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Data of the 1992-1993 Mexican Survey of Chronic Diseases in the Urban Adult Population were analyzed to investigate the effects of age and sex on the association between overweight and hypertension. Blood pressure, body weight, and height were measured in a group of 13,945 Mexicans aged 20 to 69 years living in towns and cities larger than 15,000 people. Hypertension was defined following the recommendations of the Joint National Committee for Detection, Evaluation, and Treatment of High Blood Pressure-V. Overweight was defined following the recommendations of the National Institutes of Health Consensus on Health and Obesity. The prevalence of types of hypertension was higher in men than in women, particularly in the groups of 20 to 39 years of age. Cross-classification of subjects according to the presence of hypertension and overweight confirmed the association between both variables. The odds ratio and 95% confidence intervals indicated that overweight was associated with systolic and diastolic hypertension and with isolated diastolic hypertension in women and, to a lesser extent, in men. This association was not found in the 60- to 69-year group in both sexes. Overweight did not show significant association with isolated systolic hypertension in both sexes. Results of a multiple logistic regression analysis of overweight on hypertension, controlling for age and sex, were consistent with these findings. It is suggested that other factors, independent of overweight, explain the observed gender-specific differences in the prevalence of hypertension in younger age groups. The hormonal environment of young women is one of the mentioned factors modifying the prevalence of hypertension in this group of the Mexican urban adult population.
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PMID:Overweight and hypertension: data from the 1992-1993 Mexican survey. 932 97

Although there is a high prevalence of overweight among Navajo children and adolescents, other risk factors for chronic disease in this population have received little attention. We therefore examined the distribution and interrelationships of overweight, cigarette smoking, blood pressure and plasma levels of lipids and glucose among 160 Navajo 12- to 19-y-olds. In agreement with previous reports, participants were approximately 2 kg/m2 heavier than adolescents in the general U.S. population, and the prevalence of overweight (> 85th percentile) was 35-40%. Levels of total cholesterol and blood pressure were similar to those in the general U.S. population, but Navajo adolescents had a 5-10 mg/dL lower median level of HDL cholesterol, and a 30 mg/dL higher median triglyceride level. Eight percent of the adolescents examined had either impaired glucose tolerance or diabetes mellitus as assessed through an oral glucose tolerance test (n = 10) or self-report (n = 1). Relative weight (kg/m2) was associated with adverse levels of lipids, lipoproteins and glucose, with overweight adolescents having a fivefold greater risk for elevated triglyceride levels than other adolescents. Tobacco use was fairly prevalent among boys (24% cigarettes, 23% smokeless tobacco), but not girls (9% cigarettes, 3% smokeless tobacco). Because of its associations with other risk factors and with various chronic diseases in later life, it may be beneficial to focus on the primary prevention of obesity among Navajo children and adolescents.
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PMID:Obesity, levels of lipids and glucose, and smoking among Navajo adolescents. 933 79

Obesity is a chronic disease, which similar to diabetes and hypertension, requires long-term treatment. The patient must be willing to make major changes in eating habits, lifestyle, and physical activity to achieve long-lasting results.
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PMID:Obesity. 945 56

Migraine headache is a common syndrome, afflicting millions, that has so far defied a definitive cure. Experimental research studies of the syndrome tend to describe the triggering factors separately. We propose a common denominator--namely, high levels of blood lipids and free fatty acids--as underlying factor in the development of migraine headaches. Biological states that may cause increases in free fatty acids and blood lipids include: high dietary fat intake, obesity, insulin resistance, vigorous exercise, hunger, consumption of alcohol, coffee, and other caffeinated beverages, oral contraceptives, smoking, and stress. Elevated blood lipids and free fatty acids are associated with increased platelet aggregability, decreased serotonin, and heightened prostaglandin levels. These changes lead to the vasodilatation that precedes migraine headache. We suggest that migraine headache should not be seen as an isolated symptom, but as a first signal of potential biochemical imbalances in the body, which can lead to development of chronic disease.
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PMID:In search of the ideal treatment for migraine headache. 948 75

Obesity threatens to become the foremost cause of chronic disease in the world. Being obese can induce multiple metabolic abnormalities that contribute to cardiovascular disease, diabetes mellitus, and other chronic disorders. Unfortunately, prevalence of obesity is increasing both in the United States and worldwide. Reasons for the rising prevalence include urbanization of the world's population, increased availability of food supplies, and reduction of physical activity. Although severe obesity has received much attention in the clinical setting, most obesity in the general public is only moderate. Even so, moderate obesity can elicit several metabolic abnormalities that are precursors to chronic disease. Therefore, for the population as a whole, moderate obesity is responsible for most obesity-related disorders. Moderate obesity is undoubtedly multifactorial in origin, and acquired influences probably exceed genetic factors in its causation. These acquired causes thus deserve greater attention in the development of a public health strategy for the control of overweight in the general population. A major public health effort is urgently needed to counter the increasing frequency of moderate obesity in the United States and throughout the world.
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PMID:Multifactorial causation of obesity: implications for prevention. 949 71

