Encyclopedia of Obesity
Edited by: Kathleen Keller
- Publisher: SAGE Publications, Inc. |
- Publication Year: 2008 |
- Online Publication Date: April 21, 2008 |
- DOI: http://dx.doi.org/10.4135/9781412963862 |
- Print ISBN: 9781412952385 |
- Online ISBN: 9781412963862 |
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"This work, featuring a reading level appropriate for high school audiences and above, is recommended for academic and public libraries."—Library JournalThe Encyclopedia of Obesity is as much of a reference resource as it is a tool to raise awareness in the medical and public health communities. With almost 500 entries, these two volume summarize pertinent topics in obesity and related health conditions, including molecular biology, psychology, medicine, public health and policy, food science, environmental health, and pharmaceuticals. The editor has chosen topics that capture the current climate of obesity research while still addressing and defining the core concepts related to this condition. Based on a theme of “Moving Forward in an Ever Expanding World” articles address topics for a changing society that is slowly adapting ...
- Reader's Guide
- Entries A-Z
- Subject Index
- Biological or Genetic Contributors to Obesity
- Children and Obesity
- Dietary Interventions to Treat Obesity
- Disordered Eating and Obesity
- Environmental Contributors to Obesity
- Health Implications of Obesity
- Medical Treatments for Obesity
- New Research Frontiers on Obesity
- Obesity and Ethnicity/Race
- Obesity and the Brain or Obesity and Behavior
- Obesity as a Public Health Crisis
- Psychological Influences and Outcomes of Obesity
- Societal Influences and Outcomes of Obesity
- Women and Obesity
- Worldwide Prevelance of Obesity
Copyright © 2008 by SAGE Publications, Inc.
All rights reserved. No part of this book may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher. Readers are advised and encouraged to seek either a professional opinion or a medical diagnosis for any condition they may have.
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Library of Congress Cataloging-in-Publication Data
Encyclopedia of obesity / Kathleen Keller, general editor.
Includes bibliographical references and index.
ISBN 978-1-4129-5238-5 (cloth)
1. Obesity–Encyclopedias. I. Keller, Kathleen.
This book is printed on acid-free paper.
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About the General Editor[Page vi]
Kathleen Keller, Ph.D.
Research Associate, New York Obesity Research Center
Assistant Professor, Columbia University Institute of Human Nutrition
Kathleen Keller received her doctoral degree in Nutritional Sciences at Rutgers University in 2002, and her thesis focused on the genetics of taste perception, eating, and body weight in young children. She completed a three-year post-doctoral training fellowship at the New York Obesity Research Center where she specialized in childhood obesity research studies. In 2005, Keller received funding from the National Institutes of Health to continue research in the area of taste genetics and obesity in children, and she continues to work on this research at present. Most of her studies take place in the Child Taste and Eating Laboratory at St. Luke's Roosevelt Hospital in New York City, where she is currently serving as the Director.
While actively conducting research in childhood obesity, Keller has continued a number of mentoring, teaching, and writing activities. She is an Assistant Professor in the Institute of Human Nutrition at Columbia University, and an Assistant Adjunct Lecturer in the Department of Health Sciences at Brooklyn College. She regularly mentors high school research students, many of whom have gone on to win national recognition for research conducted in her laboratory. Further, Keller writes monthly executive summaries for a Columbia University seminar series on Appetitive Behavior. Through these varied teaching and writing responsibilities, she has gained an appreciation for the complexities of the obesity epidemic and the broad interests of researchers who work in this important field.
IN MEDICAL TERMS, obesity is defined simply as an excess amount of adipose or fat tissue. The terms adipose and obesity both have their origins in Latin. Adipose stems from adeps, meaning fat, while obesity comes from the Latin—obesus—which, in turn, is a contraction of two Latin words, ob and edere, meaning to devour or eat away. At the most basic level, obesity is a disease of imbalance. Energy (in the form of calories) that is coming into the body outweighs the energy that is expended.
Historically, the disease has been known in every society, and can be evidenced as far back as the Ancient Egyptians. Hippocrates, the so called father of medicine, made one of the first accounts of the risks posed by being obese, and his suggestions for treatment were not that far removed from diets of today. He prescribed hard labor, sleeping on a hard bed, eating only once per day, eating fatty food for greater satiation, and walking naked as long as possible! Certainly, his patients would have lost weight when following that regimen, however, the practicality of implementing that medical advice today is questionable. The critical issue, however, is why obesity, despite origins in the ancient world, a simple cause and treatment, is one of the most salient threats to the welfare of our present society.
In recent years, the public's general interest and alarm in the obesity epidemic has become apparent. It is no longer possible to avoid the issue: newspapers, the evening news, health magazines, the fashion industry, television and movies, all contribute to the public's both interest, and inevitable saturation from the issues surrounding this epidemic. Cultural analysts would not be far off in stating that our current society is obsessed with both food, and the consequences of an excess of food—obesity. For a society that relies on the mass media for much of its education, the genuine fear of many health and medical professionals is that the general public will receive incorrect messages. As someone who works in the field, I often find myself biting my tongue at family functions or social gatherings, simply to prevent getting involved in arguments about the latest diet fads (most of which are ineffective). However, I also understand the public's deep frustrations over the state of medically purveyed obesity treatments—because there is no magic pill or treatment to cure and eradicate the disease. The best medical advice is to reduce your caloric intake by eating a variety of healthy foods and increase the amount of physical activity you get. Seems quite simple, but still, the majority of us will struggle to maintain a healthy weight, and this struggle is one we must fight for the rest of our lives.
The current interest and obsession with both food and obesity in present society is a predictable reaction to the recent increases in the occurrence of this disease. Over the past three to four decades, the prevalence of obesity in the United States has been consistently [Page viii]on the rise, and depending on what resource you consult, the number of obese adults is estimated at anywhere between 30 and 35 percent. If you expand this definition to include overweight (a less severe condition of excess body weight), those numbers skyrocket to between 60 and 65 percent. Further, according to most recent data from the National Health and Nutrition Examination Survey (NHANES), one of the primary surveys designed to study the health and nutrition status of adults and children in the United States, it is estimated that between 16 to 18 percent of children and adolescents are obese, while over one-third are overweight. Clearly, it is no wonder why some experts have suggested that researchers no longer ask the question “What causes people to become obese?” and that a better question might be, “How do some people remain lean in an environment of excess?”
The cut-offs for obesity are defined using reference standards for Body Mass Index, or BMI. BMI is a unit of weight that is adjusted for height, and is thought to be a good estimation of the amount of body fat one has. Depending on where BMI lies, cut-offs for lean, overweight, and obese have been defined. These classifications were set by expert committees who assessed some increased risk of morbidity and mortality with increasing BMI. But these categories are not without controversy, and even the scientific research community is at odds for defining the exact contribution that excess weight makes toward reducing life expectancies. The fact that obesity lowers quality of life is less controversial though, and it is well documented that even losing modest amounts of weight can improve health parameters and improve overall well-being.
While the contribution of obesity to increasing mortality risk in adults can be debated, there is growing concern that today's youths will be the ones to pay most dearly for this epidemic. If estimates continue as projected, the current generation of children will grow up to become the most obese in history. More importantly, it is expected that today's youths will actually be the first to have shorter life expectancies than their parents, a fact mainly attributed to early deaths due to obesity-related diseases. A clear example of this can be seen with Type 2 diabetes, the type of diabetes that results because the body can no longer produce enough insulin to meet the body's needs. Obesity exacerbates the progression of this illness, and over the course of 10 to 20 years, eventually the body becomes completely resistant to the effects of insulin. Until recently, this disease was rarely seen in children. Juvenile onset diabetes, now called Type 1 diabetes, was the form of this disease seen in children. Currently, it is estimated that over half of new diabetes cases in children are now Type 2. Once known as “adult-onset diabetes”, Type 2 diabetes can now be seen in children as young as 2 years of age. The combination of the right genetic and environmental conditions has made for astoundingly rapid increases in the development of this disease in a population where it was once nonexistent.
The statistics are undoubtedly alarming. While awareness of the problem is arguably at an all time high, the general public and most health professionals are still unaware as to how to treat obesity, both on an individual basis and at the level of public policy. Furthermore, the perception amongst both the lay public and many health professionals is that obesity is largely due to a lack of will power and occurs in individuals of weak constitution. Thus, we blame the obese individual for his or her condition. Persons who suffer from the illness are made to pay for two seats on an airplane. They are rejected for health and life insurance policies. They are stigmatized in the mass media, in the workplace, and even by the medical professionals who treat them. Rarely has a medical condition been encountered where such ambiguity exists over how to treat the illness, and where on many occasions, the burden and blame is put on the individual. Therefore, the most important reason for this text is to provide education and awareness to the public that obesity is a complex, multi-faceted disease with biological, environmental, and socially mediated causes and consequences.
While several experts in the field recently debated the relationship between obesity and increased mortality, there is little argument for the direct role that being overweight plays on reducing quality of life. The burdens due to obesity, both individually and on a population level, are many. During childhood, obesity is particularly debilitating, and these children are often teased relentlessly and bullied by their classmates. Obesity is also associated with a range of health problems, such as Type 2 diabetes, cardiovascular disease, certain cancers, osteoarthritis, sleep apnea, hypertension, and many others. Thus, shorter life expectancies in obese patients are most likely attributed to the wide range of aﬄictions that coincide with this condition. Even if life expectancy is not shortened, the quality of those years for an obese individual might be lower, as they are prone to suffer both physically [Page ix]and cognitively. As a society, we all pay this burden through higher health care costs, which in 2005 were estimated at $75 billion annually. The cost to treat both obesity and obesity related illnesses contributes to nearly 10 percent of the total medical expenditure in the United States.
One of the most important questions to ask is why we, as a society, continue to “expand,” and similarly on an individual level, why is it so difficult to maintain a healthy weight. This question will be the focus of many of the topics explored in this encyclopedia. The answer is complex, in that despite the fact that obesity is simply a disease of energy imbalance, the exact reasons for this imbalance are vast, and in some cases unknown. Variations in biology between one human and another have blessed some with a perpetually lean frame, while others continually battle to keep their waist lines down.
Currently, we know of nearly 250 genes that can be altered, with outcomes affecting body weight regulation, and thus risk for obesity. Perhaps more pervading, though, is the current environment in developed countries that seems to encourage energy consumption. There are few places in the world where one can travel and not be within quick access to multiple fast restaurants and convenience stores. Economic conditions are such that high fat, high carbohydrate foods cost much less per calorie than do more healthful fruits and vegetables. To complicate matters, most U.S. cities and suburbs are not designed to promote safe walking or bicycling, but rather favor the convenience of automobile travel. Moreover, this generation of children are faced with multiple media sources, including television, computers, and ever-appealing video games.
