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Generic SF-36 Scales and Summary Scores Interview Specific Gastric Bypass Questionnaire Battery Gothenburg Quality of Life Scale and others Battery Quality of Life Index and others Generic SF-36 Scales Generic Rosser Index Specific Harris hip score questionnaire Generic SF-36 Kellner questionnaire Generic Sickness Impact Profile SIP , Mood Adjective Check List MACL Specific Three-Factor Eating Questionnaire TEFQ found in the interpretation guidelines for the SF-36 Health Survey 35 . Since...
References Njq
1. Wang ZM, Pierson RN Jr, Heymsfield SB. The five level model a new approach to organizing body composition research. Am J Clin Nutr 1992 56 19-28. 2. Snyder WM, Cook MJ, Nasset ES, Karhausen LR, Howells GP, Tipton IH. Report of the Task Group on Reference Man. Oxford Pergamon Press, 1975. 3. Pietrobelli A, Formica C, Wang ZM, Heymsfield SB. Dual-energy x-ray absorptiometry body composition model review of physical concepts. Am J Physiol 1997 271 E941-E951. 4. Moore FD, Oleson, KH, McMurray,...
Antimigraine And Antihistaminergic Drugs
Weight gain is a common and early side effect of drugs such as sanomigran 69 and cyproheptadine 70 probably due to their combined antihista-minergic and serotonergic effect. The weight changes are, however, rather modest and the clinical importance of the problem is limited. Because to its ability to increase appetite attempts have been made to use cyproheptadine as a pharmacological support in the treatment of both anorexia nervosa 71 and cancer cachexia 72 , but so far without encouraging...
Introduction Sxv
Cortisol is the principal glucocorticoid hormone in humans, contributing to homeostatic regulation of basal metabolism and salt and water balance, and modulating the response to stress. Normal adult human adrenal glands secrete around 5-15 mg per day of cortisol. Only a small fraction is excreted as free cortisol in urine, saliva or bile. The rest is cleared by several metabolic pathways before conjugation and urinary excretion. In the past the enzymes responsible for this metabolism of...
Risk Factors For Atherosclerotic Cardiovascular Disease In Obesity
Although obesity has been established as an independent risk factor for the development of atheros- Table 25.1 Ventricular dysfunction reported in severely obese patients 1. Impaired ventricular function 2. Abnormal response to exercise 3. Depressed contractility related to ventricular mass 5. Reduced ventricular wall and septal size clerotic cardiovascular disease ACVD , obese people often present well-recognized coronary risk factors such as hypertension, lipid abnormalities, and type 2...
Health Impact of Obesity in Childhood
Obese children and adolescents are at increased risk of developing a number of health problems. The most significant long-term consequence is the persistence of obesity and its associated health risks into adulthood. Some 30 of obese children become obese adults. This is more likely when the onset of obesity is in late childhood or adolescence and when the obesity is severe. Other obesity-related symptoms include psychosocial problems, raised blood pressure and serum triglycerides, abnormal...
John G Kral
SUNYDownstate Medical Center, New York, USA Those who cannot remember the past are condemned to repeat it. Surgical treatment of obesity 'bariatric surgery' anti-obesity surgery passes the pragmatic test it works, most of the time. It is also cost-effective and on a cost per-kg-lost basis is superior to any other method of weight loss for class II and III obesity. Most important the results are durable, defined as providing maintenance of medical significant weight loss for more than 5 years....
Screening For Obesity To Prevent Type 2 Diabetes
The primary prevention of type 2 diabetes is an urgent issue and weight control in the population seems to be the most important part of the preventive process. The drastic predictions concerning the time trends of obesity and type 2 diabetes call urgently for research aimed at finding a solution or more probably several solutions to the problem. One approach could be a mass screening programme examining the whole population for body weight and offering obese individuals the opportunity to...
Key Factors Underlying the Increase in Childhood Obesity Rates
The fact that obesity is emerging as the most prevalent nutritional disease among children and adolescents in the developed world is hardly surprising. As outlined earlier, the highly technological societies of today have created an environment where it is increasingly convenient to remain sedentary whilst all forms of physical activity and active recreation are discouraged. Children are particularly susceptible to such changes as many of the decisions about diet and physical activity patterns...
