Best Practices in the Prevention and

Treatment of Childhood Obesity

Michael Coles, Ph.D.

Wade Gilbert, Ph.D.
Department of Kinesiology
California State University, Fresno

June 2005
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Table of Contents

I. ACKNOWLEDGMENTS 3

II. INTRODUCTION 4

III. EXECUTIVE SUMMARY 7

IV. RESEARCH COMPENDIUM 23

V. WEB-BASED RESOURCES 246

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Acknowledgements

This report was sponsored by the Central California Center for Health and Human Services
(CCCHHS) at California State University, Fresno.

Data collection and report formatting assistance was provided by Andres Hernandez, Sarah
McCord, and Adam Smith.
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Introduction

The purpose of this report is to present a summary of research and resources that directly address
prevention and treatment strategies for obesity. This report is designed to complement other
obesity best practice reports and research reviews (i.e., Colorado Department of Public Health
and Education, 2003; Parizkova & Hills, 2005; Taskforce on Community Preventive Services,
2005; Voss & Wilkin, 2003).

Although the consequences of obesity have been debated (Gibbs, 2005), there is no challenge to
the fact that obesity is now prevalent both in the United States and globally (World Health
Organization, 1997). Results of a recent national study show that approximately 16% of youth
12-19 years of age are considered overweight (National Center for Health Statistics, 2004b). This
is triple the amount from measures done in 1980 (National Center for Health Statistics, 2004a).
Inactivity among adolescents is a contributing factor for the increasing trends in overweight
(USDHHS, 2000). In fact, in 1996, the Surgeon General classified inactivity as a health risk and
recommended physical activity promotion as a critical policy and research area.

More than ever, children and adolescents are developing cardiovascular disease, Type II
diabetes, metabolic syndrome, and other chronic disease. For example, risk factors for
premature coronary heart disease (CHD) include family history, cigarette smoking, elevated
blood pressure, severe obesity, diabetes mellitus, physical inactivity, elevated concentrations of
total and low-density lipoprotein (cholesterol), and a low concentration of high-density
lipoprotein (cholesterol). A number of these risk factors, including, obesity, hyperlipidemia, and
inactivity have been tracked from adolescent into adulthood (Anding et al., 1996). In a study
done on CHD risk factors in youth, more than 80% of the subjects had at lease one risk factor
and 25% demonstrated two or more risk factors (Anding et al., 1996). In a recent study on youth
with Metabolic Syndrome (also known as Insulin Resistance Syndrome, or Syndrome X),
metabolic risk was inversely related to physical activity and there was a significant positive
interaction between physical activity and fitness (Brage et al., 2004).

Obesity has been identified by the US Surgeon General as one of the most preventable chronic
diseases and billions of dollars are spent each year to fight obesity. The prevention and treatment
of obesity is extremely complicated because obesity is the result of many factors. In the latest
Dietary Guidelines for Americans it is explicitly acknowledged that the two most significant
causes of rising obesity rates in America are declining levels of physical activity and poor diet
(USDHHS & USDA, 2005). Poor diet together with lack of physical activity is now considered
the second leading cause of death, behind only tobacco use, in America (USDHHS, 2004).

Therefore, the purpose of this report is to summarize common best practice recommendations
that address the two primary causes of obesity, diet and physical inactivity. The report includes
three sections: (a) an executive summary of best practice information directed at diet and
physical activity solutions to the problem of childhood obesity, (b) a compendium of research
related to obesity prevention and treatment, and (c) a listing of web-based resources which
provide information about obesity prevention and treatment.
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Methodology and Delimitations

The information presented in these three sections is based on a comprehensive search and review
of English journal articles published between 1995 and 2005 and websites related to obesity. The
following electronic databases were searched using the terms obesity prevention and obesity
treatment: Agricola, Biological Abstracts, CAB Direct, CINAHL, Expanded Academic ASAP,
GPO, PAIS International, Physical Education Index, PsychInfo, PubMed, and SPORT Discus.
Online resources were identified by searching known obesity related web sites and their links, as
well as conducting a Google (www.google.com) search combining obesity and the following
terms: treatment, prevention, education, treatment programs, prevention programs, education
programs, health, and fitness. A record for each journal article and website was entered into the
EndNote bibliographic software program (Thomson ISI ResearchSoft, 2004).

The executive summaries are best viewed as brief overviews of the empirically-based strategies
that have been reported in the recent literature. The annotated bibliography includes reference
information, abstracts, and a subject index for over 930 journal articles. The online resources
section includes web addresses and site descriptions, and is organized by type of source (i.e.,
government, corporate, association).

References

Anding, J. D., Kubena, K. S., McIntosh, W. A., & OBrien, B. (1996). Blood lipids,
cardiovascular fitness, obesity, and blood pressure: The presence of potential coronary
heart disease risk factors in adolescents. Journal of American Dietetic Association, 96(3).
238-243.

Brage, S., Wedderkopp, N., Ekelund, U., Franks, P. W., Wareham, N. J., Andersen, L. B., &
Froberg, K. (2004). Features of the metabolic syndrome are associated with objectively
measured physical activity and fitness in Danish children: the European Youth Heart
Study. Diabetes Care, 27(9). 2141-2149.

Colorado Department of Public Health and Education (2003). Best practices: Obesity
prevention for children and youth. Retrieved May 15, 2005 from
http://www.cdphe.state.co.us/ps/bestpractices/topicsubpages/obesity.html

Gibs, W. W. (2005, May 23). Obesity: An overblown epidemic? Scientific American. Retrieved
June 8, 2005 from
http://www.sciam.com/article.cfm?chanID=sa006&articleID=000E5065-2345-128A-
9E1583414B7F0000

National Center for Health Statistics. (2004a). Obesity still a major problem, new data show.
Hyattsville, MD: USDHHS.

National Center for Health Statistics. (2004b). Prevalence of overweight among children and
adolescents: United States 1999-2002. Hyattsville, MD: USDHHS.
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Parizkova, J., & Hills, A. (2005). Childhood obesity: Prevention and treatment (2nd ed.). Boca
Raton, FL: CRC Press.

Taskforce on Community Preventive Services. (2005). Promoting physical activity. Retrieved

May 15, 2005 from
http://www.thecommunityguide.org/pa/

Thomson ISI ResearchSoft. (2004). EndNote v8. Stamford, CT: Author.

USDHHS (2000). Physical activity. Retrieved June 15, 2005 from

http://www.healthypeople.gov/Document/html/uih/uih_bw/uih_4.htm#physactiv

USDHHS (2004). Progress review: Physical activity and fitness. Retrieved June 22, 2005 from
http://www.healthypeople.gov/data/2010prog/focus22/

USDHHS & USDA. (2005). Dietary guidelines for Americans 2005. Retrieved June 15 from
http://www.healthierus.gov/dietaryguidelines/

Voss, L., & Wilkin, T. (Eds.). (2003). Adult obesity: A pediatric challenge. London: Taylor &
Francis.

World Health Organization. (1997). Obesity: Preventing and managing the global epidemic.
Geneva: WHO.
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Executive Summary
Obesity Best Practices: Diet and Physical Activity Evidence
Diet and Dietary Habits

Clearly, the prevalence of childhood obesity is increasing (Caballero, 2004; Kaur et al., 2003).
There are two primary ways in which diet can have an impact in this battle. It can play a role in
the treatment of the problem or it can function to help prevent the condition from occurring. The
following information will illustrate the ineffective role diet manipulation strategy alone has on
treatment of child or adolescent obesity. Emphasis instead will be placed on the more important
practice of prevention, especially in those young individuals that are at high risk for developing
increased adiposity.

Diet and dietary habits do play a role in the treatment of obesity. This is true both for adults and
children. However, experts generally agree, that dietary treatment of obesity alone is relatively
ineffective in these groups of individuals. This has been demonstrated in a study conducted using
differing weight reducing diets on massively obese, 11- to 16-year-old children. Substantial
weight loss was obtained with moderately energy-restricted diets with normal fat content. But
after weight loss, mean weight again increased in these individuals. In addition, after weight loss
there was a concurrent shift back towards obesity-associated behavioral patterns. A more
successful approach to treatment has been established using multidisciplinary dietary-behavioral-
physical activity intervention programs (Nemet et al., 2005). The treatment of childhood obesity
is very difficult and only necessary if prevention has failed. So, prevention should be the primary
focus when considering a best practice approach to deal with the problem of childhood obesity.

With regard to prevention, it has been suggested that child and adolescent obesity preventative
strategies should emphasize increased physical activity rather than diet because of fears relating
to the adverse effects of fostering inappropriate eating patterns and/or disorders (Watts et al.,
2005). Even with this important point made, experts do agree that it is likely that habits learned
during early childhood and into adolescence can profoundly influence the development of adult
obesity and the subsequent development of chronic disease that goes along with it. A variety of
best practice themes related to improving the dietary habit of children and adolescents aimed at
prevention have been offered in the literature and through various programs and organizations.

Many individuals have offered educated opinions related to the most important factors associated
with the ideal obesity prevention program. Experts have summarized the ideal obesity prevention
program as being multi-faceted and agree that there are very few proven preventive strategies for
children (Caballero, 2004). Those things, however, that are often mentioned when describing
successful programs include, breastfeeding infants and generally improving infant and toddler
diets. It appears that composition of food in toddler and childrens diets may have a greater
impact on the development of childhood obesity that merely overeating (Parizkova & Hills,
2005). It has been suggested that infants and toddlers should eat less protein and that toddlers
and children in preschool consume more carbohydrates (Caroli & Lagravinese, 2002) and fiber
(Kimm, 1995). Authorities also argue that successful programs need to include monitoring,
especially in high-risk children, and education to children and primary care givers in an attempt
to enlighten them as to the real dietary needs of the children. This education should include
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lessons on not using food as a form of reward and/or consolation (Caroli & Lagravinese, 2002).
It has also been suggested that schools, communities, food industries, and mass media get
involved in an effort to promote environments that encourage healthy nutrition (Sothern, 2004).

Monitoring obesity development in children seems to be a key part of a preventative practice

(Shephard, 2004). It is suggested that childrens growth should be monitored using the body
mass index (BMI), and body composition analysis. Furthermore, it is suggested that risk factors
associated with dietary and physical activity histories should also be closely monitored. These
practices are especially important when other highly interdependent factors, such as hereditary,
geographic, economic, environmental, and cultural, predispose a child to a higher risk for
developing the condition.

Good nutritional practice for children starts before the child is born. It is important to recognize
that malnutrition during the early stages of fetal development may bring about obesity later in
life (Popkin, 2001). Research suggests that when a developing fetus is exposed to hyperglycemic
conditions it is likely to develop obesity during childhood (Barker, 1998). Likewise, when a
mother is obese during pregnancy there is a greater likelihood that the child will become obese.
A specific example of this is illustrated in the results of a study with low-income children whose
mothers were obese in early pregnancy. This study revealed a more than double the risk of
obesity for children at 2 to 4 years of age when the babies were born to mothers who were obese
during early pregnancy (Whitaker, 2004). After the birth of the child, reduced breastfeeding
practices have also been linked to the eventual development of obesity in the child. As a
reference, an analysis of longitudinal data from the Centers for Disease Control and Prevention
Pediatric Nutrition Surveillance System suggest that breastfeeding longer than 6 months will
provide health benefits to children, including reducing the potential for the development of
obesity in childhood (Grummer Strawn & Mei, 2004). While this effect is thought to be less
influential than others (i.e. genetics and environment), it is still important enough to be
considered when examining nutritional best practices (Campbell, 2003; Dewey, 2003; McCarter
Spaulding, 2004). Lastly, research shows an increase risk of childhood obesity in children who
have mothers that smoke (Toschke, 2003). These points suggest that a strategy to prevent obesity
in preschoolers is to provide prenatal nutritional education and promote proper nutritional
practice during pregnancy. In addition it is important to identify at risk newborns, specifically
those with obese mothers who will not breastfeed for extended lengths of time and who smoke,
and begin comprehensive monitoring, modeling, and formal and informal education programs
(both nutritional and physical activity based) for these children and their care givers.

Nutritional education programs have been shown to be effective in the prevention of childhood
obesity. These education programs can be both formal and traditional and/or they can be
informal and non-traditional. All, however, should emphasize the importance of using healthy
weight-control practices (Neumark Sztainer et al., 2000).

The use of formal educational programs and strategies should be considered when discussing
best practices related to obesity prevention. It has been suggested that these educational based
programs should focus on teaching about the importance of consuming a balanced diet and
increasing food variety (Westenhoefer, 2002). Some experts suggest that by age 4 childrens
propensity to eat a variety of foods begins to decline. If variety is not introduced during this time
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life-long aversions to foods may develop. This may dramatically influence healthy eating choices
(Cashdan, 1994). Other educational practices should include providing guidance regarding a
range of healthy and acceptable body weights and body compositions, while at the same time
promoting a variety of flexible healthy eating strategies that allow children to maintain a healthy
weight and body composition. Schools seem to be a viable place for these kinds of programs.
The results of a recent pilot study has demonstrated that school may be a good setting for
promoting healthy lifestyles in children, but it also requires follow-up in other social
environments. School-based programs should be long-lasting, multi-faceted and sustainable.
They should involve all children in a school, they should target the whole environment, and they
should be behaviorally focused (Warren et al., 2003). The Center for Disease Control and
Prevention issued a recent report with guidelines for ensuring a quality nutrition program within
a comprehensive school health plan. The recommendations include advancing school policy on
nutrition, and developing a sequential and coordinated curriculum that includes appropriate and
fun instruction for students. In addition, the CDC recommends integration of school food service
and nutrition education, staff training, family and community involvement, and program
evaluation (CDC, 1996). Researchers have confirmed the positive impact that the CDC
guidelines can have on lowering the rates of childhood obesity and improving the overall eating
and exercise behaviors in children that attend schools that follow these guidelines (Veugelers &
Fitzgerald. 2005). There has also been some promising work done in community-based after
school programs, provided these programs are multi-dimensional and include nutritional
education and physical activity promotion for the whole family (Story et al., 2003). While this
formal education is important, it is unfortunately not always readily accessible. When this is the
case an informal education offered by the family becomes very important.

The family, especially parents or primary care providers, undoubtedly profoundly influence the
nutritional habits of children during the formative years. It has been suggested that a childs
weight is directly impacted through the familys food preferences as well as eating and activity
patterns. In this regard, experts report that parents play many roles when it comes to managing a
childs weight and eating patterns (McCaffree, 2003). These roles include that of a provider, an
enforcer and a role model. As a provider, a parent or primary care provider should make healthy
foods available at home as research has shown that children who eat more fruits and vegetables
in early years are more likely to consume these foods in greater abundance later in life. As an
enforcer, a parent can unknowingly promote a reduction in a childs ability to self-regulate food
intake. Therefore, caution must be exercised when restricting or managing a child or infants diet
or over-management could result that may lead to an inability in a child being able to self-
regulate later in life. Being a positive role model, as it relates to healthy weight management, is
critical (McCaffree, 2003). This modeling serves as a direct reflection of good self-care that
reinforces the promotion of healthy behaviors by presenting a positive self-image by the parent
or primary care provider. Formal education programs and less formal family based nutritional
edification and modeling situations are very important best practices in obesity prevention.
Another approach is to use the less traditional and very influential popular media as a vehicle for
good dietary practice promotion.

Television watching is highly related to obesity in children and adolescents (Caroli et al., 2004).
It has been suggested that television watching promotes unhealthy habits both in the form of
reduced physical activity and poor dietary example. Research shows that the number of
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television food advertisements targeting children has increased recently, and that there has been
an increased emphasis in the promotion of junk food in all of its forms. It is clear that the popular
media has a profound influence on children. It has been suggested, therefore, that a best practice
may be to use this media in a more constructive and positive way. In this regard an attempt can
be made to model healthy dietary habits and spread correct information on good nutrition and
obesity prevention during the important early childhood years.

Diet and Dietary Habits: Best Practices Summary

In summary, it is clear that the best diet practice is to prevent obesity from occurring. It has been
repeatedly shown that treatment is very difficult and requires major life-style and behavioral
modification. It has also been shown that obesity treatment, in the form of dietary intervention,
must be done in a highly controlled, integrated, and carefully managed way. Prevention is not
easy either. It also includes combining the efforts of many. It requires consistent monitoring of
obesity status in the form of BMI and/or body composition. This is especially true for at risk
individuals. These individuals, generally speaking, have mothers who were obese and had poor
diets during pregnancy, who did not breastfeed or breastfed for short durations, and/or whose
primary care giver(s) are obese and/or practice poor dietary modeling. It appears as though
education, whether it be formal or informal, is critical. This education needs to come at an early
stage in a childs life as dietary habits and food preferences seem to develop very quickly.
Research shows that school-based programs that follow clearly defined recommendations are
most successful. Finally, as with any program that requires dietary manipulation, treatment-based
or preventative, there is increased potential for the development of eating disorders. Because of
this many may argue that promotion of increased use of physical activity as prevention and/or
treatment, as opposed to or at least in combination with dietary resolutions, may be a superior
method to dealing with child and adolescent obesity.

Physical Activity

The widely accepted scientific definition of physical activity (PA) is a bodily movement
produced by skeletal muscles resulting in caloric expenditure (Caspersen, Powell, & Christenson,
1985; USDHHS, 2005). Populations shown to be at high risk for physical inactivity, such as
minority, low socioeconomic status, and children, have been the primary target of most PA
intervention research. In the federal governments Healthy People 2010, women, less educated,
African Americans and Hispanics, disabled, and those over the age of 75 are identified as
populations with low rates of PA (USDHHS, 2000). Based on evolving policy, guidelines, and
interdisciplinary links there has been a recent shift in PA interventions from vigorous exercise to
moderate intensity activity. It is generally accepted that the relationship between PA and health
outcomes is curvilinear. Therefore the potential for greatest public impact is found with moderate
physical activity interventions developed for physically inactive individuals.

The 2005 Dietary Guide for Americans provides adults with three sets of recommendations for
PA in order to promote a healthy body weight (USDHHS & USDA, 2005). The recommendation
for healthy adults wanting to reduce their chronic disease risk is 30 minutes daily of moderate-
intensity PA. In order to manage body weight and prevent unhealthy weight gain 60 minutes of
moderate to vigorous intense PA on most days of the week is recommended. Lastly, to sustain
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weight loss it is recommended that adults participate in 60 to 90 minutes of moderate intensity

PA daily. The recommendation for youth is to complete at least 60 minutes of PA each day of
the week. Moderate intensity PA is characterized by an increase in breathing or heart rate, a
perceived exertion of 11 to 14 on the Borg scale, 3 to 6 metabolic equivalents (oxygen use), or
any activity that results in an expenditure of 3.5 to 7 calories per minute (USDHHS, 2005).
Examples of moderate intensity PA include brisk walking, swimming, or mowing the lawn.
Vigorous intensity PA is associated with large increases in breathing or heart rate, a perceived
exertion of 15 or greater on the Borg scale, more than 6 metabolic equivalents, or any activity
that expends more than 7 calories per minute (USDHHS, 2005). Activities classified as vigorous
intensity PA include jogging, aerobic dance, or cycling uphill.

Unfortunately we now live in a society that has systematically removed opportunities for daily
PA. Less than 5% of the nations high schools require daily physical education and less than
30% of high school youth participate in daily physical education. Even in schools that do require
daily physical education, most students (62%) are inactive over 50% of the class time. What is
perhaps most troubling about the physical inactivity epidemic is that patterns of physical activity
developed in youth predict lifelong physical activity behaviors and well-being (Guo et al., 1994;
Must et al., 1992; Telama et al., 1997). This is evident in the physical inactivity statistics for the
adult population. Healthy People 2010s latest progress review for physical activity and fitness
shows that 38% of adults dont participate in any leisure time PA (USDHHS, 2004). Only 33%
of adults meet government guidelines for PA and these statistics have not changed significantly
from the 1997 data used to prepare the Healthy People 2010 objectives.

Given the scope of the physical inactivity problem, there have been many government initiatives
to promote physically active lifestyles. These include the VERB media campaign, the Presidents
Challenge, Steps to a HealthierUS, and the You Can!, Steps to Healthier Aging campaign
(USDHHS, 2004). Because youth spend most of their time in school, physical education has
repeatedly been identified as the optimal context for promoting the adoption and maintenance of
a physically active lifestyle (NASPE, 2002; Pangrazi, 2003; USDHHS, 2000). The question then
becomes: Which intervention programs are most effective at helping Americans adhere to
physical activity guidelines in order to prevent weight gain and promote weight loss? The
following strategies are highlighted in the recent Progress Review for Physical Activity and
Fitness as ones that have demonstrated strong evidence of effectiveness in increasing PA: point-
of-decision prompts, communitywide campaigns, school-based physical education, individually
adapted behavior-change programs, creation of or enhanced access to places for physical
activity, and informational outreach activities (USDHHS, 2004). The remainder of this executive
summary provides a brief overview of some of the recent research on these types of strategies.
No research on the effectiveness of point-of-decision prompts were identified with the search
criteria used to prepare this obesity best practices report and therefore no further discussion of
this strategy is provided.

Communitywide Campaigns

A major concern for these types of campaigns is their ability to effectively reach and recruit
members of the community. It appears that a multiple method recruitment strategy, targeting all
high risk groups, is needed otherwise only certain segments of the community will participate
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(Yancey et al., 2003). A review of the ROCK! Richmond initiative shows that individuals who
responded to the recruitment media were mostly African Americans and females with
significantly higher BMIs and a family history of chronic disease. The participants were also
found to have higher employment, education, and income levels than a random sample of
Richmond residents. Communitywide campaigns that intentionally target specific high risk
samples of the community have been shown to be effective.

A Los Angeles County example focused on workplace PA integration for African Americans and
reported that nearly 50% of the organizations made some changes in their workplace routines
demonstrating broad, but not complete, support for PA integration (Yancey et al., 2004). There
were observed differences by organization type suggesting that different types of PA initiatives
may need to be offered for different types of workplace contexts. Interactive weekly group
sessions on diet and PA topics and a comparison intervention that focused on global self-esteem
were compared in a communitywide campaign targeting African Americans in Memphis (Beech
et al., 2003). The active intervention participants made significant gains in healthy diet and PA
behaviors. In just 12 weeks the participants increased their moderate to vigorous PA by 12%. In
contrast, the comparison intervention participants only showed trends toward positive health
(BMI and waist circumference).

