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Textbook of Obesity
Companion website: Textbook of ObesityThis book is accompanied by a companion website:www.wiley.com/go/akabas/obesityThe website includes: Extensive bank of Questions and Answers All figures from the book for downloading Note-taking outline for each chapter Webliography
Textbook of ObesityBiological, Psychological andCultural InfluencesEditorsSharon R. AkabasSally Ann LedermanBarbara J. MooreA John Wiley & Sons, Ltd., Publication
This edition first published 2012 2012 by John Wiley & Sons, Ltd.Wiley-Blackwell is an imprint of John Wiley & Sons, formed by the merger of Wiley’s global Scientific,Technical and Medical business with Blackwell Publishing.Blackwell Publishing was acquired by John Wiley & Sons in February 2007. Blackwell’s publishing programhas been merged with Wiley’s global Scientific, Technical and Medical business to form Wiley-Blackwell.Registered office: John Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ,UKEditorial offices:9600 Garsington Road, Oxford, OX4 2DQ, UKThe Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK2121 State Avenue, Ames, Iowa 50014-8300, USAFor details of our global editorial offices, for customer services and for information about how to apply forpermission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell.The right of the author to be identified as the author of this work has been asserted in accordance with theUK Copyright, Designs and Patents Act 1988.All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, ortransmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise,except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission ofthe publisher.Designations used by companies to distinguish their products are often claimed as trademarks. All brandnames and product names used in this book are trade names, service marks, trademarks or registeredtrademarks of their respective owners. The publisher is not associated with any product or vendormentioned in this book. This publication is designed to provide accurate and authoritative information inregard to the subject matter covered. It is sold on the understanding that the publisher is not engaged inrendering professional services. If professional advice or other expert assistance is required, the services ofa competent professional should be sought.Library of Congress Cataloging-in-Publication DataTextbook of obesity : biological, psychological, and cultural influences / editors, Sharon R. Akabas,Sally Ann Lederman, Barbara J. Moore.p. ; cm.Includes bibliographical references and index.ISBN 978-0-470-65588-7 (hardback : alk. paper)I. Akabas, Sharon R. II. Lederman, Sally Ann III. Moore, Barbara J., 1947–[DNLM: 1. Obesity. WD 210]616.3'98–dc232011035230A catalogue record for this book is available from the British Library.Wiley also publishes its books in a variety of electronic formats. Some content that appears in print maynot be available in electronic books.Set in 10.5/12.5 pt Minion by Toppan Best-set Premedia LimitedPrinted in Singapore12012
saryxiiIntroductionPart I12346Understanding the ScopeEpidemiology, etiology, andconsequences of obesityBarbara J. Moore and Xavier Pi-SunyerCultural attitudes and biasestoward obese personsJanet D. Latner, Rebecca M. Puhl, andAlbert J. StunkardThe application of public healthlessons to stemming the obesityepidemicRodney Lyn, Barbara J. Moore, andMichael EriksenPsychodynamic approaches to thetreatment of obesityBonnie Bernstein andEdward MandelbaumPart II5viiEtiologyGenetic contributions to thedevelopment of obesityDaniel Shriner, Issa Coulibaly,Georgina Ankra-Badu, Tesfaye M. Baye,and David B. AllisonHidden persuaders: environmentalcontributors to obesityBrian Wansink7813542588493951089White adipose tissue as adynamic organAliki Kosteli andAnthony W. Ferrante Jr.Appetite and body weightregulationJoseph R. VasselliEating behaviors in obesity:the role of appetiteSusan Carnell, Leora Benson, andJane Wardle10 The relation of pregnancy andlactation to obesity developmentin the mother and childSally Ann Lederman123133161181Part III Health Consequences19711 Effect of obesity on developmentand health in childhoodIleana Vargas and Sharron Dalton19912 Impact of obesity duringadulthood on chronic disease:diabetes, hypertension, metabolicsyndrome, cardiovasculardisease, and cancerJeanine B. Albu209Part IV Assessment22113 Measurement of human bodycomposition to assess obesityDympna Gallagher and Jung-Eun Yim22314 Assessment of obesity risk inthe communityCarmen R. Isasi, Nichola Davis, andJudith Wylie-Rosett239v