Predicting Total Body Fat from Skinfold Thicknesses
Four skinfold thicknesses are conventionally meas Figure 4.5 Standard body mass index curves from birth to 20 years for boys a, above and girls b, opposite . Copyright Child Growth Foundation. Reproduced by permission. Copies of the CGF BMI charts are available from Harlow Printing, Maxwell Street, South Shileds NE33 4PU, UK Figure 4.5 Standard body mass index curves from birth to 20 years for boys a, above and girls b, opposite . Copyright Child Growth Foundation. Reproduced by permission....
Orexigenic Neuropeptides
NPY is a 36 amino acid neuropeptide that is widely distributed in the brain. In the hypothalamus, it is synthesized in the arcuate nucleus and released in the paraventricular nucleus. It stimulates food intake by binding to Y1 and or Y5 receptor subtypes 12-14 . This increase in feeding can be observed upon infusing the peptide intracerebroventricularly i.c.v. in normal rats and is accompanied by a rapid, sustained and marked increase in body weight 15,16 . Central NPY infusion also stimulates...
Trends In Fat Intake
During recent decades, trends of declining fat intake have been reported for most countries. However, both diet surveys and food disappearance data suggest that for most countries, fat intake is still above the recommended 30 of total energy. Countries like the USA and Norway have reported particular success in reduction of dietary fat intake 1,2 . In the USA, for instance, a reduction in energy from fat from about 40 to 33 was achieved between 1960 and 1995 1 . In Norway, fat intake was...
Info Lxb
29. Trends in average weights and heights of men An insurance experience. Statistical Bulletin of the Metropolitan Life Insurance Company 1966 47 11-13. 30. Trends in Average weights and heights of men An insurance experience. Statistical Bulletin ofthe Metropolitan Life Insurance Company 1970 51 6-7. 31. Bennett W, Gurin J. The Dieter's Dilemma. New York Basic Books, 1982. 32. Abraham S. Obese and Overweight Adults in the United States. Vital and Health Statistics. Series 11, No. 230. DHHS...
References Ihi
1. Rohner-Jeanrenaud F, Cusin I, Sainsbury A, Zakrzewska KE, Jeanrenaud B. The loop system between neuropeptide Y and leptin in normal and obese rodents. Horm Metab Res 1996 28 642-648. 2. Schwartz MW, Figlewicz DP, Baskin DG, Woods SC, Porte D Jr. Insulin in the brain a hormonal regulator of energy balance. Endocr Rev 1992 13 387-414. 3. Campfield LA, Smith FJ, Guisez Y, Devos R, Burn P. Recombinant mouse OB protein evidence for a peripheral signal linking adiposity and central neural...
References 1
1. WHO. Obesity Preventing and Managing the Global Epidemic. Geneva WHO, 1998. WHO NUT NCD 98.1. 2. Popkin BM, Leyou G, Fengying Z, Guo X, Haijiang M, Zohoori N. The nutrition transition in China a cross- sectional analysis. Eur J Clin Nutr 1993 47 333-346. 3. Lean MEJ, Han TS, Seidell JC. Impairment of health and quality of life in men and women with a large waist. Lancet 1998 351 853-856. 4. Han TS, Van Leer EM, Seidell JC, Lean MEJ. Waist circumference action levels in the identification of...
References Wcw
1. Sj str m L. Surgical intervention as a strategy for treatment of obesity. Endocrine Suppl 2000 in press. 2. Sj str m L, Larsson B, Backman L, Bengtsson C, Bouchard C, Dahlgren S, et al. Swedish Obese Subjects SOS . Recruitment for an intervention study and a selected description of the obese state. Int J Obes Relat Metab Disord 1992 16 465-479. 3. Deitel M. Surgery for the Morbidity Obese Patient. Philadelphia Lea amp Febiger, 1989. 4. Sj str m CD, Lissner L, Wedel H, Sj str m L. Reduction...
