Approach to the obese patient wanting to exerciseDocument Transcript
Database: Ovid MEDLINE(R) <1966 to January Week 4 2004>
1 exp Obesity/ (54206)
2 exp EXERCISE/ or exp EXERCISE THERAPY/ (40066)
3 1 and 2 (2764)
4 limit 3 to (human and english language) (2379)
5 exp *Obesity/ and 4 (1713)
6 (exp *EXERCISE/ or exp *EXERCISE THERAPY/) and 5 (823)
7 limit 6 to yr=1996-2004 (569)
8 limit 7 to yr=2000-2004 (358)
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Berke EM. Morden NE.
University of Massachusetts Medical School, Worcester 01610, USA.
Medical management of obesity.[erratum appears in Am Fam Physician 2001 Aug
15;64(4):570]. [Review] [26 refs]
American Family Physician. 62(2):419-26, 2000 Jul 15.
Obesity is one of the most common medical problems in the United States and a
risk factor for illnesses such as hypertension, diabetes, degenerative arthritis
and myocardial infarction. It is a cause of significant morbidity and mortality
and generates great social and financial costs. Obesity is defined as a body
mass index greater than 30. Many patients accomplish weight loss with diet,
exercise and lifestyle modification. Others require more aggressive therapy.
Weight loss medications may be appropriate for use in selected patients who meet
the definition of obesity or who are overweight with comorbid conditions.
Medications are formulated to reduce energy intake, increase energy output or
decrease the absorption of nutrients. Drugs cannot replace diet, exercise and
lifestyle modification, which remain the cornerstones of obesity treatment. Two
new agents, sibutramine and orlistat, exhibit novel mechanisms of action and
avoid some of the side effects that occurred with earlier drugs. Sibutramine
acts to block uptake of serotonin, norepinephrine and dopamine, while orlistat
decreases fat absorption in the intestines. [References: 26]
McInnis KJ. Franklin BA. Rippe JM.
Dept of Exercise Science and Physical Education, University of Massachusetts,
Boston, Massachusetts 02125, USA. email@example.com
Counseling for physical activity in overweight and obese patients.[see
comment]. [Review] [33 refs]
Comment in: Am Fam Physician. 2003 Mar 15;67(6):1199-200, 1202; PMID:
12674450, Comment in: Am Fam Physician. 2003 Mar 15;67(6):1266-8; PMID: 12674454
American Family Physician. 67(6):1249-56, 2003 Mar 15.
Obesity has reached epidemic proportions in the United States. More than 60
percent of U.S. adults are now overweight or obese (defined as at least 30 lb
[13.6 kg] overweight), predisposing more than 97 million Americans to a host of
chronic diseases and conditions. Physical activity has a positive effect on
weight loss, total body fat, and body fat distribution, as well as maintenance
of favorable body weight and change in body composition. Many of the protective
aspects of exercise and activity appear to occur in overweight persons who gain
fitness but remain overweight. Despite the well-known health and quality-of-life
benefits of regular physical activity, few Americans are routinely active.
Results of research studies have shown that physician intervention to discuss
physical activity (including the wide array of health benefits and the potential
barriers to being active) need not take more than three to five minutes during
an office visit but can play a critical role in patient implementation. This
article describes elements of effective counseling for physical activity and
presents guidelines for developing physical activity programs for overweight and
obese patients. [References: 33]
Dubbert PM. Carithers T. Sumner AE. Barbour KA. Clark BL. Hall JE. Crook
University of Mississippi School of Medicine, Jackson, USA.
Obesity, physical inactivity, and risk for cardiovascular disease. [Review]
American Journal of the Medical Sciences. 324(3):116-26, 2002 Sep.
Despite considerable progress in understanding disease mechanisms and risk
factors, improved treatments, and public education efforts, cardiovascular
disease (CVD) remains the leading cause of death in the United States. Obesity
and physical inactivity, 2 important lifestyle-related risk factors for CVD, are
prevalent in the southeastern United States and are becoming more prevalent in
all racial groups and areas of the country. In reviewing these risk factors, we
explored topics including prevalence and trends in population data; associated
psychosocial and environmental factors; and some of the mechanisms through which
these risk factors are thought to contribute to CVD. We identified significant,
but as yet poorly understood, racial disparities in prevalence of obesity, low
levels of physical activity, and correlates of these risk factors and examined
important differences in the complex relationship between obesity, diabetes, and
cardiovascular disease risk between African American and European American
women. The Jackson Heart Study will provide important and unique information
relevant to many unanswered questions about obesity, physical inactivity, and
obesity in African Americans. [References: 99]
Costacou T. Mayer-Davis EJ.
Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
15213, USA. firstname.lastname@example.org
Nutrition and prevention of type 2 diabetes. [Review] [121 refs]
Annual Review of Nutrition. 23:147-70, 2003.
In recent years, the prevalence of type 2 diabetes has increased alarmingly
worldwide, giving diabetes the dimension of an epidemic. Striking parallel
increases in the prevalence of obesity reflect the importance of body fatness as
a contributing factor to diabetes incidence. Moreover, it has been estimated
that up to 75% of the risk of type 2 diabetes is attributable to obesity. Recent
clinical trials and observational epidemiologic studies demonstrate the efficacy
of lifestyle changes, including decreased energy intake, decreased fat intake,
and weight loss, as well as regular participation in physical activity, in
improving insulin sensitivity (SI) and reducing the risk of diabetes. This
review evaluates evidence of the effect of diet on insulin resistance, insulin
secretion, and glucose tolerance, and reflects on directions for future work
toward primary prevention of type 2 diabetes. [References: 121]
French SA. Story M. Jeffery RW.
Division of Epidemiology, University of Minnesota, 1300 South Second Street,
Minneapolis, Minnesota 55454, USA. email@example.com
Environmental influences on eating and physical activity. [Review] [100 refs]
Annual Review of Public Health. 22:309-35, 2001.
Obesity has increased dramatically over the past two decades and currently
about 50% of US adults and 25% of US children are overweight. The current
epidemic of obesity is caused largely by an environment that promotes excessive
food intake and discourages physical activity. This chapter reviews what is
known about environmental influences on physical activity and eating behaviors.
Recent trends in food supply, eating out, physical activity, and inactivity are
reviewed, as are the effects of advertising, promotion, and pricing on eating
and physical activity. Public health interventions, opportunities, and potential
strategies to combat the obesity epidemic by promoting an environment that
supports healthy eating and physical activity are discussed. [References: 100]
Blaak EE. Saris WH.
Department of Human Biology, Nutrition Research Centre, Maastricht University,
Substrate oxidation, obesity and exercise training. [Review] [74 refs]
Best Practice & Research Clinical Endocrinology & Metabolism. 16(4):667-78,
Regular physical exercise is of the utmost importance in the treatment of
obesity because exercise is one of the factors determining long-term weight
maintenance in weight reduction programmes and because exercise has been
associated with a reduced risk for developing type 2 diabetes mellitus and
cardiovascular disease. Obesity is associated with an impaired utilization of
fat as a fuel during post-absorptive conditions, during beta-adrenergic
stimulation and possibly during exercise, although the latter data are
controversial.One of the underlying mechanisms for the positive effect of
exercise training in obesity may be related to its effects on fat utilization
because exercise training has been shown to increase basal fat oxidation and
exercise fat oxidation in lean volunteers. Data on the effect of aerobic
exercise training on exercise fat oxidation are controversial, whereas the
available data indicate that exercise training may not be able to increase
resting fat oxidation or 24-hour fat oxidation in obese subjects. Because
disturbed muscle fat oxidation may be a primary event in the aetiology of
obesity it is of the utmost importance to obtain more information on how and
whether exercise training may be able to compensate for these impairments.