Taken together, these environmental conveniences that signify growth and development of society, favor over-consumption, while simultaneously reducing the energy required to perform daily activities. Our genes, some of which were selected for during times of famine and food scarcity, are now faced with survival in a time of unparalleled food surplus. Because we evolved when food environments were much different than they are today, we continue to be much more efficient at holding onto calories than we are at expending them. All of these effects, in concert, have contributed to the current obesity epidemic.The Encyclopedia
The purpose of this two-volume encyclopedia is to catalog entries from a variety of expert contributors from a vast array of obesity-related disciplines, including molecular biology, psychology, medicine, public health and policy, food science, environmental health, pharmaceuticals, physiology, endocrinology, and many others to summarize pertinent topics in obesity, and related health conditions. Approximately 475 entries are included that address the broad scope of the disease, from molecular and genetic causes, to the treatment of this disease at the public policy level. The editors have chosen topics that capture the current climate of obesity research, while still addressing and defining the core concepts related to this disease. Additionally, we have relied on experts from the medical and scientific research community to provide the majority of entries. In many cases, entries are written by pioneering or premiere researchers in the topic at hand. Our intention in this text is to create a reliable, accurate, and thorough resource for information about the obesity epidemic. Scholars, educators, researchers, physicians, and the general public should be able to access this resource for current, factual details on topics related to obesity.
This encyclopedia is targeted at a variety of audiences, from scholars to the general public. It is intended to serve as a general and nontechnical resource for students, teachers, and researchers who wish to understand the development of obesity as it prevails in the developing and under-developed nations.
Scholars who are conducting research will be able to access hundreds of topics related to obesity, all within a single text. This text should be a helpful reference to enrich current knowledge, or to investigate new topics of interest. Because obesity is such a pervading illness, the editors are dedicated to exploring the broad scope of topics related to obesity, in a user friendly manner that a variety of science and non-science disciplines can access.
In determining which topics to include, the editors first defined 15 to 20 major themes to address. Once the overall themes were established, we developed a list of potential topics to discuss within each theme. As a peer-review of these topics, we accepted feedback from many of the invited contributors, and adapted, added, or deleted many topics based on this review.
The final list is intended to be a broad overview of the relevant issues related to obesity, its etiology, consequences, treatment, outcomes, and policy implications. It is, however, in no way an exhaustive list. Thus, this resource is intended to be a starting place for learning about obesity, with additional references [Page x]provided at the end of each topic for additional research.
A quick perusal of these volumes will alert the reader to several obvious details about the text. First, the scope of obesity is extremely broad. A number of the articles address specific genes, proteins, receptors, or hormones that are involved with the development of obesity. Obviously, it would not be feasible, or practical, to write entries on each of the genes or proteins associated with obesity. Thus, the editors and contributors attempted to capture the “highlights” of this genetic research, with general headings on the genetics of obesity addressing this literature on a broad spectrum.
Second, the reader will notice that the layout of the text is much like that of a standard reference encyclopedia. This convenient organization will assist readers most when they have a specific idea of the term they wish to investigate, however, for readers who do not know the specific search term, each article is crossreferenced with other article headings. Third, as in most encyclopedias, there is some repetition in the material in these texts. For example, the topic of eating disorders is addressed in a number of sub-topics, (“Disordered Eating,” “Eating Disorders and Athletes,” “Eating Disorders and School Children,” and “Eating Disorders and Gender”). Each entry will have a slightly different focus, but some major concepts might be reviewed in multiple entries. This redundancy is considered by the editors to be a positive attribute, since inevitably the themes that are repeated are ones that should be considered “take home messages.”Moving Forward in an Ever-Expanding World
In 2002, two teenagers from New York City filed a lawsuit against McDonalds alleging that daily exposure to the fast food giant's meals caused them to become obese and face lifelong health problems. Two years later, a documentary called “Super Size Me” followed Morgan Spurlock over 30 days of consuming McDonald's super sized entrees for three meals a day. Over the course of this time, he faced a range of unpleasant side effects, and medical consequences, the most logical conclusion being that McDonald's caused these medical nightmares. As a third insult, Eric Schlosser's 2001 book Fast Food Nation was made into a movie in 2006, which made light of the dark side of the fast food industry—one that is interested only in the bottom line and cares little about the quality of food and health of consumers. These examples of what seemed to be common themes in the twenty-first century shed light on the mindset of many individuals within the field. As prominent Yale psychologist and weight loss expert Kelly D. Brownell describes, many feel as though we are living in a “toxic environment.” Undoubtedly, the politics of food and food acquisition in the United States and developing countries have made conditions ideal for the development of widespread obesity. The future of this epidemic will likely see more attempts to strike against this system, and to fix problems at the policy level, so that on an individual basis, living a healthier lifestyle is feasible and encouraged. While smaller changes, such as taxation of “empty calorie” foods like sodas and candies in some states, have already occurred, it is unlikely that the fast food industry will be made to pay for these costs. None of the many health-related lawsuits against these industries have been successful, and in 2004, the House banned future fast food lawsuits.
Despite limited success in striking against fast food industries, many other changes in the environment to favor healthier lifestyles are occurring. In 2006, the Board of Health in New York City voted to make it the first major city to ban the use of trans fats in restaurants by 2008. Following the largely successful ban on smoking in this city, the outlawing of trans fats was another step in the right direction. While trans fats are probably no more likely to make you obese than saturated or unsaturated fats, they have been linked to other health problems, such as coronary heart disease. Other major cities have passed similar laws. In addition, there are countless other examples of local and state initiatives to encourage more healthful lifestyles, by encouraging better access to parks, improving and building walking paths, reinstating physical activity in schools, improving choices of school lunches, and a variety of other examples, some of which will be highlighted in this text. While this does not eliminate the responsibility on the individual, it does help procure an environment that facilitates access to healthful food and safe activity for all, regardless of what neighborhood, city, state, or country. Consequently, these policy changes over the past few years appear to be moving us in the right direction. With continued government interest and increased personal awareness, the ability to reverse the effects of this disease are well within reach., General Editor
Reader's Guide[Page xi]
This list is provided to assist readers in finding articles related by category or theme.
Biological or Genetic Contributors to Obesity
- Adrenergic Receptors
- Agouti and Agouti Related Protein
- Animal Models of Obesity
- Animal QTLs (Quantitative Trait Locus)
- Bardet-Biedl Syndromes
- Cannabinoid Receptor
- CD36 and FAT (Fatty Acid Transporters)
- Cholecystokinin (CCK)
- Cushing Syndrome
- Db/Db Mouse
- Dopamine Receptor
- Down's Syndrome
- Epistatic Effects of Genes on Obesity
- Estrogen-Related Receptor
- Familial Lipodystrophies
- Fatty Acid Transport Proteins
- Genetic Taste Factors
- Glucagon Receptor
- G-Protein Coupled Receptors
- Growth Hormone
- HDL Receptors
- Histamine Receptor
- Hormone Sensitive Lipase
- Human QTLs
- Insulin and Insulin Resistance
- Insulin-Like Growth Factors
- Intrauterine Growth Restriction
- LDL Receptors
- Leptin Receptors
- Lipoprotein Lipase
- Low Birth Weight
- Mendelian Disorders Related to Obesity
- Metabolic Rate
- Monogenic Effects that Result in Obesity
- NPY (Neuropeptide Y)
- Obesity and the Immune System
- Obesity Gene Map
- Ob/Ob Mouse
- Opioid Receptor
- Perilipins [Page xii]
- POMC (Proopiomelanocortin)
- PPAR (Peroxisome Proliferator-Activated Receptors)
- Prader-Willi Syndrome
- Protein Kinase
- Set or Settling Point
- Thrifty Gene Hypothesis
- Thrifty Gene Hypothesis and Obesity
- Thyroid Hormone
- TNF (Tumor Nucrosis Factors)
- Transgenics and Knockouts for Obesity-Related Genes
- Tubby Candidate Gene
- Twin Studies and Genetics of Obesity
- Uncoupling Proteins
- Viral Causes of Obesity
Children and Obesity
- Atherosclerosis in Children
- Bariatric Surgery in Children
- Behavioral Treatment of Child Obesity
- Beverage Choices in Children and Obesity
- Changing Children's Food Habits
- Childhood Obesity as a Risk Factor for Adult Overweight
- Childhood Obesity Treatment Centers
- Children and Diets
- Ethnic Disparities in the Prevalence of Childhood Obesity
- Family Behavioral Interventions
- Family Therapy in the Treatment of Overweight Children
- Flavor Programming and Childhood Food Preferences
- Food Intake Assessments in Children
- Formation and Development of Food Preferences
- Genetic Taste Factors
- Hypertension in Children
- Implications of Restriction of Foods on Child Feeding Habits
- Medical Interventions for Children
- Metabolic Disorders and Childhood Obesity
- Morbid Obesity in Children
- National Weight Loss Efforts for Children
- Overweight Children and School Performance
- Overweight Children and the Media
- Peer Influences on Obesity in Children
- Pharmacological Treatment of Childhood Obesity
- Physical Activity in Children
- Prevalence of Childhood Obesity in Developing Countries
- Prevalence of Childhood Obesity in the United States
- Prevalence of Childhood Obesity Worldwide
- School-Based Interventions to Prevent Obesity
- Self-Esteem and Children's Weight
- Stigmas against Overweight Children
- Type 2 Diabetes
Dietary Interventions to Treat Obesity
- Atkins Diet
- Calcium and Dairy Products
- Caloric Restriction
- Carbohydrate “Addictions”
- Chromium Picolinate
- Diet Myths
- Dietary Restraint
- Fast Foods
- Fiber and Obesity
- Fruits and Vegetables
- High-Carbohydrate Diets
- High-Protein Diets
- Jenny Craig
- L.A. Weight Loss
- Liquid Diets
- Low-Calorie Diets
- Low-Fat Diets
- Non-Diet Approaches
- Nutrition Fads
- Physical Activity and Obesity
- Portion Control
- South Beach Diet
- Supplements and Obesity
- Very Low-Calorie Diets
- Water and Obesity
- Weight Watchers
- Zone, The
Disordered Eating and Obesity
- Anorexia Nervosa
- Appetite Signals [Page xiii]
- Binge Eating
- Body Dysmorphic Disorder
- Body Image
- Bulimia Nervosa
- Childhood Onset Eating Disorders
- Cognitive-Behavioral Therapy
- Dieting: Good or Bad?