Info Wsf
aAge-standardized rate per 100000 persons. Hypothetical number of cases has been calculated by using the incidence rate among individuals in the BMI range of 29.0-30.9. aAge-standardized rate per 100000 persons. Hypothetical number of cases has been calculated by using the incidence rate among individuals in the BMI range of 29.0-30.9. THREE SELECTIVE SCREENING PROGRAMMES FOR OBESITY A PROPOSITION As stated earlier, the screening procedure for obesity, whether using BMI or waist circumference...
Recent New Experience With Antiobesity Drugs
Sibutramine Figure 31.1 is a centrally acting agent that dose-dependently inhibits serotonin and noradrenaline reuptake 49 . Sibutramine's action in inhibiting the reuptake of serotonin enhances satiety and thus decreases energy intake 50 . By inhibiting noradrenaline reuptake, sibutramine enhances sympathetic outflow, including to brown adipose tissue, leading to increased thermogenesis and thus increased energy expenditure. Figure 31.1 Structure of sibutramine and orlistat, two recent drugs...
References Vmy
1. Goldberg GR, Black AE, Jebb SA, et al. Critical evaluation of energy intake data using fundamental principles of energy physiology, 1 derivation of cut-off limits to identify under-recording. Eur J Clin Nutr 1991 45 569-581. 2. Frost G, Masters K, King C, et al. A new method of energy prescription to improve weight loss. J Hum Nutr Diet 1991 4 369-373. 3. Prochaska JO, Norcross JC, Diclemente CC. Changing for Good. New York Avon Brooks, 1995. 4. Foster GD, Wadden TA, Vogt RA, Brewer G. What...
Background And Rationale
This section looks at health-related quality of life its past, present and future status, what it is and the reasons for measuring it. How the Need for Quality of Life Measures in Medicine Evolved From Negative to Positive Health Concepts The mission of health care services today is not only to cure disease, restore function, and alleviate ailment, but also to prevent disease and promote health. After World War II the 'academic world' tried to reorient the concept of health by broadening its...
Field Anthropometric Methods
Using an underwater weighing method to predict body fat is impractical for large field studies, requiring facilities and the cooperation of subjects and expertise of the investigators. Proxy anthropometric methods Table 4.1 have been employed including skinfolds 2 , body mass index BMI 3 , and skinfolds combined with various body circumferences 4-6 to predict body fat estimated by underwater weighing. Body fat predicted from these equations shows high correlations with body fat measured by...
Risk Factor Changes
In a 2-year report of 282 men and 560 women, pooled from the surgically treated group and the control group, risk factor changes were examined as a function of weight change 15 . Ten kilogram weight loss was enough to introduce clinically significant reductions in all traditional risk factors except total cholesterol Figure 35.6 . Although it is known that total cholesterol is reduced short term 1-6 months by moderate weight losses 16,17 , Figure 35.6 illustrates that 30 to 40 kg maintained...
References Nwx
1. Andrews RC, Walker BR. Glucocorticoids and insulin resistance old hormones, new targets. Clin Sci 1999 96 513-523. 2. Samra JS, Clark ML, Humphreys SM, MacDonald IA, Bannister PA, Frayn, KN. Effects of physiological hyper-cortisolemia on the regulation of lipolysis in subcu taneous adipose tissue. J Clin Endocrinol amp Metabol 1998 83 626-631. 3. Bronnegard M, Arner P, Hellstrom L. Glucocorticoid receptor messenger ribonucleic acid in different regions of human adipose tissue. Endocrinology...
References Ilr
1. Singh J, Prentice AM, Diaz E, Coward WA, Ashford J, Sawyer M, Whitehead RG. Energy expenditure of Gambian women during peak agricultural activity measured by doubly-labeled water method. Br J Nutr 1989 62 315-329. 2. Prentice AM, Black AE, Coward WA, Cole TJ. Energy expenditure in overweight and obese adults in affluent societies an analysis of 319 doubly-labelled water measurements. Eur J Clin Nutr 1996 50 93-97. 3. Prentice AM, Da vies HL, Black AE, Ashford J, Coward WA, Murgatroyd PR,...
Key Features And Patterns Of The Global Obesity Epidemic
Closer analysis of obesity prevalence and trend data from around the world reveals a number of interesting patterns and features. These include an increase in population mean BMI with socioeconomic transition, a tendency for urban populations to have higher rates of obesity than rural populations, a tendency for peak rates of obesity to be reached at an earlier age in the less developed and newly industrialized countries, and a tendency for women to have higher rates of obesity than men. These...