Schrauwen P. Westerterp KR.
Department of Human Biology, Maastricht University, The Netherlands.
The role of high-fat diets and physical activity in the regulation of body
weight. [Review] [92 refs]
British Journal of Nutrition. 84(4):417-27, 2000 Oct.
The prevalence of obesity is increasing in westernized societies. In the USA
the age-adjusted prevalence of BMI > 30 kg/m2 increased between 1960 and 1994
from 13% to 23% for people over 20 years of age. This increase in the prevalence
of obesity has been attributed to an increased fat intake and a decreased
physical activity. However, the role of the impact of the level of dietary fat
intake on human obesity has been challenged. High-fat diets, due to their high
energy density, stimulate voluntary energy intake. An increased fat intake does
not stimulate its own oxidation but the fat is stored in the human body. When
diet composition is isoenergetically switched from low to high fat, fat
oxidation only slowly increases, resulting in positive fat balances on the short
term. Together with a diminished fat oxidation capacity in pre-obese subjects,
high-fat diets can therefore be considered to be fattening. Another
environmental factor which could explain the increasing prevalence of obesity is
a decrease in physical activity. The percentage of body fat is negatively
associated with physical activity and exercise has pronounced effects on energy
expenditure and substrate oxidation. High-intensity exercise, due to a lowering
of glycogen stores, can lead to a rapid increase in fat oxidation, which could
compensate for the consumption of high-fat diets in westernized societies.
Although the consumption of high-fat diets and low physical activity will easily
lead to the development of obesity, there is still considerable inter-individual
variability in body composition in individuals on similar diets. This can be
attributed to the genetic background, and some candidate genes have been
discovered recently. Both leptin and uncoupling protein have been suggested to
play a role in the prevention of diet-induced obesity. Indeed, leptin levels are
increased on a high-fat diet but this effect can be attributed to the increased
fat mass observed on the high-fat diet. No effect of a high-fat diet per se on
leptin levels is observed. Uncoupling proteins are increased by high-fat diets
in rats but no data are available in human subjects yet. In conclusion, the
increased intake of dietary fat and a decreasing physical activity level are the
most important environmental factors explaining the increased prevalence of
obesity in westernized societies. [References: 92]
Pescatello LS. VanHeest JL.
University of Connecticut, School of Allied Health Professions, Storrs
Physical activity mediates a healthier body weight in the presence of obesity.
[Review] [39 refs]
British Journal of Sports Medicine. 34(2):86-93, 2000 Apr.
Ross R. Janssen I. Tremblay A.
School of Physical and Health Education, Queen's University, Kingston, Ontario
Obesity reduction through lifestyle modification. [Review] [72 refs]
Canadian Journal of Applied Physiology. 25(1):1-18, 2000 Feb.
Obesity is a worldwide public health problem. One in three Canadians is
overweight, a prevalence that is already high and increasing. Moreover, 54% of
men and 37% of Canadian women are characterized as abdominally obese, the
phenotype that is strongly associated with cardiovascular disease and type II
diabetes. These observations underscore the importance of considering the
efficacy of methods commonly used to reduce total and abdominal obesity. These
strategies include a decrease in energy intake (diet), an increase in energy
expenditure (exercise), or pharmacological intervention. The combination of diet
and exercise is more commonly prescribed, with pharmacological intervention
suggested only when lifestyle changes fail to achieve weight loss.The aim of
this report is to review current knowledge regarding the influence of diet and
exercise as treatment strategies for obesity reduction and provide
recommendations for attaining and maintaining a healthy weight. The importance
of diet composition in the treatment of obesity is also considered. [References:
Poirier P. Despres JP.
Department of Pharmacy, Laval University School of Pharmacy, Sainte-Foy,
Exercise in weight management of obesity. [Review] [115 refs]
Cardiology Clinics. 19(3):459-70, 2001 Aug.
Obesity is a chronic metabolic disorder associated with CVD and increased
morbidity and mortality. When the BMI is > or = 30 kg/m2, mortality rates from
all causes, and especially CVD, are increased by 50% to 100%. There is strong
evidence that weight loss in overweight and obese individuals improves risk
factors for diabetes and CVD. Additional evidence indicates that weight loss and
the associated diuresis reduce blood pressure in both overweight hypertensive
and nonhypertensive individuals, reduce serum TG levels, increase high-density
lipoprotein cholesterol levels, and may produce some reduction in low-density
lipoprotein cholesterol concentrations. Of interest, even if weight loss is
minimal, obese individuals showing a good level of cardiorespiratory fitness are
at reduced risk for cardiovascular mortality than lean but poorly fit subjects.
Insulin and catecholamines have pronounced metabolic effects on human adipose
tissue metabolism. Insulin stimulates LPL and inhibits HSL; the opposite is true
for catecholamines. There is regional variation in adipocyte TG turnover
favoring lipid mobilization in the visceral fat depots and lipid storage in the
peripheral subcutaneous sites. The hormonal regulation of adipocyte TG turnover
is altered in obesity and is most marked in central obesity. There is resistance
to insulin stimulation of LPL; however, LPL activity in fasted obese subjects is
increased and remains so following weight reduction. Catecholamine-induced
lipolysis is enhanced in visceral fat but decreased in subcutaneous fat.
Numerous adaptive responses take place with physical training. These adaptations
result in a more efficient system for oxygen transfer to muscle, which is now
able to better utilize the unlimited lipid stores instead of the limited
carbohydrate reserves available. In addition, the reduced adipose tissue mass
represents an important mechanical advantage, allowing better long-term work.
Gender differences have been reported in the adaptation of adipose tissue
metabolism to aerobic exercise training. Physical training helps counteract the
permissive and affluent environment that predisposes reduced-obese subjects to
regain weight. An exercise program using weight resistance modalities may also
be included safely, and it improved program retention in a multidisciplinary
weight management program that was designed for obese children. Thirty to 45
minutes of physical activity of moderate intensity, performed 3 to 5 days a
week, should be encouraged. All adults should set a long-term goal to accumulate
at least 30 minutes or more of moderate-intensity physical activity on most, and
preferably all days. Public health interventions promoting walking are likely to
be the most successful. Indeed, walking is unique because of its safety,
accessibility, and popularity. It is noteworthy that there is a clear
dissociation between the adaptation of cardiorespiratory fitness and the
improvements in the metabolic risk profile that can be induced by endurance
training programs. It appears that as long as the increase in energy expenditure
is sufficient, low-intensity endurance exercise is likely to generate beneficial
metabolic effects that would be essentially similar to those produced by high-
intensity exercise. The clinician should therefore focus on the improvement of
the metabolic profile rather than on weight loss alone. Realistic goals should
be set between the clinician and the patient, with a weight loss of
approximately of 0.5 to 1 pound per week. It should be kept in mind that since
it generally takes years to become overweight or obese, a weight loss pattern of
0.5 or 1 pound per week will require time and perseverance to reach the proposed
target. However, the use of physical activity as a method to lose weight seems
inversely related to patients' age and BMI and directly related to the level of
education. Thus, public health interventions helping these groups to become
physically active remain a challenge and further emphasize the importance of the
one-on-one interaction between the clinician/health care professional with the
obese individual "at risk" of CVD. This notion is critical, as it has been shown
that less than half of obese adults have reported being advised to lose weight
under the guidance of health care professionals. [References: 115]
University Physicians Clinic, University of Virginia Health System, Box
800671, Charlottesville, VA 22908, USA. firstname.lastname@example.org
Exercise considerations in hypertension, obesity, and dyslipidemia. [Review]
Clinics in Sports Medicine. 22(1):101-21, vii, 2003 Jan.