- Disinhibited Eating
- Eating Disorders and Athletes
- Eating Disorders and Gender
- Eating Disorders and Obesity
- Eating Disorders in School Children
- Families of Eating Disorder Patients
- Feminist Perspective and Body Image Disorders
- Genetic Influences on Eating Disorders
- Night Eating Syndrome
- Physiological Aspects of Anorexia
- Physiological Aspects of Bulimia
- Prevalence of Disordered Eating
- Sexual Abuse and Eating Disorders
- Treatment Centers for Eating Disorders
- Weight Cycling and Yo-Yo Dieting
Environmental Contributors to Obesity
- Accessibility of Foods
- Advertising of Foods to Children
- Children's Television Programming
- Economics of Food
- Energy Density
- Fast Foods
- Food Advertising
- Food Labeling
- Governmental Subsidizing of Energy Dense Foods
- Inaccessibility of Exercise
- Increased Reliance on Automobiles
- Increasing Portion Sizes
- Parental and Home Environments
- Safe Play Opportunities for Children
- School Lunch Programs
- Schools and Obesity
- Sodas and Soft Drinks
- Sugar and Fat Substitutes
- Toxic Environment
Health Implications of Obesity
- Appetite Control
- Back Pain
- Blood Lipids
- Body Image
- Breast Cancer
- Colon Cancer
- Congestive Heart Failure
- Elevated Cholesterol
- Fatty Liver
- Gallbladder Disease
- Gastroesophageal Reflux (GERD)
- Gastrointestinal Disorders
- Gestational Diabetes
- High-Density Lipoproteins
- Kidney Failure
- Kidney Stones
- Low-Density Lipoproteins
- Menstrual Problems
- Mortality and Obesity
- Ovarian Cancer
- Ovarian Cysts
- Overall Diet Quality
- Polycystic Ovary Disease
- Respiratory Problems
- Sexual Health
- Sleep Apnea
- Type 2 Diabetes
- Urinary Incontinence in Severe Obesity in Women
- Uterine Cancers
Medical Treatments for Obesity
- American Medical Association
- American Obesity Association
- Cost of Medical Obesity Treatments
- Dieting: Good or Bad? [Page xiv]
- Future of Medical Treatments for Obesity
- Gastric Bypass
- Health Coverage of Gastric Surgeries
- International Obesity Task Force
- Liquid Diets
- Low-Calorie Diets
- Medical Interventions for Children
- Medications that Affect Nutrient Partitioning
- Multidisciplinary Bariatric Programs
- Noradrenergic Drugs
- North American Association for the Study of Obesity
- Orlistat (Xenical)
- Physician-Assisted Weight Loss
- Qualifications for Gastric Surgery
- Roux-en-y Gastric Bypass
- Serotonergic Medications
- Sibutramine (Meridia)
- Thyroid Medications
- Vertical Banded Gastroplasty
- Very Low-Calorie Diets
New Research Frontiers on Obesity
- Bioelectrical Impedance Analysis
- Bod Pod and Pea Pod
- CART Peptides
- Combined Approaches to Treatment
- Computerized Tomography
- DEXA (Dual Energy X-ray Absorptiometry)
- Dilution Techniques
- Doubly Labeled Water
- Drug Targets that Decrease Food Intake/Appetite
- Drugs that Block Fat Cell Formation
- Energy Expenditure Technologies
- Food Technology
- Frontiers in Maintenance and Prevention
- Functional Foods
- Functional Magnetic Resonance Imaging
- Genetic Mapping of Obesity-Related Genes
- Hormone Disorders
- Indirect Calorimetry
- Intestinal Microflora Concentrations
- Leptin Supplements
- Magnetic Resonance Imaging Scans for Viewing Body Composition
- Microarray Analysis
- New Candidate Obesity Genes
- New Drug Targets that Prevent Fat Absorption
- New Drug Targets to Improve Insulin Sensitivity
- New Drug Targets to Increase Metabolic Rate
- Non-Diet Approaches
- Obesity and Viruses
- Quantitative Trait Locus Mapping
- SNP Technologies
- Three-D Image Reconstruction
- Translational Research
- Whole-Body Potassium Counting
Obesity and Ethnicity/Race
- African Americans
- Asian Americans
- Body Fat Distribution in African Americans
- Body Fat Distribution in Asian Americans
- Body Fat Distribution in Hispanic Americans
- Cardiovascular Disease in African Americans
- Cardiovascular Disease in Asian Americans
- Cardiovascular Disease in Hispanic Americans
- Dominican Americans
- Ethnic Variations in Body Fat Storage
- Ethnic Variations in Obesity-Related Health Risks
- Health Disparities—NIH Strategic Plan
- Hispanic Americans
- Hypertension in African Americans
- Hypertension in Asian Americans
- Hypertension in Hispanic Americans
- Mexican Americans
- Native Americans
- Obesity and Socioeconomic Status
- Pima Indians
- Puerto Rican Americans
- Sisters Together
- Thrifty Gene Hypothesis
- U.S. Office of Minority Health
- Western Diets
Obesity and the Brain or Obesity and Behavior
- Appetite Control
- Autonomic Nervous System [Page xv]
- Cannabinoid System
- Central Nervous System
- Conditioned Food Preferences
- Corticotropin-Releasing Hormone
- Drugs and Food
- Fat Taste
- Flavor: Taste and Smell
- Folic Acid and Neural Tube Defects
- Food “Addictions”
- Food Reward
- Gustatory System
- Inherited Taste Preferences
- Liking vs. Wanting
- Medications that Increase Body Weight
- Mood and Food
- Nutrient Reward
- Olfactory System
- Oxytocin and Food Intake
- Peripheral Nervous Sytem
- Pituitary Gland
- Sensory-Specific Satiety
- Sweet Taste
- Sympathetic Nervous System
- Taste Aversion Learning
- Taste Reactivity
- Thyroid Gland
Obesity as a Public Health Crisis
- Access to Nutritious Foods
- American Academy of Pediatrics
- American College of Sports Medicine
- American Diabetes Association
- American Dietetic Association
- American Heart Association
- American Medical Association
- American Obesity Association
- American Society for Bariatric Surgery
- Built Environments
- Center for Maternal and Child Health
- Center for Nutrition Policy and Promotion
- Center for Science in the Public Interest
- Centers for Disease Control and Prevention
- Child Obesity Programs
- Community Level Initiatives to Prevent Obesity
- Community Programs to Prevent Obesity
- Council on Size and Weight Discrimination
- Economics of Obesity
- Expanded Food and Nutrition Program
- Federal Initiatives to Prevent Obesity
- Food and Drug Administration
- Food Guide Pyramid
- Food Labeling
- Food Marketing to Children
- Food Stamp Nutrition Education Program
- Government Agencies
- Head Start
- Healthy Eating Index
- Healthy People 2010
- National Association to Advance Fat Acceptance
- National Cancer Institute
- National Center for Health Statistics
- National Eating Disorders Association
- National Heart, Lung, and Blood Institute
- National Institutes of Health
- North American Association for the Study of Obesity
- Obesity in Schools
- Office of Dietary Supplements
- Office of Minority Health
- Policy to Prevent Obesity
- President's Council on Physical Fitness and Sports
- Safety of Urban Environments
- School Initiatives to Prevent Obesity
- Shape-Up America!
- Social Marketing and Obesity
- State and Local Initiatives to Prevent Obesity
- Taxation of Unhealthy Foods
- Toxic Environment
- U.S. Department of Agriculture
- U.S. Department of Health and Social Services
- Weight Control Information Network
Psychological Influences and Outcomes of Obesity
- Addictive Behaviors
- Anorexia Nervosa
- Binge Eating
- Bulimia Nervosa
- Cognitive-Behavioral Therapy [Page xvi]
- Compulsive Overeating
- Disordered Eating
- Eating Disorders in School Children
- External Controls
- Night Eating Syndrome
- Obsessive Compulsive Disorder
- Psychiatric Medicine and Obesity
- Self-Esteem and Obesity
Societal Influences and Outcomes of Obesity
- Body Image
- Breastfeeding vs. Formula Feeding
- Built Environments
- Calcium Intake and Dairy Products
- Carbohydrate and Protein Intake
- Computers and the Media
- Eating Out in the United States
- Fat Acceptance
- Fat Intake
- Flavor Learning
- Food Advertising and Obesity
- Food Guide Pyramid
- Food Intake Patterns
- Food Labeling
- Food Preferences
- Governmental Policy and Obesity
- Income Level and Obesity
- Nutrition Education
- Obesity and Academic Performance
- Obesity and Drug Use
- Obesity and Sports
- Obesity and the Media
- Obesity in Schools
- Personal Relationships and Obesity
- Physical Activity Patterns in the Obese
- Soda and Soft Drink Intake
- Stereotypes and Obesity
- Variety of Foods and Obesity
- Virtual Environments
- Weight Discrimination
- Women and Dieting
- Western Diet
Women and Obesity
- Assessment of Obesity and Health Risks
- Bariatric Surgery in Women
- Body Image
- Breast Cancer
- Colon Cancer
- Coronary Heart Disease in Women
- Early Onset Menarche and Obesity in Women
- Economic Disparities among Obesity in Women
- Endometrial and Uterine Cancers
- Estrogen Levels
- Ethnic Disparities among Obesity in Women
- Exercise and Physical Activity among Obese Women
- Fat Acceptance
- Food Preferences