viContentsPart V Prevention and InterventionApproaches and Settings15 Behavioral approaches to thetreatment of obesityMeghan L. Butryn, Vicki L. Clark,and Maria C. Coletta16 Non-dieting approaches to thetreatment of obesityMelissa A. Napolitano andGary D. Foster17 Dietary intervention approaches tothe treatment of obesityCathy A. Nonas and KarenReznik Dolins18 Pharmacological approaches to thetreatment of obesityGeorge A. Bray25125327329531019 Surgical treatment of severe obesity:patient selection and screening,surgical options, and nutritionalmanagement320Marc Bessler, Daniel Davis,Beth Schrope, Akuenzunkpa Ude,Nancy L. Restuccia,Meredith Urban-Skuro, andMary DiGiorgi20 Metabolic consequences ofweight reductionMichael Rosenbaum33321 The role of physical activity inweight loss and weight lossmaintenanceJamile A. Ashmore, Georita Frierson,and Steven N. Blair34422 The challenge of weight lossmaintenance: successful losersRena R. Wing and James O. Hill35423 Treatment of obesity in theprimary care settingLouis J. Aronne and Judy Townsend36524 Worksite health promotion forobesity preventionWahida Karmally and Megan Tubman37425 Treatment of overweight andobesity in childrenSharron Dalton and Ileana Vargas38426 School-based interventions foroverweight and obesitypreventionIsobel R. Contento, Pamela A. Koch,and Angela Calabrese-Barton40027 Preventing childhood obesity:It Takes a NationBarbara J. Moore, I. J. Frame, andNinia BaehrIndexCompanion website: Textbook of ObesityThis book is accompanied by a companion website:www.wiley.com/go/akabas/obesityThe website includes: Extensive bank of Questions and Answers All figures from the book for downloading Note-taking outline for each chapter Webliography424463
ContributorsEditorsSharon R. Akabas, PhD, Director, MS Program, AssociateDirector of Educational Initiatives, Institute of HumanNutrition, College of Physicians and Surgeons, ColumbiaUniversity, New York City, NY, USASally Ann Lederman, PhD, Special Lecturer, Institute ofHuman Nutrition, College of Physicians and Surgeons,Columbia University, New York City, NY, USABarbara J. Moore, PhD, President and CEO, Shape UpAmerica!, Clyde Park, MT, USAContributorsJeanine B. Albu, MD, Associate Director, EndocrinologyFellowship Training Program, Division of Endocrinologyand Metabolism, St. Luke’s Roosevelt Hospital Center,New York City, NY, USADavid B. Allison, PhD, Professor of Biostatistics,Department of Biostatistics, School of Public HealthUniversity of Alabama at Birmingham, AL, USAGeorgina Ankra-Badu, Whitehaven, Cumbria, UnitedKingdomLouis J. Aronne, MD, Clinical Professor of Medicine atWeill Cornell Medical College, Director, Weill Cornell’sComprehensive Weight Control Program, New YorkCity, NY, USAJamile A. Ashmore, PhD, Director, Behavioral MedicineCenter, Plano, TX, USANinia Baehr, MA, RN, Department of Health andHuman Development, Montana State University,Bozeman, MT, USATesfaye M. Baye, PhD, Assistant Professor, Divison ofAsthma Research, Cincinnati Children’s Hospital MedicalCenter, Cincinnati, OH, USALeora Benson, MS, Research Technician, New YorkObesity Research Center, St. Luke’s-Roosevelt Hospital& Institute of Human Nutrition, Columbia University,New York City, NY, USABonnie Bernstein, PhD, Adjunct Professor, TeachersCollege, Columbia University, New York City, NY, USAMarc Bessler, MD, Professor of Clinical Surgery,Chief, Division of Minimal Access/Bariatric Surgery,Department of Surgery, College of Physicians andSurgeons, Columbia University, New York City, NY, USASteven N. Blair, PED, Professor, Department of ExerciseScience and Epidemiology and Biostatistics, ArnoldSchool of Public Health, University of South Carolina,Columbia, SC, USAGeorge A. Bray, MD, Boyd Professor, Chief, Division ofClinical Obesity and Metabolism, Pennington BiomedicalResearch Center, Baton Rouge, LA, USAMeghan L. Butryn, PhD, Research Assistant Professor,Department of Psychology, Drexel University, Philadel phia, PA, USAAngela Calabrese-Barton, PhD, Professor, Departmentof Teacher Education, Michigan State University. EastLansing, MI, USASusan Carnell, PhD, Research Fellow, PhD New YorkObesity Research Center, St. Luke’s-Roosevelt Hospital& Institute of Human Nutrition, Columbia University,New York City, NY, USAVicki L. Clark, PhD, Post-Doctoral Fellow, Depart ment of Psychology, Drexel University, Philadelphia, PA,USAMaria C. Coletta, PhD, Post-Doctoral Fellow, Depart ment of Psychology, Drexel University, Philadelphia,PA, USAIsobel R. Contento, PhD, Mary Swartz Rose Professorof Nutrition and Education, and Coordinator, Programin Nutrition, Department of Health and BehaviorStudies, Teachers College, Columbia University, NewYork City, NY, USAIssa Coulibaly, PhD, Post-Doctoral Fellow, Departmentof Biostatistics, Section on Statistical Genetics, Universityof Alabama at Birmingham, AL, USAvii