Sports medicine practitioners who care for a wide array of athletes and active
individuals will consistently face issues regarding chronic cardiovascular
diseases and their associated risk factors. Among these, hypertension, obesity,
and dyslipidemia are common clinical conditions that may be encountered even
amongst elite caliber athletes. Consequently, those entrusted with the care of
this active population must recognize the presence of these disorders and feel
comfortable with their management in the face of continued sports or exercise
participation. This article reviews the pathophysiology of these conditions as
they relate to athletes and outlines the value of continued exercise in the
management of each of these entities while addressing the specific and unique
treatment needs of active individuals. [References: 150]
Liu S. Manson JE.
Division of Preventive Medicine, Department of Medicine, Brigham and Women's
Hospital and Harvard Medical School, Boston, Massachusetts 02215, USA.
Dietary carbohydrates, physical inactivity, obesity, and the 'metabolic
syndrome' as predictors of coronary heart disease. [Review] [115 refs]
Current Opinion in Lipidology. 12(4):395-404, 2001 Aug.
Several decades of epidemiological and clinical research have identified
physical inactivity, excessive calorie consumption, and excess weight as common
risk factors for both type 2 diabetes mellitus and coronary heart disease. This
trio forms the environmental substrate for a now well-recognized metabolic
phenotype called the insulin resistance syndrome. Recent data suggest that a
high intake of rapidly absorbed carbohydrates, which is characterized by a high
glycemic load (a measure of carbohydrate quality and quantity), may increase the
risk of coronary heart disease by aggravating glucose intolerance and
dyslipidemia. These data also suggest that individuals who are obese and insulin
resistant are particularly prone to the adverse effects of a high dietary
glycemic load. In addition, data continue to accumulate suggesting the important
beneficial effects of physical activity, even at moderate levels, and weight
reduction on improving insulin sensitivity and reducing the risk of coronary
heart disease. Future metabolic studies should continue to quantify the
physiological impact of different foods on serum glucose and insulin, and such
information should routinely be incorporated into large-scale and long-term
prospective studies, in which the possible interaction effects between diet and
other metabolic determinants such as physical activity and obesity can be
examined. Until more definitive data are available, replacing refined grain
products and potatoes with minimally processed plant-based foods such as whole
grains, fruits, and vegetables, and reducing the intake of high glycemic load
beverages may offer a simple strategy for reducing the incidence of coronary
heart disease. [References: 115]
Willey KA. Singh MA.
School of Exercise and Sport Science, the University of Sydney, Lidcombe,
Battling insulin resistance in elderly obese people with type 2 diabetes:
bring on the heavy weights. [Review] [68 refs]
Diabetes Care. 26(5):1580-8, 2003 May.
Exercise improves insulin resistance and has beneficial effects in preventing
and treating type 2 diabetes. However, aerobic exercise is hindered in many type
2 diabetic patients because of advancing age, obesity, and other comorbid
conditions. Weight lifting or progressive resistance training (PRT) offers a
safe and effective exercise alternative for these people. PRT promotes favorable
energy balance and reduced visceral fat deposition through enhanced basal
metabolism and activity levels while counteracting age- and disease-related
muscle wasting. PRT improves insulin sensitivity and glycemic control; increases
muscle mass, strength, and endurance; and has positive effects on bone density,
osteoarthritic symptoms, mobility impairment, self-efficacy, hypertension, and
lipid profiles. PRT also alleviates symptoms of anxiety, depression, and
insomnia in individuals with clinical depression and improves exercise tolerance
in individuals with cardiac ischemic disease and congestive heart failure; all
of these aspects are relevant to the care of diabetic elders. Moreover, PRT is
safe and well accepted in many complex patient populations, including very frail
elderly individuals and those with cardiovascular disease. The greater
feasibility of using PRT over aerobic exercise in elderly obese type 2 diabetic
individuals because of concomitant cardiovascular, arthritic, and other disease
provides a solid rationale for investigating the global benefits of PRT in the
management of diabetes. [References: 68]
Minehira K. Tappy L.
Institut de physiologie, Universite de Lausanne, Lausanne, Switzerland.
Dietary and lifestyle interventions in the management of the metabolic
syndrome: present status and future perspective. [Review] [44 refs]
European Journal of Clinical Nutrition. 56(12):7 p following 1262, 2002 Dec.
OBJECTIVE: To review the mechanisms underlying the metabolic syndrome, or
syndrome X, in humans, and to delineate dietary and environmental strategies for
its prevention. DESIGN: Review of selected papers of the literature. RESULTS:
Hyperinsulinemia and insulin resistance play a key role in the development of
the metabolic syndrome. Strategies aimed at reducing insulin resistance may be
effective in improving the metabolic syndrome. They include low saturated fat
intake, consumption of low-glycemic-index foods, physical exercise and
prevention of obesity. CONCLUSIONS: Future research, in particular the genetic
basis of the metabolic syndrome and the interorgan interactions responsible for
insulin resistance, is needed to improve therapeutic strategies for the
metabolic syndrome. [References: 44]
Molnar D. Livingstone B.
Department of Paediatrics, University of Pecs, Hungary. email@example.com
Physical activity in relation to overweight and obesity in children and
adolescents. [Review] [109 refs]
European Journal of Pediatrics. 159 Suppl 1:S45-55, 2000 Sep.
Fitness and physical activity levels of children and adolescents are commonly
addressed but data on scientific investigations are both equivocal and
methodologically diverse. The intensity and type of physical activity that
benefit health and development during childhood are not known. Measurement of
activity in children is problematic since there is no valid method of assessing
activity levels that is feasible for use in large field studies. Most studies
using self-report methods, heart rate studies using low heart rate threshold and
doubly labelled water studies indicate relatively high levels of activity in
children. The three national surveys on large representative samples reported
that 60% to 70% of all children were involved in sufficient physical activity
according to various definitions. Heart rate studies demonstrate that children
generally perform short bouts of moderate to vigorous activities and seldom
participate in long-sustained vigorous activities. They also proved that
children perform large volumes of activity in the lower heart rate zones. It is
generally accepted that boys are more active than girls and physical activity
declines by age (peak around 13 to 14 years of age). The difference between the
physical activity of European and North American children or between children
living in different European countries is difficult to judge due to the
diversity of methodology and definitions. CONCLUSION: There is a need to
identify more clearly the quantity and type of activity which improves the
health and promotes the normal development of children and to improve the
methods assessing physical activity. [References: 109]
Division of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA.
Regulation of lipid mobilization and oxidation during exercise in obesity.
[Review] [15 refs]
Exercise & Sport Sciences Reviews. 29(1):42-6, 2001.
Regulation of lipid mobilization and oxidation during exercise in obesity.
Exerc. Sport Sci. Rev. Vol. 29, No. 1, pp 42-46, 2001. Obesity is associated
with metabolic disorders that may be related to alterations in lipid
mobilization and oxidation. Although exercise is essential for successful weight
management, the regulation of fatty acid metabolism during exercise in obesity
is unclear. This review discusses factors that regulate fat metabolism during
exercise and the effects of endurance training on these responses. [References:
Ross R. Freeman JA. Janssen I.
School of Physical and Health Education, Queen's University, Kingston,
Ontario, Canada. firstname.lastname@example.org
Exercise alone is an effective strategy for reducing obesity and related
comorbidities. [Review] [17 refs]
Exercise & Sport Sciences Reviews. 28(4):165-70, 2000 Oct.