Although not evidence based, other suggestions for increasing the effectiveness of
communitywide campaigns include local tax initiatives on products that are contraindicated with
increasing PA, such as soft drinks, fast food, and automobiles (Nestle & Jacobson, 2000).
Another suggestion is to integrate communitywide campaigns into a multidisciplinary
collaborative that includes state, school district, and local government. One such example is the
Action for Healthy Kids (AFHK) program that has established teams in 51 states (Moag
Stahlberg, 2004).

School-based Physical Education

Although school-based physical education curriculum interventions are consistently advocated as

one of the most effective contexts for changing PA attitudes and behaviors, there is surprisingly
scant evidence of this strategy being implemented or studied. In contrast, numerous studies are
available documenting school-based interventions outside of the physical education curriculum,
particularly new curricular additions and after-school programs.

One physical education program that was identified was the New Moves program which is an
obesity prevention program for adolescent girls. The New Moves program has been tested in
multiple school sites and includes nutritional guidance, social support, and daily physical activity
across a 16 week curriculum. Participants in the intervention were compared against a control
group and the strongest predictors for behavioral change were time constraints and social support
for PA from peers, parents, and teachers (Neumark-Sztainer et al., 2003a). At postintervention
participants showed significant changes in PA, eating patters, self-image, and progression in
their stage of behavioral change (Neumakr-Sztainer et al., 2003b). It was concluded that a
decrease in perceived time constraints would result in a mean weekly increase of 53 minutes of
PA, and an increase in perceived social support would lead to an additional 35 minutes of weekly
PA (Miller, 2004). An 8-month follow-up, however, showed no statistically significant
 13

differences between intervention and control participants for most outcome variables (Neumark-
Sztainer et al., 2003b).

One of the most visible examples of a non-physical education school-based PA modified

curriculum intervention is Pathways (Caballero et al., 2003; Davis et al., 2003; Gittelsohn et al.,
2003; Going et al., 2003; Steckler et al., 2003; Stevens et al., 2003; Stone et al., 2003; Teufel et
al., 1999). The 3-year program designed for American Indian youth used a randomized control
design with 41 schools (21 intervention and 20 control) and nearly 2,000 grades 3 to 5 students
(and their parents, school administrators, and teachers). The intervention is framed by social
learning theory and includes four components: (1) change in dietary intake, (2) increase in
physical activity, (3) a classroom curriculum focused on healthy eating and lifestyle, and (4) a
family-involvement program. Multiple quantitative and qualitative methods such as in-depth
interviews, questionnaires, direct observations and accelerometers were used to collect data on a
wide range of psychosocial (self-efficacy, knowledge, behavioral intentions, body image) and
health (body fat, PA) variables. No significant decrease was noted in the primary dependent
variable (percentage body fat), nor were significant changes found in PA levels. However,
percent of calories from fat and saturated fat in school lunches was significantly reduced in the
intervention schools as was total energy intake from 24-hour recalls. Intervention participants
also reported increases in PA (self-report) and healthy behavior knowledge (Stone et al., 2003).
Other significant positive changes were found in the areas of knowledge and attitudes (Caballero
et al, 2003). Healthy food intentions and participation in physically active behaviors increased
both in boys and girls (Stevens et al., 2003). Knowledge of health messages increased, but no
differences were found in food content knowledge.

Pathways has received strong support by all groups of participants, although school
administration and lack of family support were perceived as barriers at some intervention sites.
The mean score for attitude toward the program was 3.5 on a 5-point scale (5=very positive). The
school climate was also assessed and the school climate score was positively associated with
classroom curriculum and student exposure indices. However, school climate did not show any
association with family attendance, food service, or physical activity implementation (Gittelsohn
et al., 2003). Evaluation of program delivery shows that teachers trained to provide the Pathways
curriculum almost always delivered it as expected (93% of lessons delivered). The greatest
challenge with the program appears to be increasing parent involvement. The family (parent)
component of the intervention included three components: (a) family packs with diet tips and
interactive assignments, (b) health related family events on-site, and (c) formation of school-
based family advisory councils. At the beginning of the school year a Family Fun Night with
learning booths was provided and the year ended with a Family Celebration. The year-end
Family Celebration included a healthy meal and student demonstrations of Pathways curriculum
activities. Evaluation data show that the family packs and the health related family events were
well received. The third strategy, family advisory councils, was difficult to implement and did
not receive high ratings (Teufel et al., 1999). Overall only 45% of the parents participated at
grade three and 63% at grades four and five (Steckler et al., 2003).

Another example of a highly successful school-based intervention is the PATH (Physical

Activity and Teenage Health) program (Fardy et al., 2004). PATH is a 12-week health and
wellness school-based intervention for adolescents that has been implemented in dozens of
 14

schools in New York State. PATH includes a workbook designed to help students establish a
personalized wellness program that includes exercise prescription, appropriate diet modification,
stress management, and smoking avoidance (Fardy et al., 2004, p. 366). Students who complete
the PATH intervention show significant improvements in health knowledge and behaviors, and
in aerobic fitness (Fardy et al., 2004).

Non-curricular interventions to increasing PA with youth in schools have also been tested, but
generally these interventions suffer from low attendance (Jago & Baranowski, 2004). Yin and
colleagues (2005) recently initiated a 3-year after-school program designed to increase PA in
elementary school children in 18 schools. This large-scale randomized control study will include
three components: (a) academic enrichment, (b) a healthy snack, and (c) physical activity in a
mastery-oriented environment. Results have yet to be published on the effectiveness of this
program.

Individually Adapted Behavior-change Programs

Numerous family-based interventions that involve parents in treatments designed to change PA

behaviors and attitudes in their children have been conducted (Berry et al., 2004). It is
recommended that behavioral counselors use multiple intervention-related strategies such as self-
monitoring, stimulus control, cognitive restructuring, social support, and relapse prevention
(Foreyt & Poston, 1998). A secondary analysis of randomized, controlled studies found that
changes in parent standardized BMI scores significantly predicted child standardized BMI score
changes, both at 6-months and 24-months following treatment (Wrotniak et al., 2004). Greatest
changes were found in children with parents who scored in the highest quartile of standardized
BMI change. Results are based on hierarchical regression models that examined BMI change
independent of factors such as age, gender, SES, and baseline parent and child BMI.

Interventions that match the counseling strategies to participants stage of change for PA have
demonstrated positive changes in fat reduction and PA (Steptoe et al., 2001). Positive results
have been found with theory-based interventions designed to change PA attitudes and behaviors.
Significant positive changes have consistently been found on measures of self-efficacy, PA,
cardiorespiratory fitness, both at intervention completion and at long-term follow-up intervals
(Dallow & Anderson, 2003). Interventions that include the development of self-control skills
have produced significant increases in PA, cardiorespiratory fitness, reduced body weight, fat
mass, blood pressure, cholesterol, and dietary habits (Carels et al., 2004). Although participants
had maintained increases in PA at a 1-year follow-up they regained 63% of posttreatment weight
loss. Stimulus control and reinforcement interventions also show positive immediate and long-
term changes in PA, BMI, and dietary habits (Epstein et al., 2004).

The type and frequency of social support received during a PA intervention is an important
consideration. A study comparing individual versus group support showed that although both
strategies were effective, the group support participants had statistically significant changes in
PA and cholesterol reduction (Mello et al., 2004). Internet-based social support has been
examined in at least one study (Harvey-Berino et al., 2002). Following a 6-month in-person
behavioral obesity treatment program, participants were separated into three 12-month
maintenance conditions: (a) frequent in-person support, (b) minimal in-person support, and (c)
 15

Internet support. Although weight loss did not differ significantly among the groups during the
obesity treatment phase, the Internet support group participants gained significantly more weight
during the maintenance phase

Access for Places for PA

It appears that few published studies are available to show the impact of environment
modifications on PA at the community level. One example of research on the built environment
is a case study of the San Francisco region using household activity data to examine the relation
between urban design and nonmotorized travel (Cervero et al., 2003). Results show that built-
environment factors were influential, but much less so, than control variables like steep terrain,
on walking and bicycling. It was concluded that much more evidence is needed before
recommendations can be provided. This gap between scientific evidence and practical guidelines
provided the initiative for the Centers for Disease Control and Prevention to host a special
workshop on this topic in May 2002 (Dannenberg et al., 2003). Participants from a wide range of
community interests such as air pollution, water quality, transportation, housing, social
marketing and architecture contributed to the creation of a research agenda. Best practices for
community design and revitalization will be extremely limited until the proposed research is
completed and disseminated.

One potential area of study related to access to PA, from a community perspective, is walking
patterns of residents. A study of childrens walking patterns to and from school shows that the
three most statistically significant factors determining this type of PA are parent perception of
PA, parent history of school transport, and household distance from school (Ziviani et al., 2004).
Low caregiver motivation for PA has also been shown in other studies to be a perceived barrier
for PA (Gordon et al., 2004). Based on these results it appears that built environment policies
will have limited impact on resident PA patterns unless coupled with interventions designed to
change parent attitudes toward PA and healthy lifestyles. It has also been found that traffic
congestion and parent fears for child safety influence active travel to school (Jago &
Baranowski, 2004).

Information Outreach Activities

There appears to be very limited scientific evidence on the efficacy of information outreach
activities. Recent data from American campaigns do show significant behavioral changes, at
least with certain age groups of the population. The governments VERB media campaign
targeting youth 9-13 year old claims a 34% increase in physical activity among children aged 9
to 10 years and a 27% increase for girls, and the Presidents Challenge reports that 7 million
fitness awards were processed in the 2002-2003 school year (USDHHS, 2004).

A comprehensive study of a national campaign in England shows a much different trend when
data from across the entire population are included. There is evidence that national outreach
campaigns do create awareness, but the message is not consistently received across all segments
of the population and behavioral change is rare. Over 50% of the population recognized the
campaign and 30% remembered the healthy lifestyle message (Wardle et al., 2001). There was
no difference in awareness between overweight and normal weight individuals. Although no
 16

differences in awareness were found across socio-economic groups, message recall was
significantly lower in low education and ethnic minority populations. Furthermore, less than 1%
actually registered to participate in the campaign.

Perhaps one explanation for the low integration (message recall and behavioral change) of
information outreach programs is the format of the message and apparent lack of consistency
across health-care professionals. Fulton and colleagues (2004) reviewed PA recommendations
provided for the public health community and the clinical community and found inconsistent
recommendations. In the clinical community the recommendations were seldom explicit and in
both contexts recommendations specific to overweight youth were rarely provided.

Physical Activity Interventions: Best Practices Summary

The ultimate goal of PA interventions is to increase actual PA that will be sustained over time; in
essence, a lifestyle change that will reduce the risk of obesity and related diseases. Although
there are many recommendations and highly visible campaigns, there still remains relatively
sparse data that can be used to make evidenced-based decisions. Researchers must address basic
methodological problems such as establishing standard and valid methodologies for measuring
PA. The CDC recently identified the Physical Activity Monitor, a belt-worn device that
automatically records locomotion, duration, and intensity, as a promising assessment tool for PA
intervention research (USDHHS, 2004). Other research weaknesses that have been identified
include lack of participant randomization, participant attrition, and single group designs (Banks
Wallace & Conn, 2002). Despite these research limitations, several trends are evident. First,
gender differences are consistently found on a wide range of dependent variables following
interventions. Second, parental involvement is critical to realizing positive changes in PA
attitudes and behaviors in youth. Third, evidence of long-term maintenance of positive changes
PA (and associated diet and health variables) following an intervention is almost nonexistent.
Fourth, of all the strategies recommended by the CDC, individually adapted behavior-change
programs appear to have the most empirical support. Fifth, despite repeated calls for school-
based physical education interventions few published reports are available from studies using
this approach.

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 22

Yancey, A. K., Jordan, A., Bradford, J., Voas, J., Eller, T. J., Buzzard, M., Welch, M., &
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 23

Research Compendium

Abdel-Hamid, T. K. (2003). Exercise and Diet in Obesity Treatment: An Integrative System

Dynamics Perspective. Medicine and Science in Sports and Exercise, 35(3), 400-413.

Demonstrate the utility of System Dynamics computer modeling to study and gain insight
into the impacts of physical activity and diet on weight gain and loss.

Abraham, K. (2004). Recognizing and treating childhood obesity. The American Journal for
Nurse Practitioners, 8(9), 31-32, 35-38.

Childhood obesity is a major public health problem that is getting worse every year; in
fact, it has reached epidemic proportions. Over the past three decades, the proportion of
overweight/obese children in the United States has increased from 4% in 1974 to 15.3%
in 2000. More than 20% of adolescents and 10% of 6- to 12-year-olds are overweight,
and more than 25% of children are clinically obese, making it the most prevalent
nutritional disease in US children. The goal of "Healthy People 2010," a national health
promotion and disease prevention initiative, is to reduce the prevalence of overweight
and obesity in children and adolescents to 5%.

Adolfsson, B., Carlson, A., Unden, A., and Rossner, S. (2002). Treating obesity: a qualitative
evaluation of a lifestyle intervention for weight reduction. Journal of health Education, 61(3),
244-258.

To identify which factors are considered important for eating habits and weight change in
obese participants in a one-year weight reduction programme at a primary health care
centre.

Agren, G., Narbro, K., Naslund, I., Sjostrom, L., and Peltonen, M. (2002). Long-term effects of
weight loss on pharmaceutical costs in obese subjects. A report from the SOS intervention study.
International Journal of Obesity and Related Metabolism Disorders, 184-192.

Although intentional weight reduction improves obesity-related comorbidities, the

associations between weight reduction, medication and related costs are rarely studied.
This study investigates the long-term effects of weight change on medication for diabetes
and cardiovascular disease (CVD) in severely obese subjects.

Aguilar, S. C. A., Rojas, R., Gomez, P. F. J., Garcia, E., Valles, V., Rios, T. J. M., Franco, A.,
Olaiz, G., Sepulveda, J., and Rull, J. A. (2002). Prevalence and characteristics of early-onset type
2 diabetes in Mexico. American Journal of Medicine, 113(7), 569-574.

To investigate the prevalence and characteristics of patients with type 2 diabetes

diagnosed before the age of 40 years (early-onset disease) in a nationwide, population-
based study.
 24

Al Lawati, J. A., Mohammed, A. J., Al Hinai, H. Q., and Jousilahti, P. (2003). Prevalence of the
metabolic syndrome among Omani adults. Diabetes Care, 26(6), 1781-1885.

To estimate the prevalence of the metabolic syndrome by age and sex in the Omani
population as defined by the third report of the National Cholesterol Education Program
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in
Adults (Adult Treatment Panel III [ATP III]) of North America.

Alfano, C. M., Klesges, R. C., Murray, D. M., Beech, B. M., and McClanahan, B. S. (2002).
History of sport participation in relation to obesity and related health behaviors in women.
Preventive Medicine, 34(1), 82-90.

Organized sport participation in youth is a common form of physical activity; yet, little is
known about how it is associated with adult obesity and related health behaviors. The
purpose of this study was to investigate whether a history of youth sport participation was
related to adult obesity, physical activity, and dietary intake among women.

Allen, M., Touger Decker, R., O'Sullivan Maillet, J., and Holland, B. (2003). A survey of obesity
management practices of pediatricians in New Jersey. Topics in Clinical Nutrition, 18(1), 3-12.

The purpose of this study was to examine obesity management practices and variables
influencing those practices of members of the New Jersey Chapter of the American
Academy of Pediatrics (n = 1246).

Alleyne, S. I., and LaPoint, V. (2004). Obesity, among Black adolescent girls: genetic,
psychosocial, and cultural influences. Journal of Black Psychology, 30(3), 344-365.

The causes, consequences and prevention of obesity among a subgroup of American

population, African American adolescent girls are discussed. Genetic, psychosocial and
cultural factors that may influence susceptibility to obesity, and preventive strategies are
highlighted.

Allison, D. B., and Faith, M. S. (2000). Point/counterpoint. Genetic and environmental

influences on human body weight: implications for the behavior therapist. Nutrition Today,
35(1), 18-21.

Knowledge of genetic influences on human obesity has dramatically advanced in recent

years. However, data that documents the critical role of genetic factors have also
provided some of the strongest support for the importance of the environment. This
article clarifies common misconceptions about the role of the environment and the
potential for behavioral intervention.
Allison, D. B., and Weber, M. T. (2003). Treatment and prevention of obesity: What works, what
doesn't work, and what might work. Lipids, 38(2), 147-155.

We provide a very broad conceptual overview of some of the issues involved in the
treatment and prevention of obesity. Data suggest that clinicians have some ability to
 25

promote positive changes with obesity treatment. The environment, though important in
influencing one's degree of adiposity, has largely transient effects that do not tend to
carry over from one time to substantially later times. In contrast, the genetic influences on
body mass index at any one time do tend to carry over to later times. This information
influences the types of approaches that are and are not likely to be successful in terms of
preventing obesity or reducing obesity on a population level. A second issue concerns the
composition of weight lost. Conditional on fat loss, weight loss has been associated with
an increased mortality rate (MR) whereas, conditional upon weight loss, fat loss has been
associated with a decreased MR. This suggests that we should seek treatments that
maximize the proportion of weight lost as fat. Third, the efficacy of current treatments is
far below patients' expectations and desires. We need both to increase the efficacy of our
treatments dramatically and help patients adjust their expectations so that they can take
satisfaction in smaller weight losses. Perhaps, with continued efforts at enhancing
treatments, we will see incremental advances in the treatment and prevention of obesity.

Aminot Gilchrist, D. V., and Anderson, H. D. I. (2004). Insulin resistance-associated

cardiovascular disease: potential benefits of conjugated linoleic acid. The Role of Conjugated
Linoleic Acid in Human Health: proceedings of a workshop held in Winnipeg, Canada, March
13-15, 2003. American Journal of Clinical Nutrition, 79(6S), 1159S-63S.

Type 2 diabetes and associated cardiovascular disease have reached global epidemic
proportions. Recent data from the World Health Organization Multinational Study of
Vascular Disease in Diabetes indicate that cardiovascular disease is the leading cause of
mortality (52% of deaths) in individuals with type 2 diabetes. Although insulin resistance
plays a critical role in the pathogenesis of type 2 diabetes-related cardiovascular disease,
other related risk factors often cluster in a single patient; the combination of insulin
resistance and these risk factors is known as the metabolic syndrome. According to the
World Health Organization definition, this constellation of risk factors includes
hypertension, elevated plasma triacylglycerol, reduced HDL cholesterol, central obesity,
and microalbuminuria. The Multiple Risk Factor Intervention Trial showed that, although
diabetes or insulin resistance is an independent risk factor for cardiovascular disease
mortality, these other components of the metabolic syndrome confer additive risk. Thus,
to effectively address cardiovascular disease in persons with diabetes, intervention would
ideally target all these factors. Conjugated linoleic acid could represent a candidate agent.
The therapeutic potential of conjugated linoleic acid against insulin resistance-associated
cardiovascular disease is discussed on the basis of the reported effects of conjugated
linoleic acid on individual components of the metabolic syndrome.

Andersen, R. (2003). Obesity: Etiology, assessment, treatment, and prevention. Champaign, IL:
Human Kinetics.

CONTENTS: Part I - Etiology of obesity: [1] Prevalence of overweight and obesity in the
United States; [2] Psychosocial correlates and consequences of obesity; [3] Economic
aspects of obesity: a managed care; [4] Genetic influences on obesity; Part II -
 26

Assessment of the obese patient: [5] Health-related quality of life in obese individuals;
[6] Body composition assessment in the obese; [7] Clinical evaluation of the obese
patient; [8] Dietary intake: recording and analyzing; [9] Assessment of physical activity
and energy expenditure; Part II - Treatment and prevention: [10] The importance of body
weight maintenance in successful aging; [11] Treating and preventing pediatric obesity;
[12] Medical nutrition therapy application; [13] Physical activity treatment; [14] Physical
activity as a therapeutic modality; [15] Helping individuals reduce sedentary behavior;
[16] Physical activity promotion as a public health strategy for obesity prevention; [17]
Medication for weight; [18] Future directions in treating obesity; Index; About the editor.

Andersen, R. E. (1999). Exercise, an active lifestyle, and obesity: making the exercise
prescription work. Physician and Sports Medicine, 27(10), 41-42, 44, 47-48.

An active lifestyle can play an important role in helping overweight patients both lose
and manage their weight. The traditional exercise prescription of regular bouts of
continuous vigorous exercise may need to be modified to increase rates of adoption and
compliance. Recent data suggest that accumulating several short bouts of moderate to
vigorous activity each day may improve adherence to the program. Understanding the
barriers to activity that overweight people face--such as fear or embarrassment--can help
physicians prescribe appropriate exercise routines, which may ultimately help them with
better weight management.

Anderson, A. S. (2004). Food intake and obesity - the hidden details. Journal of Human Nutrition
and Dietetics, 17(3), 181-182.

There are many indications that obesity levels within each of the UK countries are
following a North American trend where there has been an increase in obesity from 14.5
to 30.9% in the population between 1971 and 2000. It is clear that on both sides of the
Atlantic that food consumption data will be less than perfect because it is self reported
and subject to recall bias. Clearly, there are a number of factors that will impact on recall.
Beasley et al. (see record 2004-17060-005) demonstrate that satiety levels influence
portion weight recall and illustrate this point well with respect to chips.

Anderson, A. S., Marshall, D. W., and Lea, E. J. (2004). Shared lives-an opportunity for obesity
prevention? Appetite, 43(3), 327-329.