The United States is in the midst of an escalating epidemic of obesity. Over one-third of the adult population in the United States is currently obese and the prevalence of obesity is growing rapidly. By any criteria, obesity represents a chronic disease which is associated with a wide range of comorbidities, including coronary heart disease (CHD), Type 2 diabetes, hypertension and dyslipidemias. The comorbidities of obesity are common, occurring in over 70% of individuals with a BMI of > or = 27. In addition to obesity itself, excessive accumulation of visceral abdominal fat and significant adult weight gain also represent health risks. Physicians have an important role to play in the treatment of obesity. Unfortunately, the medical community has not been involved actively enough to help stem the major epidemic of obesity occurring in the United States. This article puts forth a proposed model for the treatment of obesity in clinical practice, including obtaining the "vital signs" of obesity, recommending lifestyle measures, and instituting pharmacologic therapy when appropriate. By utilizing a chronic disease treatment model, physicians can join other health care professionals to effectively treat the chronic disease of obesity. Relatively modest weight loss, on the order of 5-10% of initial body weight can result in significant health improvements for many patients and represent an achievable goal for most obese patients.
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PMID:The case for medical management of obesity: a call for increased physician involvement. 956 73

There are major efforts underway to educate the primary care physician about the health risks of obesity. Obesity is a chronic disease that requires chronic management. We must establish models that allow primary care physicians to participate in the chronic management of obesity, while recognizing that the interest and ability of primary care physicians to participate in obesity management will vary. Three general models of obesity management are proposed for the primary care physician, ranging from minimal evaluation to complete evaluation and treatment. In order for the models to be implemented, we must consider establishing a category of obesity specialists who can develop comprehensive treatment programs to which patients with obesity can be referred, and who can provide leadership and guidance for primary care physicians who are involved in obesity management. The North American Association for the Study of Obesity (NAASO) could help establish obesity specialists and provide a structure to allow them to provide leadership for obesity treatment.
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PMID:Dealing with obesity as a chronic disease. 956 74

This article reviews recent research on the prevalence and virulence of obesity as a causal risk factor for mortality and morbidity. The prevailing assumption that obesity, by itself, is a chronic disease or a primary risk factor for health is challenged. A historical perspective is used to analyze the efficacy of various medical and educational approaches that have attempted to alter body size in the pursuit of enhanced physical health. The motivational discrepancies between society's media-induced desire for thinness and the health field's risk reduction approach to weight loss are outlined. Finally, ethical issues are raised in relation to current weight control measures, implications for future educational efforts are discussed, and potential guidelines for future weight management programs are presented.
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PMID:Weight loss management: a path lit darkly. 961 45

Relative to information on activities of daily living, information regarding the onset of and recovery from mobility difficulty has been limited. Drawing upon data gathered from 6,376 self-respondents aged 51-61 years at baseline (1992) who were successfully reinterviewed in 1994 as part of the Health and Retirement Survey, the authors were able to build upon and add to knowledge gained from previous studies of the onset of and recovery from mobility difficulty. Hierarchical logistic regression was used to separate the direct and indirect effects of predictors of mobility difficulty onset and recovery at 2-year follow-up. To separate direct and indirect effects, the authors categorized various predictors as being related to sociodemographic factors, economic factors, health behavior, chronic disease, or physical impairment, and the categories were sequentially incorporated into a series of equations. The order in which the predictors were incorporated into the equations followed from a theoretical model of the disability process. In this study of mobility difficulty, the strongest direct predictors of recovery were having little baseline difficulty and the absence of diabetes mellitus, lung disease, and frequent pain. The strongest direct predictors of onset were female sex, less education, low net worth, lack of private health insurance, obesity, and frequent pain. Few indirect predictors for either onset or recovery were identified. Predictors of recovery were few and differed from predictors of onset. Further efforts are needed to identify modifiable predictors among females, persons with few economic resources, and those with frequent pain.
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PMID:Predictors of onset of and recovery from mobility difficulty among adults aged 51-61 years. 966 5

Obesity has reached what some scientists see as epidemic proportions. Clearly, a rethinking of the medical nutritional therapeutic approach is needed. Treatment programs must include a variety of health professionals to facilitate the lifestyle changes needed to treat this condition. There is a role in obesity management for registered dietitians, behaviorists, physicians, exercise physiologists, and geneticists. A chronic disease treatment model is being proposed. Are dietitians ready for the challenge?
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PMID:Obesity as an epidemic: facing the challenge. 978 29


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