The commonly held view that exercise alone is not a useful strategy for
obesity reduction is drawn from studies with limitations that confound
interpretation. Recent evidence counters the dogma that daily exercise produces
only modest weight loss and suggests that exercise without diet restriction is
an effective strategy for reducing obesity and related co-morbidities.
Department of Exercise Science and Physical Education, University of
Massachusetts-Boston, Mass 02125, USA. email@example.com
Diet, exercise, and the challenge of combating obesity in primary care.
[Review] [25 refs]
Journal of Cardiovascular Nursing. 18(2):93-100; quiz 101-2, 2003 Apr-Jun.
Obesity has reached epidemic proportions in the United States and in most
industrialized nations. More than 60% of US adults are now overweight or obese,
predisposing over 97 million Americans to a host of chronic lifestyle diseases,
particularly cardiovascular disease. Despite the existence of explicit evidence-
based consensus reports on the health risks of obesity and the health benefits
of even moderate amounts of weight loss, many patients do not receive advice
from their health care providers to lose weight or on how to do so effectively.
Even modest physical activity and small incremental healthy dietary changes when
incorporated into one's lifestyle have a positive effect on weight loss and
promote the maintenance of favorable body weight and body composition changes
with advancing age. This article describes elements of effective counseling and
practical guidelines for developing a healthy lifestyle approach for overweight
and obese individuals. [References: 25]
Womble LG. Clark VL. Wadden TA.
University of Pennsylvania School of Medicine, Department of Psychiatry,
Philadelphia, USA. Womble@mail.med.upenn.edu
Diet and physical activity for obesity: how effective are they?. [Review] [23
Journal of Endocrinological Investigation. 25(10):922-4, 2002 Nov.
Department of Family Medicine, Medical University of South Carolina,
Charleston, SC 29425, USA. firstname.lastname@example.org
Effective management of obesity.[see comment]. [Review] [46 refs]
Comment in: J Fam Pract. 2003 Aug;52(8):635; PMID: 12899819
Journal of Family Practice. 52(1):34-42, 2003 Jan.
Successful treatment of obesity usually requires multiple interventions. The
choice of therapies should be guided by the initial assessment of a patient's
degree of obesity and comorbid conditions, if present. A variety of
interventions can achieve short-term weight loss, but rebound weight gain is
common when therapy is stopped. Thus, programs for weight maintenance are
critical to ultimate success. [References: 46]
Keller C. Fleury J. Mujezinovic-Womack M.
University of Texas Health Science Center, San Antonio School of Nursing, 7703
Floyd Curl Drive, San Antonio, TX 78284, USA.
Managing cardiovascular risk reduction in elderly adults. By promoting and
monitoring healthy lifestyle changes, health care providers can help older
adults improve their cardiovascular health. [Review] [35 refs]
Journal of Gerontological Nursing. 29(6):18-23, 2003 Jun.
Primary care practitioners must explore the most effective techniques for
promoting cardiovascular risk reduction in older adults. Managing lifestyle
modification risk factors, such as smoking cessation, obesity, sedentary
lifestyle, and nutrition is discussed in this article. Other risk factor
modification efforts, often not highlighted, include managing homocysteinemia,
and sedentary behavior. These factors are presented as equally important
modifiable coronary heart disease risks. [References: 35]
Nemet D. Cooper DM.
Center for the Study of Health Effects of Exercise in Children, University of
California, Irvine, College of Medicine, Orange 92868, USA. email@example.com
Exercise, diet, and childhood obesity: the GH-IGF-I connection. [Review] [36
Journal of Pediatric Endocrinology & Metabolism. 15 Suppl 2:751-7, 2002 May.
The recent "obesity epidemic" among children and adolescents is a major public
health concern. The mechanisms responsible for the increased incidence of
childhood obesity are not yet well understood. The absence of a clear mechanism
makes treating the obese child or adolescent a difficult task, and standardized
therapeutic approaches simply do not yet exist. Metabolic derangements
associated with obesity may contribute to the difficulty in treatment. Observed
abnormalities in the growth hormone (GH)-insulin-like growth factor-I (IGF-I)
axis in obese adults and the impact of exercise on the GH-IGF-I system are of
particular relevance to the growing obese child. In this review, we focus on the
interacting mechanisms of diet and exercise through specific hormonal mediators
and their contribution to the current obesity epidemic. An improved
understanding of these mechanisms may be helpful in creating effective treatment
programs for children with obesity. [References: 36]
Sothern MS. Schumacher H. von Almen TK. Carlisle LK. Udall JN.
Prevention of Childhood Obesity Laboratory, Louisiana State University,
Pennington Biomedical Research Center, Baton Rouge 70808, USA.
Committed to kids: an integrated, 4-level team approach to weight management
in adolescents. [Review] [18 refs]
Journal of the American Dietetic Association. 102(3 Suppl):S81-5, 2002 Mar.
The integrated, 4-level approach of Committed to Kids is successful because of
several factors: The sessions are designed to entertain the adolescents and
promote initial success; The program features parent-training methods in short,
interactive, educational sessions; In severely obese adolescents, the diet
intervention results in noticeable weight loss that motivates the patient to
continue; also, the improved exercise tolerance resulting from the weight loss
promotes increased physical activity; and The program team provides consistent
feedback-patients and their families receive results and updates every 3 months.
Most importantly, the program is conducted in groups of families. The adolescent
group dynamics and peer modeling are primary components of the successful
management of obesity in youth. [References: 18]
Geriatric Research Education and Clinical Center, Central Arkansas Veterans
Healthcare System, Little Rock 72205, USA. firstname.lastname@example.org
Nutrition and health promotion in older adults. [Review] [100 refs]
Journals of Gerontology Series A-Biological Sciences & Medical Sciences. 56
Spec No 2:47-53, 2001 Oct.
During recent decades, the concept of health promotion has become a legitimate
part of health care because of the aging of the postwar baby boom generation. As
this population ages, the potential strain on health care systems will increase
because the greatest use of health care services occurs during the last years of
life. In older adults there are many correctable health factors that can be
assessed through screening protocols. Hypertension, cholesterol, hearing,
vision, diabetes, and cancer screening are well integrated into health promotion
programs; nutrition promotion programs are not as well integrated. Reluctance to
develop health promotion programs for older adults exists because of a
perception that they would not follow such plans or change their lifestyles.
However, longitudinal studies have shown that health promotion activities extend
the number of years of health in older people although the relationship weakens
in older age. Changes in diet and exercise patterns are most effective in the
prevention of nutrition-related conditions when they are instituted early in
life, but positive effects can occur at any age. If nutritional interventions
are instituted early, a substantial reduction in health care expenditures may
result from a decrease in the incidence or the delayed onset of these
conditions. Changes in behaviors (reducing salt and fat intake) were positively
associated with a belief that consuming a healthful diet would contribute to
better health. The use of a variety of adult education theories and models will
enhance behavior changes that lead to more healthful habits and enable a health
educator to be successful in effecting change. [References: 100]
Leermakers EA. Dunn AL. Blair SN.
Division of Epidemiology and Clinical Applications, Cooper Institute, Dallas,
Texas, USA. email@example.com
Exercise management of obesity. [Review] [40 refs]
Medical Clinics of North America. 84(2):419-40, 2000 Mar.