A longitudinal design was used to survey individual members of 22 couples about food
choices, dietary intake and body weight around three months prior to cohabitation and
again about three months after the moving-in date. Changes after cohabitation included
an increase in shared meal occasions, increased likelihood of including alcohol at meal
times and social support for dietary temptations (and restrictions). Body weight increased
significantly in women (58.3 +/- 7.1 - 59.8 +/- 7.9 kg) and in men (76.7 +/- 12.0 - 78.4
+/- 12.5 kg). This life stage may be a missed opportunity for obesity prevention
initiatives. Copyright 2004 Elsevier Ltd. All rights reserved.
 27

Anderson, D. C., Jr. (2005). Pharmacologic prevention or delay of type 2 diabetes mellitus. Ann
Pharmacother, 39(1), 102-9.

To evaluate the current data on pharmacologic interventions intended to prevent or delay

the onset of type 2 diabetes mellitus.

Anderson, J. W., Konz, E. C., Frederich, R. C., and Wood, C. L. (2001). Long-term weight-loss
maintenance: a meta-analysis of US studies. American Journal of Clinical Nutrition, 74(5), 579-
84.

Current perception is that participants of a structured weight-loss program regain all of

their weight loss within 5 y. The objective was to examine the long-term weight-loss
maintenance of individuals completing a structured weight-loss program.

Anderson, S. E., Bandini, L. G., Dietz, W. H., and Must, A. (2004). Relationship between
temperament, nonresting energy expenditure, body composition, and physical activity in girls.
International Journal of Obesity and Related Metabolism Disorders, 28(2), 300-306.

The aim of this study is to assess the extent that predilection for movement, as measured
by a temperament questionnaire, contributes to nonresting energy expenditure and body
composition in girls. Baseline data for 196 premenarcheal non-obese girls aged 8-12 y
were obtained from a longitudinal study of growth and development. The association of
activity temperament with nonresting energy expenditure in girls with low and high
levels of physical activity was evaluated. Body composition was estimated by total body
water.

Anderssen, S. A., Holme, I., Urdal, P., and Hjermann, I. (1998). Associations between central
obesity and indexes of hemostatic, carbohydrate and lipid metabolism: results of a 1-year
intervention from the Oslo Diet and Exercise Study. Scandinavian Journal of Medicine and
Science in Sports, 8(2), 109-115.

The relationships of central obesity and physical fitness to indexes of hemostatic, lipid
and glucose metabolism both at baseline and after 1 year of diet and exercise intervention
were examined in 209 sedentary middle-aged men and women with increased coronary
risk factor levels. Central obesity was measured as either waist circumference or
waist/hip ratio. Maximal oxygen uptake was used as a measure of physical fitness.

Anghelescu, I., Klawe, C., and Szegedi, A. (2002). Add-on combination and maintenance
treatment: Case series of five obese patients with different eating behavior. Journal of Clinical
Psychopharmacology, 22(5), 521-524.

In this observational study, a new drug treatment regimen was evaluated in 5 obese
patients with a mean age of 39.6 years and an initial body mass index between 34.5 and
38.3 kg/msuperscript 2 for a period of 96 weeks. The patients showed restrained and
unrestrained eating patterns according to a German version of the Three-Factor Eating
 28

Questionnaire and were treated in an add-on regimen with the combination of three drugs
with different anorectic properties that were consecutively introduced in an interval of 16
weeks.

Antipatis, V. J., Kumanyika, S. K., Jeffery, R. W., Morabia, A., and Ritenbaugh, C. (1999).
Confidence of health professionals in public health approaches to obesity prevention.
International Journal of Obesity, 23(9), 1004-1006.

To assess the views of professionals working in the obesity field on the potential
usefulness and feasibility of implementing different types of public health prevention
strategies. A questionnaire listing 20 public health strategies was mailed to pre-registrants
of an international obesity prevention symposium. Respondents were asked to rate how
useful and how feasible they felt each of the listed actions would be for the prevention of
obesity in their home countries.

Apovian, C. M. (2000). The medical management of obesity and the role of pharmacotherapy: an
update. Nutrition in Clinical Practice, 15(1), 5-12.

The prevalence of obesity in the United States has been increasing since the 1980s and
has become a public health concern. The etiology of obesity is complex and includes a
host of genetic influences in addition to overconsumption of energy and a sedentary
lifestyle. Obesity is strongly associated with several chronic diseases, such as
cardiovascular disease and diabetes, and thus accounts for significant morbidity and
mortality. The previous failures of short-term therapy for obesity have led experts to
recognize that obesity is a chronic disease that should be treated with long-term programs
to ensure the best chance for maintenance of weight loss. In addition, clinical studies
have demonstrated that a modest weight loss of 5% to 10% can produce significant
decreases in comorbidities. This articles summarizes the current medical approach to the
treatment of obesity and includes strategies for diet modification, exercise therapy, and
lifestyle change.

Appolinario, J. C., Bueno, J. R., and Coutinho, W. (2004). Psychotropic drugs in the treatment of
obesity: what promise? CNS Drugs, 18(10), 629-652.

Obesity is a chronic and highly prevalent medical condition associated with increased
risk for the development of numerous and sometimes fatal diseases. Despite its severity,
there are few anti-obesity agents available on the market. Although psychotropic agents
are not approved for the treatment of obesity, they have been used by clinicians as a
therapeutic tool in daily clinical practice. The purpose of this article is to review the
rationale, as well as the evidence, for the potential use of these agents in obesity
treatment.Evidence for the efficacy of psychotropic agents in obesity treatment comes
from different sources.

Armstrong, W. J., Johnson, P., and Duhme, S. (2001). The effect of commercial thermogenic
weight loss supplement on body composition and energy expenditure in obese adults. Journal of
Exercise Physiology, 4(2), 28-32.
 29

The purpose was to determine the effects of an herbal preparation containing ma huang,
bitter orange and guarana on resting energy expenditure (REE), blood chemistries, and
body composition in obese adults.

Aronne, L. J. (1998). Modern medical management of obesity: the role of pharmaceutical

intervention. Journal of the American Dietetic Association, S23-S26.

The medical model of obesity treatment-combining diet, exercise, and behavior

modification with antiobesity agents suffered a setback when fenfluramine and
dextenfluramine were withdrawn from the market because of an association between
these medications and valvular regurgitation. The Food and Drug Administration has
recently approved sibutramine (Meridia), a norepinephrine and serotonin reuptake
inhibitor that was originally developed as an antidepressant, but which has also been
shown to reduce weight.

Aronne, L. J. (2001). Treating obesity: a new target for prevention of coronary heart disease.
Progress in Cardiovascular Nursing, 16(3), 98-106, 115.

Recognition by the American Heart Association that obesity is a major modifiable risk
factor for coronary heart disease has prompted health providers to take a more active role
in obesity management. Obesity has long been known to accompany a host of chronic
diseases, e.g., type II diabetes, hypertension, and dyslipidemia. We now recognize that
obesity is itself a chronic disease with a complex etiology; like diabetes and hypertension,
it is treatable with a similar chronic disease treatment model. Relatively modest weight
loss confers disproportionate health benefits, improving a roster of risk factors. Diet,
exercise, and behavior modification still compose the gold standard of treatment. If these
measures fail, medication and surgery should be considered for appropriate patients. With
current techniques, many patients can achieve realistic weight goals that can be
maintained over the long term.

Aronne, L. J. (2004). Gastric pacing is not enough: additional measures for an effective obesity
treatment program. Obesity Surgery, 14(1), 23-28.

Obesity has long been considered a behavioral disorder. Recent breakthroughs in our
understanding of body weight regulation, however, have shown that once adipose tissue
accumulates, a system of overlapping neuroendocrine systems actively resists weight
loss. This counter-regulatory mechanism, which has evolved as protection against
starvation, causes changes in appetite and metabolism that limit the amount of weight lost
with every obesity intervention, including surgery. Future therapies for obesity will focus
on neutralizing the counter-regulatory mechanisms in a coordinated manner, making
greater weight losses possible. At this point, gastric stimulation appears to play a role in
suppressing the compensatory mechanisms of the gut. Thus, gastric stimulation should
work best when combined with other treatments such as diet, exercise, and behavioral
change.
 30

Assaf, A. R., Parker, D., Lapane, K. L., Coccio, E., Evangelou, E., and Carleton, R. A. (2003).
Does the Y Chromosome make a difference? Gender differences in attempts to change
cardiovascular disease risk factors. Journal of Women's Health, 12(4), 321-330.

The purpose of this study was to determine if gender differences exist in attempts to
change cardiovascular disease (CVD) risk factor behaviors, specifically cigarette
smoking, sedentary lifestyle, and overweight, and if the success of these attempted
behavior changes also differs by gender in the Pawtucket Heart Health Program (PHHP).
The risk factors were considered in reference to individuals who needed to change a
particular risk factor behavior.

Astrup, A. (2001). Dietary strategies for weight management -- the importance of carbohydrates.
proceedings of the Kellogg's Nutrition Symposium 2000, Sydney, 8 August 2000. Australian
Journal of Nutrition and Dietetics, 58(S9-S12, Suppl 1).

The prevalence of obesity is increasing rapidly in all age groups globally and is one of the
fastest growing epidemics, now affecting 4 to 8% of children and 10 to 20% of adults.
Obesity is followed by serious co-morbidities such as type 2 diabetes, cardiovascular
disease, certain cancers, and reduced life expectancy, and these complications may
account for five to ten per cent of all health costs. There is robust evidence to support the
view that a diet which is low in carbohydrates and high in fat is energy dense and,
together with physical inactivity, is an independent risk factor for weight gain and
obesity. Furthermore, interactions between dietary fat and physical fitness determine fat
balance, so that the obesity promoting effect of a high fat diet is enhanced in susceptible
subjects, particularly in sedentary individuals with a genetic predisposition to obesity.
Skipping breakfast may further increase the risk of obesity. A diet with a higher fat
content seems to be better tolerated without weight gain by physically active individuals
than by sedentary people.

Astrup, A., Caterson, I., Zelissen, P., Guy-Grand, B., Carruba, M., Levy, B., Sun, X., and
Fitchet, M. (2004). Topiramate: Long-Term Maintenance of Weight Loss Induced by a Low-
Calorie Diet in Obese Subjects. Obesity Research, 12(10), 1658-1669.

To examine the safety and efficacy of topiramate (TPM) for maintaining weight
following a low-calorie diet.

Atkinson, R. L. (1997). Use of drugs in the treatment of obesity. Annual Review of Nutrition, 17,
383-403.

The use of drug therapy in obesity is reviewed under the headings: Physiological
mechanisms of action of obesity drugs; Reduction of energy intake; Increase in energy
expenditure; Theory of altered defense of body weight; Categories of obesity drugs and
biochemical mechanisms of action; Centrally active serotonergic agents; Centrally active
adrenergic agents; Experimental drugs or drugs not currently approved; Gut peptides,
CNS neurotransmitter agonists and antagonists, thermogenic agents; Gene products;
 31

Practical aspects of integrating drugs into obesity treatment; Who should be treated with
obesity drugs? How should obesity drugs be used? Studies with single drugs; Studies
with drug combinations; Concerns about drug treatment of obesity; Changes in the
central nervous system; Primary pulmonary hypertension; and Integration of obesity
drugs into a comprehensive obesity treatment programme.

Atkinson, R. L. (1998). Guidelines for the initiation of obesity treatment. Journal of Nutrition,
546-552.

Obesity is epidemic in America. About 80 million Americans are obese, 33.4% of adults
and about 20% to 25% of children. Obesity produces morbidity and mortality: there are
300,000 obesity-related deaths annually in America. The definition of obesity has not
been standard. Recently, the Word Health Organization defined overweight as a body
mass index (BMI = kg/m2) of 25 and obesity as a BMI of "> or =" 30. A BMI of "> or ="
35 produces a high risk from obesity and of "> or =" 40 produces a severe risk. The
presence of complications of obesity (hypertension, diabetes, dyslipidemia, sleep apnea,
etc.) increases the risk. Treatments of obesity depend on the severity of obesity, the
presence of complications, and the absence of exclusions.

Baker, S., Barlow, S., Cochran, W., Fuchs, G., Klish, W., Krebs, N., Strauss, R., Tershakovec,
A., and Udall, J. (2005). Overweight children and adolescents: a clinical report of the north
american society for pediatric gastroenterology, hepatology and nutrition. Journal of Pediatric
Gastroenterol Nutrition, 40(5), 533-43.

Childhood overweight and obesity are major health problems with immediate and long-
term consequences of staggering magnitude. Despite this, there are few preventive and
therapeutic strategies of proven effectiveness available to public health and clinical
practitioners. Accruing such evidence is currently and appropriately a health policy
priority, but there is an urgent need to intervene even before comprehensive solutions are
fully established. The aim of this Clinical Report on Overweight Children and
Adolescents is to present information on current understanding of pathogenesis and
treatment of overweight and obesity. We report on the epidemiology, molecular biology
and medical conditions associated with overweight; on dietary, exercise, behavioral,
pharmacological and surgical treatments; and on the primary prevention of overweight in
children and adolescents.

Balagopal, P., George, D., Patton, N., Yarandi, H., Roberts, W. L., Bayne, E., and Gidding, S.
(2005). Lifestyle-only intervention attenuates the inflammatory state associated with obesity: a
randomized controlled study in adolescents. Journal of Pediatrics, 146(3), 342-8.

The primary goals were to understand the relationship among the inflammatory factors,
C-reactive protein (CRP), interleukin-6 (IL-6), and fibrinogen, and indices of obesity in
normoglycemic, insulin-resistant adolescents and to investigate the impact of a lifestyle-
only intervention on these nontraditional risk factors for cardiovascular disease (CVD).
 32

Ball, G. D. C., and McCargar, L. J. (2003). Childhood obesity in Canada: a review of prevalence
estimates and risk factors for cardiovascular diseases and type 2 diabetes. Canadian Journal of
Applied Physiology, 28(1), 117-140.

Childhood obesity in Canada has become increasingly prevalent over the past 2 decades.
Despite inconsistencies regarding different anthropometric indicators, cut-offs, and
reference populations, both regional and national investigations have revealed high
numbers of overweight and obese children and adolescents. A number of risk factors and
health consequences have been associated with increased levels of body fatness in youth.
Specifically, risk factors for cardiovascular diseases (CVD) and type 2 diabetes are
known to develop early in life and tend to emerge in clusters among overweight
youngsters. Unhealthy lifestyle behaviours (i.e., physical inactivity), a genetic
disposition, and a centralized body fat distribution, all contribute to increased risk. In
order to prevent future generations of children from experiencing increased morbidity
and mortality as overweight and obese adults, coordinated efforts at all levels (family,
school, community, and government) must be established with a long-term commitment
to promote healthy nutrition and physical activity behaviours in our youth.

Banks Wallace, J., and Conn, V. (2002). Interventions to promote physical activity among
African American women. Public Health Nursing, 19(5), 321-335.

The lack of routine physical activity among African American women places them at risk
for negative health outcomes associated with inactivity. The number of studies focused
on African American women has increased dramatically in the past decade. This review
examined the intervention research literature testing strategies to increase activity among
African American women. Eighteen studies with 1,623 subjects were retrieved. Diverse
interventions, settings, and measures were reported. Common methodologic weaknesses
included lack of randomization of subjects, single-group design, instruments without
documented validity and reliability, significant attrition, and questionable timing of
outcome variable measurement. Strategies to design and deliver culturally appropriate
interventions are reviewed. Suggestions for future research, such as examining intragroup
differences and communal resources, are provided.

Banks Wallace, J., Enyart, J., and Johnson, C. (2004). Recruitment and entrance of participants
into a physical activity intervention for hypertensive African American women. Advances in
Nursing Science, 27(2), 102-116.

Decreasing health disparities between White Americans and racial/ethnic minority

populations is a public health priority. An ongoing inability to attract sufficient numbers
of African Americans and other people of color to participate in research studies is a
major barrier to accomplishing this goal. Participation of racial/ethnic minorities in
intervention studies is especially critical to the development of appropriate strategies to
promote health among these populations. This article examines the effectiveness of
preintervention meetings as well as interactions between African American research team
 33

members and potential participants as recruitment strategies. Intersections between

recruitment and health promotion are also addressed.

Banning, M. (2005). The management of obesity: the role of the specialist nurse. British Journal
of Nursing, 14(3), 139-44.

Obesity is a global problem, independent of age. The numbers of obese individuals are
now reaching epidemic proportions around the world. This is contributing to the risk of
inherent comorbidity. The pathophysiology of obesity, although widely debated, is still
unclear with suggestions that multiple genetic mutations may have a key role in the
development, but as yet no one genetic mutation is felt to be entirely responsible.
Biochemical manifestations such as diabetes may play a role. The first goal of
management of the obese patient will involve dietary and behavioural modification and a
programme of physical exercise. In primary care settings, nurses are suitably placed to
assess and manage obese patients (National Institute for Clinical Excellence (NICE),
2001a). The nursing profession needs to rise to the challenge and prepare nurses for a
specialist role in obesity management.

Banning, M. (2005). Obesity. The management of obesity: the role of the specialist nurse. British
Journal of Nursing, 14(3), 139-144.

Obesity is a global problem, independent of age. The numbers of obese individuals are
now,reaching epidemic proportions around the world. This is contributing to the risk of
inherent comorbidity. The pathophysiology of obesity, although widely debated, is still
unclear with suggestions that multiple genetic mutations may have a key role in the
development, but as yet no one genetic mutation is felt to be entirely responsible.
Biochemical manifestations such as diabetes may play a role. The first goal of
management of the obese patient will involve dietary and behavioural modification and a
programme of physical exercise. In primary care settings, nurses are suitably placed to
assess and manage obese patients (National Institute for Clinical Excellence (NICE),
2001a). The nursing profession needs to rise to the challenge and prepare nurses for a
specialist role in obesity management.

Bar Or, O. (2000). Juvenile obesity, physical activity, and lifestyle changes: cornerstones for
prevention and management. Physician and Sports Medicine, 28(11), 51-52.

Because many obese children and adolescents become obese adults, the recent rapid
increase in juvenile obesity poses a major public health challenge. Obese children and
youth are often more sedentary than their nonobese peers, but a low level of physical
activity has not yet been proven as a cause of obesity. Nevertheless, enhanced physical
activity is a cornerstone in a multidisciplinary approach to preventing and treating
juvenile obesity. Giving exercise recommendations focused for obese youth is crucial.
For example, patients may do best with aquatic exercise and in groups of obese peers.
Cutting down on sedentary behaviors, like watching TV, can reap long-term benefits.
 34

Bar Or, O. (2003). The juvenile obesity epidemic: is physical activity relevant? Sports Science
Exchange, 16(2), 1-6.

Reviews the dramatic surge in prevalence of children and adolescent obesity in many
developed and underdeveloped countries. Although the causes of this epidemic are not
clear, the reduction in time spent in physical activity and the increase in sedentary
pursuits such as television viewing and computer games are likely contributing factors.

Bar Or, O., Foreyt, J., Bouchard, C., Brownell, K. D., Dietz, W. H., Ravussin, E., Salbe, A. D.,
Schwenger, S., St. Jeor, S., and Torun, B. (1998). Physical activity, genetic, and nutritional
considerations in childhood weight management. Medicine and Science in Sports and Exercise,
30(1), 2-10.

Discusses juvenile obesity which is a serious, increasingly prevalent problem in

technologically developed societies. Almost one-quarter of US children are now obese, a
dramatic increase of over 20% in the past decade. It is intriguing that the increase in
prevalence has been occurring while overall fat consumption has been declining. Body
mass and composition are influenced by genetic factors, but the actual heritability of
juvenile obesity is not known.

Baranowski, T., Cullen, K. W., Nicklas, T., Thompson, D., and Baranowski, J. (2002). School-
based obesity prevention: A blueprint for taming the epidemic. American Journal of Health
Behavior, 26(6), 486-493.

Reviewed the literature on school-based obesity prevention programs to identify what can
be done to minimize the increasing levels of obesity. 20 articles reporting school-based
dietary or physical activity change programs were identified that used BMI or skinfolds
as part of the evaluation. Seven studies obtained change in BMI and differed from those
not finding change in 3 ways: Program implementers were not classroom teachers;
intervention targeted middle or high schools; and inactivity reduction was promoted. An
8-step research strategy was delineated to develop and evaluate programs with a
maximum chance of taming the obesity epidemic.

Baranowski, T., Klesges, L. M., Cullen, K. W., and Himes, J. H. (2004). Measurement of
outcomes, mediators, and moderators on behavioral obesity prevention research. Preventive
Medicine, 38(Supp), S1-S13.

Measurement enables intervention scientists to determine whether their interventions had

the intended outcome effects and the expected pathways of effects across mediating
variables. Low reliability of measurement (i.e., substantial random error) attenuates the
relationships of these measures to other variables, including treatment effects. This
attenuation may indicate that interventions were not effective, when in truth they were.
There has been little assessment of the quality of measurement in obesity prevention
trials.
 35

Barba, G., Troiano, E., Russo, P., Venezia, A., and Siani, A. (2005). Inverse association between
body mass and frequency of milk consumption in children. British Journal of Nutrition, 93(1),
15-9.

Recent studies have shown an inverse association between the level of dietary Ca,
particularly from dairy sources, and body weight in adults; there is, however, a paucity of
data regarding this relationship in children. We therefore investigated this issue in 1087
children who underwent body weight and height measurement during a survey on
childhood obesity.

Barbeau, P., Gutin, B., Litaker, M. S., Ramsey, L. T., Cannady, W. E., Allison, J., Lemmon, C.
R., and Owens, S. (2003). Influence of physical training on plasma leptin in obese youths.
Canadian Journal of Applied Physiology, 28(3), 382-396.

Little is known about the effects of different intensities of physical training on plasma
leptin. This study examined the effect of two intensities of physical training on leptin in
obese teenagers, and explored correlates at baseline and in response to 8 months of
physical training.

Barkley, L. C., Waitz, M. L., Robinson, K. M., Kottenhahn, R. K., and Datto, G. A., III. (2003).
Using BMI to monitor and treat adolescent obesity. Family Practice Recertification, 25(1), 29-
37.

