UNIVERSITY Guidelines for Childhood Obesity Prevention Programs: Promoting Healthy Weight in Children http://www.cnr. http://www.edu/depts/fcs/food/index.shtml Programs for Overweight Children http://nature.edu/cwh/activities/trends.berkeley. BERKLEY Berkeley Center for Weight and Health http://www.ces.shtml Children and Weight: What Can Communities Do? http://www.ces.edu/pitt/fcs/childObesity.edu/depts/fcs/food/pubs/index.ncsu.berkeley.cnr.edu/cwh/resources/progs_projs_nutrfs.htm Links to information on food and nutrition. http://www.

edu/pipermail/prc-obesity-network-cwh/2005-May/ . 288 Physical Activity Programs http://nature.shtml Links to articles on obesity.berkeley.berkeley.berkeley.edu/cwh/resources/progs_projs_paguide.shtml Physical Activity and Nutrition Program Guidelines http://nature. http://nature.edu/cwh/resources/progs_projs_pa.