When dealing with overweight patients, it is important to treat obesity as a
chronic condition requiring long-term management. Physicians do not send a
patient with hypertension home with just one bottle of pills and expect blood
pressure to be managed forever. Similarly, it is naive to think that sending an
overweight patient home with only a single word of advice to "lose weight" will
solve the problem. Medical staff would be wise to adopt the attitude that
obesity requires long-term intervention and management, just as hypertension
requires ongoing monitoring and management. Continued attention to patients'
physical activity is required. It is important for physicians to spend a few
minutes discussing physical activity with their patients. The patient's current
and past levels of physical activity should be assessed as well as the barriers
to and benefits of activity. Normal-weight patients should accumulate at least
30 minutes of moderate-intensity activity on most days of the week, and
overweight patients should accumulate 60 to 80 minutes per day, every day. The
physician can provide some simple tools, such as a step counter and self-
monitoring forms, to promote increases in activity and can follow up with the
patient after the office visit. This information may sound like a lot to cover,
especially given the limited time available for each patient. By spending 3 to 5
minutes intervening, however, physicians can play a critical role in promoting
health. Physicians should set a goal to address one specific topic (e.g., a
brief discussion of exercise benefits and barriers) and try one strategy (e.g.,
introduce self-monitoring) during the next counseling session with patients. It
is also important for physicians to remember that their success in changing
behavior may be in small increments. These small changes can and do eventually
lead to success for many patients and physicians. [References: 40]
Exercise Science Programs, The George Washington University Medical Center,
Washington DC 20052, USA. firstname.lastname@example.org
How effective are traditional dietary and exercise interventions for weight
loss?. [Review] [68 refs]
Medicine & Science in Sports & Exercise. 31(8):1129-34, 1999 Aug.
Health care professionals have used restrictive dieting and exercise
intervention strategies in an effort to combat the rising prevalence of obesity
in affluent countries. In spite of these efforts, the prevalence of obesity
continues to rise. This apparent ineffectiveness of diet and exercise
programming to reduce obesity has caused many health care providers, obesity
researchers, and lay persons to challenge the further use of diet and exercise
for the sole purpose of reducing body weight in the obese. The purposes of this
paper were to examine the history and effectiveness of diet and exercise in
obesity therapy and to determine the best future approach for health promotion
in the obese population. A brief survey of the most popular dieting techniques
used over the past 40 yr shows that most techniques cycle in and out of
popularity and that many of these techniques may be hazardous to health. Data
from the scientific community indicate that a 15-wk diet or diet plus exercise
program produces a weight loss of about 11 kg with a 60-80% maintenance after 1
yr. Although long-term follow-up data are meager, the data that do exist suggest
almost complete relapse after 3-5 yr. The paucity of data provided by the
weight-loss industry has been inadequate or inconclusive. Those who challenge
the use of diet and exercise solely for weight control purposes base their
position on the absence of weight-loss effectiveness data and on the presence of
harmful effects of restrictive dieting. Any intervention strategy for the obese
should be one that would promote the development of a healthy lifestyle. The
outcome parameters used to evaluate the success of such an intervention should
be specific to chronic disease risk and symptomatologies and not limited to
medically ambiguous variables like body weight or body composition. [References:
Institute for Exercise and Environmental Medicine, Presbyterian Hospital of
Dallas, TX 75231. email@example.com
Mechanical ventilatory constraints in aging, lung disease, and obesity:
perspectives and brief review. [Review] [44 refs]
Medicine & Science in Sports & Exercise. 31(1 Suppl):S12-22, 1999 Jan.
Mechanical ventilatory constraints in aging, lung disease, and obesity;
perspectives and brief review. Med. Sci. Sports Exerc., Vol. 31, No. 1 (Suppl.),
pp. S12-S22, 1999. One of the most difficult tasks of cardiopulmonary exercise
testing is to determine the influence of ventilatory limitations on the
ventilatory response to exercise. Currently there is no generally accepted
method in which to quantify the magnitude of mechanical ventilatory constraints
during exercise. Nor is there agreement on how to quantify maximal ventilatory
capacity. To address these issues, this article focuses on the evaluation of
mechanical ventilatory constraints during exercise and provides an overview of
the mechanical ventilatory constraints that are encountered with aging, lung
disease, and obesity. [References: 44]
Rauramaa R. Vaisanen SB.
Kuopio Research Institute of Exercise Medicine, Kuopio, Finland.
Physical activity in the prevention and treatment of a thrombogenic profile in
the obese: current evidence and research issues. [Review] [46 refs]
Medicine & Science in Sports & Exercise. 31(11 Suppl):S631-4, 1999 Nov.
PURPOSE: To evaluate the impact of regular physical activity on thrombogenic
profile in obese individuals. DESIGN: Medline-based literature search with
emphasis on controlled randomized clinical trials. The focus was on the impact
of physical activity on platelet aggregation, fibrinogen, and plasminogen
activator inhibitor-1(PAI-1) in overweight and obese subjects. RESULTS: Physical
activity increases acutely 1) platelet number and activity, 2) activation of
coagulation leading to a thrombin generation, and 3) simultaneous activation of
fibrinolysis. On the other hand, hemostatic changes resulting from regular
exercise training are limited to few data on platelets and blood coagulation and
to some indications of increased fibrinolysis. Obesity is a risk factor for
atherosclerotic cardiovascular diseases, and it is associated with
hypertriglyceridemia, hyperinsulinemia, and non-insulin-dependent diabetes
(NIDDM). These states interfere with a balance between blood coagulation and
fibrinolysis leading to an increased thrombogenesis. Regular physical activity
reduces platelet aggregability, while the effects on plasma fibrinogen and
fibrinolytic activity remain unclear. CONCLUSIONS: Although obesity associates
with several unfavorable derangements in the hemostatic system, data on the
interactions of regular physical activity with blood coagulation in overweight
or obese subjects are scarce. Therefore, controlled randomized clinical trials
with adequate statistical power are needed for the evaluation of physical
activity in the prevention and treatment of obesity-related atherothrombotic
disorders. [References: 46]
Blair SN. Horton E. Leon AS. Lee IM. Drinkwater BL. Dishman RK. Mackey
M. Kienholz ML.
Cooper Institute for Aerobics Research, Dallas, TX, USA.
Physical activity, nutrition, and chronic disease. [Review] [202 refs]
Medicine & Science in Sports & Exercise. 28(3):335-49, 1996 Mar.
Epidemiologic, animal, clinical, and metabolic studies demonstrate the
independent roles of physical activity and nutrition in the prevention and
treatment of several chronic diseases. Fewer data are available to describe the
synergistic effects of exercise and diet, and questions remain as to whether and
how these two lifestyle factors work together to promote health and prevent
disease. This paper briefly reviews many of the known effects of physical
activity and nutrition on the prevention and treatment of coronary heart
disease, non-insulin-dependent diabetes mellitus, obesity, and osteoporosis as
well as how exercise and diet may work together. A discussion of how to increase
physical activity levels and how to improve dietary intake also is included.
Finally, current exercise and dietary recommendations are summarized, as are
directions for future research. [References: 202]
Epstein LH. Coleman KJ. Myers MD.
Department of Psychology, University at Buffalo, NY 14260, USA.
Exercise in treating obesity in children and adolescents. [Review] [52 refs]
Medicine & Science in Sports & Exercise. 28(4):428-35, 1996 Apr.
This paper reviews the use of exercise programs with obese children and
adolescents. Studies included for review met two criteria: 1) children or
adolescents were defined as obese using objective criteria for obesity, and 2)
obese children or adolescents were provided either different types of exercise
programs or an exercise program compared with a no-exercise control condition.
Thirteen controlled outcome studies were identified. Experimental design,
methods, and outcomes are presented and evaluated for each study. Factors that
should be considered in research testing exercise interventions are discussed,
including adherence, diet, age, gender, and type of exercise. In addition, the
potential for exercise programs in the prevention of obesity in childhood and
adolescence is discussed. The results support the continued use of exercise in
combination with diet for child and adolescent obesity treatment, but the
limited number of controlled studies indicates the need for more research in the
area. The potential for exercise programs in the prevention of obesity in
childhood and adolescence is discussed. [References: 52]
Ross R. Janssen I.