Primary care physicians play a pivotal role in the identification of overweight and obese
adolescents and prevention of subsequent health problems. Useful tools for evaluation are
body mass index (BMI) and growth charts. BMI can be used to reassure a teenager whose
weight is within the normal range and to educate an overweight patient about obesity.
Such identification allows for early intervention. A persistently elevated BMI should
trigger screening for related morbidities.

Barlow, S. E., Trowbridge, F. L., Klish, W. J., and Dietz, W. H. (2002). Treatment of child and
adolescent obesity: reports from pediatricians, pediatric nurse practitioners, and registered
dietitians. Pediatrics, 110(1), 229-236.

The primary aim of this study was to identify interventions used by pediatric health care
providers in treatment of overweight children and adolescents to identify provider
educational needs. A secondary aim was to examine the association of certain provider
characteristics with recommended evaluation practices.

Barnes, J. T., Elder, C. L., and Pujol, T. J. (2004). Overweight and Obese Adults: Pathology and
Treatment. Strength and Conditioning Journal, 26(3), 64-65.

This 2-part column focuses on exercise recommendations and considerations for

overweight and obese individuals. The first part concentrates on the pathology and
treatment of the overweight or obese individual.
 36

Barnett, A. (2001). Type 2 diabetes and cardiovascular disease. part one. Nursing Times, 97(5),
33-35.

The long-term complications of type 2 diabetes, particularly cardiovascular disease, are

of great concern. In part one of a four-part series, Anthony Barnett shows how managing
risk factors can reduce mortality and cardiovascular events.

Barr, S. I. (2001). Nutrition and physical activity: why we must move from a casual acquaintance
to a lifelong partnership. Canadian Journal of Dietetic Practice and Research, 62(3), 134-139.

Both nutrition and physical activity have important roles in health promotion and disease
prevention, and are viewed by the public as closely related and synergistic. However, the
present level of interaction between professionals in the two areas is limited, and could be
described as a "casual acquaintance." Using heart disease, osteoporosis and obesity as
examples of chronic conditions that affect the health and well-being of Canadians,
reasons why the level of interaction between nutrition and exercise professionals must
move to a "lifelong partnership" are discussed.

Barry, K. (2002). Using exercise as preventive medicine. GAHPERD Journal, 35(3), 1.

Describes the APEX (Adiposity Prevention through Exercise) in Black Girls Project
which the National Institutes of Health implemented in Richmond County, Georgia.

Bartlett, S. J. (2003). Motivating patients toward weight loss: practical strategies for addressing
overweight and obesity. Physician and Sports Medicine, 31(11), 29-36.

Primary care physicians may feel ill-equipped to counsel patients about practical methods
for weight loss, even though the benefits of maintaining a healthy weight are well known.
The tools physicians need for tailoring therapy are a range of options that address
exercise, diet, and behavior change. Overcoming the barriers to a frank discussion of
weight and using available resources for weight management can make a healthy
difference for overweight and obese patients.
 37

Bartlett, T., Lancaster, R., and New, N. (2005). Pediatric obesity: use a team approach. Clinical
Advisor, 8(1), 22, 25-28, 31.

With excess weight in children reaching epidemic levels, treatment will be successful
only if the patient, family, and clinician participate.

Barton, S. B., Walker, L. L. M., Lambert, G., Gately, P. J., and Hill, A. J. (2004). Cognitive
change in obese adolescents losing weight. Obesity Research, 12(2), 313-319.

To investigate how obese adolescents think about themselves in terms of exercise, eating,
and appearance and whether these cognitions change over the course of a residential
weight loss camp.

Bassey, E. (2000). The benefits of exercise for the health of older people. Reviews in Clinical
Gerontology, 10(1), 17-31.

Presents evidence that physical activity can contribute to health and wellbeing in old age.
Specifically, this review explores whether increases in physical activity in later life can
reduce the risk of developing certain chronic diseases, and whether exercise has any
ameliorating role once these diseases are established. Most of the evidence reviewed rests
on large prospective epidemiological studies of disease incidence, or disease-specific
mortality, with a long time-course that allows for adequate statistical power. Particular
attention is given to cardiovascular, metabolic, skeletal and respiratory diseases. The
effects of exercise on the immune system, cancer risk, obesity, and psychological health
and cognitive function are discussed. In addition, the benefits of exercise for patients who
suffer from stroke, diabetes, osteoporosis, falls, and osteoarthritis are outlined. The
authors conclude that active lifestyles reduce disease incidence; the earlier the active
lifestyles are established, the better, but increasing activity levels even late in life is also
beneficial for reducing morbidity and mortality, and for ameliorating symptoms.

Battle, E., and Brownell, K. D. (1996). Confronting a rising tide of eating disorders and obesity:
Treatment vs prevention and policy. Addictive Behaviors, 21(6), 755-765.

Eating disorders and obesity are rising in prevalence and are problems of considerable
public health significance. Prevailing treatments have a limited impact on public health
because the disorders do not yield easily to intervention and because the treatments are
costly and available to few. Shifting from a medical to a public health model argues for
increased focus on both prevention and public policy. Research on prevention is in its
early stages but must be aggressively pursued. Even less is known about policy, but
recommendations are made to alter policy so that consumption of healthful foods
increases, consumption of unhealthful foods decreases, and levels of physical activity are
enhanced.
 38

Battle, E. K., and Brownell, K. D. (1996). Confronting a rising tide of eating disorders and
obesity: treatment vs. prevention and policy. Addictive Behaviors, 21(6), 755-765.

Treatment and prevention of <i>anorexia nervosa</i>, bulimia and binge eating disorder,
and obesity are reviewed. Factors for consideration in developing a public policy to
combat the problem of appetite disorders are also discussed.

Baughcum, A. E., Chamberlin, L. A., Deeks, C. M., Powers, S. W., and Whitaker, R. C. (2000).
Maternal perceptions of overweight preschool children. Pediatrics, 106(6), 1380-1386.

Childhood obesity is a major public health problem, and prevention efforts should begin
early in life and involve parents.

Bautista Castano, I., Doreste, J., and Serra Majem, L. (2004). Effectiveness of Interventions in
the Prevention of Childhood Obesity. European Journal of Epidemiology, 19(7), 617-622.

The prevalence of childhood obesity, as with that of adulthood, has increased

considerably over the past few years and has become a serious public health problem.
Once established, its treatment is very difficult and, hence, prevention of childhood
obesity using different types of intervention appears promising. The objective of this
present report is to review interventions that had been conducted over the past 11 years in
the environment of the family, schools and community, and directed towards the
prevention of childhood obesity. We reviewed the different strategies employed, the
different criteria used in defining weight status, the evaluation and follow-up methods,
and the degree of effectiveness.Benefits other than reduced weight gain were assessed, as
well. In our review, we selected 14 intervention studies. The differences in design,
duration and outcome assessments make direct comparison difficult. Nevertheless, it
seems that nutritional education and promotion of physical activity together with
behaviour modifications, decrease in sedentary activities and the collaboration of the
family could be the determining factors in the prevention of childhood obesity.

Bautista Castano, I., Molina Cabrillana, J., Montoya Alonso, J. A., and Serra Majem, L. (2004).
Variables predictive of adherence to diet and physical activity recommendations in the treatment
of obesity and overweight, in a group of Spanish subjects. International Journal of Obesity,
28(5), 697-705.

To assess the factors that could predict a successful completion of a weight loss program.
A single-centered, cross-sectional, prospective study conducted over 4 y. Data were
obtained on 1018 overweight subjects (788 women, 230 men) aged 14.8-76.3 y (mean
38.4) and body mass index (BMI) of 31.7 (range 25.03-57.1) seeking help to lose weight
at a specialist obesity clinic. A program involving a hypocaloric, Mediterranean diet was
prescribed plus recommendations for free-time exercise and day-to-day activity.
 39

Beale, L. (2002). Prevention is better than a cure. SportEX Health,(14): 9-11.

A strong association exists between physical inactivity and the emergence of chronic
diseases in modern industrialised societies. The human genome has evolved with an
environment of high physical activity through the hunter-gatherer and agricultural eras.
With the current high-technological, labour-saving and sedentary lifestyle, the human
body is failing to function properly to maintain health. This article takes an overview on
how physical activity can play an important role in prevention and treatment of chronic
diseases.

Beech, B. M., Klesges, R. C., Kumanyika, S. K., Murray, D. M., Klesges, L., McClanahan, B.,
Slawson, D., Nunnally, C., Rochon, J., McLain, A. B., and Pree, C. J. (2003). Child- and parent-
targeted interventions: The Memphis GEMS pilot study. Ethnicity and Disease, 13(Supplement
1), S1-53.

To assess the feasibility, acceptability, and outcomes of 2 versions of a culturally

relevant, family-based intervention to prevent excess weight gain in pre-adolescent
African-American girls.

Beech, B. M., Kumanyika, S. K., Baranowski, T., Davis, M., Robinson, T. N., Sherwood, N. E.,
Taylor, W. C., Relyea, G., Zhou, A., Pratt, C., Owens, A., and Thompson, N. S. (2004). Parental
cultural perspectives in relation to weight-related behaviors and concerns of African-American
girls. Obesity Research, 12 Suppl, 7S-19S.

To determine whether cultural perspectives of parents may influence children's eating and
physical activity behaviors and patterns of weight gain.

Beilin, L. J. (2004). Update on lifestyle and hypertension control. Clin Exp Hypertens, 26(7-8),
739-46.

This brief update on lifestyle and blood pressure control will focus on complex dietary
patterns, issues related to obesity, hypertension and dietary sodium, meta-analyses on
exercise, alcohol, coffee consumption and magnesium and some recent data on
antioxidant vitamins.

Bell-Anderson, K. S., and Bryson, J. M. (2004). Leptin as a potential treatment for obesity:
progess to date. Treatments in Endocrinology, 3(1), 11-19.

Despite significant reductions in the consumption of dietary fat, the prevalence of obesity
is steadily rising in western civilization. Of particular concern is the recent epidemic of
childhood obesity, which is expected to increase the incidence of obesity-related
disorders. The obese gene (ob) protein product leptin is a hormone that is secreted from
adipocytes and functions to suppress appetite and increase energy expenditure. Leptin is
an attractive candidate for the treatment of obesity as it is an endogenous protein and has
been demonstrated to have potent effects on bodyweight and adiposity in rodents.
 40

Bell, C. G., Walley, A. J., and Froguel, P. (2005). The genetics of human obesity. Nat Rev
Genet, 6(3), 221-34.

Obesity is an important cause of morbidity and mortality in developed countries, and is

also becoming increasingly prevalent in the developing world. Although environmental
factors are important, there is considerable evidence that genes also have a significant
role in its pathogenesis. The identification of genes that are involved in monogenic,
syndromic and polygenic obesity has greatly increased our knowledge of the mechanisms
that underlie this condition. In the future, dissection of the complex genetic architecture
of obesity will provide new avenues for treatment and prevention, and will increase our
understanding of the regulation of energy balance in humans.

Bell, J., and Standish, M. (2005). Communities and health policy: a pathway for change. Health
Aff (Millwood), 24(2), 339-42.

Improving the health system can reduce the effects of health disparities, but it can do
little to eliminate them. An upsurge in new research is documenting the impact of
physical, social, and economic environmental factors: air quality, housing conditions,
racism, relationship to community institutions, and neighborhood economic conditions,
all of which affect health status over time. A combined focus on community and the
policies that affect communities' environments presents opportunities for altering and
ameliorating the underlying forces at the heart of the determinants of health. This
Perspective presents examples of successful community involvement and policy change.

Bendixen, H., Flint, A., Raben, A., C, H. O., Mu, H., Xu, X., Bartels, E. M., and Astrup, A.
(2002). Effect of 3 modified fats and a conventional fat on appetite, energy intake, energy
expenditure, and substrate oxidation in healthy men. American Journal of Clinical Nutrition,
75(1), 47-56.

Different dietary fats are metabolized differently in humans and may influence energy
expenditure, substrate oxidation, appetite regulation, and body weight regulation.

Berg, A. (2004). Interaction between lifestyle, body composition and activities of daily living.
Isokinetics and Exercise Science, 12(1), 37-38.

Lifestyle and body composition are significant variables influencing the scenario of
morbidity and mortality in our population. In combination with genetic factors, lifestyle
and body composition are responsible for the development and progression of chronic
diseases such as insulin resistance, type II diabetes, hypertension and coronary heart
disease. People are eating more and exercising less resulting in a positive energy balance
and an increase of body weight.
 41

Berg, F., Buechner, J., and Parham, E. (2003). Guidelines for childhood obesity prevention
programs: promoting healthy weight in children. Journal of Nutrition Education and Behavior,
35(1), 1-4.

These guidelines for obesity prevention programs encourage a health-centered, rather

than weight-centered, approach that focuses on the whole child, physically, mentally, and
socially. The emphasis is on living actively, eating in normal and healthful ways, and
creating a nurturing environment that helps children recognize their own worth and
respects cultural foodways and family traditions. It is recognized that obesity, eating
disorders, hazardous weight loss, nutrient deficiencies, size discrimination, and body
hatred are all interrelated and need to be addressed in comprehensive ways that do no
harm.

Berg, F. M. (1999). Health risks associated with weight loss and obesity treatment programs.
Journal of Social Issues, 55(2), 277-298.

Because treating obesity through weight loss has been a major public health priority, a
large number of people are trying to lose weight at any given time. Many weight loss
techniques widely available and widely used have adverse physical effects. This article
reviews the research on risky weight loss methods, including prescription and over-the-
counter diet pills, semistarvation and other food restriction diets, stomach reduction
surgery, purging, laxatives, diuretics, vomiting, and fasting.

Berke, E. M., and Morden, N. E. (2000). Medical management of obesity. American Family
Physician, 62(2), 419-426, 303-306, 448.

Obesity is one of the most common medical problems in the United States and a risk
factor for illnesses such as hypertension, diabetes, degenerative arthritis and myocardial
infarction. It is a cause of significant morbidity and mortality and generates great social
and financial costs.

Berkowitz, R. I., Stallings, V. A., Maislin, G., and Stunkard, A. J. (2005). Growth of children at
high risk of obesity during the first 6 y of life: implications for prevention. American Journal of
Clinical Nutrition, 81(1), 140-6.

The contribution of familial factors to adiposity in children is poorly understood. The

objective was to assess differences in growth in the first 6 y of life in children born to
either overweight or lean mothers.

Berry, D. (2004). An emerging model of behavior change in women maintaining weight loss.
Nursing Science Quarterly, 17(3), 242-250.

This study is based on and expands Newman's theory of health as expanding

consciousness with women who maintained weight loss for at least 1 year. The researcher
engaged in two in-depth interviews with twenty women. Individual patterns for
participants who maintained weight loss revealed a personal journey of self-discovery
 42

and control with initial chaos, choice, and then emergence of behaviors reflecting
expanded consciousness. Looking across participants, six patterns emerged from the data
with evolution of a model of change that has implications for nursing practice at defined
times within the change process of weight loss.

Berry, D., Galasso, P., Melkus, G., and Grey, M. (2004). Obesity in youth: implications for the
advance practice nurse in primary care. Journal of the American Academy of Nurse
Practitioners, 16(8), 326-334.

To discuss the advanced practice nurse's diagnosis and management of obesity in youth
in primary care. Recent research suggests a genetic and environmental etiology
associated with impaired glucose tolerance, type 2 diabetes, hypertension,
hyperlipidemia, and hypertriglyceridemia. Nutrition education, increasing physical
activity, decreasing sedentary behaviors, and behavioral modification have been used
with varying success. Management is directed at healthy lifestyle behavior change for
youth and their families.

Berry, D., Sheehan, R., Heschel, R., Knafl, K., Melkus, G., and Grey, M. (2004). Family-based
interventions for childhood obesity: a review. Journal of Family Nursing, 10(4), 429-449.

The purpose of this article is to critically evaluate the evidence related to family-based
interventions designed to treat childhood obesity. A MEDLINE, PSYCLIT, and CINAHL
search identified articles published between January 1980 and January 2004 relating to
family-based interventions. Thirteen studies were included, and all of the interventions
used nutrition education, exercise, and behavioral interventions, including behavioral
modification, behavioral therapy, or problem solving. Behavioral modification
interventions targeted children and parents together or separately and were reported to be
successful in improving weight-loss outcomes in both parents and children. Behavioral
therapy interventions targeting children and parents together or the parents of children
separately improved weight outcomes. Problem-solving interventions that targeted
parents of children showed improved weight outcomes for their children.

Berry, S. (2004). Promoting children's health: Integrating school, family, and community.
Journal of Pediatric Psychology, 29(3), 241-242.

This reviewed book is written with the premise that professionals must work to integrate
systems of care to manage successfully and prevent health care concerns. The authors
offer theoretical models as well as provide specific guidelines for both developing and
evaluating programs of care. Their models and guidelines are both grounded in evidence-
based strategies and a consistently strong linkage of science and practice.

Berteus Forslund, H., Torgerson, J. S., Sjostrom, L., and Lindroos, A. K. (2005). Snacking
frequency in relation to energy intake and food choices in obese men and women compared to a
reference population. International Journal of Obesity and Related Metabolism Disorders, 29(6),
711-9.
 43

To investigate snacking frequency in relation to energy intake and food choices, taking
physical activity into account, in obese vs. reference men and women.

Berube Parent, S., Prud'homme, D., St Pierre, S., Doucet, E., and Tremblay, A. (2001). Obesity
treatment with a progressive clinical tri-therapy combining sibutramine and a supervised diet-
exercise intervention. International Journal of Obesity and Related Metabolism Disorders, 1144-
1153.

Sibutramine favors a negative energy balance and also has the potential to increase heart
rate and blood pressure. We investigated if a progressive supervised sibutramine-diet-
exercise clinical intervention could increase the body weight loss previously reported
while minimizing the potential cardiostimulatory effects of this drug.

Bessesen, D. H. (2003). Future directions in weight control: molecular and genetic discoveries
pave the way. Symposium: second of two articles on obesity. Postgraduate Medicine, 1147(6),
30-32, 35-38.

Obesity is the result of a long-standing imbalance between energy intake and energy
expenditure, aided by a complex biologic system that regulates appetite and favors intake.
New knowledge about substances that stimulate or inhibit appetite offers hope that drug-
based solutions will be found for the current high prevalence of obesity in the United
States. In this article, Dr Bessesen highlights some of the new molecular and genetic
discoveries related to obesity and outlines the hypothalamic neural pathways involved in
regulating food intake.

Bhathena, S. J., and Velasquez, M. T. (2002). Beneficial role of dietary phytoestrogens in obesity
and diabetes. American Journal of Clinical Nutrition, 76(6), 1191-1201.

Evidence is emerging that dietary phytoestrogens play a beneficial role in obesity and
diabetes. Nutritional intervention studies performed in animals and humans suggest that
the ingestion of soy protein associated with isoflavones and flaxseed rich in lignans
improves glucose control and insulin resistance. In animal models of obesity and
diabetes, soy protein has been shown to reduce serum insulin and insulin resistance.

Bianchi, G., Marzocchi, R., Agostini, F., and Marchesini, G. (2005). Update on nutritional
supplementation with branched-chain amino acids. Curr Opin Clin Nutr Metab Care, 8(1), 83-7.

Branched-chain amino acids (BCAAs) have a peculiar role in whole-body nitrogen

metabolism. BCAAs are not only a substrate for protein synthesis, but also modulate
several components of the synthetic machinery and help to conserve muscle mass;
accordingly, several conditions, characterized by protein loss and catabolic status, are
likely to benefit from amino acid administration. In addition, the competitive action of
BCAAs on amino acid transport across the blood-brain barrier may ultimately alter the
synthesis of brain neurotransmitters, involved in neurological diseases. RECENT
FINDINGS: Both putative actions of BCAAs have been tested in controlled clinical
studies in the last few years. The beneficial effects on nutrition were reported to improve
 44

muscle performance, reduce protein loss during bed-rest, favor weight loss in obesity,
reduce catabolism in trauma patients and improve clinical outcomes in patients with
advanced cirrhosis. In this last area, the effects on nutrition might be coupled with the
effects on hepatic encephalopathy mediated by improved neurotransmission, successfully
tested in mania, tardive dyskinesia and spinocerebellar degeneration.

Bianchini, F., Kaaks, R., and Vainio, H. (2002). Overweight, obesity, and cancer risk. Lancet
Oncology, 3(9), 565-574.

Over the past few decades the proportion of people with excess body weight has been
increasing in both developed and less developed countries. About 50% of men and 35%
of women in Europe are currently estimated to be overweight or obese. In addition to an
increase in the risk of cardiovascular disease and type II diabetes, the evidence
summarised here shows that excess body weight is directly associated with risk of cancer
at several organ sites, including colon, breast (in postmenopausal women), endometrium,
oesophagus, and kidney. In part, these associations with cancer risk may be explained by
alterations in the metabolism of endogenous hormones-including sex steroids, insulin,
and insulin-like growth factors-which can lead to distortion of the normal balance
between cell proliferation, differentiation, and apoptosis. Avoidance of weight gain thus
seems to be an important factor for cancer prevention.

Birkenfeld, A. L., Schroeder, C., Boschmann, M., Tank, J., Franke, G., Luft, F. C., Biaggioni, I.,
Sharma, A. M., and Jordan, J. (2002). Paradoxical effect of sibutramine on autonomic
cardiovascular regulation. Circulation, 106(19), 2459-2465.

Sibutramine, a serotonin and norepinephrine transporter blocker, is widely used as an

adjunctive obesity treatment. Norepinephrine reuptake inhibition with sibutramine
conceivably could exacerbate arterial hypertension and promote cardiovascular disease.
Methods and Results: In 11 healthy subjects (7 men, age 27+-2 years, body mass index
23.1+-0.7 kg/m2), we compared the effect of sibutramine or matching placebo (ingested
26, 14, and 2 hours before testing) on cardiovascular responses to autonomic reflex tests
and to a graded head-up tilt test.

Blackett, P. R., Blevins, K. S., Quintana, E., Stoddart, M., Wang, W., Alaupovic, P., and Lee, E.
T. (2005). ApoC-III bound to apoB-containing lipoproteins increase with insulin resistance in
Cherokee Indian youth. Metabolism, 54(2), 180-7.