Molecular Level
Elements are distributed into molecular components which can be grouped into the five main categories of lipids, proteins, glycogen, water and minerals Figure 6.3 1 . The main atomic level elements are organized into molecular level components. The molecular level is often divided, for practical purposes, into two main components, fat and fat-free mass FFM . Fat-free mass is usually considered to be the metabolically active portion of body mass at the molecular body composition level. Another...
Growth Hormone And Abdominal Obesity
Secretion of Growth Hormone in Abdominal Obesity With increased adiposity, GH secretion is blunted with a decrease in the mass of GH secreted per burst but without any major impact on GH secretory burst frequency 69 . Moreover, the metabolic clearance rate of GH is accelerated 70 . The serum insulin-like growth factor I IGF-I concentration is primarily GH dependent and influences GH secretion though a negative feedback system 71 . The serum levels of IGF-I are inversely related to the...
Energy Metabolism
Alactacid Energy Metabolism Adenosine Triphosphate The immediate source for muscle contraction is delivered from splitting of adenosine triphosphate ATP to adenosine diphosphate ADP and a 'free' phosphate ion P . This reaction is very fast and does not normally limit energy turnover and muscle performance. However, the ATP stores in the muscles are very limited. The whole ATP pool would be emptied in only a few seconds of muscle contraction. Therefore ATP has to be continuously regenerated...
Measurement Of Adiposity
Body mass reflects energy content, although actual energy stores are also related to stature, age and gender 5 . The usual approach today is to adjust body weight for stature as body mass index BMI calculated as body weight kg height m2 or 705 x pounds inches2 . BMI has a curvilinear relationship with the body's main energy store, fat, when fatness is expressed as a percentage. Cross-sectional studies suggest that percentage fat is also related to at least three additional factors after...
Contributors
David B. Allison Obesity Research Center, St Lukes Roosevelt Hospital Center, 1090 Amsterdam Avenue, 14th Floor, New York, NY 10025, USA Bj rn Andersson Department of Medicine, Sahlgrenska University Hospital, University of G teborg, S-413 45 G teborg, Sweden Email bjorn.andersson medfak.gu.se Vicki J. Antipatis MSc International Obesity Task Force, Rowett Research Institute, Greenburn Road, Bucksburn, Aberdeen AB21 9SB, UK Email Vantipatis aol.com Angelo Avogaro Department of Clinical and...
References Rla
1. Southgate DAT, Durning JVGA. Calorie conversion factors an experimental reassessment of the factors used in the calculation of the energy value ofhuman diets. Br J Nutr 1970 24 517-535. 2. Swaminathan R, King RFGJ, Holmfiled J et al. Thermic effect of feeding carbohydrate, fat, protein and mixed meal in lean and obese subjects. Am J Clin Nutr 1985 42 177-181. 3. Shetty PS, Prentice AM, Goldberg GR et al. Alterations in fuel selection and voluntary food intake in response to isoenergetic...
Bernard Jeanrenaud1 and Francoise RohnerJeanrenaud2
1 Lilly Corporate Center, Indianapolis, Indiana, USA and 2 Geneva University School of Medicine, Interrelationships Between Hypothalamic Neuropeptides and Leptin in the Maintenance of Body Weight Homeostasis, or Evolution to Obesity It is now accepted that body weight homeostasis is maintained via a series of complex interactions that occur between the brain, the hypothalamus in particular, and the periphery 1-3 , notably via a hormone, leptin, synthesized in and secreted from adipose tissue 4...
Pathology Of Cortisol Metabolism
Much of what we have learnt of the physiology of cortisol metabolism has been inferred from observations of the consequences of pathology. In this section, we review these pathological clinical syndromes and experimental models. Measurement of Cortisol Metabolism in Humans The established technique for assessing different routes of cortisol metabolism in humans is to measure the principal metabolites of cortisol in urine, using gas chromatography-mass spectrometry GCMS 120,121 . Examples of...