School of Physical and Health Education, Queen's University, Ontario, Canada.
Physical activity, total and regional obesity: dose-response considerations.
[Review] [48 refs]
Medicine & Science in Sports & Exercise. 33(6 Suppl):S521-7; discussion
S528-9, 2001 Jun.
PURPOSE: This review was undertaken to determine whether exercise-induced
weight loss was associated with corresponding reductions in total, abdominal,
and visceral fat in a dose-response manner. METHODS: A literature search
(MEDLINE, 1966--2000) was performed using appropriate keywords to identify
studies that consider the influence of exercise-induced weight loss on total
and/or abdominal fat. The reference lists of those studies identified were
cross-referenced for additional studies. RESULTS: Total fat. Review of available
evidence suggested that studies evaluating the utility of physical activity as a
means of obesity reduction could be subdivided into two categories based on
study duration. Short-term studies (< or = 16 wk, N = 20) were characterized by
exercise programs that increased energy expenditure by values double (2200 vs
1100 kcal.wk-1) that of long-term studies (> or = 26 wk, N = 11). Accordingly,
short-term studies report reductions in body weight (-0.18 vs -0.06 kg x wk(-1))
and total fat (-0.21 vs -0.06 kg x wk(-1)) that are threefold higher than those
reported in long-term studies. Moreover, with respect to dose-response issues,
the evidence from short-term studies suggest that exercise-induced weight loss
is positively related to reductions in total fat in a dose-response manner. No
such relationship was observed when the results from long-term studies were
examined. Abdominal fat. Limited evidence suggests that exercise-induced weight
loss is associated with reductions in abdominal obesity as measured by waist
circumference or imaging methods; however, at present there is insufficient
evidence to determine a dose-response relationship between physical activity,
and abdominal or visceral fat. CONCLUSION: In response to well-controlled,
short-term trials, increasing physical activity expressed as energy expended per
week is positively related to reductions in total adiposity in a dose-response
manner. Although physical activity is associated with reduction in abdominal and
visceral fat, there is insufficient evidence to determine a dose-response
relationship. [References: 48]
Votruba SB. Horvitz MA. Schoeller DA.
From the Department of Nutritional Sciences, University of Wisconsin-Madison,
Madison, WI 53706, USA.
The role of exercise in the treatment of obesity. [Review] [68 refs]
Nutrition. 16(3):179-88, 2000 Mar.
The prevalence of obesity in the USA has increased dramatically in the past
decade. This foreshadows an increase in the rates of morbidity and mortality
from obesity-related diseases and increases in the number of individuals
undergoing weight-loss therapy. Although exercise has long been recommended for
inclusion in such therapy, the present review has found that it has had little
or no effect on weight loss per se when the exercise is limited to the typically
prescribed 3-5 h/wk of moderate or vigorous activity. However, further review
has shown that exercise helps to preserve and at times even increase fat-free
mass during weight loss. At the same time, fat loss is generally increased.
Neither type nor amount of exercise appears to have much effect during
treatment, with the possible exception of resistance training, which is
associated with the best outcome for fat-free mass. The most important role of
exercise, however, is in the maintenance of the weight loss. In this respect,
the volume of exercise seems to be important because several lines of evidence
have indicated that exercise must expend roughly 2500 kcal/wk to maintain weight
loss. Studies of weight maintenance, however, have generally not included
randomized controls; thus, further research is required to solidify these
conclusions. [References: 68]
Ainsworth BE. Youmans CP.
Prevention Research Center, Department of Epidemiology & Biostatistics, Norman
J. Arnold School of Public Health, 730 Devine Street, University of South
Carolina, Columbia, SC 29208, USA.
Tools for physical activity counseling in medical practice. [Review] [27 refs]
Obesity Research. 10 Suppl 1:69S-75S, 2002 Nov.
Fenster CP. Weinsier RL. Darley-Usmar VM. Patel RP.
Department of Nutrition Sciences, University of Alabama at Birmingham,
Birmingham, AL 35294, USA.
Obesity, aerobic exercise, and vascular disease: the role of oxidant stress.
[Review] [49 refs]
Obesity Research. 10(9):964-8, 2002 Sep.
Oxidant formation in the vasculature contributes to vascular disease and
dysfunction associated with obesity. In contrast, exercise-dependent production
of oxidants may stimulate adaptive responses that protect against the
development of such diseases. In this review, we discuss current concepts in the
biology of reactive oxygen and nitrogen species and how their function is
modulated in the context of vascular disease, obesity, and aerobic exercise.
Thorburn AW. Proietto J.
Department of Medicine, University of Melbourne, Royal Melbourne Hospital,
Victoria, 3050 Australia. firstname.lastname@example.org
Biological determinants of spontaneous physical activity. [Review] [90 refs]
Obesity Reviews. 1(2):87-94, 2000 Oct.
A decline in daily physical activity levels is clearly a major factor
contributing to the current obesity epidemic affecting both developed and
developing countries in the world. This escalating problem is associated with
increased morbidity and mortality and reduced psychosocial health. Thus,
increasing physical activity has become the strategy of choice in public health
strategies to prevent obesity. Efforts to improve levels of physical activity in
the population rely upon an accurate understanding of the determinants of
physical activity. Most research has focused on environmental and social
influences, while the potential for physical activity to be controlled by
intrinsic biological processes has been largely overlooked. This review presents
some of the compelling and diverse evidence that has emerged recently showing
that physical activity energy expenditure is a critical factor in both the
successful regulation of energy balance in normal individuals, as well as the
abnormal regulation of energy balance that characterizes obesity. Although the
metabolic and genetic factors involved in these regulatory processes remain
mostly unidentified, some novel discoveries have been made in this area recently
and these are described within this review. [References: 90]
Perez-Martin A. Raynaud E. Mercier J.
Service Central de Physiologie Clinique, Unite CERAMM (Centre d'Exploration et
de Readaptation des Anomalies Metaboliques et Musculaires), CHU Lapeyronie 34295
Montpellier, France. email@example.com
Insulin resistance and associated metabolic abnormalities in muscle: effects
of exercise. [Review] [132 refs]
Obesity Reviews. 2(1):47-59, 2001 Feb.
Skeletal muscle is a major site of insulin resistance. In addition to glucose
transport, oxidative disposal and storage defects, insulin resistant muscle
exhibit many other metabolic abnormalities. After a brief review of insulin
resistance determinants, we will focus on muscular abnormalities in obesity and
type 2 diabetes. Glucose and lipid metabolism defects will be analysed and their
interactions discussed. Exercise can improve many of these muscular
abnormalities and the mechanisms underlying exercise-induced benefits have been
clarified during the past decades. Therefore, exercise training has proved to be
useful in the management of insulin resistant states, i.e. mainly obesity,
especially in its truncal distribution, and type 2 diabetes. However, exercise
prescription remains poorly codified, and results on glycaemic control are
sometimes conflicting. In the last part of this review, we will emphasize the
pathophysiological basis for an individualized exercise prescription in insulin
resistant subjects. [References: 132]
Bianchini F. Kaaks R. Vainio H.
International Agency for Research on Cancer, 150 cours Albert Thomas, 69372
Lyon, France. Bianchini@iarc.fr
Weight control and physical activity in cancer prevention. [Review] [5 refs]
Obesity Reviews. 3(1):5-8, 2002 Feb.
Overweight and obesity have reached epidemic dimensions worldwide, mainly due
to consumption of high energy diets and increased sedentary behaviour.