- Gestational Diabetes
- Implications of Gestational Development
- Maternal Influences on Child Feeding
- Menopause and Obesity
- Morbid Obesity in Women
- Obese Women and Social Stigmatization
- Polycystic Ovary Disease
- Pregnancy Prevalence of Obesity in U.S. Women
- Self-Esteem in Obese Women
- Support Groups for Obese Women
- Waist-to-Hip Ratio
- Women and Diabetes
- Women and Dieting
List of Entries[Page xvii]
List of Contributors[Page xxiii]
Adams, David P., Armstrong Atlantic State University, Savannah, Georgia
Ahmad, Juveria, Columbia University, Institute of Human Nutrition
Ahmed-Sarwar, Nabila, Ferris State University, College of Pharmacy
Aja, Susan, Johns Hopkins University, School of Medicine
Akter, Farhana, King's College London
Al-Daghri, Nasser M., College of Science, King Saud University, Saudi Arabia
Aldasouqi, Saleh, College of Human Medicine at Michigan State University
Alkharfy, Khalid M., College of Pharmacy, King Saud University
Allison, Kelly C., University of Pennsylvania, School of Medicine
AlRubeaan, Khalid Ali, University Diabetes Center, King Saud University
Anani, Muna, King Faisal Specialist Hospital and Research Center
Anderson, Aaron, Touro University School of Medicine
Andre, Nancy V., Independent Scholar
Aschemeyer, Jayme A., Kansas City University of Medicine and Biosciences
Asem, Neda, David Geffen School of Medicine at UCLA
Axen, Kathleen V., City University of New York
Baker, Randal S., Michigan Weight Loss Specialists
Beekley, Matthew D., University of Indianapolis
Belzer, Lisa, Rutgers, State University of New Jersey
Berg, Miriam, Council on Size & Weight Discrimination
Berk, Evan, New York Obesity Research Center
Berkowitz, Robert I., The Children's Hospital of Philadelphia
Bermudez, Odilia, Tufts University School of Medicine
Berthaud, Jimmy, Columbia University, Institute of Human Nutrition
Bischel, Mandy, Independent Scholar
Bishop, Chanelle, The Children's Hospital of Philadelphia
Black, Elizabeth, Columbia University Medical Center
Boling, Christy, Duke University
Bose, Mousumi, Rutgers University
Boslaugh, Sarah, BJC HealthCare, Saint Louis, Missouri
Brathwaite, Nina, University of Nevada, Las Vegas
Brescoll, Victoria, Yale University, Rudd Center for Food Policy and Obesity[Page xxiv]
Bruning, Nancy, City University of New York
Budd, Geraldine, Drexel University
Buford, Thomas W., Baylor University, Exercise and Biochemical, Nutrition Laboratory
Bulik, Cynthia, University of North Carolina, at Chapel Hill
Butryn, Meghan L., Drexel University
Byrd-Bredbenner, Carol, Rutgers University
Campbell, Lesley V., St Vincent's Hospital, Australia
Cassano, Hope, Columbia University, Institute of Human Nutrition
Chambers, Earle C., New York Obesity Research Center
Chandran, Rekha, Baylor University
Chandrasekaran, Eashwar B., Columbia University, Institute of Human Nutrition
Choure, Anuja Gautam, Michigan State University
Corfield, Justin, Geelong Grammar School, Australia
Cottam, Daniel, Touro University School of Medicine
Courcuolas, Anita, University of Pittsburgh Medical Center
Crego, Lisa Ortigara, Independent Scholar
Crum, Alia, Yale University
Cudjoe, Ernest A., Great Lakes Surgical Associates
Curry, Christine, Independent Scholar
Cymet, Holly J., Morgan State University, Department of Chemistry
Dallal, Ramsey M. Albert Einstein Medical Center
Daniel, Gary A., Oschner Hospital
Daniel, Jerry B., Mercer University, School of Medicine
Das, Sai Krupa, Tufts University, Jean Mayer USDA Human Nutrition, Research Center on Aging
Datta, Tejwant S., Albert Einstein Medical Center
Davis, Melissa M., Scottsdale Bariatric Center
Davis, Pamela R., Centennial Center for the Treatment of Obesity
Davy, Kevin P., Virginia Tech University
Del Parigi, Angelo, Pfizer
Dellava, Jocilyn, Rutgers University
Desai, Gautam J., Kansas City University of Medicine and Biosciences
Dinkevich, Eugene, SUNY Downstate Medical School
Dove, Jacqueline Beckham, Baylor University
Dutia, Roxanne, Columbia University, Institute of Human Nutrition
Episcopo, Valerie, Syracuse University
Ernsberger, Paul, Case Western Reserve University School of Medicine
Ettinger, Susan Channer, New York Obesity Research Center
Evans, W. Douglas, Research Triangle Institute, Washington, D.C.
Ezra, Navid, David Geffen School of Medicine at UCLA
Falkenstein, Kathleen, Drexel University
Farina, Frank, Touro University School of Medicine
Fear, Georgie, Rutgers University
Fender-Scarr, Lisa K., University of Akron
Finkelson, Elizabeth Blake, Columbia University Medical Center
Fink, Jane Marie, University of Akron
Finlayson, Graham, University of Leeds
Fitzgerald, Nurgul, Rutgers University
Fong, Tung M., Merck Research Laboratories
Frame, I.J., Columbia University, Institute of Human Nutrition
Friedman, Kelli E., Duke University Medical Center
Frisard, Madlyn, Virginia Tech University
Fuller, J Ryan, New York Obesity Research Center
Gangwisch, James E., Columbia University Medical Center
Garner, David M., River Centre Clinic, Sylvania, Ohio
Gearhardt, Ashley, Yale University
Gehrman, Christine A., The Children's Hospital of Philadelphia
Geliebter, Allan, Columbia University[Page xxv]
Ghanbari, Hamid, Independent Scholar
Gluck, Marci E., Phoenix Epidemiology & Clinical Research Branch, NIH/NIDDK
Golan, Jenna, Columbia University, Institute of Human Nutrition
Gold, Jonathan, Michigan State University
Goldstein, Bradley E., Lake Erie College of Osteopathic Medicine
Gourineni, Nandy, Michigan State University
Greenfield, Jerry, Garvan Institute, Sydney, Australia
Grover, Madhusudan, Michigan State University
Guillory, Ivan, George Washington University Medical Center
Gulati, Sonia, Columbia University, Institute of Human Nutrition
Hamilton, William J., Arizona State University
Ham, Justin Sookyung, Independent Scholar
Harper, Jason, Columbia University College of Physicians & Surgeons
Harris, Alan G., Manhattan Pharmaceuticals Inc.
Hawley, Katherine, The Children's Hospital of Philadelphia
Haynos, Annie, Independent Scholar
Heuer, Chelsea A., Yale University, Rudd Center for Food Policy and Obesity
Hoffman, Daniel J., Rutgers University
Huang, Jeannie, University of California, San Diego
Jackson-Leach, Rachel, International Association for the Study of Obesity
Jaffe, Karen, Rutgers University
Janeway, Julie M., Little Victories Medical/Legal Consulting & Training
Juturu, Vijaya, Nutrition 21
Kahan, Scott, Johns Hopkins Bloomberg School of Public Health
Kalarchian, Melissa, University of Pittsburgh Medical Center
Kamchanasorm, Rudruidee, Michigan State University
Kaur, Yasmin, St. Matthew's University School of Medicine
Keller, Kathleen, Columbia University St. Luke's Roosevelt Hospital
Khanna, Panchali, Michigan State University
Kissileff, Harry R., Columbia University St. Luke's Roosevelt Hospital
Kral, Tanja V.E., University of Pennsylvania School of Medicine
Krukowski, Rebecca, Duke University Medical Center
Kwon, Jane, Rutgers University
La Flair, Lareina N., Harvard Medical School
Laird-Fick, Heather S., Michigan State University
Law, Heather, Independent Scholar
Le, Mai Nhung, Independent Scholar
Lesser, Lenard, Tufts University Family Medicine
Levin, Elizabeth, Laurentian University
Liepinis, Natalie, Children's Hospital of Philadelphia
Lilkendey, Shannon, Armstrong Atlantic State University
Lindley, Elizabeth B., Independent Scholar
Liu, Jenny, Columbia University, Institute of Human Nutrition
Lobstein, Tim, International Association for the Study of Obesity
Lofink, Hayley Elizabeth, University of Oxford
Lopez, Eleanor P., University of Health Sciences Antigua
Lowe, Michael R., Drexel University
Lundgren, Jennifer D., University of Missouri-Kansas City
MacDougall, Megan, New York University
Majumdar, Dalia, Columbia University, Institute of Human Nutrition
Makol, Ashima, Michigan State University
Mensinger, Janell, SUNY Downstate Medical Center
Michaud, Lyn, Independent Scholar[Page xxvi]
Miller, Christine, George Washington University
Miller, Dawn M., Cleveland Center for Bariatric Surgery at St. Vincent Charity Hospital
Miller, Todd A., George Washington University Medical Center
Miller, Wayne C., George Washington University Medical Center
Mirza, Nazrat, George Washington University, Children's National Medical Center
Mun, David Jaeho, Columbia University
Musante, Danila, New York State Psychiatric Institute
Myneni, Anjana, Michigan State University
Nahmias, Nissin, Albert Einstein Medical Center
Nassar, Erika I., Baylor University
Nasser, Jennifer, New York Obesity Research Center St. Luke's Roosevelt Hospital
Neu, Denese M., HHS Planning & Consulting, Inc.