viiiContributorsSharron Dalton, PhD, RD, Professor, Department ofNutrition, Food Studies, and Public Health SteinhardtSchool of Culture, Education, and Human Development,New York University, New York City, NY, USADaniel Davis, DO, Chief of Bariatric Surgery, Depart ment of Surgery, Stamford Hospital, Stamford, CT, USANichola Davis, MD, MS, Assistant Professor, Depart ment of Medicine, Albert Einstein College of Medicineof Yeshiva University, and Montefiore Medical Center,Bronx, NY, USAMary DiGiorgi, MS, MPH, Columbia University Centerfor Metabolic and Weight Loss Surgery, New YorkPresbyterian Hospital, New York City, NY, USAMichael Eriksen, ScD, Professor and Director, Instituteof Public Health, Georgia State University, Atlanta, GA,USAWahida Karmally, DrPH, RD, CDE, CLS, Director ofNutrition, Irving Institute for Clinical and TranslationalResearch, Columbia University, New York City, NY, USAPamela A. Koch, EdD, Executive Director of the Centerfor Food & Environment, Program in Nutrition,Department of Health and Behavior Studies, TeachersCollege, Columbia University, New York City, NY, USAAliki Kosteli MS, PhD, Post-Doctoral Fellow, Depart ment of Medicine, Naomi Berrie Diabetes Center,Institute of Human Nutrition, Columbia University,New York City, NY, USAJanet D. Latner, PhD, Associate Professor, Departmentof Psychology, University of Hawaii at Manoa, Honolulu,HI, USARodney Lyn, PhD, Assistant Professor, Institute of PublicHealth, Georgia State University, Atlanta, GA, USAAnthony W. Ferrante Jr. MD, PhD, Dorothy & DanielSilberberg Assistant Professor of Medicine, Departmentof Medicine, Naomi Berrie Diabetes Center, ColumbiaUniversity, New York City, NY, USAEdward Mandelbaum, LCSW, Manhattan Institute forPsychoanalysis, New York City, NY, USAGary D. Foster, PhD, Professor, Medicine and PublicHealth, Director, Center for Obesity Research andEducation, Temple University School of Medicine,Philadelphia, PA, USAMelissa A. Napolitano, PhD, Associate Professor,Kinesiology and Public Health, Temple University Schoolof Medicine, Philadelphia, Pa, USAI. J. Frame, MS, MD/PhD Candidate Albert EinsteinCollege of Medicine, Bronx, NY, USACathy A. Nonas, MS, RD, Director of the PhysicalActivity and Nutrition Program, New York CityDepartment of Health and Mental Hygiene, New YorkCity, NY, USAGeorita Frierson, PhD, Department of Psychology,Southern Methodist University, Dallas, Texas, USADympna Gallagher, EdD, Associate Professor ofNutritional Medicine, Department of Medicine St.Luke’s-Roosevelt Hospital the Institute of HumanNutrition, Columbia University, Director, Human BodyComposition Core Laboratory, Associate Director, NewYork Obesity Nutrition Research Center, New York City,NY, USAJames O. Hill, PhD, Professor of Pediatrics and Medi cine, Director, Center for Human Nutrition, Director,Colorado Nutrition Obesity Research Center (NORC),University of Colorado School of Medicine, Denver,CO, USACarmen R. Isasi, MD, PhD, Assistant Professor, Depart ment of Epidemiology & Population Health, AlbertEinstein College of Medicine of Yeshiva University,Bronx, NY, USABarbara J. Moore, PhD, President and CEO, Shape UpAmerica!, Clyde Park, MT, USAXavier Pi-Sunyer, MD, MPH, Professor of Medicine,Columbia University College of Physicians andSurgeons, Chief, Division of Endocrinology, Diabetesand Nutrition, St. Luke’s-Roosevelt Hospital, Director,New York Obesity Research Center, St. Luke’s-RooseveltHospital, New York City, NY, USARebecca M. Puhl, PhD, Director of Research, RuddCenter for Food Policy & Obesity, Yale University, NewHaven, CT, USANancy L. Restuccia, MS, RD, CDN, Bariatric Dietician,Columbia University Center for Metabolic and WeightLoss Surgery, New York Presbyterian Hospital, New YorkCity, NY, USAKaren Reznik Dolins, EdD, RD, Adjunct AssociateProfessor, Teachers College, Columbia University, SportsDietitian, Columbia University Athletics, New York City,NY, USA