Overweight and insufficient physical activity are clearly associated with
cardiovascular diseases and type 2 diabetes. Evidence is also accumulating that
they may also increase cancer risk, particularly in the colon, breast and
endometrium. This effect seems to be mediated by alterations in the metabolism
of endogenous hormones, including sex steroids and insulin, and levels of
insulin-like growth factor(IGF)-I and IGF-binding proteins. In light of the
beneficial effects of weight control and physical activity for cancer
prevention, a healthy lifestyle, keeping a low body weight and exercising most
days of the week, is recommended. [References: 5]
Metabolism & Obesity Services, Royal Prince Alfred Hospital, Missenden Road,
Camperdown, Sydney, NSW 2050, Australia. firstname.lastname@example.org
The importance of physical activity in the prevention of overweight and
obesity in childhood: a review and an opinion. [Review] [147 refs]
Obesity Reviews. 2(2):117-30, 2001 May.
The prevalence of childhood obesity is increasing and there are a number of
theoretical reasons as to why intervention may be more effective in childhood.
There are certain risk times for the development of obesity in childhood, which
provide a basis for targeted intervention. In addition, tracking data supports
the persistence of obesity, at least in later childhood, as well as
cardiovascular risk factors. Physical activity is the discretionary component of
energy expenditure and there is evidence that falling levels of physical
activity are contributing to the obesity epidemic. Physical activity in children
is related to developmental stage, is reduced with increasing age and is
influenced by parental physical activity. While there is debate about the
immediate health benefits of physical activity to children, there are data to
support that lower physical activity levels and sedentary behaviours are
associated with a higher prevalence of obesity in children. Physical activity is
an accepted strategy in the treatment of established obesity (tertiary
prevention). The role of physical activity in the prevention of obesity (primary
and secondary prevention) is less clear. However a number of recent school-based
interventions directed at either increasing physical activity and/or decreasing
sedentary behaviours, have shown encouraging results. On balance, increasing
physical activity in children is an attractive and non-restrictive approach to
obesity prevention. To adopt this approach requires the support and involvement
of many community sectors other than health. [References: 147]
Goran MI. Treuth MS.
Institute for Prevention Research, Departments of Preventive Medicine and
Physiology and Biophysics, Keck School of Medicine, University of Southern
California, Los Angeles, California, USA. email@example.com
Energy expenditure, physical activity, and obesity in children. [Review] [101
Pediatric Clinics of North America. 48(4):931-53, 2001 Aug.
Although there are physiologic and genetic influences on the various
components of energy metabolism and body weight regulation, and a major portion
of individual differences in body weight can be explained by genetic
differences, it seems unlikely that the increased global prevalence of obesity
has been driven by a dramatic change in the gene pool. It is more likely and
more reasonable that acute changes in behavior and environment have contributed
to the rapid increase in obesity and that genetic factors may be important in
the deferring individual susceptibilities to these changes. The most striking
behavioral changes that have occurred have been an increased reliance on high-
fat and energy-dense "fast foods," with larger portion sizes, coupled with an
ever-increasing sedentary lifestyle. The more sedentary lifestyle is caused by
an increased reliance on technology and labor-saving devices, which has reduced
the need for physical exertion for everyday activities. Examples of energy-
saving devices that have resulted in a secular decline in physical activity
include: Increased use of automated transport rather than walking or biking
Central heating and use of automated equipment, such as washing machines, in the
household. Reduction in physical activity in the workplace because of computers,
automated equipment, and electronic mail. Increased use of television and
computers for entertainment and leisure activities. Use of elevators and
escalators rather than stairs. Increased concern for crime, which has reduced
the likelihood of outdoor playing. Poor urban planning that does not provide
adequate biking paths or even sidewalks in some communities. Thus, the
increasing prevalence, numerous health risks, and astounding economic costs of
obesity clearly justify widespread efforts toward prevention efforts. These
prevention efforts should begin in childhood because the behaviors are learned
and continue through the lifetime. [References: 101]
Prevention of Childhood Obesity Laboratory, Division of Health and Performance
Enhancement, Pennington Biomedical Research Center, Louisiana State University,
Baton Rouge, Louisiana, USA. firstname.lastname@example.org
Exercise as a modality in the treatment of childhood obesity. [Review] [79
Pediatric Clinics of North America. 48(4):995-1015, 2001 Aug.
In a review of the literature, Glenny et al determined that family therapy and
lifestyle modification seem to be effective in the prevention and treatment of
childhood but not necessarily adult obesity. Furthermore, research indicates
that obese children are better able to maintain weight loss over a long-term
period than are adults. Based on the limited research in the treatment of
obesity in children, approaches should include family interventions with
nutrition and physical activity education, structured exercise, and behavior
modification. These interventions should be delivered by a team of health care
experts in a nurturing, nonintimidating environment; however, obese children
respond differently physiologically and emotionally to exercise than do normal-
weight children. Therefore, obese children may experience negative consequences
to participation in activities considered appropriate for normal-weight
children. In clinical settings, specialized exercise programs based on
appropriate theories that include specific recommendations for children with
varied obese conditions have been shown to enhance safety, efficacy, and
compliance during pediatric obesity treatment. Optimal results may be achieved
by combining programs to reduce sedentary behaviors based on similar theories
with specialized, structured exercise prescriptions. When used in conjunction
with appropriate dietary prescriptions and consistent behavior modification,
exercise serves as a promising modality that may reverse obese conditions during
childhood and, perhaps, prevent the onset of adult obesity. [References: 79]
Joel Health and Dental Clinic, Fort Bragg, NC, USA.
An activity calendar program for children who are overweight. [Review] [19
Pediatric Nursing. 29(1):17-22, 2003 Jan-Feb.
Sedentary lifestyle activities, such as computer use and television viewing,
are modifiable causes of overweight among children. There are many
recommendations in the literature that suggest the number of children who are
overweight must be decreased; however, none of the research describes an
instrument to achieve this goal. This article describes the use of a home-based
physical activity calendar and its successes and failures. [References: 19]
Physical Activity and Weight Management Research Center, Department of Health,
Physical, and Recreation Education, University of Pittsburgh, 140 Trees Hall,
Pittsburgh, PA 15261, USA. email@example.com
Exercise strategies for the obese patient. [Review] [32 refs]
Primary Care; Clinics in Office Practice. 30(2):393-403, 2003 Jun.
Exercise is an important component of weight-control programs, yet the impact
of exercise for weight control is based on the ability of patients to engage in
adequate levels of activity. The minimal level that should be recommended is at
least 30 minutes of moderate-intensity physical activity on most days of the
week. Although this level of physical activity may improve health-related
factors, there is some evidence to support the recommendation of higher levels
of exercise for weight-control purposes. The role of the clinician is to provide
adequate guidance to patients regarding issues related to the intensity,
duration, and mode of exercise that may be most appropriate. When addressing
these issues, it is also important to consider the barriers that individual
patients may encounter that will have an effect on adoption and maintenance of
exercise behaviors. [References: 32]
Department of Nutrition and Food Sciences, The University of Vermont,
Burlington 05405, USA. firstname.lastname@example.org
Changing eating and physical activity patterns of US children. [Review] [55
Proceedings of the Nutrition Society. 59(2):295-301, 2000 May.
The number of US children who are overweight has more than doubled over the
last decade. This change has broadened the focus of dietary guidance for
children to address nutrient overconsumption and physical activity patterns.
