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Query: UMLS:C0028754 (obesity)
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Obesity has become an epidemic in the United States and in many other countries of the world. Obesity is a chronic disease, not a failure of willpower. Diet, exercise, and behavioral modification of lifestyle are rarely successful over the long term. Medications have been used sparingly, because of concerns about addiction and ineffectiveness, but used chronically, obesity drugs are effective. The two main categories of obesity drugs are centrally active adrenergic and serotonergic agents. These drugs reduce appetite, enhance satiety, and increase energy expenditure. Use of single agents produces modest weight loss and use of combinations increases loss, but few patients reach their goal weight. Co-morbidities associated with obesity resolve or are reduced in severity with weight loss. Adverse events of major concern are changes in brain biochemistry and primary pulmonary hypertension. Published guidelines for use of obesity medications recommend they be used only for medically significant obesity.
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PMID:Use of drugs in the treatment of obesity. 924 Sep 33

The subjectively perceived health of children and adolescents has received little attention in Public Health research so far. In co-operation with school physicians of Hamburg, Eimsbuettel, 1,501 children and adolescents (grades 4 and 8, as well as their parents) were questioned with regard to health-related quality of life and health behaviour, using among others the short form of the KINDL Quality of Life Questionnaire and established psychosocial instruments. High values in the KINDL scale were found in 75% of the students, the mean value of the 0-100 transformed KINDL total scale was around 80. Adolescents--and in this group specifically the girls--reported significantly lower quality of life scores. Psychosocial strain, presence of disease and school absenteeism were negatively associated with quality of life ratings. Health-related behaviours in terms of resources in the area of food intake and risk behaviours in terms of addiction, obesity and stressors correlated with subjective health as expected. In multiple regressions these factors explained 20% of the KINDL-score variance in the total group. Taking into account indicators of functional status and life satisfaction, the percentage of explained variance increased to over 50%; here these predictors yielded a correct classification of high vs. low self-reported quality of life in 90% of the cases. The study shows that subjective health is a methodologically adequate and scientifically interesting indicator which in the public health area can be used in epidemiological research, in health reporting and in school physicians' practice to identify young persons with quality of life impairments in order to provide early and in-focus support to this group.
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PMID:[Subjective health and health behavior of children and adolescents--a survey of Hamburg students within the scope of school medical examination]. 1081 41

Experience with gastro-restrictive obesity showed the necessity of detailed research in three main tasks: 1. characteristics of morbidly obese people 2. psychological effects of surgery 3. interaction of these characteristics and effects of surgery. We carried out 7 studies with a total of 650 participants. Clinical interviews and tests measuring personality, eating behaviour, self esteem, addiction factors and quality of life were performed. Morbidly obese differ significantly from normal weight people with the exception of most personality scales. Effects of surgery can be summarized that patients learn to avoid overeating but they do not learn to nourish on healthy solid nutrition and they do not learn to exercise more than before. By paradox learning process 30-50 % of gastric banding patients establish vomiting behaviour or eating pulp and sweets. These who show low self esteem, high addiction score and high disinhibition behaviour are more at risk. Different psychological, nutritional as well as physiotherapeutic interventions are needed to help these patients.
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PMID:[Psychological aspects of bariatric surgery]. 1252 20

Obesity is an epidemic problem in the U. S. and many other industrialized nations. Historically, the drugs used for the treatment of obesity generally targeted small molecule neurotransmitters. As research grows to decipher the underlying molecular mechanisms behind energy homeostasis, it is becoming evident that the modulating effects of neuropeptides also are critical in the regulation of appetite and metabolism. The search for drugs to modify these monoaminergic and peptidergic pathways may eventually prove successful in the treatment of obesity. While tobacco smoking has long been used as one strategy to maintain a lower body weight, especially in female smokers, its adverse associations with addiction and disease overshadow its potential use as an antiobesity agent. Potential pharmacological effects of nicotine could be better understood as the intricacies of the nicotinic acetylcholine receptor are revealed. The objective of this review is threefold: first is to provide an overview of the physiological effects of nicotine on body weight while focusing on the drugs that are available as antiobesity and smoking cessation agents. Second is to provide the present status of the nicotinic acetylcholine receptor as it relates to energy homeostasis and its potential as an effective treatment modality for obesity. Third is to present the current knowledge with respect to nicotine's effects on energy homeostatic and reward related pathways at the molecular level. A better understanding of the regulatory mechanisms underlying the pharmacological effects of nicotine on body weight will provide insights in identification of potential targets for the development of appropriate medicines in the treatment of obesity.
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PMID:Nicotine, body weight and potential implications in the treatment of obesity. 1267 39