Neyer, Jonathan, University of California, San Diego
Nomura, Katherine, Columbia University
Novak, Sarah A., Yale University, Rudd Center for Food Policy and Obesity
Ochner, Christopher N., Columbia University, Institute of Human Nutrition
Ourian, Ariel J., David Geffen School of Medicine, UCLA
Padula, Alessandra, University of L’Aquila, Italy
Palmer, Debrah M., Rutgers University
Parilo, Michelle, Harvard University
Patel, Amy R., Independent Scholar
Patel, Ashwinkumar, University of Pennsylvania
Patrick, Kevin, University of California, San Diego
Peake, Phil, Prince of Wales Hospital, Sydney, Australia
Pelkman, Christine, University of Buffalo
Pervaiz, Mohammad, Michigan State University
Pham, Angela, Michigan State University
Pomeroy, Jeremy, Phoenix Epedemiology and Clinical Research Branch, NIH/NIDDK
Quinn, John M., University of Illinois at Chicago
Rad, Mohammad Soltany Rezaee, Mazandaran University of Medical Sciences, Iran
Raney, T.J., University of North Carolina at Chapel Hill
Rattan, Rishi, University of Illinois, College of Medicine
Roberto, Christina, Yale University
Robinson, Cheryl, Mercer University School of Medicine
Ruggles, Kelly Valentine, Columbia University, Institute of Human Nutrition
Saelens, Brian, University of Washington
Salamone, John D., University of Connecticut
Samaras, Katherine, Garvan Institute of Medical Research
Saunders, Paul Richard, Canadian College of Naturopathic Medicine
Schmidt, Barbara, Rutgers University
Schoen, Andrea P., University of Nevada, Las Vegas
Shah, Meera, Columbia University, Institute of Human Nutrition
Shapiro, Jennifer R., University of North Carolina at Chapel Hill, Department of Psychiatry
Shapses, Sue, Rutgers University
Sharma, Sunil, University of Pittsburgh School of Medicine
Shen, Wei, Columbia University, Institute of Human Nutrition
Smith, Andrea S., Johns Hopkins Bloomberg School of Public Health
Smith, Jeffrey, Great Lakes Surgical Associates
Smolynets, Olha, Philadelphia College of Osteopathic Medicine
Spaccarotella, Kim, Rutgers University
Sparks, Karen Jean, Little Victories Medical/Legal Consulting & Training
Spaulding, Richard, Columbia University
Spresser, Carrie, University of Missouri, Kansas City
Sridhar, Devi, University of Oxford[Page xxvii]
Stein, Stephanie, City University of New York
Stenerson, Matthew, UCSF School of Medicine
Sukumar, Deeptha, Rutgers University
Summe, Heather, Columbia University
Tan, Jonathan, SUNY Stony Brook School of Medicine
Tatevossian, Tiffany, David Geffen School of Medicine, UCLA
Tavassoly, Iman, Mazandaran University
Tavassoly, Omid, Tarbiat Modares University
Thomas, Jennifer, Yale University
Thomas, McKinley, Mercer University School of Medicine
Thompson, Kirsten, SUNY Downstate College of Medicine
Toraman, Naciye Fusun, Akdeniz University
Tran, Hung Vinh, Columbia University Institute of Human Nutrition
Turnagol, Husrev, Hacettepe University School, of Sport Sciences and Technology
Van Wye, Gretchen, New York City Department of Health and Mental Hygiene
Vassy, Jason, Washington University in St. Louis
Velcu, Laura, Touro University School of Medicine
Verma, Shivani, SUNY Downstate Medical Center
Viladrich, Anahi, City University of New York
Walsh, John, Shinawatra University
Wang, Youfa, Johns Hopkins University, Bloomberg School of Public Health
Warren, Cortney S., University of Nevada, Las Vegas
Waskey, Andrew Jackson, Dalton State College
Watson, Ralph E., Michigan State University College of Human Medicine
Welch, Mariko, Columbia University, Institute of Human Nutrition
Wharton, Christopher, Yale University
Wielopolski, Lucian, Brookhaven National Laboratory
Winograd, Claudia, University of Illinois at Urbana-Champaign
Worobey, John, Rutgers University
Yeh, Ming-Chin, City University of New York
Yoo, Grace, San Francisco State University
Zhang, Kuan, Columbia University
Zurfluh, Robert, Rutgers University[Page xxviii]
Body Mass Index[Page xxix]
Body Mass Index (BMI), also known as the Quetelet Index (see next page), is a measure combining the weight and height of an individual. Body mass index can be calculated by dividing the weight by the square of the height.
Although invented in the mid 1800s by Belgian Adolphe Quetelet, BMI is currently used as a simple clinical tool for health care professionals to determine a patients potential risk for disease and call for intervention. However, BMI has been recently and incorrectly as an “absolute” tool for medical diagnosis and care rather than an suggestive indicator of risk.
BMI is used to classify individuals into categories. The most common definitions used clinically in the United States for BMI categories include Underweight (BMI<18.5), Ideal (BMI 18.5–25), Overweight (BMI 25–30), Obese (BMI 30–40) and Morbidly Obese (BMI over 40). According to the U.S. National Health and Nutrition Examination Survey in 1994, 59 percent of American men and 49 percent of women have BMIs over 25 and therefore categorized as either overweight or obese.
BMI categories have important correlations with disease risk. Higher BMI values are associated with cardiovascular disease and higher morbidity and mortality rates for almost any disease. According to some studies, a BMI of 30 and greater translates to an increase risk of death from any cause by 50 to 150 percent. Extremely low BMI values, below the ideal category, may indicate malnutrition or an eating disorder. Although a correlation may exist, researchers are also quick to acknowledge that BMI is not entirely accurate in predicting the risk of cardiovascular disease and death because it does not distinguish body muscle and fat. However, when used appropriately, categorization of an individual using the BMI can indicate to a healthcare provider that some intervention may be needed.To use the table, find the appropriate height in the left-hand column labeled Height. Move across to a given weight (in pounds). The number at the top of the column is the BMI at that height and weight. Pounds have been rounded off.
Resource Guide[Page 811]Resource guideBooks
ABBE Research. Anti-Obesity Agents, Drugs and Substances for Weight Reduction and Health Control: Index and Analysis of New Consumer and Medical Information with References (ABBE Research, 2004)
Abramovitz, Melissa. Obesity (Thomson Gale, 2004)
Alexander-Mott, Leeann, and Lumsden, Barry D. Understanding Eating Disorders: Anorexia Nervosa, Bulimia Nervosa and Obesity (Taylor and Francis, 1994)
Allison, David B. Handbook of Assessment Methods for Eating Disorders and Weight-Related Problems: Measures, Theory and Research (SAGE, 1995)
Allison, David B. and Pi-Sunyer, Xavier, eds. Obesity Treatment: Establishing Goals, Improving Outcomes, and Reviewing the Research Agenda: Proceedings of the NATO ARW Held in New York City, June 2-5, 1993 (Springer-Verlag New York, 1995)
American College of Sports Medicine. ACSM's Guidelines for Exercise Testing and Prescription (Lipincott, 2000)
Anderson, Ross E. and Weinberg, Jennifer. Obesity: Etiology, Assessment, Treatment, and Prevention (Human Kinetics Publishers, 2003)
Atkins, R.C. Dr. Atkins' New Diet Revolution (Avon Books, 1999)
Bagchi, Debasis and Pruess, Harry G., eds. Obesity: Epidemiology, Pathophysiology, and Prevention (CRC Press, 2006)
Bjorntorp, Per, ed. International Textbook of Obesity (Wiley, 2001)
Bjorntorp, Per, ed. Recent Advances in Obesity Research (Libbey and Company, 1981)
Blundell, J.E., McArthur, R.A. and Horrobin, D.F., eds. Obesity and Its Treatment (Springer-Verlag, 1979)
Boasten, Michelle. Weight Loss Surgery: Understanding and Overcoming Morbid Obesity (FBE Service Network, 2001)
Bouchard, Claude and Bray, George A., eds. Handbook of Obesity (Marcel Dekker, 2003)
Bralow, L. and Murray L. Physicians' Desk Reference (Thomson, 2004)
Braunwald, D.E., Kasper D.L., et al. Harrison's Principles of Internal Medicine (McGraw-Hill Medical Publishing Division, 2001)
Bray, George A. Office Management of Obesity (Elsevier Health Sciences, 2003)
Brownell, Kelly and Horden, Katherine Battle. Food Fight: The Inside Story of the Food Industry, American Obesity Crisis, and What We Can Do About it (McGraw Hill Medical Publishing Division, 2004)
Brownwell, Kelly, and Fairburn, Christopher, eds. Eating Disorders and Obesity: A Comprehensive Handbook (Guilford Publications, 2005)
[Page 812]Campbell, Colin T., Campbell, Thomas M., and Robbins, John. The China Study: The Most Comprehensive Study of Nutrition Ever Conducted and the Startling Implication for Diet, Weight Loss, and Long-Term Health (Benbella Books, 2006)
Campos, Paul and Ernsberger, Paul. The Obesity Myth: Why America's Obsession with Weight is Hazardous to Your Health (Gotham, 2004)
Cassell, Dana K. and Gleaves, David H. Food for Thought: The SourceBook for Obesity and Eating Disorders (Facts on File, 2000)
Crawford, David and Jeffery, Robert W. eds. Obesity Prevention and Public Health (Oxford University Press, 2005)
Dai, Caroline and Philipson, Tomas. Economics of Obesity (University Press of the Pacific, 2005)
Davis, Barbara and Stuart, Richard B. Slim Chance in a Fat World: Behavioral Control of Obesity (Research Press, 1972)
Davis, Debra P. and Rouse, Tina I. Exploring a Vision: Integrating Knowledge for Food and Health: A Workshop Summary (National Academies Press, 2004)
DIANE Publishing Company. Workshop on Prevention and Treatment of Childhood Obesity: Research Directions (DIANE Publishing Company, 1996)
Ditmier, Lawrence F. New Development in Obesity Research (Nova Science Publishers, 2006)
Donohue, Patrica A., ed. Energy Metabolism and Obesity: Research and Clinical Applications (Springer Verlag, 2007)
Eades, M.R. and Eades, M.D. Protein Power (Bantam Books, 1996)
Ferrera, Lisa A. Body Mass Index: New Research (Nova Science Publications, 2006)
Ferrera, Lisa A. Focus on Body Mass Index and Health Research (Nova Science Publications, 2006)
Fletcher, G.F., Grundy, S.M., and Hayman, L.L. Obesity: Impact on Cardiovascular Disease (Futura Publishers, 1999)
Gard, Michael and Wright, Jan. Obesity Epidemic: Science and Ideology (Taylor and Francis, 2005)
Glasser, Jason and Hubbard, James R. Obesity (Coughlan Publishing, 2006)
Greene, Meg. Obesity (Mason Crest, 2006)
Grilo, Chris. Eating Disorders (Taylor and Francis, 2006)
Guyton, A.C., and Hall, J.E. Textbook of Medical Physiology (W. B. Saunders, 2000)
Harmon, Daniel E. Obesity (Rosen Publishing Group, 2007)
Hassink, Sandra G., ed. Parents Guide to Childhood Obesity: A Roadmap to Health (American Academy of Pediatrics, 2006)
Icon Health Publications. Morbid Obesity: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet Resources (Icon Health Publications, 2004)
Kelly, Evelyn B. Obesity (Health and Medical Issues Today Series) (Greenwood Publishing Group, 2006)
Larsen, P.R. et al., eds. Williams Textbook of Endocrinology (W.B. Saunders, 2003)
Latner, Janet D. and Wilson, Terence G., eds. Self Help Approaches for Obesity and Eating Disorders: Research and Practice (Guilford Publications, 2007)
Ling, Peter R., ed. Focus on Obesity Research (Nova Science Publishers, 2005)
Mela, David J., ed. Food, Diet and Obesity (CRC Press 2005)
Miller, William R., Addictive Behaviors: Treatment of Alcoholism, Drug Abuse, Smoking and Obesity (Elsevier Science, 1980)
Nezru, Aruthur M., Perri, Michael G., and Viegenger, Barbra J. Improving the Long-Term Management of Obesity (Wiley, 2004)
Oliver, Eric. Fat Politics: The Real Story behind America's Obesity Epidemic (Oxford University Press, 2006)
Pool, Robert. Fat: Fighting the Obesity Epidemic (Oxford University Press, 2001)
Powers, Tyrone T. Over-Weight, Over-Eating, Obesity and Morbidity in America: Index of New Information and Guide-Book for Consumers, References and Research (ABBE Publishers, 2002)
Ravussin, Eric and Stunkard, Albert J. Handbook for Obesity Treatment (Guilford Publications, 2002)
Schwartz, Bob. Diets Don't Work (Breakthru Publishing, 1996)
Sears, B. The Zone (HarperCollins, 1995)
Shima, Kenji. Obesity and NIDDM: Lessons from the Oletf Rat (Elsevier Science, 1999)
Shipp, Audrey M., ed. Obese and Overweight Adults in the United States (National Center for Health Sciences, 1982)
Smith, Clinton J. Understanding Childhood Obesity (University Press of Mississippi, 1999)
Spiller, G.A., ed. Dietary Fiber in Human Nutrition (CRC Press, 1993)
[Page 813]Steward, H.L., Bethea M.C., Andrews, S.S., and Balart, L.A. Sugar Busters (Ballantine Books, 1998)
Tsigos, Constantine, ed. Stress, Obesity, and Metabolic Syndrome (New York Academy of Sciences, 2006)
Voss, Linda. Adult Obesity: A Paediatric Challenge (Routledge, 2004)
Widmer, Pat L. Diets for Reducing Obesity Including Diet Therapy Research: Index of New Information for Reference and Practice (ABBE Publishers, 1997)
Wood, Phillip A. How Fat Works (Harvard University Press, 2006)
Woodward, Brian G. A Complete Guide to Obesity Surgery: Everything You Need to Know to Succeed (Tafford Publishing, 2001)
Woodward-Lopez, Gail, ed. Obesity: Developmental and Dietary Influences (CRC Press, 2006)Journals
American Family Physician
American Journal of Clinical Nutrition
Annals of Human Biology
Annals of Internal Medicine
Archives of Internal Medicines
British Medical Journal
Endocrinology and Metabolism Clinics of North America
International Journal of Obesity
International Journal of Obesity and Related Metabolic Disorders
Journal of Clinical Investigation
Medical Clinics of North America
Medicine and Science in Sports and Exercise
New England Journal of Medicine
Quarterly Journal of MedicineWebsites
http://www.americanheart.org – American Heart Association
http://www.cdc.gov – Center for Disease Control
http://www.dh.gov – Department of Health
http://www.health.gov – Federal Health Site
http://www.medicalnewstoday.com – Medical News Today
http://www.nationalobesityforum.org.uk – United Kingdom National Obesity Forum
http://www.obesity.org – American Obesity Association
http://www.obesitygene.pbrc.edu – Human Obesity Gene Map
http://www.obesityhelp.com – Obesity Help
http://www.obesitylaw.com – Obesity Law
http://www.obesityresearch.nih.gov – National Institute of Health on Obesity
http://www.obesitysurgery.com – Obesity Surgery
http://www.webmd.com – Web Medical Doctor[Page 814]
Appendix[Page 815]AppendixPrevalence of Obesity in Males and Females by CountryWorld Health Organization
Obesity and overweight are defined as an accumulation of excess body fat, to an extent that may impair health. A crude population measure of excess fat is the body mass index (BMI), a person's weight (in kilograms) divided by the square of his or her height (in meters). WHO defines overweight as a BMI of 25 or more, and obesity as a BMI of 30 or more. These cut-off points can provide a reference for individual assessment.
