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

Obesity and body fat distribution (FD) are established risk factors for chronic diseases. The body mass index (BMI) and the waist/hip circumference ratio (WHR) are used conventionally as indices of obesity and FD in epidemiological studies. Although some general limitations of these indices are recognized, others that affect their use in relative risks for disease are not well recognized. These include effects of sex, ethnicity, and especially age on the relationships between these indices and body composition, which can result in substantial misclassification of obesity and FD. There is considerable variability in body composition for any BMI, and some individuals with low BMIs have as much fat as those with high BMIs. This results in poor sensitivity for classifying levels of body fatness (e.g., too many "false negatives," or overweight individuals classified as not overweight), and relative risks are attenuated across all categories of BMI. A more serious problem, however, is that at different ages the same levels of BMI correspond to different amounts of fat and fat-free mass. Data from the Rosetta Study and the New Mexico Aging Process Study show that older adults have, on average, more fat than younger adults at any BMI, due to the loss of muscle mass with age. As a result, the sensitivity of BMI cutpoints with respect to body fatness decreases with age, and the use of a fixed cutpoint for all ages results in "differential misclassification bias." Taken together, these issues suggest that the increases with age in the prevalences of overweight and obesity, and in the risks for chronic diseases, may be mis-estimated using BMI. Similar issues may affect the use of WHR for estimating prevalences and associated risks of FD. New field methods for estimating body composition are available that can be applied in large, epidemiologic follow-up studies of chronic diseases. These methods will allow epidemiologists to consider, for example, whether it is increased fat, or the replacement of fat-free mass with fat, with age that is associated with risk for chronic disease.
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PMID:Human body composition and the epidemiology of chronic disease. 771 63

This study examined the effects of comorbid medical conditions (heart disease, pulmonary disease, hypertension and obesity) on the association of radiographic knee osteoarthritis (OA) with long-term difficulty in physical function. Data are from the National Health and Nutrition Examination Survey, 1971-1975 (NHANES I), a prospective epidemiologic cohort study, and the NHANES Epidemiologic Follow-up Study, 1982-1984 (NHEFS) and included 4059 persons who were 45-74 years old and participated in the detailed examination component of NHANES I. Knee OA was ascertained by anterior-posterior bilateral radiographs of the knee and self-report of knee pain, heart and pulmonary disease by self report of disease or symptoms, and hypertension and obesity by blood pressure and weight measurements. The presence of symptomatic knee OA at NHANES I was associated with reported difficulty at NHEFS 1982-84 in functions which used the lower extremity (ambulation and transfer). The presence of coexistent chronic conditions, particularly heart disease, pulmonary disease and obesity, increased the likelihood of subsequent disability. These findings suggest that knee OA is associated with long-term physical disability, and that the presence of coexistent chronic disease may increase the amount of long-term disability from knee OA.
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PMID:Long-term physical functioning in persons with knee osteoarthritis from NHANES. I: Effects of comorbid medical conditions. 772 94

Behavioral risk factors and chronic disease death rates vary markedly among the numerous American Indian tribes. Local data on prevalence of risk factors are important in determining effective community-based interventions. The authors conducted an in-person survey to ascertain the prevalence of behavioral risk factors among members of the Chippewa tribe living on reservations in Wisconsin. A total of 465 Chippewa adults were randomly selected from tribal registries and invited to participate in the study. Of these, 175 (38 percent) participated. To characterize nonrespondents, 75 nonrespondents were randomly selected and aggressively followed up. The authors compared their results with data from the 1989 Wisconsin Behavioral Risk Factor Surveillance System. Chippewa respondents reported high levels of obesity and tobacco use. No significant differences existed between the original survey and followback of nonrespondents. Compared with respondents who had telephones, those without telephones were significantly more likely to be unemployed, to be a current smoker or drinker, and to report nonuse of seatbelts. Compared with the general Wisconsin population, Chippewa adults appear to have higher prevalences of several chronic disease and injury risk factors. The original survey methodology, despite the low response rate, appeared to give a more accurate (less biased) estimate of risk factor prevalences than would have been achieved by a telephone survey.
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PMID:Behavioral risk factors of Chippewa Indians living on Wisconsin reservations. 780 Jul 94

Non-insulin-dependent diabetes mellitus (NIDDM) is a chronic disease which may take several years to develop, presumably starting in most cases with genetic susceptibility. Development of NIDDM is influenced by obesity and physical inactivity. As these risk factors can be altered by behavioral modification, and some of the physiologic abnormalities predicting diabetes, such as insulin resistance and impaired glucose tolerance, can be improved by behavioral modification and with drugs, NIDDM is potentially preventable. This potential needs to be demonstrated by randomized clinical trials.
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PMID:Prevention of non-insulin-dependent diabetes mellitus. 784 42

This chapter emphasized new directions being pursued in the behavioural treatment of obesity. Behavioural weight-loss programmes are being strengthened by their increased emphasis on low fat intake and exercise, by more direct intervention on behavioural antecedents and consequences of eating, by the use of very low calorie diets (VLCDs) and by the adoption of a chronic disease model and the concomitant lengthening of treatment programmes. With these approaches, initial weight losses of 10-20 kg can be achieved, and maintenance of weight losses of 5-10 kg can be expected. Treatments may also be strengthened by the identification of subgroups of the obese. Recently, progress has been made in this area with the description of a subgroup of the obese who have severe problems with binge eating. Binge eating disorder has been proposed as a new diagnostic category for DSM-IV. From 20 to 45% of the obese who present for treatment suffer from such problems. Obese binge eaters have worse mood and more psychopathology than obese people who do not binge eat, and are more likely to drop out of behavioural weight-control treatments. Although binge eaters may regain weight faster than non-binge eaters, both short- and long-term weight loss of binge eaters and non-binge eaters appear quite similar. Treatments have been identified that show promise in ameliorating binge eating for these patients, but these treatments have not produced weight loss. Although there has recently been concern about the possible negative effects of dieting on mood state, participation in behavioural weight-loss programmes is not associated with worsening mood in obese patients. No psychological variables have distinguished obese from non-obese individuals. Nonetheless, there is substantial prejudice against the obese. Awareness of this prejudice can lead to more sensitive and appropriate treatments for the problem of obesity.
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PMID:Behavioural and psychosocial aspects of obesity and its treatment. 798 Mar 52