ContributorsixMichael Rosenbaum, MD, Professor, Clinical Pediatricsand Medicine, Associate Program Director, GeneralClinical Research Center, College of Physicians &Surgeons, Columbia University, New York City, NY, USAJoseph R. Vasselli, PhD, Associate Research Scientist,Department of Medicine, St. Luke’s-Roosevelt HospitalCenter and The Institute of Human Nutrition, ColumbiaUniversity, New York City, NY, USABeth Schrope, MD, PhD, Assistant Surgery, Departmentof Surgery, College of Physicians and Surgeons, Colum bia University, New York City, NY, USABrian Wansink, PhD, John S. Dyson Professor ofMarketing, Department of Applied Economics andManagement, Director, Cornell Food and Brand Lab,Cornell University, Ithaca, NY, USADaniel Shriner, PhD, Research Fellow, Center forResearch on Genomics and Global Health, The NationalInstitutes for Health (NIH), Bethesda, MD, USAAlbert J. Stunkard, MD, Professor, Department ofPsychiatry, Founder, Founded the Center for Weightand Eating Disorders. University of Pennsylvania,Philadelphia, PA, USAJudy Townsend, PA-C, Weill Cornell’s ComprehensiveWeight Control Program, New York City, NY, USAMegan Tubman, MS, RD, Nutritionist, Fresh StartNutrition Studio, LLC, New York City, NY, USAAkuenzunkpa Ude, MD, Department of Surgery, NewYork University, Bellevue Hospital, New York City, NY,USAMeredith Urban-Skuro, MS, RD, Bariatric DieticianColumbia University Center for Metabolic and WeightLoss Surgery, New York Presbyterian Hospital and ValleyHospital, New York City, NY, USAIleana Vargas, MD, Assistant Clinical Professor ofPediatrics, Department of Pediatrics, Morgan StanleyChildren’s Hospital of New York Presbyterian and NaomiBerrie Diabetes Center, New York City, NY, USAJane Wardle, PhD, Professor in Clinical Psychology andDirector of the Health Behaviour Unit Cancer ResearchUK Health Behaviour Research Centre, Departmentof Epidemiology & Public Health, University CollegeLondon, London, United KingdomRena R. Wing, PhD, Professor, Department of Psychiatry& Human Behavior, Director, Weight Control andDiabetes, Research Center, Brown Medical School,Brown University, Providence, RI, USAJudith Wylie-Rosett, RD, EdD, Professor, Department ofEpidemiology & Population Health, Albert EinsteinCollege of Medicine of Yeshiva University, Bronx, NY,USAJung-Eun Yim, PhD, Research Professor, ResearchInstitute of Clinical Nutrition, Kyung Hee University,Seoul, Korea
ForewordWhile I served as U.S. Surgeon General from 1981 to1989, the data from the National Health and NutritionExamination Survey (NHANES) and the BehavioralRisk Factor Surveillance System (BRFSS) documented asurge in obesity prevalence in America. The data spurredme to found the nonprofit organization, Shape UpAmerica! in 1994, to raise awareness of obesity as ahealth issue. The prevalence of obesity has continued toclimb with upsurges documented in adults and childrenin all walks of life, with the problem more severe amongAmerica’s poor and uninsured.Progress in raising awareness of obesity as a healthissue has certainly been made, but there has been littleprogress in stemming the epidemic. We now have nearly75 million Americans categorized as “obese” and morethan 17 million are categorized as “severely obese.” Ofgreatest concern, an estimated 12 million children areobese with 2.5 million severely obese.Now we are learning that the offspring of obese andseverely obese parents are at greater risk of obesity, introducing a new understanding of the way the obesity epidemic is self-propagating through epigenetic pathways.With so many millions of Americans of childbearingpotential entering pregnancy and parenthood in theobese condition, this represents a deepening of the crisis.A broadly increased understanding of the many causesand consequences of obesity is urgently needed. Thefield has made remarkable strides enlightening us aboutthe endocrine function of fat cells and how leptin—aprotein synthesized by fat cells—crosses the blood-brainbarrier to mediate the communication between body fatdepots and regulatory centers in the brain that influenceappetite and energy balance. But much more work needsto be done, particularly to develop effective preventionand treatment approaches.xThe publishing world is highly competitive and up tonow, a comprehensive textbook such as this one didnot exist. The editors and authors of this volume havelabored for more than 3 years to create a textbook suitable for college level students and those who are beginning their graduate education. Their goal was to attractbright new minds to the field of obesity to help