There is also evidence that, on a population level, the risk of chronic disease increases progressively as average BMI increases above 21. A high body mass index is a major risk factor for a number of chronic diseases, including cardiovascular diseases, cancer and diabetes.
Abdominal fat: Fat (adipose tissue) that is centrally distributed between the thorax and pelvis and that induces greater health risk.
Absolute risk: The observed or calculated probability of an event in a population under study, as contrasted with the relative risk.
Aerobic exercise: A type of physical activity that includes walking, jogging, running, and dancing. Aerobic training improves the efficiency of the aerobic energy-producing systems that can improve cardiorespiratory endurance.
Age-adjusted: Summary measures of rates of morbidity or mortality in a population using statistical procedures to remove the effect of age differences in populations that are being compared. Age is probably the most important and the most common variable in determining the risk of morbidity and mortality.
Anorexiant: A drug, process, or event that leads to anorexia.
Anthropometric measurements: Measurements of human body height, weight, and size of component parts, including skinfold measurement. Used to study and compare the relative proportions under normal and abnormal conditions.
Atherogenic: Causing the formation of plaque in the lining of the arteries.
Behavior therapy: Behavior therapy constitutes those strategies, based on learning principles such as reinforcement, that provide tools for overcoming barriers to compliance with dietary therapy and/or increased physical activity.
Biliopancreatic diversion: A surgical procedure for weight loss that combines a modest amount of gastric restriction with intestinal malabsorption.
BMI: Body mass index; the body weight in kilograms divided by the height in meters squared (wt/ht2) used as a practical marker to assess obesity; often referred to as the Quetelet Index. An indicator of optimal weight for health and different from lean mass or percent body fat calculations because it only considers height and weight.
Body composition: The ratio of lean body mass (structural and functional elements in cells, body water, muscle, bone, heart, liver, kidneys, etc.) to body [Page G2]fat (essential and storage) mass. Essential fat is necessary for normal physiological functioning (e.g., nerve conduction). Storage fat constitutes the body's fat reserves, the part that people try to lose.
BRL 26830A: An atypical B adrenoreceptor agonist drug that in obese rodents showed an increased metabolic rate and caused a reduction in weight by decreasing body lipid content. It is not approved as a weight loss drug by FDA.
Carbohydrates: A nutrient that supplies 4 calories/gram. They may be simple or complex. Simple carbohydrates are called sugars, and complex carbohydrates are called starch and fiber (cellulose). An organic compound—containing carbon, hydrogen, and oxygen—that is formed by photosynthesis in plants. Carbohydrates are heat producing and are classified as monosaccharides, disaccharides, or polysaccharides.
Cardiovascular disease (CVD): Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure).
Central fat distribution: The waist circumference is an index of body fat distribution. Increasing waist circumference is accompanied by increasing frequencies of overt type 2 diabetes, dyslipidemia, hypertension, coronary heart disease, stroke, and early mortality. In the body fat patterns called android type (apple shaped) fat is deposited around the waist and upper abdominal area and appears most often in men. Abdominal body fat is thought to be associated with a rapid mobilization of fatty acids rather than resulting from other fat depots, although it remains a point of contention. If abdominal fat is indeed more active than other fat depots, it would then provide a mechanism by which we could explain (in part) the increase in blood lipid and glucose levels. The latter have been clearly associated with an increased risk for cardiovascular disease, hypertension, and type 2 diabetes. The gynoid type (pear-shaped) of body fat is usually seen in women. The fat is deposited around the hips, thighs, and buttocks, and presumably is used as energy reserve during pregnancy and lactation.
Cholecystectomy: Surgical removal of the gallbladder and gallstones, if present.
Cholecystitis: Inflammation of the gallbladder, caused primarily by gallstones. Gallbladder disease occurs most often in obese women older than 40.
Cholesterol: A soft, waxy substance manufactured by the body and used in the production of hormones, bile acid, and vitamin D and present in all parts of the body, including the nervous system, muscle, skin, liver, intestines, and heart. Blood cholesterol circulates in the bloodstream. Dietary cholesterol is found in foods of animal origin.
Cimetidine: A weight loss drug that is thought to work by suppression of gastric acid or suppression of hunger by blocking histamine H2 receptors. It is not approved by the FDA.
Cognitive behavior therapy: A system of psychotherapy based on the premise that distorted or dysfunctional thinking, which influences a person's mood or behavior, is common to all psychosocial problems. The focus of therapy is to identify the distorted thinking and to replace it with more rational, adaptive thoughts and beliefs.
Cognitive rehearsal: A technique used in cognitive behavior therapy. In a weight loss program, for example, individuals first imagine the situation that is causing temptation (such as eating a high fat food), describe the thoughts and feelings that accompany the imagined situation, and make positive self-statements about the situation (e.g., “I am feeling good about choosing a low calorie drink rather than the high fat cheese.”). Then the next step is to follow the positive self-statement with an adaptive behavior (such as walking away from the buffet line to chat with a friend). Finally, individuals are encouraged to reward themselves for doing well in a difficult situation, with either positive statements or material rewards, or both. The idea is to rehearse one's thoughts and behaviors prior to experiencing the potentially difficult situation,
Cognitive restructuring: A method of identifying and replacing fear-promoting, irrational beliefs with more realistic and functional ones.
Comorbidity: Two or more diseases or conditions existing together in an individual.
Computed tomography (CT) scans: A radiographic technique for direct visualization and quantification [Page G3]of fat that offers high image contrast and clear separation of fat from other soft tissues. CT can estimate total body adipose tissue volume and identify regional, subcutaneous, visceral, and other adipose tissue depots. Radiation exposure, expense, and unavailability restrict the epidemiologic use of CT.
Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the “true” effect of an intervention.
Coronary heart disease (CHD): A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results.
Cue avoidance: A stimulus control technique often used in weight loss programs in which individuals are asked to reduce their exposure to certain food cues by making a variety of changes in their habits. The rationale is to make it easier on oneself and reduce temptation by reducing contact with food cues. For example, coming home from work and feeling tired is a time when many people reach for the high fat foods if they are available. By not having the high fat foods within reach, one can avoid eating them.
Dexfenfluramine: A serotonin agonist drug used to treat obesity. FDA approval has been withdrawn.
Diabetes: A complex disorder of carbohydrate, fat, and protein metabolism that is primarily a result of relative or complete lack of insulin secretion by the beta cells of the pancreas or a result of defects of the insulin receptors.
Diastolic blood pressure: The minimum pressure that remains within the artery when the heart is at rest.
Diethylproprion: An appetite suppressant prescribed in the treatment of obesity.
Dopamine: A catecholamine neurotransmitter that is found primarily in the basal ganglia of the central nervous system. Major functions include the peripheral inhibition and excitation of certain muscles; cardiac excitation; and metabolic, endocrine and central nervous system actions.
Dual energy X-ray absortiometry (DEXA): A method used to estimate total body fat and percent of body fat. Potential disadvantages include whole body radiation and the long time required for scanning while the subject lies on a hard table.
Dyslipidemia: Disorders in the lipoprotein metabolism; classified as hypercholesterolemia, hypertriglyceridemia, combined hyperlipidemia, and low levels of high-density lipoprotein (HDL) cholesterol. All of the dyslipidemias can be primary or secondary. Both elevated levels of low-density lipoprotein (LDL) cholesterol and low levels of HDL cholesterol predispose to premature atherosclerosis.
Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial.
Energy balance: Energy is the capacity of a body or a physical system for doing work. Energy balance is the state in which the total energy intake equals total energy needs.
Energy deficit: A state in which total energy intake is less than total energy need.
