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Query: UMLS:C0028754 (obesity)
 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Obesity is considered to be a major nutritional disorder in the U.S. and in many parts of the industrialized world. The physiology of the obese and their propensity for chronic disease has been of growing interest over the past few years, and an extensive literature has begun to accumulate. Obesity is a heterogeneous disorder. When viewed in the broadest sense, it has been considered a disorder of energy balance. The development of obesity in humans is of complex etiology, involving genetic and environmental components that affect regulatory and metabolic events. The prevalence of overweight and obesity in a population depends on the particular reference or standard of desirable weight selected for use. A trend toward increasing height and weight has been evident among adults for several centuries, and among children as early as the 7th year of life in developed countries. Overweight persons are at increased risk for coronary artery disease, high blood pressure, diabetes mellitus, and cancer. The degree of overweight that carries additional risk without affecting mortality needs to be defined. Overweight most likely contributes in varying degrees to morbidity in different societies, because the risk for most common chronic diseases is multifactorial. In defining overweight and obesity, morbidity, in addition to mortality, ought to be taken into consideration. The multidisciplinary approach to the study of obesity--borrowing concepts and techniques from endocrinology, neurobiology, genetics, and nutrition--should yield new insights into how environmental factors such as diet and physical expenditure interact to influence energy metabolism and body composition.
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PMID:Characteristics of obesity: an overview. 330 Apr 91

Data on five Polynesian populations, obtained by standardized population surveys conducted during the years 1978-1980, were examined for associations between glucose tolerance and both obesity and island of residence. In both sexes, after allowing for the influence of age and obesity, there was a significant difference in glucose tolerance between the three populations considered, subjectively, to be the less traditional and the two considered as retaining a more traditional lifestyle. Regression models predicting diabetic status were weaker than those using glucose tolerance as the dependent variable, probably due to the small number of diabetic subjects in the samples. As all subjects were of Polynesian ancestry, and the results could not be explained by knowledge of ancestral affiliations between the five populations, environmental, rather than genetic factors may have been the determinants of the observed differences in glucose tolerance. This finding highlights the need for a more sophisticated approach to the study of the association between socio-cultural modernization and chronic disease in the Pacific.
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PMID:Glucose tolerance in Polynesia: association with obesity and island of residence. 334 33

This study was conducted to determine the frequency of behavioral risk factor screening and counseling by family medicine residents. Patients seen for well-care visits reported that residents screened most often for smoking and alcohol abuse. Residents inquired about stress, sedentary life-style, poor nutritional habits, and obesity less often. Few patients were counseled to reduce risks, even when unhealthy behaviors had been identified. Residents provided counseling most often for obesity, smoking, and stress; sedentary life-style, poor nutritional habits, and alcohol abuse rarely received intervention. Chart documentation of screening reported by patients was done a majority of the time only for smoking and alcohol abuse. Counseling was usually not documented. Residents screened most often for those risk factors (smoking and alcohol) they considered the most important causes of chronic disease. No relationship was found, however, between resident attitudes and likelihood of counseling. Residents agreed they needed more training to counsel patients on reducing behavioral risks.
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PMID:Risk reduction: attitudes and behavior of family practice residents. 336 Feb 28

Salient features of an operative technique designed to reduce to a minimum the iatrogenic trauma of cholecystectomy include a limited incision, muscle retraction (instead of division), specific packing and retraction, and distant manipulations by long instruments. Eighty two unselected consecutive patients with primary gallbladder disease underwent operation by this technique. Two permanently bed-confined patients were excluded from study. Acute cholecystitis was documented by histopathology review in 23 cases and chronic cholecystitis in 57 cases. Case material included usual pre-existing concomitant medical problems; five patients meeting formal criteria for the diagnosis of morbid obesity; 15 patients exceeding 199 pounds and one weighing 315 pounds; ambulatory (outpatient) cholecystectomy; 17 patients over 70 and four patients over 80 years of age; five gangrenous and one perforated gallbladders, and perigallbladder abscesses without gangrene in one case; and conspicuous absence of respiratory complications. Median and average incision length was 5.5 cm. There were no major and five minor complications. Recent experience demonstrated safe performance of elective cholecystectomy for chronic disease, regardless of degree of patient obesity, with median incision length 5 cm, median operative time 65 minutes and median post-operative hospital stay 2 days.
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PMID:Minimal trauma cholecystectomy (a "no-touch" procedure in a "well"). 336 59