us deviseinnovative research, invent new medical devices, discover new therapeutic agents for treatment, and developpublic health solutions to help us stop and reverse theepidemic. I am proud to support their effort as I sharetheir hope that making information about the complexnature of obesity more accessible to students will increasethe likelihood of finding urgently needed answers tothese highly perplexing problems.Now I am calling upon you, the reader, to help usmove the field forward and make America a healthierplace to live, learn, work and play. There is no doubt thatit takes a nation to stem obesity and regardless of yourchosen career path, we call upon you to be a part of thesolution.C. Everett Koop, MD, ScD13th U. S. Surgeon General andFounder of Shape Up America!Hanover, NHNovember 2011
AcknowledgmentsThe volume editors would like to acknowledge theimportant contributions of Institute of Human Nutritionstudents Oluwatosin Akintola, John Buza, Shaun Darrah,Sarah Goldsberry, Sheena Harris, Erin Paxson, andJordan Sill who helped at critical stages of completion ofthis text.I would like to thank Sharon R. Akabas for giving me theopportunity to collaborate on this book and other excitingprojects, enabling me to work with two smart and dearfriends, while learning things of great interest and impor tance, both from the work itself and from the two of them.Sharon R. Akabas, Barbara J. Mooreand Sally Ann LedermanI would like to extend special thanks to my husband,Denis Prager, for his patience and support during theyears of bringing this project to fruition. He is my tough est critic and best editor. I also wish to thank my post doctoral and lifelong professional mentor, Dr Judith S.Stern, for her staunch commitment to clear communi cation and for instilling a similar commitment in herstudents.Barbara J. MooreA major theme of this book is to understand thecomplexity of the factors that underlie energy balanceand weight, with the goal of understanding the over weight or obese person. Understanding is an attributeI have had modeled for me my whole life, by myparents, Eli and Rebecca Freedman, and my siblings,Karen Jimmerson, Jay Freedman, Barry Freedman,Beth Rosen, Jayne Quinn, Judy Fask, and BarbaraFreedman. This modeling has been continued in my ownfamily by my husband, Myles, and children, Sam, Leor,and Reuben. I am grateful to all of them for their love,humor, support, and patience during this arduousprocess.Sharon R. AkabasSally Ann LedermanSharon Akabas and Barbara Moore would like to jointlyacknowledge Sally Ann Lederman. She is always willingto serve as a very thoughtful sounding board and isextremely generous with her time. Over the years she hasbeen one of our toughest and most valuable critics.Without her unflagging ability to stay on task, solve prob lems, and get the job done this book would not exist.xi
Glossaryα-melanocyte-stimulating hormone(s); alpha-MSHA set of peptide hormones secreted by the anteriorpituitary gland. In the brain, release increases appetite.2003 Rotterdam criteria Criteria used to define PCOSestablished during a conference of experts who met inRotterdam in May 2003 and indicate that PCOS can bediagnosed (once certain other conditions are excluded)when two of three conditions are present: infrequentor no ovulation, indications of hyperandrogenism, orpolycystic ovaries. These criteria expand the definitionof PCOS established by an April 1990 expert conferencesponsored by NIH.95% confidence interval An estimate, determinedfrom the standard error, of the range of values for a givenvariable that would include the true mean 95% of thetime. It is used to indicate the reliability of the estimateof the mean provided by a particular sample. Greatersample sizes reduce the range of the confidence interval,making the estimate of the mean more reliable.acanthosis nigricans A darkening and thickening ofthe skin usually seen at the nape of the neck and in areaswhere opposing skin surfaces can touch and rub, such asin the groin, underarms, and beneath pendulous breasts;associated with insulin resistance.accelerometers An instrument for measuring acce leration, used in some methods that determine energyexpenditure. Initiation of movement in a part of thebody involves an acceleration, which can be counted, ifregistered on the accelerometer. Complex models areused to convert these counts into calories expended,using a variety of estimates and assumptions.This response can result in lifelong