Yesterday. School hygiene acted in a clear way. Physician, pediatrician, nurse and hygienist were employed at school and were responsible for carrying out periodic examination, vaccination of school children and youth. They also supervised groups of children with posture defects, obesity, underweight, circulatory system and respiratory tract (asthma, anaphylaxis), diseases nervous system disorders and also propagated health education at school. Inspector of Pediatrics and School Medicine was in charge of School Medical Care. Today. Reform of the Public Health System. Medical examination and services have their value in money. A school physician, some hygienists and school nurses have been dismissed to decrease the financial costs of school hygiene. All medical services must be bought by the National Health Service. Public and private medical services at doctors and nurses are organized at schools. Each service performs examinations, vaccinations bought by the National Health Service or parents. A pupil is a subject of buying medical services. He may be vaccinated by a nurse but a medical examination must be either bought or performed by home doctor. The supervision of school children with different illnesses is not conducted by a school doctor. At present all the threats of contemporary world such as alcohol, tobacco, drug addiction, nervous system illnesses and allergies which are destructive for youth start when they are teenagers. School is an important place for carrying out on a large scale prophylactic services with medical teams of paediatricians, rehabilitation specialists and psychologists. Tomorrow. School Hygiene at School. Not at home doctor's. Recommendations, Daily Hygiene: personal, oral, food mental.... Hygiene of studying, rest and daily effort. Struggle with mass media, alcohol, drug, Internet, Computer addiction, violence, stupidity and poverty. School Hygiene should be adjusted to youth's health needs in accordance with the recommendations of European Society for Social Pediatrics (ESSOP) and Committee on Public Education, American Academy of Pediatrics and reinforced, it should not be eliminated.
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PMID:[School hygiene in the past, present and future--in the opinion of the Inspector of Pediatrics and School Medicine and member of the European Society for Social Pediatrics (ESSOP)]. 1500 12

Overproduction of corticotropin-releasing hormone (CRH) and stress system abnormalities are seen in psychiatric diseases such as depression, anxiety, eating disorders, and addiction. Investigations of CRH type 1 receptor (CRHR1) nonpeptide antagonists suggest therapeutic potential for treatment of these and other neuropsychiatric diseases. However, overproduction of CRH in the brain and on its periphery and disruption of the hypothalamic-pituitary-adrenal axis are also found in 'somatic' disorders. Some rare forms of Cushing's disease and related pituitary/adrenal disorders are obvious applications for CRHR1 antagonists. In addition, however, these antagonists may also be effective in treating more common somatic diseases. Patients with obesity and metabolic syndrome who often have subtle, but chronic hypothalamic-pituitary-adrenal hyperactivity, which may reflect central dysregulation of CRH and consequently glucocorticoid hypersecretion, could possibly be treated by administration of CRHR1 antagonists. Hormonal, autonomic, and immune aberrations are also present in chronic inflammatory, autoimmune, and allergic diseases, with considerable evidence linking CRH with the observed abnormalities. Furthermore, autonomic dysregulation is a prominent feature of common gastrointestinal disorders, such as irritable bowel syndrome and peptic ulcer disease. Patients with irritable bowel syndrome and other gastrointestinal disorders frequently develop altered pain perception and affective symptoms. CRH acts peripherally to modulate bowel activity both directly through the autonomic system and centrally by processing viscerosensory and visceromotor neural signals. This review presents clinical and preclinical evidence for the role of CRH in the pathophysiology of these disorders and for potential diagnostic and therapeutic applications of CRHR1 antagonists. Recognition of a dysfunctional stress system in these and other diseases will alter the understanding and treatment of 'psychosomatic' disorders.
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PMID:Nonpeptide corticotropin-releasing hormone receptor type 1 antagonists and their applications in psychosomatic disorders. 1552 86