Because Native Americans are predisposed to obesity and type 2 diabetes associated with
coronary artery disease, we assessed whether apoC-III bound to apoB-containing
(LpB:C-III) and apoA-containing (LpA:C-III) lipoproteins, total apoC-III, apoB, and
plasma lipids are associated with insulin resistance, body mass index (BMI), and waist
circumference in Cherokee children and adolescents aged 5 to 19 years (n = 975).

Blair, S. N., and Brodney, S. (1999). Effects of physical inactivity and obesity on morbidity and
mortality: current evidence and research issues. Medicine and Science in Sports and Exercise,
31(11 Suppl), S646-S662.
 45

The purpose of this review was to address three specific questions. 1) Do higher levels of
physical activity attenuate the increased health risk normally observed in overweight or
obese individuals? 2) Do obese but active individuals actually have a lower morbidity
and mortality risk than normal weight persons who are sedentary? 3) Which is a more
important predictor of mortality, overweight or inactivity?

Blair, S. N., Horton, E., Leon, A. S., Lee, I. M., Drinkwater, B. L., Disman, R. K., Mackey, M.,
and Kienholz, M. L. (1996). Physical activity, nutrition, and chronic disease. Medicine and
Science in Sports and Exercise, 28(3), 335-349.

Epidemiologic, animal, clinical, and metabolic studies demonstrate the independent roles
of physical activity and nutrition in the prevention and treatment of several chronic
diseases. Fewer data are available to describe the synergistic effects of exercise and diet,
and questions remain as to whether and how these two lifestyle factors work together to
promote health and prevent disease. This paper briefly reviews many of the known
effects of physical activity and nutrition on the prevention and treatment of coronary
heart disease, non-insulin-dependent diabetes mellitus, obesity, and osteoporosis as well
as how exercise and diet may work together.

Block, J. P., DeSalvo, K. B., and Fisher, W. P. (2003). Are physicians equipped to address the
obesity epidemic? Knowledge and attitudes of internal medicine residents. Preventive Medicine,
36(6), 669-675.

To analyze whether internists are suited for their role in treating the growing numbers of
obese patients, we surveyed residents about their knowledge and attitudes regarding
obesity. Previous assessments have not analyzed familiarity with obesity measurement
tools or the correlation between knowledge and attitudes.

Blocker, D. E., and Freudenberg, N. (2001). Developing comprehensive approaches to

prevention and control of obesity among low-income, urban, African-American women. Journal
of the American Medical Women's Association, 56(2), 59-64.

Obesity presents a major threat to the health and well-being of low-income, urban,
African-American women. African-American women have among the highest rates of
obesity in the United States and suffer from a corresponding excess burden of obesity-
related diseases. Distinct physiological, societal, cultural, and environmental factors form
a mosaic of forces that promote weight gain and prevent weight loss in these women. To
develop specific strategies to improve their health, researchers need to better understand
the unique nutritional problems facing low-income African-American women residing in
inner cities. Individual and community interventions to promote weight reduction have
been insufficient to reverse the epidemic. A problem of this magnitude requires concerted
and comprehensive policy interventions. This paper uses an ecological approach to
suggest multilevel public health strategies to reduce obesity among urban African-
American women.
 46

Blundell, J., and Le Noury, J. (2001). Carbohydrates and appetite control. proceedings of the
Kellogg's Nutrition Symposium 2000, Sydney, 8 August 2000. Australian Journal of Nutrition
and Dietetics, 58, S13-S18 Suppl 1.

Many studies have shown that consumption of high carbohydrate foods can give rise to a
clear modulation of the expression of human appetite. The potency and time course of the
effects of various carbohydrates on satiety vary with the amount consumed and the
chemical structure. There is evidence that this biological effect can modulate the
temporal profile of hunger and the eating pattern of meals and snacks. One important
issue is the action of carbohydrate foods on satiation (within meals) and satiety (after
meals). These effects can be contrasted with the relatively weaker effects of high fat
foods. The physiological mechanisms through which carbohydrates exert an action on
appetite include plasma glucose levels, glucoreceptors, hepatic glucose metabolism and
glycogen stores. Experimental evidence indicates that the encouragement to eat high
carbohydrate (low fat) snacks or high carbohydrate breakfasts can significantly reduce
daily fat intake, limit energy intake, prevent weight gain and even induce weight loss. It
is therefore possible to design high carbohydrate diets that provide good nutrition with
adequate control over appetite and a beneficial effect on body weight.

Blundell, J. E., and Halford, J. C. G. (1995). Pharmacological aspects of obesity treatment:

towards the 21st century. International Journal of Obesity and Related Metabolism Disorders,
S51-S55.

A bio-behavioural-environmental phenomenon: Obesity is on the increase all over the

world in technologically advanced countries, developing countries and rural
communities. What is causing this upward drift in body weight? Can drugs do anything
to ameliorate the situation?

Blundell, J. E., and King, N. A. (1999). Physical activity and regulation of food intake: current
evidence. Medicine and Science in Sports and Exercise, 31(11 Suppl), S573-S583.

The evidence was reviewed on how physical activity could influence the regulation of
food intake by either adjusting the sensitivity of appetite control mechanisms or by
generating an energy deficit that could adjust the drive to eat. Interventionist and
correlational studies that had a significant influence on the relationship between physical
activity and food intake were reviewed. Interventionist studies involve a deliberate
imposition of physical activity with subsequent monitoring of the eating response.

Boreham, C., and Riddoch, C. (2001). The physical activity, fitness and health of children.
Journal of Sports Sciences, 19(12), 915-929.

It is clear that, despite their natural tendencies, children have become less physically
active in recent decades, with children today expending approximately 600 kcal.day-1
less than their counterparts 50 years ago. Although the health consequences of a reduced
energy expenditure in adults is well documented, there is little direct evidence linking
sedentariness with health in children. However, three main benefits arising from adequate
 47

childhood physical activity have been postulated. The first is direct improvements in
childhood health status; evidence is accumulating that more active children generally
display healthier cardiovascular profiles, are leaner and develop higher peak bone masses
than their less active counterparts. Secondly, there is a biological carryover effect into
adulthood, whereby improved adult health status results from childhood physical activity.
In particular, childhood obesity may be a precursor for a range of adverse health effects
in adulthood, while higher bone masses in young people reduce the risk of osteoporosis
in old age. Finally, there may be a behavioural carryover into adulthood, whereby active
children are more likely to become more active (healthy) adults. However, supporting
evidence for this assertion is weak. Given this background, recent health guidelines
suggesting that children should accumulate 60 min of moderate-intensity physical activity
every day - supplemented by regular activities that promote strength flexibility and bone
strength - appear to be justified. Future developments should include the implementation
of large-scale, longitudinal studies spanning childhood and young adulthood, the further
refinement of tools for measuring physical activity accurately in young people, and
research into the relative strength of association between fitness - as well as activity - and
health in children.

Bosch, J., Stradmeijer, M., and Seidell, J. (2004). Psychosocial characteristics of obese
children/youngsters and their families: implications for preventive and curative interventions.
Patient Education and Counseling, 55(3), 353-62.

A profile will be given of the psychosocial characteristics of obese children and

youngsters, as well as those of their families. Then several attempts of (particularly)
preventive interventions will be sketched. Differences found between clinical and non-
clinical groups of obese children and youngsters do not permit generalized statements
regarding specific psychosocial characteristics. Just as little as there exist a simple and
unequivocal image of family functioning with these children. There are great differences
between the psychological assumptions and the biological concepts about obesity.
Whereas, biological concepts are relevant for the whole obese population, psychosocial
characteristics seems to hold mainly for the clinical group of obese persons. The gap
between clinical versus non-clinical as well as curative versus preventive approaches will
be explained. There are remarkable differences between curative versus preventive
intervention goals in terms of the extent to which they focus on life style habits or
psychosocial (dys)functioning. Where prevention strategies focus more on enhancing
physical activities, curative interventions focus more on changing eating behavior
patterns and (depending on chronicity and seriousness of obesity) modifying
psychosocial dysfunctioning.
 48

Bouchard, C. (1996). Can obesity be prevented? (Conference on Nutrition and Physical Activity
to Optimize Performance and Well-Being). Nutrition Reviews, 54(4), S125-S131.

Overcoming obesity should become a national priority in North America and affluent
Western countries. Many children and adults chronically take in more calories than they
expend, an easily reversible trend. Recommended actions include establishing regular
meals, drinking water, keeping fat intake to 30% or less, walking, having regular sport
activities eliminating snacks and reducing TV time. Massive public health efforts are
needed to change the comfortable life style and excessive consumption.

Bowyer, C., and Trotter, K. (1997). Obesity treatment: future directions for the contribution of
dietitians. Journal of Human Nutrition and Dietetics, 10(2), 95-101.

This paper discusses strategies that dietitians can use, as part of a multidisciplinary team,
to promote weight loss and maintenance in obese adults.

Bowyer, C., and Trotter, K. (1997). Position paper approved by the Council of the British
Dietetic Association on 16 January 1997. Obesity treatment: future directions for the
contribution of dietitians. Journal of Human Nutrition and Dietetics, 95-101.

The British Dietetic Association (BDA) recognizes that obesity is a serious and growing
health problem in the UK. It welcomes the inclusion of reduction in the prevalence of
obesity as one of the targets of the Health of the Nation (DoH, 1992). The achievement of
this target will depend upon measures aimed at prevention, as well as improved treatment
for obesity. State Registered Dietitians (SRDs) are qualified to provide scientifically
based, independent information on nutrition and eating behaviour. They have an
important contribution to make to both public health measures and health promotion, as
well as to the development and implementation of more effective therapeutic strategies to
help those who are already obese.

Bradham, D. D., South, B. R., Saunders, H. J., Heuser, M. D., Pane, K. W., and Dennis, K. E.
(2001). Obesity-related hospitalization costs to the U.S. Navy, 1993 to 1998. Military Medicine,
166(1), 1-10.

The objective of this work was to estimate the cost to the U.S. Navy for obesity-related
hospital admissions by examining (1) inpatient utilization associated with obesity; (2) the
rank order, probability, and total facility costs of obesity-related diagnosis-related groups
(DRGs); and (3) expected inpatient expenses. The frequency and probability of inpatient
events in the Navy's active duty population were derived from the Department of
Defense's Retrospective Case Mix Analysis System. Medicare-based facility costs per
DRG were estimated. These measures were combined in a decision-analytic model.
Expected facility costs per obesity-related admission for active duty Navy personnel
increased by age group from $3,328 for 18 to 24 year olds to $5,746 for 45 to 64 year
olds. The annual avoidable inpatient cost for the Navy was estimated to be $5,842,627 for
the top 10 obesity-related DRGs. Improvements to the Navy Physical Readiness Program
 49

and other interventions that may reduce obesity, obesity-related health care use, and the
public economic burden should be pursued.

Braet, C. (1999). Treatment of obese children: A new rationale. Clinical Child Psychology and
Psychiatry, 4(4), 579-591.

The treatment of moderately overweight children should focus on changes in eating styles
rather than on dietary restraint. An educational programme has been designed with the
aim of normalizing eating behaviours in a child-friendly way and without the prescription
of a strict diet, and is illustrated with a case-report of a 12-year-old boy. The programme
is based on the principles of cognitive-behavioural therapy. Strong emphasis is put on the
therapeutic goal of self-regulation of a healthy life style. The philosophy adopted in the
programme assumes that teaching healthy eating habits has a preventive function, notably
the prevention of undesirable dieting habits and their possible side effects, such as binge-
eating. But this also has a healing function (e.g., the restoration of an adequate
intake/consumption balance and, to a lesser extent, weight control).

Bravata, D. M., Sanders, L., Huang, J., Krumholz, H. M., Olkin, I., Gardner, C. D., and Bravata,
D. M. (2003). Efficacy and safety of low-carbohydrate diets: A systematic review. JAMA:
Journal of the American Medical Association, 289(14), 1837-1850.

Reviewed literature to evaluate changes in weight, serum lipids, fasting serum glucose,
fasting serum insulin levels, and blood pressure (BP) among adults using low-
carbohydrate diets in an outpatient setting. The authors included articles describing
recipients of low-carbohydrate diets of 4 days or more in duration and 500 kcal/d or
more, and which reported both carbohydrate content and total calories consumed. The
included studies were highly heterogeneous with respect to design, carbohydrate content,
total caloric content, diet duration, and participant characteristics.

Bray, G. A. (2004). The epidemic of obesity and changes in food intake: The Fluoride
Hypothesis. Physiology and Behavior, 82(1), 115-121.

The epidemic of obesity is worldwide. It will be followed by an epidemic of diabetes.

Although there is a genetic basis for obesity and diabetes, the current epidemic reflects
the failure of our ancient genes to cope with a modern toxic environment. To put it
another way, the genetic background loads the gun, but the environment pulls the trigger.
Diet, lifestyle and exercise are the cornerstones of current approaches to treating obesity.
However, these approaches that depend on individuals making lifestyle changes have
been ineffective in preventing the epidemic. An alternative model views obesity as an
epidemiological disease with food(s) and other environmental agents acting on the host to
produce disease. The consumption patterns for many foods have changed over the past 30
years, but the increase in the consumption of high-fructose corn syrup (HFCS) for soft
drinks is far and away the largest. Moreover, the rise in HFCS intake is an environmental
insult that has occurred at exactly the same time as obesity began to increase in
prevalence. Rising soft drink consumption is associated with a decrease in milk
 50

consumption and a decrease in calcium intake, which has an inverse relationship to body
mass index (BMI).

Brochu, M., Poehlman, E. T., and Ades, P. A. (2000). Obesity, body fat distribution, and
coronary artery disease. Journal of Cardiopulmonary Rehabilitation, 20(2), 96-108.

Obesity is an independent risk factor for the development of coronary artery disease
(CAD). Obesity also increases risk for CAD indirectly through its association with
insulin resistance, hyperlipidemia, and hypertension. An increased accumulation of fat in
the intraabdominal cavity, termed visceral adiposity, is highly correlated with an adverse
coronary risk profile. In patients at risk for coronary artery disease, the treatment of
obesity results in an improved coronary risk profile. The prevalence of obesity is
extremely high in coronary populations, yet the effect of weight loss on cardiovascular
outcomes in CAD patients has received relatively little attention.

Brown, K. M., Akintobi, T. H., Pitt, S., Berends, V., McDermott, R., Agron, P., and Purcell, A.
(2004). California school board members' perceptions of factors influencing school nutrition
policy. Journal of School Health, 74(2), 52-58.

Enactment and enforcement of school nutrition policies represent key components in

adolescent overweight and obesity prevention. This study determined: 1) California
school board members' attitudes, perceptions, and motivations related to enactment of
policies that support healthy eating in schools; and 2) barriers to adopting school policies
that support healthy eating. To understand board members' decision-making process, key
informant interviews were conducted and a survey was administered to 404 school board
members. Though school board members care about the well-being of pupils, competing
priorities limit the extent to which nutrition issues get addressed at board meetings.
Members' decisions center primarily around academic achievement issues, yet they are
interested in nutrition's overall impact on children's health and academic achievement.

Brownell, K. D. (1995). Exercise and obesity treatment: psychological aspects. International

Journal of Obesity and Related Metabolism Disorders, S122-S125.

Exercise is clearly beneficial as a means for losing weight and keeping it off. Given
recent studies showing its association with maintenance, it would be difficult to argue
that any factor is more important than exercise. For an exercise program to be helpful for
obese persons, the challenges of exercise adherence must be considered, as must the
mechanisms linking exercise to weight control. Both argue for whatever activity an
individual will undertake that will produce the psychological effects that promote weight
control.

Bruce, C. R., and Hawley, J. A. (2004). Improvements in insulin resistance with aerobic exercise
training: a lipocentric approach. Medicine and Science in Sports and Exercise, 36(7), 1196-1201.

Traditional views on the metabolic derangements underlying insulin resistance and Type
2 diabetes have been largely "glucocentric" in nature, focusing on the hyperglycemic
 51

and/or hyperinsulinemic states that result from impaired glucose tolerance. But in
addition to glucose intolerance, there is a coordinated breakdown in lipid dynamics in
individuals with insulin resistance, manifested by elevated levels of circulating free fatty
acids, diminished rates of lipid oxidation, and excess lipid accumulation in skeletal
muscle and/or liver. This review examines the premise that an oversupply and/or
accumulation of lipid directly inhibits insulin action on glucose metabolism via changes
at the level of substrate competition, enzyme regulation, intracellular signaling, and/or
gene transcription. If a breakdown in lipid dynamics is causal in the development of
insulin resistance (rather than a coincidental feature resulting from it), it should be
possible to demonstrate that interventions that improve lipid homeostasis cause reciprocal
changes in insulin sensitivity. Accordingly, the efficacy of aerobic endurance training in
human subjects in mediating the association between deranged lipid metabolism and
insulin resistance will be examined.

Bryant, S. A., and Neff Smith, M. (2001). Risk factors and interventions for obesity in African-
American women. Journal of Multicultural Nursing and Health, 7(1), 54-56.

The purpose of this literature review is to examine the risk factors for obesity that relate
to African-American women. Minorities, especially African-American women, share the
US trend toward an increased prevalence rate in obesity but they bear a heavier burden of
obesityrelated diseases such as hypertension and diabetes than the rest of the population.
African American women's obesity must be placed within a context that shows the
interplay between social and political forces that influence and shapes individual
behavior. Interventions must be targeted at this population's specific needs.

Buracchi, G., Leonardi, A., Brizzi, R., Velicogna, F., and Cioffi, R. (2004). General and social-
cognitive aspects of non-control alimentation disease and obesity / Aspetti generali e socio-
cognitivi dei disturbi da alimentazione incontrollata e dell'obesita. Medicina Psicosomatica,
49(1-2), 41-48.

Binge eating disorders (BED), also known as compulsive overeating, are characterized
primarily by episodes of uncontrolled eating or binging. Many people with these
disorders are obese and have a history of weight fluctuations. Overweight and obesity are
on the increase and many people diet to lose weight. In parallel, diet-related subjects are
in vogue and over the past few years there has been an explosion of interest in any aspect
of diet (the "dieting industry"), from healthy eating throught eating disorders. In trying to
understand the causes of eating disorders, scientists have studied the personalities,
genetics, environments, and biochemistry of people with these illnesses.

Butchko, H. H., and Petersen, B. J. (2004). The obesity epidemic: stakeholder initiatives and
cooperation. Nutrition Today, 39(6), 235-244.

The obesity epidemic in the United States is growing and will only get worse unless
effective, coordinated strategies are developed and policies put into place to stem this
tide. Unfortunately, today there are more questions than answers regarding why we have
this crisis and how to solve it. Balancing the energy equation to attain and maintain a
 52

healthy body weight seems a simple concept; however, putting this concept into practice
in everyday life has clearly become a losing battle. A large research base exists to guide
the development of solutions. However, understanding the underlying science and
applying that science to create practical and successful solutions is our challenge. There
are a number of key stakeholders in the obesity epidemic-the public, regulators and
policy makers, consumer groups, and the food, beverage, and restaurant industries.

Caballero, B. (2004). Obesity prevention in children: opportunities and challenges. International

Journal of Obesity, 28(Supplement 3), S90-S95.

Longitudinal survey data from a number of countries confirm that the number of
overweight children continues to increase at alarming rates, and even developing
countries are experiencing a rise in their overweight population. There is ample
consensus that prevention strategies are essential to turn the tide of the obesity epidemic,
and yet there are still relatively few proven prevention approaches for children. An article
is presented briefly discussing some of the common features of childhood obesity
prevention programmes, focusing on the experience in the USA and Canada.

Caballero, B., Clay, T., Davis, S. M., Ethelbah, B., Rock, B. H., Lohman, T., Norman, J., Story,
M., Stone, E. J., Stephenson, L., and Stevens, J. (2003). Pathways: a school-based, randomized
controlled trial for the prevention of obesity in American Indian schoolchildren. American
Journal of Clinical Nutrition, 78(5), 1030-1038.

The objective was to evaluate the effectiveness of a school-based, multicomponent

intervention for reducing percentage body fat in American Indian schoolchildren.

Caballero, B., Himes, J. H., Lohman, T., Davis, S. M., Stevens, J., Evans, M., Going, S., and
Pablo, J. (2003). Body composition and overweight prevalence in 1704 schoolchildren from 7
American Indian communities. American Journal of Clinical Nutrition, 78(2), 308-312.

Nationwide data on obesity prevalence in American Indian communities are limited. We

describe the body composition and anthropometric characteristics of schoolchildren from
7 American Indian communities enrolled in the Pathways study, a randomized field trial
evaluating a program for the primary prevention of obesity.

Calamaro, C. J., and Faith, M. S. (2004). Preventing childhood overweight. Nutrition Today,
39(5), 194-199.

Childhood overweight continues to increase in prevalence in the United States.

Television viewing habits, food portion sizes, parent-child feeding relations, and vending
machine snack prices and availability may promote overweight in children to varying
degrees. This article reviews data pertaining to these 4 environmental considerations, as
well as practical strategies that caregivers might use for their management.

Callery, P. (2004). Children and choice. Gastrointestinal Nursing, 2(5), 14.

 53

Dr Peter Callery believes nurses play an important part in helping children to make
healthy choices.

Campbell, I. (2003). The obesity epidemic: Can we turn the tide? Heart, 89(Supplement 2), ii22-
ii24.

Obesity has reached epidemic proportions in the UK. It is important because of the
associated co-morbidities, which include cardiovascular disease, type 2 diabetes, and
osteoarthritis. The prevalence of obesity has increased because of a combination of
excessive calorific intake (for example, from increased intake of energy dense foods) and
insufficient energy expenditure (associated with a sedentary lifestyle). Weight loss of 5-
10%, which can be achieved in primary care, is associated with significant health
benefits. Obesity treatment in primary care includes lifestyle modification and drug
treatment. The prevention and treatment of obesity cannot, however, be left solely to
health professionals. Action is needed by government, the food industry, and society as a
whole.

