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Query: UMLS:C0028754 (obesity)
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An optimal diet cannot yet be defined. If we knew what an optimal diet was, additional research in nutrition would not be necessary. There is abundant evidence, however, that the usual American diet is not optimal and adequate reason to recommend modification. Current dietary recommendations were developed to prevent the occurrence of nutritional deficiency disease in the 1930's and 1940's. They have been largely successful. They were made, however, before any knowledge was available about the effects of diet upon chronic disease which now represent the primary health problems of the United States. Large amounts of data are available indicating the kids of recommendations which should be made to control hypercholesterolemia--a primary risk factor of coronary artery disease. These kinds of data together with less information upon diet and cancer, hypertension, obesity, diabetes, etc. lead to sensible and consistent dietary recommendations to moderate the dietary practices of most Americans.
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PMID:Optimal nutrition. 44 85

Nutrient requirements do not change markedly with advancing age, but life style, socioeconomic status, psychologic changes, and the presence of chronic disease alter nutrient intake in the elderly. It is important to recognize and deal with these factors in attempting to correct malnutrition and in prescribing dietary treatment. Malnutrition includes a variety of disorders: undernutrition, nutrient deficiencies and imbalances, and obesity. Frequent small feedings, with nutritional supplements for patients with profound weight loss, are the initial treatment for undernutrition. Iron supplements and a diet of foods rich in iron and in promoting iron absorption are required in treating iron deficiency anemia. Management of macrocytic anemia should include specific nutrient therapy plus improvement of diet to include leafy vegetables and animal foodstuffs. Diet is an important adjunct in treating chronic diseases. Maturity-onset diabetes mellitus often can be managed by diet alone, with attention to correct proportions of fat, carbohydrate, and protein and to the decreased caloric requirements of elderly patients. The importance of continuing dietary modifications in hyperlipidemia and hypertension is well known. Although dietary manipulation in osteoporosis is not curative, a diet high in calcium and containing adequate floride and vitamin D affords maximum dietary protection against progress of the disease.
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PMID:Guidelines for maintaining adequate nutrition in old age. 64 78

A three-year study was undertaken in the general medical clinic of a private community hospital, to assess the health behavior, health status, and profile of function of stable chronic disease was developed and tested. It was shown that these patients used a disproportionate amount of health care services. Half of the group was treated by a nurse practitioner/physician team and half by a house officer/preceptor team. Patients in both groups behaved similarly. These patients: 1) made frequent demands for outpatient services but did not need more than average hospital care; 2) tended to have problems of socio-economic indigency; 3) were likely to have hypertension, obesity, arthritis, and functional disease; 4) were chiefly women; 5) required special visits 9 percent of the time, usually for exacerbations of illness or intercurrent health problems; 6) made greater demands if they had functional complaints as a primary or secondary health problem; and 7) viewed their health more positively and functioned at a higher level if they were over 65 years of age. It was also found that the nurse practitioner, working in consultation with a physician, was able to provide high-quality health care.
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PMID:Stable chronic disease: a behavioral model. 89 11

This paper is an attempt to clarify some of the issues which face the psychiatrist in his efforts at treating the obese patient through analytic means. A thoroughgoing bias in Western culture impairs the psychiatric and non-psychiatric medical care of the obese person. Inconclusive evidence concerning the causal relation between obesity and chronic disease does not deter this cultural bias from exaggerating the role that obesity is thought to play in disease process. Whatever contribution it makes to physical illness, obesity remains a substantial social disability that is frequently associated with self-hate and feelings of ineffectiveness. Scientific investigations indicate that adiposity is determined by interactions of genetic and environmental influences acting at different levels of complexity within the organism. Hence, the adipocyte itself may influence existing fatness and retard weight reduction. Constitutional factors affecting the hypothalamus may contribute to obesity in certain individuals. Also, cortical effects determine maladaptive eating behavior and excessive adiposity. Poor eating habits which are associated with emotional conflict seem to strongly affect the development and continuance of obesity in most fat persons. The interaction among adipocyte, hypothalamus, and cerebral cortex remains unclear. The various treatments of obesity have been shown to be of little impact in helping overweight persons to sustain weight loss. Diet control, exercise, group psychotherapy, and behavior modification show slight benefit. Recent controlled studies dispute earlier claims that behavior modification is effective in achieving meaningful and lasting weight loss. Claims that intestinal bypass procedures are a useful treatment also require further supporting evidence. Psychoanalytic or intensive sustained psychotherapeutic treatment of the obese person emphasizes exploration of the entire personality. As long-neglected constructive forces are stregthened, weight loss may proceed. Psychoanalytic treatment is not indicated for obesity uncomplicated by neurotic distortions. In the presence of interpersonal problems and personal ineffectiveness, psychoanalysis has real utility. It is not clear that obesity is a major determinant of impaired physical or emotional health. Rather, the medical indictment of obesity seems to stem from the need to justify an intensely negative cultural bias. Casual disregard of this fact and of the complexity involving issues of etiology and treatment may signify inadequate appreciation in the psychoanalyst of the extent to which he participates in this cultural bias. The continuing failure of medical science to devise a means to help fat persons sustain weight loss to any meaningful degree has prevented the development of studies which would show if weight reduction truly does provide uniformly enhanced physical and emotional well-being...
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PMID:Psychoanalytic treatment of the obese person. Part III. 100 3