References Qri
1. Lew EA, Garfinkel L. Variations in mortality by weight among 750000 men and women. J Chronic Dis 1979 32 563 576. 2. De Waard F. Breast cancer incidence and nutritional status with particular reference to body weight and height. Cancer Res 1975 35 3351 3356. 3. La Vecchia C, Negri E. Public education on diet and cancer Calories, weight and exercise. In Benito E, Giacosa A, Hill M eds . Public Education on Diet and Cancer. Dordrecht Kluwer Academic Press, 1992 91 100. 4. Moller H, Mellemgaard...
Measuring Central Obesity
For a comprehensive estimate of weight-related health risk it is also desirable to assess the extent of intra-abdominal or 'central' fat accumulation. This can be done by simple and convenient measures such as the waist circumference or waist-to-hip ratio. Changes in these measures tend to reflect changes in risk factors for cardiovascular disease and other forms of chronic illness. Some experts Table 1.2 Sex-specific waist circumference measurements for identification of individuals at...
Physiology Of Cortisol Metabolism
The principal metabolites of cortisol are shown in Figure 18.2. The enzymes directly metabolizing cor tisol include the A-ring reductases 5a- and 5P-reductases , 6 -hydroxylase, 20-reductase, and 11 -hydroxysteroid dehydrogenases. In rats and mice, which lack 17-hydroxylase in their adrenal cortex, the principal glucocorticoid is corticosterone, which is subject to analogous metabolism. 11 P-Hydroxysteroid Dehydrogenases 1ip-HSDs These enzymes catalyse the interconversion of cortisol or...
Glucocorticosteroids
Weight gain is a common adverse effect of long-term pharmacological treatment with glucocor-ticoids in patients not suffering from adrenal insufficiency 104-106 . In a 12-month study of 109 patients with polymyalgia rheumatica giant cell arteritis, a steroid-related dose-dependent weight increase of between 2 and 13 kg occurred in more than 50 of all patients 104 . In a large retrospective study with 774 patients examined before and after liver transplantation, mean body mass index BMI...
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Figure 16.1 Saliva Cortisol concentrations in controls solid line , men with high stress-related Cortisol dashed line , and men with a burn out hypothalamic-pituitary-adrenal axis dotted line from references 5 and 17 and unpublished data . , P lt 0.05 , P lt 0.01 , P lt 0.0001 in comparison with controls previously in conditions of severe stress such as in war veterans, holocaust victims, chronic pain, and 'vital exhaustion' 9 , but it can apparently also be found in the general population. It...
Info Vmp
RR, relative risk odds ratio AMI, acute myocardial infarction HRT, hormone replacement therapy n.e., not examined. RR, relative risk odds ratio AMI, acute myocardial infarction HRT, hormone replacement therapy n.e., not examined. infarction, stroke and mortality in women taking unopposed oestrogen or oestrogen combined with progestogen. All of these studies have, however, been observational studies with the consequent risk of bias. Conflicting evidence has recently been reported by Hulley et...
Introduction Aql
For human and veterinary medicine, the main issue in adipose tissue biology is obesity and its associated metabolic complications. So much attention is devoted to finding ways of reducing the mass of adipose tissue and correcting complications such as hyperglycaemia and hyperlipidaemia, that its positive contributions to other metabolic functions are often overlooked. This chapter is mainly concerned with the involvement of adipose tissue in roles other than as a whole-body energy storage....
The Adipose Tissue Around Lymph Nodes
Reptiles and amphibians have just a few adipose depots, mostly in the abdomen or around the tail. This arrangement is clearly practical for tissue whose sole function is storage because the adipose tissue can undergo large changes in mass without affecting the adjacent organs. In contrast, mammalian adipose tissue is always split into a few large and numerous small depots scattered over much of the body. In many of the minor depots, including 'yellow' bone marrow, the omentum and many...
Inconsistent Trends In Obesity And Fat Intake
Although trends in fat intake have been found to correlate closely with trends in cardiovascular disease, several studies have demonstrated that obesity is increasing at the same time that fat intake is decreasing 7 . In fact, some of the countries that have experienced a substantial decrease in fat intake have noted the most dramatic increases in obesity prevalences. In Finland, for instance, prevalence of obesity rose from 10 to 14 in men and from 10 to 11 in women between the late 1970s and...