In addition to benefiting from public health programs for all Americans, American Indians and Alaska Natives are eligible for health services from the Indian Health Service (IHS), U.S. Public Health Service. Indian Health Service provides comprehensive health services, including nutrition and dietetics, to American Indians and Alaska Natives living on or near federal Indian reservations or in traditional Indian territory, such as Oklahoma and Alaska. Dramatic improvements have occurred in the health of native Americans since IHS was transferred to the Public Health Service in 1955. Infant mortality rate, maternal deaths, and deaths related to infectious diseases have all decreased. Chronic diseases are now major causes of death. Nutritional factors contribute to at least 4 of the 10 leading causes of American Indian and Alaska Native deaths--heart disease, cancer, cirrhosis, and diabetes--and to the prevalence of overweight, obesity, hypertension, and dental caries. There is still incomplete information on nutritional status and present dietary patterns, nutritive values of native foods, and nutrition education knowledge of the population. Priority nutrition objectives have been developed to address those issues.
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PMID:Nutrition in American Indian health: past, present, and future. 353 63

The majority of dietary guidelines discussed above suggest a reduction in the % of dietary calories derived from fat. Currently, approximately 40% of calories in Western countries come from fat. Some of the more recent guidelines call for a reduction in fat intake to 30% of calories. Indeed, the Committee on Diet, Nutrition and Cancer (National Academy of Sciences 1982) and the World Health Organization Report on Prevention of Coronary Heart Disease (WHO 1982) suggested that the evidence warranted an even lower fat intake, but 30% of calories is a moderate and practical target. Diets containing 30% of calories as fat are undoubtedly safe for the general population. During and immediately after the Second World War in Britain, dietary fat intake was at or about this level and no deleterious effects in the population were noted. (Greaves and Hollingsworth 1966). Indeed, the overall state of health of the population seemed improved. Furthermore, most of the world population exists and has existed on a primarily plant based diet, low in fat content, with no apparent ill effects and lower rates of chronic disease. (Mintz 1985). Most dietary guidelines recommend a reduction in saturated fat intake. The more recent guidelines suggest saturated fat should be restricted to less than 10% of total calories. While some of the earlier guidelines suggested an increase in polyunsaturated fat intake, more recent guidelines stress that polyunsaturated fat intake should not exceed 10% of calories. Thus, the focus of more recent guidelines appears to be to decrease total fat intake. Essentially all guidelines stress avoidance of obesity by avoiding excess caloric intake and increasing caloric expenditure. Diets low in total fat content are beneficial in this regard, a fact acknowledged in the Food and Nutrition Board's report "Towards Healthful Diets." (Food and Nutrition Board 1980 b) Most guidelines advise a decrease in calories derived from processed sugars and a concomitant increase in complex carbohydrate intake. This is best achieved by stressing whole grain cereals, fruits and vegetables in the diet. More recent recommendations advise moderation in the use of alcohol. Moderation in salt use is also a common theme. It is our belief that guidelines should be general in nature and not identify specific nutrients, e.g. vitamin A and C in foods, or specific foods themselves, e.g. cabbage, as conferring special benefits. The available data base does not support such specific claims.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Potential responses to and impacts of epidemiological and experimental data on dietary fat and cancer. Dietary guidelines. 353 52