Genetic factors play a role in chronic disease and conditions such as coronary heart disease, hypertension, and obesity. Individual responses to nutritional factors involved in such conditions vary depending upon a person's genetic make-up. The role of individual genes is best understood for the hyperlipidemias that predispose to coronary heart disease. Until more and better information on gene-nutritional interactions is available, general population-wide recommendations regarding a prudent diet appear reasonable. At the same time, high risk screening for certain conditions such as the hyperlipidemias is appropriate.
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PMID:Nutrition and genetic susceptibility to common diseases. 159 Feb 64

Data were collected on the nutrient intake and nutritional status of 96 single mothers and their 192 dependent children who had been displaced from their homes. The objective of the study was to provide information on the dietary adequacy of a newly identified subgroup of homeless persons, single women and their dependent children. Once situated in temporary housing, those participating in the study indicated that they believed that they were receiving sufficient food. However, a nutrient analysis found that the study subjects in all age groups were consuming less than 50 percent of the 1989 Recommended Dietary Allowances (RDA) for iron, magnesium, zinc, and folic acid. Adults were consuming less than 50 percent of the RDA for calcium. The type and amounts of fats consumed were in higher than desirable quantities for a significant number of subjects of all ages. The health risk factors of iron deficiency anemia, obesity, and hypercholesterolemia were prevalent. The findings indicate a need to examine and remedy nutrient intake deficiencies among single women who are heads of household and their dependent children in temporary housing situations. Diet-related conditions found included low nutrient intakes that may affect child growth and development, risk factors associated with chronic disease, and lack of appropriate foods and knowledge of food preparation methods in shelter situations. Applicable, understandable nutrition education should be offered mothers in shelter situations to help them make food choices at the shelter and when they become self-sufficient. Assistance programs such as the Special Supplemental Food Program for Women, Infants, and Children, and food stamps, should be available to this group.
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PMID:The nutritional status and dietary adequacy of single homeless women and their children in shelters. 159 41

Rapid socioeconomic development has led to great changes in health and disease patterns in Bahrain. Specifically, chronic diseases are replacing infectious diseases as the leading causes of morbidity and mortality. Diabetes mellitus is 1 chronic disease which causes considerable problems in Bahrain. It has a higher death rate than that of hypertension, but a lower death rate than that of cardiovascular diseases. Type 2 (noninsulin-dependent) diabetes is the most prevalent form of diabetes in Bahrain. Changes in dietary habits and lifestyle occur with rapid development in Bahrain, often resulting in obesity and decreased physical activity, particularly in women. Obesity and lack of physical exercise are risk factors of Type 2 diabetes. A community- based nutrition survey among 18-to-48 year-old mothers in Bahrain reports that 8.5% suffer from diabetes. The prevalence of diabetes among elderly Bahrainis is 13.4% (15% in females and 10.2% in males). Physicians in Bahrain tend not to list diabetes mellitus as the main cause of death; thus there is underreporting of diabetes-related mortality. Nevertheless, diabetes is responsible for 3.4% of all deaths in Bahrain. Yet, Bahrain does not have programs to detect or control diabetes. Health workers in health centers can and do provide advice on health care and dietary management, but they are not properly trained. Physicians manage diabetes through dietary restrictions, tablets, or insulin injections. Mass media promote prevention of diabetes. Their effectiveness is low, however, because educational programs are poorly designed and unattractive. The government should accord diabetes prevention and control high priority. It should support and implement training of physicians in diabetes management, public education, epidemiological surveys, and nutritional assessment of local foods.
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PMID:Diabetes mellitus in Bahrain: an overview. 164 9

When Australian Aborigines make the transition from their traditional hunter-gatherer life-style to a westernized life-style, they develop high prevalence rates of obesity (with an android pattern of fat distribution), non-insulin-dependent diabetes, impaired glucose tolerance, hypertriglyceridemia, hypertension, and hyperinsulinemia. Insulin resistance may be the common pathogenetic characteristic of this cluster of conditions associated with increased risk of cardiovascular disease. The traditional hunter-gatherer life-style, characterized by high physical activity and a diet of low energy density (low, fat, high fiber), promoted the maintenance of a very lean body weight and minimized insulin resistance. In contrast, for most Aborigines, western life-style is characterized by reduced physical activity and an energy-dense diet (high in refined carbohydrate and fat) that promotes obesity and maximizes insulin resistance. Intervention strategies aimed at prevention of insulin-resistance-related chronic disease should be directed at life-style modification. To be effective, such programs will have to be developed and controlled by Aboriginal communities.
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PMID:Westernization and non-insulin-dependent diabetes in Australian Aborigines. 166 99

Vigorous physical activity can improve the health of both adults and children. Among adults, regular physical activity can reduce risk for chronic diseases such as coronary heart disease, hypertension, noninsulin-dependent diabetes mellitus, colon cancer, and depression, as well as lower all-cause death rates (1,2). Among children, regular physical activity can reduce chronic disease risk factors such as obesity, elevated cholesterol, and hypertension (3). Physical activity patterns established during childhood may extend into adulthood (4). This report examines the prevalence of vigorous physical activity among U.S. students in grades 9-12.
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PMID:Vigorous physical activity among high school students--United States, 1990. 173 Nov 78

Behavioral approaches to obesity are usually employed in the context of short-term (10-20 wk) treatment interventions. These programs produce weight losses averaging 10 kg at the end of the program and 6.6 kg at 1-y follow-up. Improvements in long-term results may depend on a shift to a chronic disease model of obesity treatment, in which patients remain in ongoing care for extended periods of time. Highly structured diets and supervised exercise warrant further investigation as components of such a chronic disease approach to the treatment of severe obesity.
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PMID:Behavioral treatment of severe obesity. 173 24


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