Campbell, K., and Crawford, D. (2001). Family food environments as determinants of preschool-
aged children's eating behaviours: implications for obesity prevention policy. A review.
Australian Journal of Nutrition and Dietetics, 58(1), 19-25.

This review focuses on the role of family food environments in the establishment of
eating behaviours in preschool children, and its subsequent effect in the development of
obesity. It is well demonstrated that eating behaviours are likely to be established early in
life and may be maintained into adulthood, and these eating behaviours are greatly
influenced by the family food environment. Factors that are important in the family
environment are enumerated, and include parental food preferences and beliefs, children's
food exposure, role modelling, media exposure, and child-parent interactions around
food. Further examination of these factors can help in the development of better nutrition
intervention policies and strategies addressing the problems of chronic health conditions
(including obesity, in Australia).

Campbell, K., Waters, E., O Meara, S., and Summerbell, C. D. (2001). Interventions for
preventing obesity in childhood. A systematic review. Obesity Reviews, 2(3), 149-158.

Background The prevalence of obesity and overweight is increasing worldwide. Obesity

in children impacts on their health in both short- and long-term. Obesity prevention
strategies are poorly understood. Objective To assess the effectiveness of interventions
designed to prevent obesity in childhood. Search strategy Electronic databases were
searched from January 1985 to October 1999.

Campfield, L. A., Smith, F. J., and Burn, P. (1998). Strategies and potential molecular targets for
obesity treatment. Science, 29, 1383-1387.

Obesity is an increasingly prevalent and important health problem. Although treatment is

available, the long-term maintenance of medically significant weight loss (5 to 10 percent
 54

of initial body weight) is rare. Since 1995 there has been an explosion of research focused
on the regulation of energy balance and fat mass. Characterization of obesity-associated
gene products has revealed new biochemical pathways and molecular targets for
pharmacological intervention that will likely lead to new treatments. Ideally, these
treatments will be viewed as adjuncts to behavioral and lifestyle changes aimed at
maintenance of weight loss and improved health.

Carels, R. A., Darby, L. A., Cacciapaglia, H. M., and Douglass, O. M. (2004). Reducing
cardiovascular risk factors in postmenopausal women through a lifestyle change intervention.
Journal of Women's Health, 13(4), 412-426.

The impact of a 6-month lifestyle change intervention on cardiovascular risk factors in

obese, sedentary, postmenopausal women was examined. A secondary aim of this
investigation was to determine whether the addition of self-control skills training to an
empirically supported lifestyle change intervention would result in greater cardiovascular
risk reduction.

Carlisle, L. K., Gordon, S. T., and Sothern, M. S. (2005). Can obesity prevention work for our
children? Jo La State Med Soc, 157 Spec No 1, S34-41.

The prevalence of obesity in children and adolescents is higher than 20 years ago in all
racial-ethnic, age, and gender groups. Research has lead to the discovery of many risk
factors for obesity, which may help practitioners target at-risk individuals. Insight
concerning obesity prevention can come from examining other public health programs,
which center on prevention; such as smoking, seat belt use, and sexually transmitted
disease. Another guide when establishing obesity prevention is evaluation of currently
successful programs. Prevention and treatment interventions for childhood obesity should
promote the replacement of unhealthy eating and exercise practices with healthier
behaviors. The goal of prevention should always be maintenance of normal growth
patterns, rather than weight loss. In predisposed children, sedentary, non-nutritious
environments challenge metabolic capacity and promote overweight conditions, further
inactivity and increased sedentary behaviors. This results in clinically significant obesity,
reduced insulin sensitivity and ultimately type 2 diabetes later in life. Prevention of future
chronic disease in children and adults may depend on our ability to prevent the onset of
obesity in young children. This should be a primary goal of pediatricians, family health
care professionals, and public health professionals.

Carnethon, M. R., Gidding, S. S., Nehgme, R., Sidney, S., Jacobs, D. R., Jr., and Liu, K. (2003).
Cardiorespiratory Fitness in Young Adulthood and the Development of Cardiovascular Disease
Risk Factors. Journal of the American Medical Association, 290(23), 3092-3100.

Low cardiorespiratory fitness is an established risk factor for cardiovascular and total
mortality; however, mechanisms responsible for these associations are uncertain. To test
whether low fitness, estimated by short duration on a maximal treadmill test, predicted
the development of cardiovascular disease risk factors and whether improving fitness
 55

(increase in treadmill test duration between examinations) was associated with risk
reduction.

Caroli, M., Argentieri, L., Cardone, M., and Masi, A. (2004). Role of television in childhood
obesity prevention. International Journal of Obesity, 28(Supplement 3), S104-S108.

A study was conducted to assess the role of television (TV) as a tool for childhood
obesity prevention. A review of available literature on the relationship between TV and
childhood obesity, eating habits and body shape perception was done. The reviewed
studies showed the following: watching TV replaces more vigorous activities; there is a
positive correlation between time spent watching TV and being overweight or obese on
populations of different ages; obesity prevalence has increased as well as the number of
hours that TV networks dedicate to children; during the last 30 years, the rate of children
watching TV for more than 4 h/day seems to have increased; children are exposed to a
large number of important unhealthy stimulations in terms of food intake when watching
TV; over the last few years, the number of TV food commercials targeting children have
increased especially when it comes to junk food in all of its forms; the present use of food
in movies, shows and cartoons may lead to a misconception of the notion of healthy
nutrition and stimulate an excessive intake of poor nutritional food; and obese subjects
shown in TV programmes are in a much lower percentage than in real life and are
depicted as being unattractive, unsuccessful and ridiculous or with other negative traits
and this is likely to result in a worsening of the isolation in which obese subjects are often
forced.

Caroli, M., and Lagravinese, D. (2002). Prevention of obesity. Nutrition Research, 22(1/2), 221-
226.

The increased prevalence of obesity highlights the need of programmes for its prevention.
In the obesity prevention programmes calorie and nutrient intake, emotional and social
cues related to food intake must be considered. Thus, in order to prevent development of
obesity, modifying the nutritional factors would be necessary: increasing breast feeding
in terms of percentage and duration; modifying wrong weaning patterns, decreasing
protein intake and increasing fat intake until 2 years of age; modifying toddler and school
age children eating habit, decreasing fat intake and increasing carbohydrates and fibre
intake; helping parents and/or guardians to understand the real needs of their children
without using food as form of gratification, reward, and/or consolation for every negative
feelings and situations; asking governments, consumer unions, food industries, and mass
media to reduce and regulate non-nutritional food advertising during children television
time.

Carraro, R., and Garcia Cebrian, M. (2003). Role of prevention in the contention of the obesity
epidemic. European Journal of Clinical Nutrition, 57(9), S94-S97.

Obesity has become one of the major health burdens of the westernized world with an
increasing number of people affected at any age. Although genetic factors explain around
40% of individual susceptibility to the disease, obesity may and should be controlled
 56

through interventions on the individual behaviour and on the social environment. Very
promising to this aim is the role of prevention. Several levels of action have been
established as well as different types of interventions according to th targeted population.
Of special importance is the contention of childhood obesity with home and school as
privileged settings for intervention. Despite a general acknowledging of the urgency for
effective preventive measures at social, economic and political level to contrast the
increasing prevalence of obesity, no clear nationwide policies have yet been established,
and the educational and public health measures adopted so far lack that coordination and
integration that the magnitude of the situation requires.

Carroll, S., Cooke, C. B., and Butterly, R. J. (2000). Metabolic clustering, physical activity and
fitness in nonsmoking, middle-aged men. Medicine and Science in Sports and Exercise, 32(12),
2079-2086.

The relationship of both physical activity and predicted maximum oxygen consumption
(VO2max) with the clustering of metabolic risk factors associated with the metabolic
syndrome (MS) was examined within 711 employed middle-aged (46.9 +/- 7.8 yr) men.
Metabolic markers included fasting glucose, triglycerides, high-density lipoprotein
cholesterol, blood pressure, and BMI, defined by highest risk quintiles or clinically
relevant risk thresholds.

Carroll, S., and Dudfield, M. (2004). What is the relationship between exercise and metabolic
abnormalities? A review of the metabolic syndrome. Sports Medicine, 34(6), 371-418.

Prevention of the metabolic syndrome and treatment of its main characteristics are now
considered of utmost importance in order to combat the epidemic of type 2 diabetes
mellitus and to reduce the increased risk of cardiovascular disease and all-cause
mortality. Insulin resistance/hyperinsulinaemia are consistently linked with a clustering
of multiple clinical and subclinical metabolic risk factors.

Carryer, J. (2001). Embodied largeness: a significant women's health issue. Nursing Inquiry,
8(2), 90-97.

This paper describes a three-year long research project in which nine large-bodied
women have engaged in a prolonged dialogue with the researcher about the experience of
being 'obese'. The study involved an extensive review of the multidisciplinary literature
that informs our understandings of body size. The literature review was shared with
participants in order to support their critical understanding of their experience.

Carter, M., and Swinburn, B. (2004). Measuring the 'obesogenic' food environment in New
Zealand primary schools. Health Promotion International, 19(1), 15-20.

Childhood obesity is an increasing health problem in New Zealand and many other
countries. Information is needed to guide interventions that reduce the 'obesogenic'
(obesity-promoting) elements of school environments. The aim of this study was to
 57

identify and measure the obesogenic elements of the school environment and the canteen
sales of energy-dense foods and drinks.

Cavnar, M. M., Kirtland, K. A., Evans, M. H., Wilson, D. K., Williams, J. E., Mixon, G. M., and
Henderson, K. A. (2004). Evaluating the quality of recreation facilities: development of an
assessment tool. Journal of Park and Recreation Administration, 22(1), 96-114.

The purpose of this study was to develop a tool for assessing the quality of public
recreation facilities' amenities. Knowing the location, distribution, and quality of
recreation facilities can assist administrators in developing more effective programs for
encouraging physical activity across city, county, and state systems. Based on a literature
review, expert opinions, and professional standards, a tool was developed for assessing
the safety, condition, and maintenance of recreation facilities.

Cerrato, P. L. (1999). Clinical guidelines for adult obesity. Office Nurse, (OFFICE-NURSE)
1999 Feb; 12(2): 9-11 (3 ref). 12: 9-11

Like high blood pressure and elevated serum cholesterol, obesity is a silent killer.
Informing patients about the latest federal guidelines can help them reduce the potentially
life-threatening effects of carrying around too many pounds.

Cervero, R., and Duncan, M. (2003). Reviewing the evidence. Walking, bicycling, and urban
landscapes: evidence from the San Francisco Bay area. American Journal of Public Health,
93(9), 1478-1483.

Some claim that car-dependent cities contribute to obesity by discouraging walking and
bicycling. In this article, we use household activity data from the San Francisco region to
study the links between urban environments and nonmotorized travel. We used factor
analysis to represent the urban design and land-use diversity dimensions of built
environments. Combining factor scores with control variables, like steep terrain, that
gauge impediments to walking and bicycling, we estimated discrete-choice models.

Chambliss, H. O. (2004). Behavioral approaches to obesity treatment. Quest, 56(1), 142-149.

Obesity is at the forefront of the public health agenda. Why, with all the emphasis on the
health risks of obesity and the availability of multiple treatment options, is it so difficult
for people to successfully lose and maintain weight? The answer is simple: Most obesity
treatment plans tell people what to do but not how to change their behavior. Furthermore,
many people attempting weight loss focus on narrow aspects of weight loss behaviors
(e.g., specific eating or exercise plans, over-the-counter weight loss products, medication,
and in growing numbers, gastric surgery). However, weight gain is ultimately a
consequence of multiple environmental and biologic factors that encourage behaviors that
result in positive energy balance. It is unlikely that most obesity treatments will be
successful unless people learn to address the environmental, biologic, and behavioral
barriers that influence their ability to make eating and physical activity choices that
promote long-term weight management. Behavioral approaches to obesity treatment help
 58

people develop the skills they need to successfully manage their weight in a way that is
consistent with their individual barriers, goals, and lifestyles.

Chang, Y., Liou, Y., Sheu, S., and Chen, M. (2004). Unbearable weight: young adult women's
experiences of being overweight. Journal of Nursing Research, 12(2), 153-160.

Being overweight is a hazard to health. Overweight people have a very negative image
due to the marketing strategies for weight reduction and beauty products. Young women
establishing self-image, seeking affirmation of social peers, and looking for potential
mates are usually concerned about their weight and figure. To investigate the experience
of young women who think they are overweight, how they come to think in this way, and
the impact of this thinking, this qualitative pilot study conducted semi-structured
interviews with five participants. On the basis of the qualitative method, data was
subjected to constant comparison and content analysis. The phenomenon can thus be
described in three major categories: (1) Social labeling of the overweight - a slim image
is overwhelmingly preferred; (2) Pursuing attractiveness or health - a self-struggling
process; (3) Weight reduction and self control - an endless struggle. The result of the
study suggests there is a need for a competitive image to counter current obsessions with
painfully slender figures in society. To protect the public's mental and physical health,
nurses should play an active role in weight education based on a deeper and more
dynamic understanding of being overweight.

Chen-Stute, A., Kevenhoerster, K., Lawrenz, W., Krogmann, O., Kinzius, D., and Schroeder, K.
E. (2002). Out patient program for obesity in childhood (T.O.M.). International Journal of
Obesity, 26(1).

Since 1997 164 obese children aged 8 to 17 years have been participating together with
their parents in our outpatient program (T.O.M.) The treatment of obesity includes
different physical activities 3 times/week, education in nutrition and behavior by a
nutritionist and psychologist with current healthy eating guidelines. The goal is to
maintain or slightly reduce body weight, to learn self-monitoring, self-control and
longterm evaluation of their individual concept on their daily base.

Chen, J., and Kennedy, C. (2004). Family functioning, parenting style, and Chinese children's
weight status. Journal of Family Nursing, 10(2), 262-279.

Childhood obesity is an important health problem affecting Chinese and Chinese

American children.

Chen, M., Chou, C., and Hsu, C. (2005). The experiences of overweight female adolescents after
health promotion counseling. Journal of Nursing Research, 13(1), 41-47.

The experiences of female overweight adolescents undergoing weight reduction are

rarely reported. There is a paucity of studies using qualitative methodology to evaluate
weight-reduction experiences. The aim of this study was to understand the main themes
of the experiences of overweight female adolescents undergoing weight reduction after
 59

receiving school based health promotion counseling. Qualitative design was adopted and
seven focus group discussions were conducted. On the basis of the qualitative method,
the data were subjected to content analysis by means of the constant comparison method.
A total of 30 female participants studying in a junior college of nursing were recruited in
this study. All of them had been overweight or obese throughout the past four years.

Chen, M., Huang, L., Wang, E. K., Cheng, N., Hsu, C., Hung, L., and Shiao, Y. (2001). The
effectiveness of health promotion counseling for overweight adolescent nursing students in
Taiwan. Public Health Nursing, 18(5), 350-356.

This study examined the effectiveness of health promotion counseling for overweight
adolescent nursing students. The Chinese version of an established health promotion
counseling booklet developed by the author of this study was used in the counseling. The
study employed a one-group pre- and post-quasi-experimental research design from
September 1997 to June 1999. A total of 166 (17%) first-year, junior college nursing
students were found to be overweight according to the results of a health examination at
the school health center at a junior college in the Taipei Metropolitan Area. Of these 166
students, 58 were randomly selected and 49 of these had complete participation records
for the 2-year study. All subjects received 8 hours of whole group and 12 hours of small
group health promotion counseling over a 1-year period. The results show that health
promotion counseling enabled subjects to adopt healthier lifestyles and most of the
physiological variables (WLI, HDL, SBP, TC) were significantly improved.

Chernoff, R. (2002). Health promotion for older women: benefits of nutrition and exercise
programs. Topics in Geriatric Rehabilitation, 18(1), 59-67.

Health promotion activities, including improving dietary habits and participating in

physical exercise, can contribute to an increase in life expectancy and better health for
older adults. Maintenance of health and function contributes to older adults' ability to
care for themselves, to live independently. and to have a positive quality of life. Health
promotion programs designed for older women should include multiple facets:
immunizations, smoking cessation programs, alcohol counseling, dietary interventions
and nutrition education, and exercise and physical activities. Health promotion activities
have been shown to be effective as secondary health promotion strategies for older adults.

Chiasson, J. L., and Rabasa-Lhoret, R. (2004). Prevention of type 2 diabetes: insulin resistance
and beta-cell function. Diabetes, 53 Suppl 3, S34-8.

Type 2 diabetes is increasing worldwide in epidemic proportions. Its associated morbidity

and mortality is imposing a major burden on the health care system. Based on a better
understanding of the pathophysiology of glucose intolerance, clinical trials on the
prevention of diabetes have been performed. It has now been demonstrated that diet and
exercise, metformin, acarbose, and troglitazone can prevent or at least delay the
development of diabetes in subjects with impaired glucose tolerance (IGT). It is now
generally accepted that insulin resistance and beta-cell dysfunction are major factors
involved in the development of diabetes. The relative contribution of insulin resistance
 60

versus beta-cell dysfunction on the pathogenesis of diabetes has aroused much debate.
These two processes should be studied in relation to one another: their relationship is best
described as hyperbolic in nature. When this relationship is taken into consideration, it
becomes evident that subjects at risk of developing type 2 diabetes have beta-cell
dysfunction before they develop glucose intolerance. Insulin resistance may be mostly
explained by the presence of obesity and accelerate the progression to diabetes in subjects
with the propensity to beta-cell failure.

Ciolac, E. G., and Guimaraes, G. V. (2004). Physical exercise and metabolic syndrome. Revista
Brasileira de Medicina do Esporte, 10(4).

Regular physical activity practice has been recommended for the prevention and
rehabilitation of cardiovascular diseases and other chronic diseases by different health
care associations world-wide, such as the American College of Sports Medicine, the
Centers for Disease Control and Prevention, American Heart Association, National
Institute of Health, the US Surgeon General, the Brazilian Society of Cardiology and
many others. Epidemiologic studies have shown a direct relation between lack of
physical activity and the presence of multiple risk factors such as those found in the
metabolic syndrome. The regular practice of physical exercise has been show to have
beneficial effects in the prevention and treatment of blood hypertension, insulin
resistance, diabetes, dyslipidemia, and obesity. Physical training therefore should be
encouraged for both healthy individuals and those with multiple risk factors if they are
capable of participating in a physical fitness program.

Clark, A. (2004). NT clinical. The role of the school nurse in tackling childhood obesity. Nursing
Times, 100(23), 28-29.

The prevalence of obesity and overweight children of all ages is increasing. There are
many factors that can lead to obesity in children, all of which must be considered and
understood before an effective strategy can be implemented to tackle the problem.
Evidence from the Health Development Agency recommends the focus of research
should be redirected to look at the effectiveness of prevention and management strategies
rather than the generation of statistics confirming the existence of the problem.

Clark, K. (1997). Disordered eating behaviors and bone-mineral density in women who misuse
alcohol. including commentary by Allan JD, Ciliska D, Perry PA, and Hall JM with author
response. Western Journal of Nursing Research, 19(1), 32-55.

Because lower bone-mineral density is one potential physiological consequence of eating

disorders and chronic alcohol misuse, the risk for osteoporosis may be compounded in
women who have both conditions. This study investigated the frequency of eating
disorders in 25 women who misuse alcohol and compared bone-mineral density between
those with and without multiple disordered eating behaviors. Disordered eating behaviors
were assessed through the EAT-26 (Eating Attitudes Test) and a structured interview
addressing binge eating, purging, and other weight-control behaviors. Bone-mineral
density was measured using dual energy x-ray densitometry. Although only one woman
 61

met the DSM-III-R criteria for a current eating disorder, 12% had past histories
suggestive of anorexia nervosa and 40% had multiple disordered eating behaviors with
bulimic features. Bone-mineral density of the femoral neck was 9.3% greater in women
with multiple disordered eating behaviors (p </=.05).

Clark, M. M., Niaura, R., King, T. K., and Pera, V. (1996). Depression, smoking, activity level,
and health status: pretreatment predictors of attrition in obesity treatment. Addictive Behaviors,
21(4), 509-514.

Consistent predictors of attrition in obesity treatment have not been identified. This study
examined whether pretreatment psychological and health behavior variables would
predict attrition from a 26 week clinical multidisciplinary VLCD and behavior therapy
program. Higher levels of depression, current smoking, being sedentary, and having non-
treated high blood pressure were associated with treatment attrition.

Cleator, J., Wilding, J., and Wallymahmed, M. (2004). Putting weight management on the
nursing agenda. Journal of Diabetes Nursing, 8(6), 232-236.

As the obesity epidemic continues, the harmful effects of central adiposity will result in a
large increase in cases of type 2 diabetes. The majority of these people will require
weight management, placing yet greater demands on the dietetic profession. People with
type 2 diabetes respond best to an integrated, multidisciplinary approach to weight
management and nurses must consider how best to contribute to this process by
collaborating with other disciplines to develop the appropriate skills.

Clemmens, D., and Hayman, L. L. (2004). Clinical issues. Increasing activity to reduce obesity
in adolescent girls: a research review. JOGNN: Journal Obstetric Gynecologic and Neonatal
Nursing, 33(6), 801-808.

To provide a systematic review of physical activity intervention research conducted with

adolescent girls (12-19 years of age and/or in middle or high school) in the United States
and Canada during the past two decades.

Clemmens, D., and Hayman, L. L. (2004). Increasing activity to reduce obesity in adolescent
girls: a research review. JOGNN: Journal Obstetric Gynecologic and Neonatal Nursing, 33(6),
801-8.

To provide a systematic review of physical activity intervention research conducted with

adolescent girls (12-19 years of age and/or in middle or high school) in the United States
and Canada during the past two decades.

Cobb, K. F., and Solera, M. K. (2003). 5-A-Day: a strategy for environmental change. Topics in
Clinical Nutrition, 18(4), 245-253.