Ephedrine: A sympathomimetic drug that stimulates thermogenesis in laboratory animals and humans. Animal studies show that it may reduce fat content and, therefore, body weight by mechanisms that probably involve increased expenditure and reduced food intake.
Extreme obesity: A body mass index of 40 or above.
Femoxetine: A selective serotonin reuptake inhibitor drug used in obese patients for weight loss.
Fenfluramine: A serotonin agonist drug used in the treatment of obesity. FDA approval was withdrawn.
Fibrinogen: A plasma protein that is converted into fibrin by thrombin in the presence of calcium ions. Fibrin is responsible for the semisolid character of a blood clot.
Fluoxetine: An antidepressant drug used to promote weight loss whose action is mediated by highly specific [Page G4]inhibition of serotonin reuptake into presynaptic neurons. Serotonin acts in the brain to alter feeding and satiety by decreasing carbohydrate intake, resulting in weight reduction.
Framingham Heart Study: Study begun in 1948 to identify constitutional, environmental, and behavioral influences on the development of cardiovascular disease. Framingham data show that increased relative weight and central obesity are associated with elevated levels of risk factors (e.g., cholesterol, blood pressure, blood glucose, uric acid), increased incidence of cardiovascular disease, and increased death rates for all causes combined.
Gallstones: Constituents in the gallbladder that are not reabsorbed, including bile salts and lipid substances such as cholesterol that become highly concentrated. They can cause severe pain (obstruction and cramps) as they move into the common bile duct. Risk factors for cholesterol gallstone formation include female gender, weight gain, overweight, high energy intake, ethnic factors (Pima Indians and Scandinavians), use of certain drugs (clofibrate, estrogens, and bile acid sequestrants), and presence of gastrointestinal disease. Gallstones sometimes develop during dieting for weight reduction. There is an increased risk for gallstones and acute gallbladder disease during severe caloric restriction.
Gastric banding: Surgery to limit the amount of food the stomach can hold by closing part of it off. A band made of special material is placed around the stomach near its upper end, creating a small pouch and a narrow passage into the larger remainder of the stomach. The small outlet delays the emptying of food from the pouch and causes a feeling of fullness.
Gastric bubble/balloon: A free-floating intragastric balloon used in the treatment of obesity.
Gastric bypass: A surgical procedure that combines the creation of small stomach pouches to restrict food intake and the construction of bypasses of the duodenum and other segments of the small intestine to cause food malabsorption. Patients generally lose two-thirds of their excess weight after two years.
Gastric exclusion: Same as gastric partitioning and Roux-en Y bypass. A small stomach pouch is created by stapling or by vertical banding to restrict food intake. A Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the duodenum as well as the first portion of the jejunum.
Gastric partitioning: See gastric exclusion.
Gastroplasty: See also jejuno-ileostomy. A surgical procedure that limits the amount of food the stomach can hold by closing off part of the stomach. Food intake is restricted by creating a small pouch at the top of the stomach where the food enters from the esophagus. The pouch initially holds about 1 ounce of food and expands to 2-3 ounces with time. The pouch's lower outlet usually has a diameter of about 1/4 inch. The small outlet delays the emptying of food from the pouch and causes a feeling of fullness.
Genotype: The entire genetic makeup of an individual. The fundamental constitution of an organism in terms of its hereditary factors. A group of organisms in which each has the same hereditary characteristics.
Glucose tolerance: The power of the normal liver to absorb and store large quantities of glucose and the effectiveness of intestinal absorption of glucose. The glucose tolerance test is a metabolic test of carbohydrate tolerance that measures active insulin, a hepatic function based on the ability of the liver to absorb glucose. The test consists of ingesting 100 grams of glucose into a fasting stomach; blood sugar should return to normal in 2 to 21 hours after ingestion.
Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more.
Hemorrhagic stroke: A disorder involving bleeding within ischemic brain tissue. Hemorrhagic stroke occurs when blood vessels that are damaged or dead from lack of blood supply (infarcted), located within [Page G5]an area of infarcted brain tissue, rupture and transform an “ischemic” stroke into a hemorrhagic stroke. Ischemia is inadequate tissue oxygenation caused by reduced blood flow; infarction is tissue death resulting from ischemia. Bleeding irritates the brain tissues, causing swelling (cerebral edema). Blood collects into a mass (hematoma). Both swelling and hematoma will compress and displace brain tissue.
Heritability: The proportion of observed variation in a particular trait that can be attributed to inherited genetic factors in contrast to environmental ones.
High-density lipoproteins (HDL): Lipoproteins that contain a small amount of cholesterol and carry cholesterol away from body cells and tissues to the liver for excretion from the body. Low-level HDL increases the risk of heart disease, so the higher the HDL level, the better. The HDL component normally contains 20 to 30 percent of total cholesterol, and HDL levels are inversely correlated with coronary heart disease risk.
Hirsutism: Presence of excessive body and facial hair, especially in women; may be present in normal adults as an expression of an ethnic characteristic or may develop in children or adults as the result of an endocrine disorder. Apert's hirsutism is caused by a virilizing disorder of adrenocortical origin. Constitutional hirsutism is mild-to-moderate hirsutism present in individuals exhibiting otherwise normal endocrine and reproductive functions; it appears to be an inheritable form of hirsutism and commonly is an expression of an ethnic characteristic. Idiopathic hirsutism is of uncertain origin in women, who may exhibit menstrual abnormalities and sterility. Some authorities believe the hirsutism reflects hypersecretion of adrenocortical androgens.
Hypercholesterolemia (high blood cholesterol): Cholesterol is the most abundant steroid in animal tissues, especially in bile and gallstones. The relationship between the intake of cholesterol and its manufacture by the body to its utilization, sequestration, or excretion from the body is called the cholesterol balance. When cholesterol accumulates, the balance is positive; when it declines, the balance is negative. In 1993, the NHLBI National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults issued an updated set of recommendations for monitoring and treatment of blood cholesterol levels. The NCEP guidelines recommended that total cholesterol levels and subfractions of high-density lipoprotein (HDL) cholesterol be measured beginning at age 20 in all adults, with subsequent periodic screenings as needed. Even in the group of patients at lowest risk for coronary heart disease (total cholesterol 200 mg/dL and HDL 35 mg/dL), the NCEP recommended that rescreening take place at least once every five years.
Hypertension: High blood pressure (i.e., abnormally high blood pressure tension involving systolic and/or diastolic levels). The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure defines hypertension as a systolic blood pressure of 140 mm Hg or greater, a diastolic blood pressure of 90 mm Hg or greater, or taking hypertensive medication. The cause may be adrenal, benign, essential, Goldblatt's, idiopathic, malignant PATE, portal, postpartum, primary, pulmonary, renal or renovascular.
Hypertriglyceridemia: An excess of triglycerides in the blood that is an autosomal dominant disorder with the phenotype of hyperlipoproteinemia, type IV. The National Cholesterol Education Program defines a high level of triglycerides as being between 400 and 1,000 mg/dL.
Incidence: The rate at which a certain event occurs (i.e., the number of new cases of a specific disease occurring during a certain period).
Insulin-dependent diabetes mellitus (type 1 diabetes): A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes.
Ischemic stroke: A condition in which the blood supply to part of the brain is cut off. Also called “plug-type” strokes. Blocked arteries starve areas of the brain controlling sight, speech, sensation, and movement so that these functions are partially or completely lost. Ischemic stroke is the most common type of stroke, accounting for 80 percent of all strokes. Most ischemic strokes are caused by a blood clot called a thrombus, which blocks blood flow in the arteries feeding the brain, usually the carotid artery in the neck, the major vessel bringing blood [Page G6]to the brain. When it becomes blocked, the risk of stroke is very high.
Jejuno-ileostomy: See gastroplasty.
J-shaped relationship: The relationship between body weight and mortality.
Lipoprotein: Protein-coated packages that carry fat and cholesterol throughout the bloodstream. There are four general classes: high-density, low-density, very low-density, and chylomicrons.
Locus/loci: A general anatomical term for a site in the body or the position of a gene on a chromosome.
Longitudinal study: Also referred to as a “cohort study” or “prospective study”; the analytic method of epidemiologic study in which subsets of a defined population can be identified who are, have been, or in the future may be exposed or not exposed, or exposed in different degrees, to a factor or factors hypothesized to influence the probability of occurrence of a given disease or other outcome. The main feature of this type of study is to observe large numbers of subjects over an extended time, with comparisons of incidence rates in groups that differ in exposure levels.
Low-calorie diet (LCD): Caloric restriction of about 800 to 1,500 calories (approximately 12 to 15 kcal/kg of body weight) per day.
Low-density lipoprotein (LDL): Lipoprotein that contains most of the cholesterol in the blood. LDL carries cholesterol to the tissues of the body, including the arteries. A high level of LDL increases the risk of heart disease. LDL typically contains 60 to 70 percent of the total serum cholesterol and both are directly correlated with CHD risk.
Lower-fat diet: An eating plan in which 30 percent or less of the day's total calories are from fat.
Macronutrients: Nutrients in the diet that are the key sources of energy, namely protein, fat, and carbohydrates.
Magnetic resonance imaging (MRI): Magnetic resonance imaging uses radio frequency waves to provide direct visualization and quantification of fat. The sharp image contrast of MRI allows clear separation of adipose tissue from surrounding nonlipid structures. Essentially the same information provided by CT is available from MRI, including total body and regional adipose tissue, subcutaneous adipose, and estimates of various visceral adipose tissue components. The advantage of MRI is its lack of ionizing radiation and hence its presumed safety in children, younger adults, and pregnant women. The minimal present use of MRI can be attributed to the expense, limited access to instrumentation, and long scanning time.
Menopause: The cessation of menstruation in the human female, which begins at about the age of 50.
Meta-analysis: Process of using statistical methods to combine the results of different studies. A frequent application is pooling the results from a set of randomized controlled trials, none of which alone is powerful enough to demonstrate statistical significance.
Mianserine: An antidepressant sometimes used in the pharmacotherapy of bulimia nervosa.
Midaxillary line: An imaginary vertical line that passes midway between the anterior and posterior axillary (armpit) folds.
Monounsaturated fat: An unsaturated fat that is found in plant foods, including olive and canola oils.
Myocardial infarction (MI): Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed.
NHANES: National Health and Nutrition Examination Survey; conducted every 10 years by the National Center for Health Statistics to survey the dietary habits and health of U.S. residents.