Socioeconomic inequality and its impact on health is a growing concern in the European public health debate. In many countries, the issue is moving away from description towards the identification of the determinants of inequalities and the development of policies explicitly aimed at reducing inequalities in health. In Italy, ten years after the publication of the first report on inequalities in health, this topic is seldom present on the agenda of public policy makers. The purpose of this report is to update the Italian profile of social variation in health and health care in order to stimulate the debate on ways to tackle inequalities in health that are preventable. In the first section of this book, the threefold objective is to describe the principal mechanisms involved in the generation of social inequalities in health (Introduction); to report Italian data on the distribution and magnitude of this phenomenon in the last decade; and to evaluate policies and interventions in both the social (chapter 1.9, Section I) and the health sector (chapter 2.3, Section I), which are potentially useful to reduce health inequalities. It is intended for anyone who is in a position to contribute t o decision-making that will benefit the health of communities. For this reason, chapters are organized by specific determinants of inequalities on which interentions may have an impact. The methodological approach in the second section focuses on the best methods to monitor social inequalities including recommendations on social indicators, sources of information and study models, based on European guidelines revised for the Italian situation. According to data from national and local studies, mortality increases linearly with social disadvantage for a wide range of indicators at both the individual (education, social class, income, quality of housing) and the geographical level (deprivation indexes computed at different levels of aggregation). This positive correlation is evident for both sexes, with the steepest gradient observed among adults of working age, although differences persist also among the elderly. The causes of death found to be most highly correlated with social inequality, and largely responsible for the increasing inequality over the last decade, are those associated with addiction and exclusion (drug, alcohol and violence related deaths), with smoking (lung cancer) and with safety in the workplace and on the roads (accidents). Similar gradients and trends have been observed with different outcomes, such as self-reported morbidity, disability and cancer incidence (chapter 1.1, Section I). Reproductive outcomes confiirm this picture: compared to women belonging to the upper classes, those women in low conditions experience more spontaneous abortions and their children suffer from higher infant mortality and low birth weight. This is a critical issue since poor infant health, particularly for metabolic and respiratory pathologies, affects health in adult life. There is now substantive evidence showing that also socioeconomic circumstances at birth or during adolescence may have a strong impact on adult health (chapter 1.2, Section I). Differences in harmful lifestyles, such as smoking, heavy drinking, drug use, unhealthy diet, obesity and physical inactivity, have a similar effect. The only exception is smoking among women, which is positively correlated with socioeconomic status; however, since women in the upper classes have a greater tendency to quit smoking, the gradient will soon be reversed (chapter 1.7, Section I). On the other hand, most of these behaviours do not follow from free and conscious individual choice; they are a form of adaptation to chronic stress originating in the work-place (chapter 1.4, Section I), or to particularly unfavourable events and conditions, such as unemployment (chapter 1.5, Section I) or lack of family and social support (chapter 1.6, Section I). Poor socioeconomic circumstances are the threshold of absolute poverty and may lead to social exclusion, a condition with a heavy impact on health, which in Italy includes marginal groups of the native population and broader classes of immigrants (chapter 1.3, Section I). Finally, there is recent and consistent evidence on the existence of a "contextual" effect on health, as opposed to the "compositional" effect given solely by the aggregation of individual processes. According to this hypothesis, characteristics of the infrastructure, and the physical and socioeconomic environment of an area would have an impact on individual health independent from the cultural and economic resources personally available to people living in that area (chapter 1.8, Section I). With respect to the health care system, various studies are in agreement in demonstrating that poor and less educated people have inadequate access both to primary prevention and early diagnosis (chapter 2.1, Section I), and to early and appropriate care (chapter 2.2, Section I). They also experience higher rates of hospitalization, particularly in emergencies and with advanced levels of severity.
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PMID:[Inequalities in health in Italy]. 1553 46

The Third Galanin Symposium presented many different and exciting results on galanin research reflecting a major progress since the previous symposium in 1998. A major impression was the many possible relationships of galaninergic mechanisms to important brain functions such as development, cognition and ageing as well as many aspects related to a wide spectrum of diseases, including Alzheimer's disease, anxiety/depression, addiction, obesity, pain and tumour growth. These studies were based on an extensive armament of methodologies including various strains of transgenic mice. Unfortunately, the pharmaceutical industry had only a minor participation. Nevertheless, exciting developments in the generation of agonists and antagonists are emerging, providing hope that we at the next symposium will be able to validitate many of the challenging hypotheses concerning galanin and disease with the help of pharmacological tools.
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PMID:Galanin and its receptors: introduction to the Third International Symposium, San Diego, California, USA, 21-22 October 2004. 1590

The endocannabinoid system plays a major role in the regulation of body energy by stimulation of the appetite in the hypothalamus and increase of fat accumulation in adipocytes. The blockade of the cannabinoid system (CB1) by the specific inhibitor (rimonabant) decreases food intake and adiposity in animals and in humans. Moreover rimonabant lowers tobacco addiction. Clinical studies (RIO-LIPIDS and RIO-EUROPE) have recently confirmed that rimonabant combined with a hypocaloric diet over 1 year, promoted significant decrease of body weight, waist circumference and improvement of dyslipidemia. Rimonabant was well tolerated with mild and transient side effects. The future place of rimonabant in the strategy of obesity is still to be clarified.
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PMID:[Rimonabant (Acomplia), specific inhibitor of the endocannabinoid system]. 1603 41

This report summarizes the background and specific objectives for a symposium on the neurobiology of nonhomeostatic eating and drug abuse that was held at the 2004 Annual Meeting of the Society for the Study of Ingestive Behavior (SSIB). The symposium was the first of a series funded by a conference grant from four institutes of the National Institutes of Health. The encompassing goal of the series is to analyze the roles for the biological mechanisms of ingestion in obesity, eating disorders and other theoretically related areas including addiction, depression and schizophrenia. The symptoms and treatments of these diverse pathologies routinely involve aberrations in the mechanisms regulating eating and body weight. The presentations and discussion from this symposium (1) identified changes in neurotransmitter dynamics and gene expression in brain "reward circuits" accompanying learning of behaviors to obtain palatable foods or drugs of abuse; (2) analyzed behavioral findings in animals and humans, and neuroimaging data in humans, supporting treatment with GABA(B) agonists to reduce craving for drugs of abuse and possibly for highly rewarding foods; and (3) used neuroimaging data in humans to establish novel serotonergic targets for normalizing reward processes and impulse control in anorexia nervosa and bulimia. Overall, the symposium clearly revealed our rapidly broadening understanding of the alterations in the brain at the molecular, cellular and systems levels that are associated with craving and nonhomeostatic consumption of food and drugs of abuse. This knowledge gained largely in animal models translates to novel and better strategies for treating human patients.
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PMID:NIH symposium series: ingestive mechanisms in obesity, substance abuse and mental disorders. 1612 61


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