Despite the well-documented health benefits of eating 5+ fruits and vegetables, few
Americans do it. Convenience, eating out, and changes in the traditional family meal
 62

make eating 5 to 9 fruits and vegetables a day challenging. At the same time, obesity and
its related chronic diseases are increasing to epidemic proportions. The environment
presents both causes and possible solutions for the high prevalence of obesity. 5-A-Day
provides simple, positive concepts with positive health benefits. Environmental/policy
research interventions that promote 5-A-Day in work sites and supermarkets show
promise as effective strategies to support health and to prevent obesity.

Cogan, J. C. (1999). A new national health agenda: providing the public with accurate
information. Journal of Social Issues, 55(2), 383-401.

For decades the recommendations provided by federal agencies have been decidedly one-
sided, focusing on the dangers of obesity and need for weight loss. Therefore the public
has been presented with incomplete and inaccurate information, which has stagnated our
understanding of health. The primary objective needed for a new national health agenda
is for the government to provide the public with complete and accurate information about
health, weight, and dieting.

Cogswell, M. E., Perry, G. S., Schieve, L. A., and Dietz, W. H. (2001). Obesity in women of
childbearing age: risks, prevention, and treatment. Primary Care: Update for Ob/Gyns, 8(3), 89-
105.

Criteria for overweight and obesity are discussed together with the prevalence and
incidence of these conditions. Mortality, chronic disease, fertility and pregnancy risks
associated with overweight and obesity are described. Pregnancy outcomes include:
maternal morbidity, operative delivery, high infant birth weight, congenital
malformations and perinatal mortality. The importance of obesity prevention among
women (both non-pregnant and pregnant) is emphasized and behavioural therapy
strategies are presented.

Colak, R., and Ozcelik, O. (2004). Effects of short-period exercise training and orlistat therapy
on body composition and maximal power production capacity in obese patients. Physiological
Research, 53(1), 53-60.

We examined the effects of weight loss induced by diet-orlistat (DO) and diet-orlistat
combined with exercise (DOE) on maximal work rate production (Wmax) capacity in
obese patients. Total of 24 obese patients were involved in this study. Twelve of them
were subjected to DO therapy only and the remaining 12 patients participated in a regular
aerobic exercise-training program in addition to DO therapy (DOE).
 63

Coleman, K. J., Tiller, C. L., Sanchez, J., Heath, E. M., Sy, O., Milliken, G., and Dzewaltowski,
D. A. (2005). Prevention of the epidemic increase in child risk of overweight in low-income
schools: the El Paso coordinated approach to child health. Arch Pediatr Adolesc Med, 159(3),
217-24.

To assess the impact on children's health of translating an evidence-based national

intervention trial (Child and Adolescent Trial for Cardiovascular Health [CATCH]) to
low-income elementary schools with primarily Hispanic students.

Collins, C. A. (2003). Survey of dietetic management of overweight and obesity and comparison
with best practice criteria. Nutrition & Dietetics, 60(3), 177-185.

The Dietitians Association of Australia (DAA) is endeavouring to support best practice

for dietetic management of overweight and obesity in Australia. The aims of this member
survey were to describe current dietetic services and intervention strategies in obesity
management and to compare current practice with that reported previously.

Collins, C. A., and Kym, P. R. (2003). Prospects for obesity treatment: MCH receptor
antagonists. Current Opinion in Investigational Drugs, 4(4), 386-394.

This article discusses the expression of melanin-concentrating hormone (MCH) and

MCH receptors (MCHR) in the brain and other regions of the central nervous system, and
their involvement in body weight regulation by triggering an increase in food intake as
observed in mouse models.

Collins, F., and Pronk, K. (2001). Insight. Acting on Australia's weight: a local areas focus on a
national strategy. Australian Journal of Nutrition and Dietetics, 58(4), 242-245.

Overweight and obesity are increasing. While life expectancy and some health statistics
are improving, obesity is one of the few health problems that is moving in the wrong
direction. Acting on Australia's weight: a strategic plan for the prevention of overweight
and obesity was developed by the National Health and Medical Research Council in
1997. An audit conducted in June 2000 in the Greater Bunbury area, Western Australia,
determined what action was being taken in line with the national strategic plan.

Collins, J., Johnson, S. L., and Krebs, N. F. (2004). Screen for and treat overweight in 2- to 5-
year-olds? Yes! Contemporary Pediatrics, 21(10), 60-62, 65-66, 68.

Waiting until a child gets older before addressing weight concerns may be too late.
Routinely assessing weight and providing anticipatory guidance about eating and
physical activity can help prevent weight problems from taking hold--possibly for a
lifetime. Includes a Guide for Parents.

Contaldo, F., and Pasanisi, F. (2005). Obesity epidemics: simple or simplicistic answers?
Clinical Nutrition, 24(1), 1-4.
 64

Among the strategies suggested to face obesity epidemics there is also a mere reduction
of only 100-200 kcal day, i.e. less mouthfuls of food and a little more walking every day.
Are these proposals "simple and feasible" or, vice versa, "simplicistic and unrealistic"
solutions? A possible source of such confusion comes firstly from dietary guidelines: the
"food pyramid" may easily lead to misinterpretation as low-fat foods enriched in simple
sugars produce similar metabolic abnormalities as saturated fat rich foods. Replacement
of fruit derived fructose with other fructose-enriched beverages is not adequately
considered.

Cook, V. V., and Hurley, J. S. (1998). Prevention of type 2 diabetes in childhood. Clinical
Pediatrics, 37(2), 123-129.

The incidence of type 2 diabetes has increase dramatically in the past decade in Pima
children (aged 5-17 yrs), living in the Gila River Indian Community. Obesity and
development of diabetes are strongly related in Pima Indians (e.g., W. C. Knowler et al,
1990). As a result, the primary prevention program called Quest was implemented in
1996 at an elementary school in the Gila River Indian Community for students in
kindergarten and grades 1-2. The purpose of the Quest program is to conduct a health
evaluation of the children and to provide them and their parents with information about
diabetes prevention through nutrition education and an exercise program. Quest is made
up of 4 components: (1) biochemical and anthropometric assessments, (2) classroom
instruction about diabetes, (3) increased daily physical activity at school, and (4) a
structured school breakfast and lunch program. Preliminary results of the program
indicate that the school provides a stable environment for behavior change and
interventions that slow weight gait gain in early childhood.

Cooksey, C., and Lanza, A. P. (2003). Examining diabetes health benefits in health plans of large
employers. Journal of Public Health Management and Practice, S30-S35.

Components of the contract specifications (also known as model purchasing

specifications) for diabetes care that were developed by George Washington University
(Washington, D.C.) and the Centers for Disease Control and Prevention were applied to
20 health plans from two Fortune 500 companies as well as the Federal Employee Health
Benefits Plan to investigate the extent of diabetes-related benefits available to employees.

Costa, A., Conget, I., and Gomis, R. (2002). Impaired glucose tolerance: is there a case for
pharmacologic intervention? Treatments in Endocrinology, 1(4), 205-10.

Impaired glucose tolerance (IGT) is determined by measuring plasma glucose levels 2

hours after glucose loading in the oral glucose tolerance test. There is good evidence
from epidemiologic and prospective trials [e.g. Diabetes Epidemiology: Collaborative
Analysis of Diagnostic Criteria in Europe (DECODE)] linking IGT with the development
of type 2 diabetes mellitus and cardiovascular disease (CVD). IGT is characterized by an
increase in postprandial glucose levels, which is considered the earliest metabolic
abnormality in type 2 diabetes mellitus.
 65

Costacou, T., and Mayer Davis, E. J. (2003). Nutrition and prevention of type 2 diabetes. Annual
Review of Nutrition, 23, 147-170.

In recent years, the prevalence of type 2 diabetes has increased alarmingly worldwide,
giving diabetes the dimension of an epidemic. Striking parallel increases in the
prevalence of obesity reflect the importance of body fatness as a contributing factor to
diabetes incidence. Moreover, it has been estimated that up to 75% of the risk of type 2
diabetes is attributable to obesity. Recent clinical trials and observational epidemiologic
studies demonstrate the efficacy of lifestyle changes, including decreased energy intake,
decreased fat intake, and weight loss, as well as regular participation in physical activity,
in improving insulin sensitivity (SI) and reducing the risk of diabetes. This review
evaluates evidence of the effect of diet on insulin resistance, insulin secretion, and
glucose tolerance, and reflects on directions for future work toward primary prevention of
type 2 diabetes.

Cote, M. P., Byczkowski, T., Kotagal, U., Kirk, S., Zeller, M., and Daniels, S. (2004). Service
quality and attrition: an examination of a pediatric obesity program. International Journal for
Quality in Health Care, 16(2), 165-173, 188.

To examine the demographic, illness, and quality of care determinants of service attrition
in a paediatric obesity program, and to elucidate factors that may promote families' return
to care.

Cottam, R. (2004). Obesity and culture. Lancet, 364(9441), 1202-1203.

Comments on an article "The economics of obesity: the public interest," by Michael

Grossman and Inas Rashad. The article discusses the link between obesity and culture. If
the overweight (47% of men and 33% of women) and obese groups (21% and 23%,
respectively) are combined, over two-thirds of men and over half of women in England
were either overweight or obese in 2001. The authors linked the price of cigarettes with
increases in the number of obese people, and suggested that efforts to curb cigarette
smoking could have had unintended side-effects, which are now having to be tackled.
The UK House of Commons Select Committee's report on obesity suggests that obesity
"will soon surpass smoking as the greatest cause of premature loss of life". But could
obesity be linked to tobacco consumption-with a decrease in one leading to a rise in the
other?

Coveney, J. (2002). What does research on families and food tell us? Implications for nutrition
and dietetic practice. Nutrition and Dietetics: Journal of the Dietitians Association of Australia,
59(2), 113-119.

This review examines research on food and family life. The evidence suggests that the
dynamics of family relationships crucially affects individuals' food choices, the
healthiness of their choices and the social patterns that evolve from family food events.
Food choices change as reciprocal responsibilities develop when couples establish
 66

relationships and cohabit. The arrival of children also changes family dynamics. Food
preferences are influenced by family rule-setting as adults attempt to shape food choices
of children. Conversely, children can also influence adult food choice in families. The
role of social class and single parent status play an important role in food choice. Most
research addressing family food choice is not situated within a social setting which limits
its usefulness markedly. Since nutritionists and dietitians deal with individuals and
groups for whom family life is an important influence, they would benefit from more
evidence about food choices within this important social context.

Covington, C. Y., Cybulski, M. J., Davis, T. L., Duca, G. E., Farrell, E. B., Kasgorgis, M. L.,
Kator, C. L., and Sell, T. L. (2001). Kids on the move: preventing obesity among urban children.
American Journal of Nursing, 101(3), 73-75, 77, 79.

Children of low-income urban families are at increased risk for obesity, but 'dieting' isn't
the answer. Here's how nurses can have an influence

Cowbrough, K. (2004). How dietary measures can help reduce unhealthy blood cholesterol
levels. Professional Nurse, 20(4), 33-5.

While cholesterol is produced naturally by our bodies, a high blood concentration of

certain types of cholesterol is a predisposing factor for coronary heart disease. Some of
the reasons for developing unhealthy levels of cholesterol are discussed, together with
some dietary strategies to reduce them to acceptable levels.

Crawford, P. B., Gosliner, W., Strode, P., Samuels, S. E., Burnett, C., Craypo, L., and Yancey,
A. K. (2004). Walking the Talk: Fit WIC wellness programs improve self-efficacy in pediatric
obesity prevention counseling. American Journal of Public Health, 94(9), 1480-1485.

Six sites of the California Special Supplemental Nutrition Program for Women, Infants,
and Children (WIC) participated in a staff wellness pilot intervention designed to
improve staff self-efficacy in counseling WIC clients about childhood overweight. A pre-
post test design with intervention and control groups was used; outcome measures
included staff perceptions of the intervention's effects on the workplace environment,
their personal habits and health beliefs, and their counseling self-efficacy.

Crespo, C. J., and Arbesman, J. (2003). Obesity in the United States: a worrisome epidemic.
Physician and Sports Medicine, 31(11), 23-28.

In the past decades, obesity has reached epidemic proportions in the United States, even
among children, adolescents, and young adults. The prevalence of obesity is higher
among non-Hispanic black (36%) and Mexican American women (33%) than among
non-Hispanic white women (22%). Various explanations for increased obesity have been
proposed, including decreases in exercise and occupational and recreational physical
activity and an increase in sedentary lifestyles. Television watching is directly related to
obesity and energy intake among children age 8 to 16 years and may be a target for
 67

intervention. Physicians can use these data to help counsel patients about weight
management, especially in reducing inactivity and overeating.

Cresswell, J. (2004). Policy round-up. SportEX Health, (SPORTEX-HEALTH) 2004 Apr; (20):
9-10. 20: 9-10.

The need to address the future problems caused by the current rising trend of obesity has
given an added impetus to encouraging physical activity in the general population. This
article gives a brief overview of the various Government initiatives and strategies set to
encourage our population to get moving.

Crow, S. J., Peterson, C. B., Levine, A. S., Thuras, P., and Mitchell, J. E. (2004). A survey of
binge eating and obesity treatment practices among primary care providers. International Journal
of Eating Disorders, 35, 348-353.

Obesity is an increasingly prevalent condition and many obese individuals binge eat. It is
unclear how much knowledge physicians possess regarding binge eating, but the limited
existing data suggest that primary care physicians frequently do not identify obesity as a
clinical problem. The objective of this study was to examine physician knowledge and
treatment recommendations regarding binge eating and obesity.

Crump, W. J. (2004). Primary prevention of hypertension: the seventh Joint National Committee
report. Family Practice Recertification, 26(4), 61-66, 60.

The seventh report of the Joint National Committee has continued to place emphasis on
the need to prevent high blood pressure through lifestyle changes. These include
maintaining normal body weight, reducing dietary sodium intake, maintaining adequate
potassium intake, exercising regularly, limiting alcohol consumption, and eating a diet
rich in fruits and vegetables with reduced saturated and total fat. Prevention can be
considered a population approach for everyone or a more specific approach targeted to
those with high-risk factors.

Cummings, D. E., and Schwartz, M. W. (2003). Genetics and pathophysiology of human obesity.
Annual Review of Medicine: Selected Topics in Clinical Sciences, 54, 453-471.

Obesity has become a leading public health concern. Over 1 billion people are now
overweight or obese, and the prevalence of these conditions is rising rapidly. Remarkable
new insights into the mechanisms that control body weight are providing an increasingly
detailed framework for a better understanding of obesity pathogenesis. Key peripheral
signals, such as leptin, insulin, and ghrelin, have been linked to hypothalamic
neuropeptide systems, and the anatomic and functional networks that integrate these
systems have begun to be elucidated. This article highlights some of these recent findings
and their implications for the future of obesity treatment.
 68

Cunningham Sabo, L., Snyder, M. P., Anliker, J., Thompson, J., Weber, J. L., Thomas, O., Ring,
K., Stewart, D., Platero, H., and Nielsen, L. (2003). Impact of the Pathways food service
intervention on breakfast served in American-Indian schools. Preventive Medicine, 37(6), S46-
S54.

Pathways was a multisite, multicomponent obesity prevention intervention for American-

Indian schoolchildren. The goal of the school breakfast and lunch component was to
reduce fat content of school meals to 30% or fewer calories from fat without
compromising dietary quality.

Cunningham, S. L., Snyder, M. P., Anliker, J., Thompson, J., Weber, J. L., Thomas, O., Ring, K.,
Stewart, D., Platero, H., and Nielsen, L. (2003). Impact of the Pathways food service
intervention on breakfast served in American-Indian schools. Preventive Medicine, 37(6 Part 2),
S46-S54.

Pathways was a multisite, multicomponent obesity prevention intervention for American-

Indian schoolchildren. The goal of the school breakfast and lunch component was to
reduce fat content of school meals to 30% or fewer calories from fat without
compromising dietary quality.

Curran, M. P., and Scott, L. J. (2004). Orlistat: a review of its use in the management of patients
with obesity. Drugs, 64(24), 2845-64.

Orlistat is an inhibitor of gastrointestinal lipases and, therefore, prevents the absorption of

dietary fat. This agent reduces weight in obese adults and adolescents with or without
comorbidities (including type 2 diabetes mellitus, hypercholesterolaemia, hypertension,
metabolic syndrome) who received up to 4 years of therapy in conjunction with a
hypocaloric diet. In obese patients, orlistat in combination with a hypocaloric diet
improved metabolic risk factors and reduced the risk of developing type 2 diabetes.
Furthermore, this agent was cost effective in patients with obesity, particularly those with
type 2 diabetes. Orlistat is generally well tolerated, with gastrointestinal adverse events
being most commonly reported. Orlistat, in addition to lifestyle and dietary intervention,
is thus an attractive option for the treatment of patients with obesity, especially those with
associated comorbidities or at risk of developing type 2 diabetes.

Dallow, C. B., and Anderson, J. (2003). Using Self-efficacy and a Transtheoretical Model to
Develop a Physical Activity Intervention for Obese Women. American Journal of Health
Promotion, 17(6), 373-381.

To assess the effectiveness of applying behavior change theory to a physical activity

intervention for obese, sedentary women. A 48-week randomized controlled trial.
Subjects were randomized to one of two intervention groups. A university classroom and
a local health club. Fifty-eight sedentary, obese women.
 69

Dalton, S. (2004). Schools and the rising rate of overweight children: prevention and intervention
strategies. Topics in Clinical Nutrition, 19(1), 34-40.

The causes of overweight and obesity in children are multifactorial as are the solutions.
Schools are one place where several factors promote obesity-or could prevent its rapid
rise. In an ideal world, family meals provide the opportunity for parents to serve
nutritious food in appropriate portion sizes, to pass on healthy eating habits, and to
strengthen family bonds through mealtime conversations. Increasingly, children eat 1 or 2
meals in school. Working with schools is an excellent way to restore the health of our
children by providing attractive and nourishing food choices, a variety of physical
activities for children of all sizes and abilities, and opportunities to learn about food and
health in the classroom.

Daniel, K. (2001). Tackling teenage obesity. Community Practitioner, 74(12), 456-457.

Newspaper cuttings files have grown heavy over the past five years with horror stories on
the effect that western society's obsession with super slimness -- body facism to coin a
media mantra -- is having on a generation of teenagers. The QNI's Karen Daniel looks at
a project helping overweight teenagers to help themselves.

Danielzik, S., Czerwinski, M. M., Langaese, K., Dilba, B., and Mueller, M. J. (2004). Parental
overweight, socioeconomic status and high birth weight are the major determinants of
overweight and obesity in 5-7 y-old children: baseline data of the Kiel Obesity Prevention Study
(KOPS). International Journal of Obesity, 28(11), 1494-1502.

To identify the major risk factors of overweight and obesity in prepubertal children.

Danielzik, S., Langnase, K., Mast, M., Spethmann, C., and Muller, M. J. (2002). Impact of
parental BMI on the manifestation of overweight 5-7 year old children. European Journal of
Clinical Nutrition, 41(3), 132-138.

There is an increase in the prevalence of overweight and obese children. Genetic and
environmental factors are contributing factors but the influence of parental nutritional
state on early manifestation of overweight is not well characterised. To systematically
investigate the impact of parental BMI on the manifestation of overweight in 5 to 7 year
old children.

Dankner, R., Chetrit, A., Lubin, F., and Sela, B. A. (2004). Life-style habits and homocysteine
levels in an elderly population. Aging Clin Exp Res, 16(6), 437-42.

Increased plasma total homocysteine (Hcy) is a known cardiovascular disease (CVD) risk
factor, related to several components of the established CVD risk profile. Observational
studies support the role of modifying life-style related risk factors such as diet, physical
activity and alcohol consumption in CVD prevention. Regular physical activity protects
against coronary artery disease, possibly through its role in controlling risk factors such
as hypertension, diabetes mellitus and obesity, but also independently. The aim of our
 70

study was to test the hypothesis that there is an association between physical activity,
life-style habits and plasma Hcy levels in an elderly population.

Dannenberg, A. L., Jackson, R. J., Frumkin, H., Schieber, R. A., Pratt, M., Kochtitzky, C., and
Tilson, H. H. (2003). Public health matters. The impact of community design and land-use
choices on public health: a scientific research agenda. American Journal of Public Health, 93(9),
1500-1508.

The design of a community's built environment influences the physical and mental health
of its residents. Because few studies have investigated this relationship, the Centers for
Disease Control and Prevention hosted a workshop in May 2002 to help develop a
scientific research agenda on these issues. Workshop participants' areas of expertise
included physical activity, injury prevention, air pollution, water quality, urban planning,
transportation, architecture, epidemiology, land use, mental health, social capital,
housing, and social marketing. This report describes the 37 questions in the resulting
research agenda. The next steps are to define priorities and obtain resources.

Dart, L. (2005). Working with families to prevent obesity: a community - campus partnership.
Journal of Family and Consumer Sciences, 97(2), 20-29.

The faculty consultants from the Texas Christian University and the Cornerstone
Community Center of Texas together organized an obesity prevention and dietary
guidelines training program. The details of the program that was based on giving health
awareness to families are presented.

Datar, A., and Sturm, R. (2004). Physical education in elementary school and body mass index:
Evidence from the Early Childhood Longitudinal Study. American Journal of Public Health,
94(9), 1501-1506.

We examined the effect of physical education instruction time on body mass index (BMI)
change in elementary school.

Davey, R. C. (2004). The obesity epidemic: too much food for thought? British Journal of Sports
Medicine, 38(3), 360-363.

Traditional treatment strategies and public health interventions aimed at reducing the
incidence of obesity are proving inadequate at controlling the global epidemic of this
condition. The main focus of any intervention should be on preventing small excesses of
weight, which lead to large weight gain over time, as once a large amount of excess
weight is gained, it is very difficult to lose. The only effective approach is for
governments to implement radical policy change, to regulate food consumption and
control the food industry in a similar way to that of the tobacco industry, by banning the
advertising of selected produce, taxing certain foods, and rationing the purchase of
others.
 71

Davis, M. S., Miller, C. K., and Mitchell, D. C. (2004). More favorable dietary patterns are
associated with lower glycemic load in older adults. Journal of the American Dietetic
Association, 104(12), 1828-35.