Neural tube defects: These defects include problems stemming from fetal development of the spinal cord, spine, brain, and skull, and include birth defects such as spina bifida, anencephaly, and encephalocele. Neural tube defects occur early in pregnancy at about 4 to 6 weeks, usually before a woman knows she is pregnant. Many babies with neural tube defects [Page G7]have difficulty walking and with bladder and bowel control.
Neuronal atrophy: Nerve cell death and function loss.
Obesity: The condition of having an abnormally high proportion of body fat. Defined as a body mass index (BMI) of greater than or equal to 30. Subjects are generally classified as obese when body fat content exceeds 30 percent in women and 25 percent in men. The operational definition of obesity in this document is a BMI 30.
Observational study: An epidemiologic study that does not involve any intervention, experimental or otherwise. Such a study may be one in which nature is allowed to take its course, with changes in one characteristic being studied in relation to changes in other characteristics. Analytical epidemiologic methods, such as case-control and cohort study designs, are properly called observational epidemiology because the investigator is observing without intervention other than to record, classify, count, and statistically analyze results.
Orlistat: A lipase inhibitor used for weight loss. Lipase is an enzyme found in the bowel that assists in lipid absorption by the body. Orlistat blocks this enzyme, reducing the amount of fat the body absorbs by about 30 percent. It is known colloquially as a “fat blocker.” Because more oily fat is left in the bowel to be excreted, Orlistat can cause an oily anal leakage and fecal incontinence. Orlistat may not be suitable for people with bowel conditions such as irritable bowel syndrome or Crohn's disease.
Osteoarthritis: Noninflammatory degenerative joint disease occurring chiefly in older persons, characterized by degeneration of the articular cartilage, hypertrophy of bone at the margins, and changes in the synovial membrane. It is accompanied by pain and stiffness.
Overweight: An excess of body weight but not necessarily body fat; a body mass index of 25 to 29.9 kg/m2.
Peripheral regions: Other regions of the body besides the abdominal region (i.e., the gluteal-femoral area).
Pharmacotherapy: A regimen of using appetite suppressants to manage obesity by decreasing appetite or increasing the feeling of satiety. These medications decrease appetite by increasing serotonin or catecholamine—two brain chemicals that affect appetite.
Phenotype: The entire physical, biochemical, and physiological makeup of an individual as determined by his or her genes and by the environment in the broad sense.
Phentermine: An adrenergic isomeric with amphetamine, used as an anorexic; administered orally as a complex with an ion-exchange resin to produce a sustained action.
Polyunsaturated fat: An unsaturated fat found in greatest amounts in foods derived from plants, including safflower, sunflower, corn, and soybean oils.
Postprandial plasma blood glucose: Glucose tolerance test performed after ingesting food.
Prevalence: The number of events, e.g., instances of a given disease or other condition, in a given population at a designated time. When used without qualification, the term usually refers to the situation at specific point in time (point prevalence). Prevalence is a number, not a rate.
Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups.
Protein: A class of compounds composed of linked amino acids that contain carbon, hydrogen, nitrogen, oxygen, and sometimes other atoms in specific configurations.
Randomization: Also called random allocation. Is allocation of individuals to groups, e.g., for experimental and control regimens, by chance. Within the limits of chance variation, random allocation should make the control and experimental groups similar at the start of an investigation and ensure that personal judgment and prejudices of the investigator do not influence allocation.
Randomized clinical trial (RCT): An epidemiologic experiment in which subjects in a population are randomly [Page G8]allocated into groups, usually called study and control groups, to receive or not to receive an experimental prevention or therapeutic product, maneuver, or intervention. The results are assessed by rigorous comparison of rates of disease, death recovery, or other appropriate outcome in the study and control groups, respectively. RCTs are generally regarded as the most scientifically rigorous method of hypothesis testing available in epidemiology.
Recessive gene: A gene that is phenotypically expressed only when homozygous.
Refractory obesity: Obesity resistant to treatment.
Relative risk: The ratio of the incidence rate of a disease among individuals exposed to a specific risk factor to the incidence rate among unexposed individuals; synonymous with risk ratio. Alternatively, the ratio of the cumulative incidence rate in the exposed to the cumulative incidence rate in the unexposed (cumulative incidence ratio). The term relative risk has also been used synonymously with odds ratio. This is because the odds ratio and relative risk approach each other if the disease is rare (5 percent of population) and the number of subjects is large.
Resting metabolic rate (RMR): RMR accounts for 65 to 75 percent of daily energy expenditure and represents the minimum energy needed to maintain all physiological cell functions in the resting state. The principal determinant of RMR is lean body mass (LBM). Obese subjects have a higher RMR in absolute terms than lean individuals, an equivalent RMR when corrected for LBM and per unit surface area, and a lower RMR when expressed per kilogram of body weight. Obese persons require more energy for any given activity because of a larger mass, but they tend to be more sedentary than lean subjects.
Risk: The probability that an event will occur. Also, a nontechnical term encompassing a variety of measures of the probability of a generally unfavorable outcome.
Roux-en-Y bypass: See gastric exclusion; the most common gastric bypass procedure.
Saturated fat: A type of fat found in greatest amounts in foods from animals, such as fatty cuts of meat, poultry with the skin, whole-milk dairy products, lard, and in some vegetable oils, including coconut, palm kernel, and palm oils. Saturated fat raises blood cholesterol more than anything else eaten. On a Step I Diet, no more than 8 to 10 percent of total calories should come from saturated fat, and in the Step II Diet, less than 7 percent of the day's total calories should come from saturated fat.
Secular trends: A relatively long-term trend in a community or country.
Serotonin: A monoamine vasoconstrictor, found in various animals from coelenterates to vertebrates, in bacteria, and in many plants. In humans, it is synthesized in the intestinal chromaffin cells or in the central or peripheral neurons and is found in high concentrations in many body tissues, including the intestinal mucosa, pineal body, and central nervous system. Produced enzymatically from tryptophan by hydroxylation and decarboxylation, serotonin has many physiologic properties (e.g., inhibits gastric secretion, stimulates smooth muscle, serves as central neurotransmitter, and is a precursor of melatonin).
Sibutramine: A drug used for the management of obesity that helps reduce food intake and is indicated for weight loss and maintenance of weight loss when used in conjunction with a reduced-calorie diet. It works to suppress the appetite primarily by inhibiting the reuptake of the neurotransmitters norepinephrine and serotonin. Side effects include dry mouth, headache, constipation, insomnia, and a slight increase in average blood pressure. In some patients it causes a higher blood pressure increase.
Sleep apnea: A serious, potentially life-threatening breathing disorder characterized by repeated cessation of breathing due to either collapse of the upper airway during sleep or absence of respiratory effort.
Social pressure: A strategy used in behavior therapy in which individuals are told that they possess the basic self-control ability to lose weight, but that coming to group meetings will strengthen their abilities. The group is asked to listen and give advice, similar to the way many self-help groups, based on social support, operate.
Stoma size: The size of a new opening created surgically between two body structures.
Stress incontinence: An involuntary loss of urine that occurs at the same time that internal abdominal [Page G9]pressure is increased, such as with laughing, sneezing, coughing, or physical activity.
Stress management: A set of techniques used to help an individual cope more effectively with difficult situations in order to feel better emotionally, improve behavioral skills, and often to enhance feelings of control. Stress management may include relaxation exercises, assertiveness training, cognitive restructuring, time management, and social support. It can be delivered either on a one-to-one basis or in a group format.
Submaximal heart rate test: Used to determine the systematic use of physical activity. The submaximal work levels allow work to be increased in small increments until cardiac manifestations such as angina pain appear. This provides a more precise manipulation of workload and gives a reliable and quantitative index of a person's impairment if heart disease is detected.
Surgical procedures: See jejuno-ileostomy, gastroplasty, gastric bypass, gastric partitioning, gastric exclusion, Roux-en Y bypass and gastric bubble.
Systolic blood pressure: The maximum pressure in the artery produced as the heart contracts and blood begins to flow.
Triglyceride: A lipid carried through the blood stream to tissues. Most of the body's fat tissue is in the form of triglycerides, stored for use as energy. Triglycerides are obtained primarily from fat in foods.
Type 2 diabetes: Usually characterized by a gradual onset with minimal or no symptoms of metabolic disturbance and no requirement for exogenous insulin. The peak age of onset is 50 to 60 years. Obesity and possibly a genetic factor are usually present.
Validity: The degree to which the inferences drawn from study results, especially generalization extending beyond the study sample, are warranted when account is taken of the study methods, the representativeness of the study sample, and the nature of the population from which it is drawn.
Vertical banded gastroplasty: A surgical treatment for extreme obesity; an operation on the stomach that involves constructing a small pouch in the stomach that empties through a narrow opening into the distal stomach and duodenum.
Very low-calorie diet (VLCD): The VLCD of 800 (approximately 6-10 kcal/kg body weight) or fewer calories per day is conducted under physician supervision and monitoring and is restricted to severely obese persons.
Very low-density lipoprotein (VLDL): The lipoprotein particles that initially leave the liver, carrying cholesterol and lipid. VLDLs contain 10 to 15 percent of the total serum cholesterol along with most of the triglycerides in the fasting serum; VLDLs are precursors of LDL, and some forms of VLDL, particularly VLDL remnants, appear to be atherogenic.
Visceral fat: One of the three compartments of abdominal fat. Retroperitoneal and subcutaneous are the other two compartments.
VO2 max: Maximal oxygen uptake is known as VO2 max and is the maximal capacity for oxygen consumption by the body during maximal exertion. It is used as an indicator of cardiorespiratory fitness.
Waist circumference: To define the level at which the waist circumference is measured, a bony landmark is first located and marked. The subject stands, and the technician, positioned to the right of the subject, palpates the upper hip bone to locate the right ileum. Just above the uppermost lateral border of the right ileum, a horizontal mark is drawn and then crossed with a vertical mark on the midaxillary line. The measuring tape is then placed around the trunk, at the level of the mark on the right side, making sure that it is on a level horizontal plane on all sides. The tape is then tightened slightly without compressing the skin and underlying subcutaneous tissues. The measure is recorded in centimeters to the nearest millimeter.
Waist-hip-ratio (WHR): The ratio of a person's waist circumference to hip circumference. WHR looks at the relationship between the differences in the measurements of waist and hips. Most people store body fat in two distinct ways, often called the “apple” and “pear” shapes, either the middle (apple) or the hips (pear). For most people, carrying extra weight around their middle increases health risks more than carrying extra weight around their hips or thighs. Overall obesity, however, is still of greater risk than body fat storage locations or WHR. A WHR 1.0 is in the danger zone, with risks of heart disease and other ailments connected with being overweight. For men, a ratio of .90 or less is considered safe, and for women, .80 or less.