Appetite And The Drive To Eat
For years the focus of investigations of appetite control has centred upon the termination of eating. This is because the termination of an eating episode being the endpoint of a behavioural act was perceived to be an unambiguous event around which empirical studies could be organized. Consequently satiety came to be the concept which formed the basis for accounts of appetite. However, some 50 years ago there was an equal emphasis on the excitatory or drive features of appetite. This was...
Dietary And Behavioural Principles In The Treatment Of Obesity. International
1. Department of Agriculture, Agricultural Research Service. Data tables results from USDA's 1995 continuing survey CSFI DHKS 1995. Riverdale, Md. Food Surveys Research Group, 1995 CD-ROM . 2. Johansson L, Drevon CA, Bjorneboe GEA. The Norwegian diet during the last hundred years in relation to coronary heart disease. Eur J Clin Nutr 1996 50 277 283. 3. Fogelholm M, Mannisto S, Vartiainen E, Pietinen P. Determinants of energy balance and overweight in Finland 1982 and 1992. Int J Obes 1996 20...
Info Tyf
111. Sichieri R, Coitmho DC, Leao MM, Recme E, Everhart JE. High temporal, geographic, and income variation in body mass index among adults in Brazil. Am J Public Health 1994 84 5 793 798. 112. Ellaway A, Anderson A, McIntyre S. Does area of residence affect body size and shape Int J Obes 1997 21 304 308. 113. Gerding AL. Taste ratings of obese people, and taste preferences based on geographical location. Bull Psychonomic Soc 1992 30 6 509 510. 114. Sobal J, Khan LK, Bisogni CA. A conceptual...
Regulation Of Adipose Tissue Distribution In Humans Bjorntorp Per
1. Kretschmer E. Physique and Character. New York Har-court, 1936. Originally published in German 1921. 2. WHO. Obesity. Preventing and Managing the Global Epidemic. Report of a WHO consultation on obesity, Geneva, 3 5 June 1997, WHO NUT NCD 98. 1. Geneva WHO, 1998. 3. Vague J. La diff renciation sexuelle facteur determinant des formes de l'obesite. Presse Med 1947 30 339-341. 4. Kvist H, Chowdhury B, Grangard U, Tyle'n U, SjOstrOm L. Total and visceral adipose tissue volumes derived from...
The Psychobiological System Of Appetite Control
It is now accepted that the control of appetite is based on a network of interactions forming part of a psychobiological system. The system can be conceptualized on three levels Figure 8.1 . These are the levels of psychological events hunger perception, cravings, hedonic sensations and behavioural operations meals, snacks, energy and macronut-rient intakes the level of peripheral physiology and metabolic events and the level of neurotransmitter and metabolic interactions in the brain 2 ....
Antiepileptic Drugs
Weight gain is one of the most prevalent side effects of several antiepileptic drugs, but has been particularly related with the use of valproate valproic acid , a short-chain fatty acid widely used as an antiepileptic drug, and sometimes for the treatment of mania 46-49 . In retrospective studies, treatment with valproate has been found to increase body weight by 4.0 to 7.5 kg in more than 60 of the patients 47,48 . It has not been possible to detect any differences between weight-gainers and...
Info Dfo
measurement sites and calculation equations are presented in Tables 6.3 and 6.4. Other equations and methods can be found in the reviews of Heyms-field et al. 8 and Roche 9 . In addition to predicting whole-body fatness, an-thropometric measurements are also used to estimate regional fat either as absolute individual skinfold measurements or as mid-extremity fat areas using the following formula limb fat area mid limb circumference x skinfold - n x skinfold2 4 1 Mid-arm, calf, and thigh fat...
Methods For Anthropometric Measurements
Weight is measured by digital scales or beam balance to the nearest 100 g. For those unable to stand, electronic chair scales Weighcare C, Marsden Ltd, London are available. For field work, portable scales are used. Equipment is calibrated regularly by standard weights 4 x 10 kg and 8 x 10 kg , and the results of test weighing recorded in a book. Subjects are weighed in light clothing, fasting and with an empty bladder, preferably at the same time of day. Height is measured by stadiometer to...