protection fromreinfection with the same antigen.adipocyte A connective tissue cell containing one ormore fat droplets. The adipocyte is the defining cell typewithin adipose tissue; also known as “fat cell.”adipogenesis The formation of fat; fat cell proliferation.adipokines Any of a variety of compounds secretedby adipose tissue; some play important roles as signalingmolecules in energy balance and metabolism.adiponectin An adipokine, a protein hormone secretedby adipose tissue. Has generally beneficial effects oninsulin-sensitive tissues and the vascular system.adjusted odds ratio An odds ratio statistically adjustedfor other factors that might affect the chance of thedisease. See odds ratio.adrenal hyperandrogenism Excessive production ofandrogen hormones (testosterone, dehydroepiando sterone, etc.) by the adrenal glands.adrenalectomy Removal of the adrenal gland.afferent centers Areas of the brain that integratesignals from the body and send outgoing (efferent)messages via neural pathways to other parts of CNS andto other parts of the body.agouti protein A protein produced in the body(endogenous) that has a strong stimulating effect onappetite. It acts as an antagonist of the melanocortinreceptors MC3R and MC4R.ad libitum An amount of food freely chosen by anindividual; unrestricted food intake.air displacement plethysmography A method fordetermining body volume. It consists of two connectedchambers in one of which the subject is placed, theother being a reference chamber that contains pressuremeasuring instruments. A flexible diaphragm is mountedin the common wall between the chambers. The ratio ofthe pressures in the two chambers as the diaphragm ismoved is inversely related to the ratio of the air volu mes within the chambers, allowing calculation of bodyvolume.adaptive immune responses An immune responsedependent on action of antigen-specific lymphocytes.Akt One of a set of protein kinases with variousfunctions, including apoptosis and insulin signaling.activity thermogenesis Energy expenditure above thatused when at rest.acute phase reactants Proteins whose concentra tion in the plasma are changed significantly duringinflammation.xii
Glossaryalanine aminotransferase (ALT) An enzyme found inthe plasma, liver, and other tissues; it catalyzes theconversion of alanine to alpha-ketoglutarate by transferof an amino group. Elevated blood levels are used as aindicator of liver damage.alimentary limb In bariatric surgeries, the portion ofthe remaining intestinal tract that carries food.alkaline phosphatase An enzyme made in liver, bone,intestine, and kidney. If levels are elevated in blood, itsuggests liver disease or damage or bone problems.alternative complement pathway A part of theimmune system that does not depend on the action ofantibodies. It kills pathogens quickly, before antibodysynthesis can occur. It operates by the binding of aprotein, complement protein C3b, to the pathogensurface.anatomical bony landmark Protuberances on thebones that can be used to identify specific anatomicallocations on the body surface.androgen receptor A receptor that is activated bybinding androgen hormones (hormones that determinemale secondary sex characteristics).angiogenic Relating to the formation of new bloodvessels.angina pectoris A feeling of pain or pressure in thechest, often radiating to the arms, neck, or back, causedby inadequate oxygen delivery to part of the muscle ofthe heart.angiotensinogen A plasma precursor of angiotensin, acompound that causes blood vessels to constrict, raisingblood pressure.anorexiant A substance that causes loss of appetite.ANS tone The level of activity in the autonomicnervous system.anthropometry Measurement of the physical charact eristics of the body, such as its size, weight, shape andproportions.antigen Any substance foreign to the body that evokesan immune response.antihyperglycemic agents A substance that promotesthe normalization of blood glucose levels.apocrine odor The odor emitted by the apocrine sweatglands, glands found mostly in the armpit and genitalareas.arcuate nucleus (ARC) An area in the hypothalamusthat contains neurons that secrete appetite-enhancingxiiineuropeptide Y, and appetite-suppressing melanocortins,and many other substances.area postrema (AP) An area of the brain, on the baseof the 4th ventricle, that is involved in feeding controland in vomiting.associative learning A learning process by whichstimuli become linked together.AST (aspartate aminotransferase) An