Total fat consumption expressed as a percentage of energy intake has decreased
among US children. However, this decrease is largely the result of increased
total energy intake in the form of carbohydrates and not necessarily due to
decreased fat consumption. The majority of children aged 5-17 years are not
meeting recommendations for Ca intakes. Much of this deficit is attributed to
changing beverage consumption patterns, characterized by declining milk intakes
and substantial increases in soft-drink consumption. On average, US children are
not eating the recommended amounts of fruits and vegetables. US adolescents
become less active as they get older, and one-quarter of all US children watch >
or = 4 h television each day, which is positively associated with increased BMI
and skinfold thickness. There is an urgent need in the USA for effective
prevention strategies aimed at helping children grow up with healthful eating
and physical activity habits to achieve optimal health. [References: 55]
Department of Physiology and Nutrition, University of Navarra, Pamplona,
Body-weight regulation: causes of obesity. [Review] [130 refs]
Proceedings of the Nutrition Society. 59(3):337-45, 2000 Aug.
The aetiology and treatment of obesity have been fraught with disappointment
for researchers, because the mechanisms that control fuel homeostasis and
adiposity are incompletely understood. It is assumed that regulatory processes
match the dietary fuel supply with energy requirements in order to maintain a
stable body mass and adiposity. In this context several theories have been
proposed to explain the laws of thermodynamics describing the conservation and
transformation of energy in living organisms. In the light of new evidence it
can now be hypothesized that the control of body weight and composition depends
on an axis with three interrelated and self-controlled components: (1) food
intake; (2) nutrient turnover and thermogenesis; (3) body fat stores. Complex
feedback mechanisms underlie all these components. The major factors involved in
obesity seem to be dietary and physical activity habits. These factors are
affected by susceptibility genes that in turn may influence energy expenditure,
fuel metabolism, muscle fibre function and appetite or food preferences.
However, the increasing rates of obesity cannot be explained exclusively by
changes in the gene pool, although genetic variants that were previously
'silent' are now being triggered by the high availability of energy- and fat-
dense foods, and by the increasingly sedentary lifestyle of modern societies.
The study of factors such as genetics and lifestyle implicated in weight gain
and obesity is crucial for predictions about the future impact of the global
epidemic of obesity, and provides a unique opportunity for the implementation of
preventive action. [References: 130]
UKK Institute for Health Promotion Research, Tampere, Finland.
Health benefits of physical activity with special reference to interaction
with diet. [Review] [79 refs]
Public Health Nutrition. 4(2B):517-28, 2001 Apr.
Regular physical activity causes numerous and substantial performance-
improving and health-enhancing effects. Most of them are highly predictable,
dose-dependent and generalizable to a wide range of population groups. Many of
the biological effects of regular, moderate physical activity translate into
substantially reduced risk of coronary heart disease, cerebrovascular disease,
hypertension, maturity onset diabetes, overweight and obesity, and osteoporosis.
These effects also substantially reduce the risk of deterioration of functional
capacity. In the genesis of these conditions, a lack of physical activity and
inadequate nutrition act synergistically and in part additively, and they
operate largely through the same pathways. It is conceivable to suggest that the
prevalence of, e.g, the above mentioned metabolic diseases is so high in Europe
largely because of the high prevalence of sedentariness and inadequate
nutrition. Thus, both physical activity and nutrition have to be given strong
emphasis in policies, strategies and programmes that will be developed and
implemented for improving the health of Europeans. [References: 79]
School of Health and Social Studies, University of Warwick, Coventry, UK.
Inequalities in diet and physical activity in Europe. [Review] [86 refs]
Public Health Nutrition. 4(2B):701-9, 2001 Apr.
The contribution of food, nutrition and physical activity to inequalities in
health across Europe is largely unexplored. This paper summarizes cross
sectional survey data on food patterns and nutrient intakes, and briefer data on
physical activity, by various indicators of socio-economic status for countries
across Europe. Factors are examined which underlie the outcome data seen. These
include structural and material conditions and circumstances which contribute to
excluding socio-demographic groups from participating in mainstream patterns of
living. Trends in social and economic conditions, and their implications for
nutritional and physical wellbeing are briefly outlined. [References: 86]
Research Department of Human Nutrition, The Royal Veterinary and Agricultural
University, Denmark. email@example.com
Healthy lifestyles in Europe: prevention of obesity and type II diabetes by
diet and physical activity. [Review] [56 refs]
Public Health Nutrition. 4(2B):499-515, 2001 Apr.
The prevalence of obesity is increasing rapidly in all age groups in most EU-
countries and is one of the fastest growing epidemics, now affecting 10-40% of
the adult population. Obesity increases the risk of serious co-morbidities such
as type 2 diabetes, cardiovascular disease, certain cancers and reduced life
expectancy, and these complications may account for 5-10% of all health costs in
EU countries. The risk of diabetes is particularly increased by obesity, and
80-95% of the increase in diabetes can be attributed to obesity and overweight
with abdominal fat distribution. There is robust evidence from cross-sectional
and longitudinal studies to support that an energy-dense, high fat diet and
physical inactivity are independent risk factors for weight gain and obesity.
Furthermore, interaction between dietary fat and physical fitness determine fat
balance, so that the obesity promoting effect of a high fat diet is enhanced in
susceptible subjects, particularly in sedentary individuals with a genetic
predisposition to obesity. Ad libitum consumption of diets low in fat and high
in protein and complex carbohydrates, with a low glycaemic index, contributes to
the prevention of weight gain in normal weight subjects. It also causes a
spontaneous weight loss of 3-4 kg in overweight subjects, and has beneficial
effects on risk factors for diabetes and CVD. To prevent obesity and diabetes
there are grounds for recommending the combination of increasing daily physical
activity level to a PAL-value of at least 1.8 and reducing dietary fat content
to 20-25 energy-% in sedentary subjects, and to 25-35% in more physically active
individuals. [References: 56]
Exercise Science Programs, The George Washington University Medical Center,
Washington, DC 20052, USA. firstname.lastname@example.org
Effective diet and exercise treatments for overweight and recommendations for
intervention. [Review] [61 refs]
Sports Medicine. 31(10):717-24, 2001.
Traditional diet and exercise treatments for obesity have been ineffective in
reducing the prevalence of overweight in the population. Treatment outcomes for
overweight can be measured in terms of physical parameters (e.g. bodyweight,
percentage body fat, body mass index), medical terms (e.g. blood pressure, blood
glucose control, blood lipid levels), psychological terms (e.g. eating
pathology, self-esteem, mood state) and behavioural terms (e.g. frequency of
exercise, eating patterns, self healthcare). Regardless of the specific outcome
measures used to define successful treatment, the desired outcome must be
maintained for several years to be considered effective. Energy restrictive
diets cause significant initial bodyweight loss, but are plagued with high
dropout- and relapse-rate. Low-fat diets have met with minimal success for
bodyweight control, but nonetheless can significantly lower blood lipid levels.
High-protein/low-carbohydrate diets are claimed to be the most effective in
reducing bodyweight, but there are no scientific data to support these claims.
Persons on these types of diets are also at the greatest risk for metabolic
adverse effects. Nondieting approaches and programmes that stress 'health at any
size' have not been researched rigorously, but preliminary data show minimal
bodyweight loss with significant improvements in psychological state, eating
pathology and well-being. Exercise is the only variable that consistently shows
effectiveness in physiological, medical, psychological and behavioural outcomes.
A treatment programme that has the greatest potential for success, regardless of
outcome measure, is a programme that consists of 4 key components. These
components are: (i) pre-evaluation, where historical information is gathered and
used to set programme goals, objectives and outcome measures; (ii) exercise,
wherein enjoyable exercise is encouraged for health, bodyweight control and well
being; (iii) a behavioural plan, which is based on patterns of eating and
activity that will lead to the desired outcome measures; and (iv) a maintenance
plan, that helps the individual develop skills for maintaining newly developed
behaviours. [References: 61]