The observation of large differences in breast cancer rates between countries has led to the hypothesis that excessive intake of dietary fat is an important risk factor for breast cancer in women. Case-control and prospective studies, however, generally have failed to show associations between dietary fat and breast cancer risk. There therefore is only weak evidence that modest reductions in fat intake (for instance to levels of 30% of caloric intake from fat) will reduce breast cancer risk. The possible benefits of lowering fat intake to levels substantially below 30% of calories will need to be tested in a randomized trial. In the meantime, the possible roles of micronutrient imbalances and childhood nutritional factors need to be studied better. Obesity is related to breast cancer in a complex way that suggests that a hormonal correlate of excessive body weight might affect breast cancer growth and metastasis. The potential benefit of intentional weight loss as an adjunct breast cancer treatment deserves further study. Many studies have suggested that drinking alcohol, even at modest levels, might increase breast cancer risk. Because the potential benefits of modest levels of alcohol for cardiovascular disease may outweigh the risk for breast cancer, recommendations for total alcohol abstinence may be premature for women with an average breast cancer risk. Women at unusually high risk for breast cancer who have a lower-than-average risk for cardiovascular disease, however, might make an informed decision to abstain from alcohol intake. Following current dietary advice to increase the amount of fruits, vegetables, and whole grains in the diet while reducing fats is certainly prudent for women to reduce their risk of several chronic disease, but current data points to the somber conclusion that such changes probably will have little effect on breast cancer risk.
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PMID:Nutritional risk factors for breast cancer. 800 99

The Waianae Diet Program (WDP) is a community-based program designed at the Waianae Coast Comprehensive Health Center in response to the high rates of obesity and chronic disease among Native Hawaiians. Its foundation is a 3-week program of traditional Hawaiian diet and cultural teachings. It employs 8 innovations in clinical nutrition and health promotion theory: 1. Non-calorie restricted weight loss protocol, 2. Dietary clinical intervention, 3. Cultural sensitivity, 4. Transition diet, 5. Whole-person approach, 6. Group ohana (family) support, 7. Community intervention, and 8. Role modeling. It has demonstrated significant weight loss with no calorie restriction, improvement in blood pressure, serum glucose, and serum lipids. It appears to have wide acceptance in the Hawaiian community. More studies are warranted to determine the long-term effect of this program.
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PMID:The Waianae Diet Program: a culturally sensitive, community-based obesity and clinical intervention program for the Native Hawaiian population. 805 Aug 95

Alterations in personal health habits can prevent disease and reduce morbidity and mortality. We examined the association between self-reported healthy behavioral change and age, sex chronic disease, plasma cholesterol, and body mass index in an older Caucasian population in southern California. Overall, about two thirds of respondents reported decreased dietary salt or fat intake over the last 15 years, whereas one third reported increased frequency of exercise. Women were more likely than men to report increasing exercise, changing diet, or reading self-help materials. Individuals 50-69 years of age reported more positive health behavior changes than those 70 years and older. Those with diabetes and hypertension were more likely to decrease salt intake, but less likely to increase exercise than those without disease. Hypertensive and diabetic men, but not women, were also more likely to change their diet or read self-help materials than their peers without disease. The presence of risk factors for cardiovascular disease, such as obesity, elevated serum cholesterol, diabetes, and hypertension, were generally associated with positive alterations in diet and inversely related to increasing exercise.
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PMID:Factors associated with health behavior change among residents 50 to 96 years of age in Rancho Bernardo, California. 817 28

Obesity is a critical problem in black women. Black women have been found to have twice the rate of obesity of white women, and the origins of obesity appear to be in adolescence. To date, few obesity prevention and treatment programs have been designed specifically for black female adolescents and black women. In this review, the biopsychosocial factors surrounding obesity in the black female population are discussed, including the significance of body fat distribution for the development of diseases common to the black population, such as diabetes and hypertension; the cultural tolerance for overweight and obesity in black women; and the importance of family and social networks in the dissemination of health information. Programs that stress early intervention during adolescence are identified as having the most potential to make an impact on obesity in black women and, ultimately, to reduce chronic disease. However, such interventions must be sensitive to cultural belief systems and values. The need to eliminate a predominantly white, Anglo-Saxon, ethnocentric viewpoint to prevent and treat obesity in black female adolescents is stressed.
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PMID:Preventing obesity in black women by targeting adolescents: a literature review. 817 29

Measurement of the growth of children among different populations has been important in assessing health and nutritional status. It is also useful in predicting functional consequences and long-term outcomes in the adult population. Childhood and adolescent growth patterns have been related to life expectancy as well as to the development of specific diseases such as coronary heart disease, diabetes and cancer (breast, ovary, prostate and pancreas). Childhood and adolescent growth has also been indirectly related to adult obesity. While these indirect observations do not suggest strategies for clinical intervention during childhood, they provide a framework for considerations of the influence of adolescent growth and maturation on the risk of chronic diseases, and for the application of anthropometry to research on diet and chronic disease.
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PMID:Functional consequences from varying patterns of growth and maturation during adolescence. 826 92


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