enzyme whoseblood levels are used as a test of liver function.attrition The loss of participants in a study. It is usuallyexpressed numerically as a percentage of those originallyenrolled or assigned to a treatment.autocrine A type of cell signaling in which a cellsecretes signal molecules that act on itself or other neigh boring cells of the same type.autonomic systems The part of the nervous systemthat controls involuntary visceral functions such as theheartbeat, digestion, and glandular secretions. Includesthe sympathetic and parasympathetic components.autosomal Related to any chromosome other than asex chromosome.autosomal genetic disorder A genetic condition thatresults from a gene on an autosome (i.e., not sexchromosome linked).autosomal recessive disorder A disorder that appearsonly in people who have two mutated copies of an auto somal gene, one from each parent.bariatric surgery Surgical procedures designed toreduce body weight. Different approaches will reducenutrient absorption or decrease the amount of food thatcan be eaten at one sitting, or both.beta-blockers Drugs that decrease the heart rate andlower blood pressure by blocking cellular beta-receptors.These receptors normally are responsive to epinephrineand norepinephrine; the interaction with the drug affectsheart rate and contractility, vasodilation, blood pressureand other physiological activities.binge-eating disorder An eating disorder involvingrepeated episodes of excessive overeating, feelings ofloss of control and worthlessness. These are not balancedwith compensatory actions to correct the excess intake,such as by fasting, vomiting, using laxatives, or exercisingexcessively.bioelectrical impedance; bio-impedance analysis (BIA)A method for estimating body composition (total bodywater, extracellular water) from the conductance andresistance of the body, determined by applying a small
xivGlossaryelectric current across a portion of the body (e.g., handto foot).BMI growth charts Charts produced by the CDC,used for assessing the growth of children.body dissatisfaction Concerns with body shape, inparticular the experience of “feeling fat.”body mass index (BMI) A measure used to classify theappropriateness of weight relative to height. Calculatedas weight (kg) divided by height (meters) squared.Previously called Quetelet’s Index, after AdolpheQuetelet, its developer. Used as an indicator of bodyfatness.borborygmi The noises made when gas moves in theintestine.appetite regulation; thus far their effects on mood havebeen considered too high risk and drugs affecting thesereceptors have not obtained FDA approval.cardiac valvulopathy The condition where a valve ofthe heart is diseased.catecholamine Hormones (including dopamine,epinephrine an
weight reduction 333 Michael Rosenbaum 21 The role of physical activity in weight loss and weight loss maintenance 344 Jamile A. Ashmore, Georita Frierson, and Steven N. Blair 22 The challenge of weight loss maintenance: successful losers 354 Rena R. Wing and James O. Hill 23 Treatment of obesity in the primary care setting 365
Prevalence of obesity and severe obesity in US children, 1999‐2014. Obesity, 2016 May;24(5):1116-23. Wang et al. What childhood obesity prevention programmes work? A systematic review and meta-analysis. Obes Rev, 2015 Langford et al. Obesity prevention and the Health Promoting Schools framework: essential components and barriers to .
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Obesity Obesity is a disease where a person’s weight is in an unhealthy range (BMI of 30.0-39.9). It is a disease that can lead to other health problems. Talk with your healthcare provider to better understand and treat obesity. Severe Obesity Someone who is more than 100 pounds over their
2. Obesity trends and co-morbid consequences. 3. Poverty, obesity and food econo-mics. 4. Genetics and Caribbean culture. 5. The cost of obesity to develop-ment. Dimensions 1- Obesity Epide-miology: Prevalence, Age and Gender Relationships The most striking features of Figure 1 are (a) the high prevalence of overweight (BMI 25) and obesity
beneficial effect of weight loss on a myriad of obesity-related co- morbidities. In an effort to translate the emerging science and practice of obesity care for clinicians, the . Practical Manual of Clinical Obesity. has been written as a practical, evidence-based companion guide to the textbook . Clinical Obesity in Adults and Children
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