To examine the effects of intensive patient and/or physician diabetes education on patient health outcomes, a controlled trial was conducted in which internal medicine residents and their 532 diabetic patients were randomly assigned to: routine care; patient education; physician education; or both patient and physician education. Patient outcome data were analyzed either by analysis of covariance on post intervention values (2-hour post-prandial plasma glucose [PPG]; body weight [BW]; blood pressure [BP]; or analysis of variance conducted on change values (fasting plasma glucose [FPG] and glycosylated hemoglobin [A1Hgb]). After patient education, significant improvements were observed in FPG, A1Hgb, BW, and systolic and diastolic BP. Physician education resulted in significant decreases in FPG, A1Hgb and BW. The combination of patient plus physician education resulted in the greatest improvements in patients' health outcomes including FPG, A1Hgb, PPG, BW and diastolic BP. Adjusted systolic BPs were not significantly different in the two groups. While these physiologic improvements were statistically and probably clinically significant, hyperglycemia and obesity still persisted. Thus, achieving optimal patient outcomes for a chronic disease like diabetes mellitus may require a greater or more effective use of resources than currently estimated.
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PMID:DIABEDS: a randomized trial of the effects of physician and/or patient education on diabetes patient outcomes. 354 57

The prevalence of chronic disease based on a mailed questionnaire was estimated as part of a continuing epidemiological study of a retirement community. The prevalence of eight chronic diseases (high blood pressure, angina, myocardial infarction, stroke, diabetes, rheumatoid arthritis, glaucoma, and cancer) was determined across all age and sex groups. The relationships between these diseases and several health related life-style practices were assessed. A health index summarizing five practices (smoking, alcohol consumption, exercise, sleep and obesity) was clearly related to the prevalence of disease.
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PMID:Prevalence of chronic disease and health practices in a retirement community. 373 24

The consequences of migration for the Samoan population of California are discussed within the context of other studies focusing on Samoan native and migrant populations in Samoa and Hawaii. The social, cultural and economic characteristics of California Samoans are described and data are presented for body morphology, blood pressure, psychosocial stress and social support, general morbidity patterns and mortality rates for 1978-1982. Although the nature of disease risks appear profound in this population, particularly patterns of extreme obesity and psychosocial stress, mortality rates for heart disease and stroke are less than might be expected among other American groups. Such unexpectedly low mortality rates may represent the relatively healthy experience of older cohorts of migrants, or be a result of proportionally few individuals having lived long enough in California to develop cardiovascular and other chronic disease that have lengthy natural histories. We postulate that at present Samoan social structure, particularly the high status that accrues with aging in traditional Samoan society, may act as a buffer for the risk factors we observed and their expected outcomes. If so, the U.S.-born Samoans who are currently passing through childhood and early adult years with progressively less awareness of Samoan values of family and social structure will exhibit the same risks we describe here, but lack the available social buffers that currently exist for their parents.
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PMID:Migration and biocultural adaptation: Samoans in California. 374 58

Although several risk factors for heart disease including high blood pressure, diabetes mellitus, and lipid and lipoprotein abnormalities are associated with overweight, overweight is not consistently associated with coronary heart disease risk. Some prospective studies of white men (life insurance cohorts, airline pilots, cancer study volunteers, and the Framingham population) have shown a positive linear relationship of weight to coronary heart disease. Other epidemiologic studies show a negative association, no association, a U-shaped relationship, or a threshold effect. The inconsistencies do not appear to be explained by differences in the definition or distribution of obesity, duration of follow-up, or risk factor distribution. Neither misclassification bias nor confounding by cigarette smoking or chronic disease appears to explain the inconsistencies. No known protective effect of obesity could explain these divergent findings. Inconsistent results with regard to the nature, strength, and linearity of the association between obesity and atherosclerosis do not support the hypothesis that obesity causes atherosclerosis, despite its biological plausibility.
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PMID:Obesity, atherosclerosis, and coronary artery disease. 390 65


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