Glycemic load represents the total glycemic effect of the diet and may reduce the risk for
chronic disease by affecting the risk for obesity and by altering metabolic endpoints. The
food choices associated with lower-glycemic-load diets have received little investigation.
Therefore, the purpose of this research was to examine the food patterns associated with
lower-glycemic-load diets to establish targeted intervention messages.

Davis, S. M., Clay, T., Smyth, M., Gittelsohn, J., Arviso, V., Flint Wagner, H., Holy Rock, B.,
Brice, R. A., Metcalfe, L., Stewart, D., Vu, M., and Stone, E. J. (2003). Pathways curriculum and
family interventions to promote healthful eating and physical activity in American Indian
schoolchildren. Preventive Medicine, 37(6, Pt 2), S24-S34.

Pathways, a multisite school-based study aimed at promoting healthful eating and

increasing physical activity, was a randomized field trial including 1704 American Indian
third to fifth grade students from 41 schools in seven American Indian communities. The
intervention schools received four integrated components: a classroom curriculum, food
service, physical activity, and family modules. The curriculum and family components
were based on Social Learning Theory, American Indian concepts, and results from
formative research. Process evaluation data were collected from teachers, students, and
families. Knowledge, Attitudes, and Behavior Questionnaire data were collected from
1150 students including both intervention and controls. There were significant increases
in knowledge and cultural identity in children in intervention compared to control schools
with a significant retention of knowledge over the 3 years, based on the results of
repeating the third and fourth grade test items in the fifth grade. Family members
participated in Family Events and take-home activities, with fewer participating each
year.

Davis, S. M., Going, S. B., Helitzer, D. L., Teufel, N. I., Snyder, P., Gittelsohn, J., Metcalfe, L.,
Arviso, V., Evans, M., Smyth, M., Brice, R., and Altaha, J. (1999). Pathways: a culturally
appropriate obesity-prevention program for American Indian schoolchildren. American Journal
of Clinical Nutrition, 69(Supplement 4), 796S-802S.

A review is presented concerning "Pathways", a culturally appropriate obesity prevention

study for American Indian schoolchildren, grades 3-5, that promotes increased physical
activity and healthy eating patterns. The Pathways intervention was developed through a
collaboration of Universities and American Indian nations, schools, and families and
focuses on individual, behavioural, and environmental factors and merges constructs
from social learning theory with American Indian customs and practices. The Pathways
programme was developed during 3 years of feasibility testing in American Indian
schools. The theoretical and cultural underpinnings of the programme, the construction
process of the intervention, the curriculum and physical education components of the
intervention, formative assessment, school food service and family components of the
intervention are the focus of this review.
 72

Davis, S. P., Davis, M., Northington, L., Moll, G., and Kolar, K. (2002). Childhood obesity
reduction by school based programs. ABNF-Journal, 13(6), 145-149.

Childhood obesity has become one of the most common health problems facing children
in America. Results from the Third National Health and Nutrition Examination Survey
reveal that ethnic minority children in the United States are at particular risk for
development of cardiovascular disease due to their disproportionate levels of obesity. In
treating childhood obesity among ethnic minorities, practitioners need to be mindful of
the cultural norms surrounding body size. Additional concerns that must be addressed
include the effects of target marketing of unhealthy foods toward ethnic minorities and
environmental deterrents to outside physical activities, to name a few. Strategies given to
address the problem of childhood obesity among ethnic minorities include, increasing the
child's physical activity, reducing television viewing and the adoption and maintenance
of healthy lifestyle practices for the entire family.

Daynard, R. A., Howard, P. T., and Wilking, C. L. (2004). Private enforcement: litigation as a
tool to prevent obesity. Journal of Public Health Policy, 25(3-4), 408-17.

Private enforcement, or litigation, has played a historic role in protecting public health in
the United States. Litigation is often employed as a means to protect public health when
government regulation is absent or ineffectual. Litigation has been successfully employed
to control both asbestos and tobacco and is poised for success in combating the obesity
epidemic. Litigation is effective because it makes public industry practices and increases
industry self-policing. Litigation related to obesity would likely employ theories of
"unfair and deceptive trade practice" or general "personal injury" or tort claims. While
opponents to the use of litigation often cite personal responsibility and the individual as
the true locus of liability, these arguments fail to take into account the context of an
individual's choice.

De Oliveira, M. C., Sichieri, R., and Moura, A. S. (2003). Weight Loss Associated With a Daily
Intake of Three Apples or Three Pears Among Overweight Women. Nutrition, 19(3), 253-256.

We investigated the effect of fruit intake on body weight change. Hypercholesterolemic,

overweight (body mass index > 25 kg/m super(2)), and non-smoking women, 30 to 50 y
of age, were randomized to receive, free of charge, one of three dietary supplements:
apples, pears, or oat cookies. Women were instructed to eat one supplement three times a
day in a total of six meals a day. Participants (411 women) were recruited at a primary
care center of the State University of Rio de Janeiro, Brazil.

De Zwaan, M., Burgard, M. A., Schenck, C. H., and Mitchell, J. E. (2003). Night time eating: a
review of the literature. European Eating Disorders Review, 11(1), 7-24.

This study reviews the published research on night time eating, including the night eating
syndrome (NES) and the nocturnal eating/drinking syndrome (NEDS). Studies were
identified by a computerized literature search (PubMed, PsycInfo) and by references from
 73

the papers obtained. In addition, published abstracts from recent conferences in the areas
of eating disorders and obesity were included. Individual studies were reviewed and their
results summarized. Wakeful night time eating appears to be a frequent symptom which
is more common among the obese. The data suggest an early age of onset with a chronic
course in many patients. There appears to be considerable overlap between NES and
NEDS. Treatment studies are sparse. The clinical features of these syndromes, their
comorbidities, and their prevalence rates remain a matter of debate. It is unclear if the
night eating syndrome presents a distinct entity that is of clinical relevance. The current
nosologies may not capture the natural clustering of eating and sleep-related pathology as
it occurs in general population samples.

Deforche, B., De Bourdeaudhuij, I., and Bouckaert, J. (2001). 1.5 year follow-up of obese
children after a 10 month residential program. International Journal of Obesity, 25(2).

This study investigates the evolution of overweight and health behaviour 1.5 year after
treatment. At the end of treatment and 1,5 year later, physical activity (PA) (Taylor
questionnaire), determinants of PA (structured interview), fat and fibre intake (Flemish
short fat and fibre test) were measured in 24 children (pretreatment Adjusted Body Mass
Index (ABMI) = 179.1 plus or minus 24.6%). Although children have a quite healthy
food and exercise behaviour, their ABMI 1.5 year after treatment has increased from 122
plus or minus 14% to 154 plus or minus 22% (p <.001).

Deibert, P., Koenig, D., Schmidt-Trucksaess, A., Zaenker, K. S., Frey, I., Landmann, U., and
Berg, A. (2004). Weight loss without losing muscle mass in pre-obese and obese subjects
induced by a high-soy-protein diet. International Journal of Obesity, 28(10), 1349-1352.

To determine change of weight, body composition, metabolic and hormonal parameters

induced by different intervention protocols. DESIGN: Randomized, controlled study
including participants exhibiting a BMI between 27.5 and 35. Three different
interventions containing lifestyle education (LE-G), or a substitutional diet containing a
high-soy-protein low-fat diet with (SD/PA-G) or without (SD-G) a guided physical
activity program.

Dennis, K. E., Pane, K. W., Adams, B. K., and BingBing, Q. (1999). The impact of a shipboard
weight control program. Obesity Research, 7(1), 60-67.

The specific aim was to determine whether a multifaceted approach to weight loss and
physical readiness could be implemented onboard a deployed combatant ship of the US
Navy.
 74

Dennis, K. E., Tomoyasu, N., McCrone, S. H., Goldberg, A. P., Bunyard, L., and Qi, B. B.
(2001). Self-efficacy targeted treatments for weight loss in postmenopausal women. Scholarly
Inquiry for Nursing Practice, 15(3), 259-276.

Matching behavioral treatment programs to different types of obese clients is a rarely

studied strategy, thus guidelines for identifying who might benefit most from which
program remain elusive. This study categorized the weight control self-efficacy beliefs of
obese, postmenopausal women, and determined the effects of self-efficacy targeted
versus non-targeted (control) treatment on weight loss outcomes (body habitus, physical
conditioning, affect, and eating behaviors). Obese (BMI 33 +/- 5), postmenopausal (60
+/- 6 years old) women (n = 59) participated in a 6-month weight loss program. The 37
women categorized by Q methodology as Assured (self-confident, independent) were
randomized to Assured (AT) or Non-Targeted (NT) treatment; the 22 Disbelievers
(doubtful, wavering) were randomized to Disbeliever (DT) or NT treatment. At baseline,
the Assureds had significantly smaller body girths and reported significantly greater self-
esteem, fewer symptoms of binge eating, and less negative affect overeating than the
Disbelievers. Improvement in these variables with weight loss erased significant
differences between the groups and was a desired outcome. Treatment delivery type may
have influenced attrition rate, since significantly more Assureds dropped from NT than
AT and significantly more Disbelievers dropped from DT than NT. Thus, the self-
efficacy type may serve as a means to identify different types of treatment needs (flexible
vs. rigid) to sustain women's adherence and success in the program. The significant
weight loss outcomes for women in all groups argues for the incorporation of strategies to
enhance self-efficacy but not the need for specific treatments that directly target self-
efficacy types.

Denzer, C., Reithofer, E., Wabitsch, M., and Widhalm, K. (2004). The outcome of childhood
obesity management depends highly upon patient compliance. European Journal of Pediatrics,
163(2), 99-104.

Over the last 20 years, obesity in childhood and adolescence has become a major public
health concern due to dramatically increasing prevalence rates. We evaluated the
outcome of 294 children (135 girls, 159 boys) aged 6-16 years (median 10.9 years)
enrolled in a single centre outpatient obesity intervention programme consisting of
periodical visits to the outpatient unit with regular medical and dietetic counselling
aiming at a modification of dietary and activity patterns of patients and parents.

Department of Health and Human Services. (2000). Promoting better health for young people
through physical activity and sports.

A report to the President from the Secretary of Health and Human Services and the
Secretary of Education.
 75

Deurenberg-Yap, M., Schmidt, G., Staveren, W. A. v., and Deurenberg, P. (2000). The paradox
of low body mass index and high body fat percentage among Chinese, Malays and Indians in
Singapore. International Journal of Obesity and Related Metabolism Disorders, 1011-1017.

To study the relationship between body fat percentage and body mass index (BMI) in
three different ethnic groups in Singapore (Chinese, Malays and Indians) in order to
evaluate the validity of the BMI cut-off points for obesity. DESIGN: Cross-sectional
study.

Devlin, M. J., Yanovski, S. Z., and Wilson, G. T. (2000). Obesity: what mental health
professionals need to know. American Journal of Psychiatry, 157(6), 854-866.

Obesity is a highly prevalent condition with significant health implications. This report
summarizes recent clinically relevant findings concerning the pathogenesis and treatment
of obesity and considers their implications for psychiatric diagnosis and management.

Dewey, K. G. (2003). Is breastfeeding protective against child obesity? Journal of Human

Lactation, 19(1), 9-18.

Recent studies suggest that breastfeeding reduces the risk of child obesity to a moderate
extent. Of 11 studies that examined prevalence of overweight in children older than 3
years of age and that had a sample size of > or = 100 per feeding group, 8 showed a lower
risk of overweight in children who had been breastfed, after controlling for potential
confounders. The 3 "negative" studies lacked information on the exclusivity of
breastfeeding.

Dietz, W. H. (2004). The effects of physical activity on obesity. Quest, 56(1), 1-11.

The epidemic of obesity has resulted from an imbalance of energy intake and energy
expenditure. Further weight gain of individuals and populations can be prevented if
energy intake balances energy expenditure. For those who are overweight, reduction in
weight can only be achieved by a negative energy balance in which energy expenditure
exceeds intake. In this manuscript, we will describe the epidemic of obesity and explore
the evidence that reduced energy expenditure accounts for obesity, the role that physical
activity plays in weight reduction, and the steps necessary to achieve energy balance
within the population.

DiMaria-Ghalili, R. A., and Amella, E. (2005). Nutrition in older adults. American Journal of
Nursing, 105(3), 40-50; quiz 50-1.

Both physiologic and psychosocial changes affect the nutritional status of adults over the
age of 65. Malnutrition is, in fact, a greater threat to this population than obesity. This
article reviews the intake requirements of older adults and discusses the risk factors that
can lead to malnutrition, including diet, limited income, isolation, chronic illness, and
physiologic changes. Assessment and nursing interventions are also addressed.
 76

DiPietro, L. (1999). Physical activity in the prevention of obesity: current evidence and research
issues. Medicine and Science in Sports and Exercise, 31(11 Suppl), S542-S546.

The relation between habitual physical activity and the prevention of overweight and
obesity in adults based on the evidence from the epidemiologic literature is described.
Literature was reviewed of current findings from large population-based studies of
forward directionality in which physical activity was considered as a primary study
factor. The longitudinal evidence suggests that habitual physical activity plays more of a
role in attenuating age-related weight gain, rather than in promoting weight loss.
Moreover, recent data suggest that increasing amounts of physical activity may be
necessary to effectively maintain a constant body weight with increasing age. Over
decades, small savings in excess weight gain accumulate into net savings that may be
quite meaningful with regard to minimizing the risk associated with obesity-related
disorders. The question remains as to how important maintaining a constant body weight
through middle age and into older age is to healthy, already-active people of normal body
weight.

Dixey, R., Sahota, P., Atwal, S., and Turner, A. (2001). Children talking about healthy eating:
data from focus groups with 300 9-11-year olds. BNF Nutrition Bulletin, 26(1), 71-79.

The aim of this project was to gain insight into children's understanding of healthy eating,
and to explore the barriers and facilitating factors for dietary behaviour change in
children. The 'Apples' project is concerned with obesity prevention, and an understanding
of children's perceptions of healthy eating, fatness and thinness are vital in order for
school-based programmes to be appropriately designed and delivered.

Dizdar, O., and Alyamac, E. (2004). Obesity: an endocrine tumor? Medical Hypotheses, 63(5),
790-792.

Obesity is one of the most common disorders in clinical practice. The prevalance of
obesity has increased by more than 60% since 1990. Adipose tissue acts as an endocrine
organ secreting many factors into the blood, known as adipokines, including leptin,
adipsin, acytation-stimulating protein, adiponectin, etc. This article examines the
hypothesis that obesity may be evaluated as an endocrine tumor, regarding its genetic
basis, hyperplasia and hypertrophy of adipocytes, neovascularisation within the adipose
tissue associated with growth, and beneficisal metabolic effects of surgical removal of
excess adipose tissue by liposuction. Assuming obesity as an endocrine tumor may bring
out new treatment modalities. Liposuction as "cytoreductive surgery", antiangiogenic
teraphy or antineoplastic drugs may be important components of obesity treatment in
future. Copyright 2004 Elsevier Ltd. All rights reserved.

Doak, C. M., Adair, L. S., Bentley, M., Monteiro, C., and Popkin, B. M. (2005). The dual burden
household and the nutrition transition paradox. International Journal of Obesity, 29(1), 129-136.

The purpose of this study is to document the prevalence of households with underweight
and overweight persons (henceforth referred to as dual burden households) and their
 77

association with income and urban residence. The explorations by urban residence and
income will test whether dual burden households differ from 'underweight only' and
'overweight only' households, respectively. These comparisons are relevant to
differentiating or adapting nutrition-related interventions wherever obesity and
undernutrition cluster at the household level. Population: Data analysis is based on
national surveys conducted in Brazil, China, Indonesia, the Kyrgyz Republic, Russia,
Vietnam and the United States.

Dobryzn, A., and Ntambi, J. M. (2005). Stearoyl-CoA desaturase as a new drug target for obesity
treatment. Obesity Reviews, 6(2), 169-175.

Summary Stearoyl-CoA desaturase (SCD), the rate-limiting enzyme in monounsaturated

fatty acid synthesis, has recently been shown to be the critical control point regulating
hepatic lipogenesis and lipid oxidation. As several manifestations of the metabolic
syndrome and type 2 diabetes mellitus are associated with alterations in intracellular lipid
partitioning, we propose that SCD1 may be a potential therapeutic target in the treatment
of obesity and the metabolic syndrome. In support of this notion, we have shown that
SCD1-deficient mice have increased energy expenditure, reduced body adiposity,
increased insulin sensitivity and are resistant to diet-induced obesity and liver steatosis.
Furthermore, SCD1 was found to be specifically repressed during leptin-mediated weight
loss, and leptin-deficient obob mice lacking SCD1 showed marked correction of the
hypometabolic phenotype and hepatic steatosis. Much evidence indicates that the direct
anti-steatotic effect of SCD1 deficiency stems from increased fatty acid oxidation and
decreased lipid synthesis. All of these findings reveal that pharmacological manipulation
of SCD activity might be of benefit in the treatment of obesity, diabetes, liver steatosis
and other diseases of the metabolic syndrome.

Dohm, G. L. (2001). Mechanisms of Muscle Insulin Resistance in Obese Individuals.

International Journal of Sport Nutrition and Exercise Metabolism, 11, S64-S70.

We previously reported that insulin resistance in skeletal muscle of obese individuals was
associated with decreases in insulin signal transduction and tyrosine kinase activity of the
insulin receptor. Herein is reviewed the recently published data supporting the hypothesis
that protein kinase C (PKC) phosphorylates the insulin receptor on serine/threonine
residues to decrease tyrosine kinase activity and cause insulin resistance. Treatment of
insulin receptors from obese subjects with alkaline phosphatase restored tyrosine kinase
activity, suggesting that the reduced activity was a result of hyperphosphorylation of the
receptor. Incubating human muscle fiber strips with PKC inhibitors restored insulin
action in muscle of obese patients, while activating PKC with a phorbol ester caused
insulin resistance in muscle from lean control patients. The beta isoform of PKC was
elevated in muscle of obese, insulin-resistant patients. These data are consistent with the
hypothesis that elevated PKC activity may cause insulin resistance by phosphorylating
the insulin receptor to decrease tyrosine kinase activity.
 78

Doll, L., Dino, G., Deutsch, C., Holmes, A., Mills, D., and Horn, K. (2001). Circle of research
and practice. Linking research and practice: two academic-public health collaborations that are
working. Health Promotion Practice, 2(4), 296-300.

In this commentary, two examples of successful collaboration between academic research

centers and public health agencies at a statewide level are described. One program sought
to reduce tobacco use, whereas the other has the goal of improving physical activity and
nutrition among children and youth and reducing child and adolescent obesity and
subsequent health risks. Thefatures of the collaboration contributing to their success are
outlined, as is the federal role in fostering these partnerships.

Donnelly, J. E., Kirk, E. P., Jacobson, D. J., Hill, J. O., Sullivan, D. K., and Johnson, S. (2003).
Effects of 16 mo of verified, supervised aerobic exercise on macronutrient intake in overweight
men and women: the Midwest Exercise Trial. American Journal of Clinical Nutrition, 78(5),
950-957.

It is commonly believed that moderate aerobic exercise leads to changes in diet

composition, specifically, an increase in carbohydrate intake at the expense of fat intake.

Donnelly, J. E., Smith, B., Jacobsen, D. J., Kirk, E., Dubose, K., Hyder, M., Bailey, B., and
Washburn, R. (2004). The role of exercise for weight loss and maintenance. Best Pract Res Clin
Gastroenterol, 18(6), 1009-29.

Exercise provides a means of increasing energy expenditure and may help adjust energy
balance for weight loss and maintenance. At least 30 minutes a day of moderate intensity
aerobic exercise per day is recommended for weight loss and maintenance but greater
amounts appear to increase the magnitude of weight loss and maintenance. Resistance
training has recently been shown to have positive effects on body composition but does
not typically show significant decreases in weight.

Douketis, J. D., Feightner, J. W., Attia, J., and Feldman, W. F. (1999). Periodic health
examination, 1999 update: 1. Detection, prevention and treatment of obesity. Canadian Medical
Association Journal, 160(4), 513-525.

A meta-analysis to evaluate evidence relating to the effectiveness of methods to prevent

and treat obesity was performed in order to provide recommendations for the prevention
and treatment of obesity in adults aged 18 to 65 years in Canada. In adults with obesity
(body mass index (BMI) greater than 27) management options include weight reduction,
prevention of further weight gain or no intervention.

Drapeau, V., Despres, J. P., Bouchard, C., Allard, L., Fournier, G., Leblanc, C., and Tremblay,
A. (2004). Modifications in food-group consumption are related to long-term body-weight
changes. American Journal of Clinical Nutrition, 80(1), 29-37.
 79

Dietary patterns play an important role in the control of body weight. Objective: The aim
of this study was to verify whether changes in some dietary patterns over a 6-y follow-up
period would be associated with weight changes.

Drapeau, V., Desprs, J. P., Bouchard, C., Allard, L., Fournier, G., Leblanc, C., and Tremblay,
A. (2004). Modifications in food-group consumption are related to long-term body-weight
changes. American Journal of Clinical Nutrition, 80(1), 29-37.

Dietary patterns play an important role in the control of body weight. Objective: The aim
of this study was to verify whether changes in some dietary patterns over a 6-y follow-up
period would be associated with weight changes.

Drapeau, V., Therrien, F., Richard, D., and Tremblay, A. (2003). Is visceral obesity a
physiological adaptation to stress? Panminerva Medica, 45(3), 189-195.

Visceral obesity represents an important risk factor associated with hypertension,

diabetes and cardiovascular diseases. Since this condition is associated with a disruption
of the functioning of the HPA axis, stress-induced HPA axis activation has been
identified to play an important role in this preferential body fat accumulation.

Drewnowski, A., and Barratt Fornell, A. (2004). Do healthier diets cost more? Nutrition Today,
39(4), 161-168.

Energy-dense foods, some of which are high in refined grains, added sugars, and added
fats, provide dietary energy at a far lower cost than do lean meats, fish, fresh vegetables,
and fruit. Food costs may be one barrier to the adoption of healthier diets, especially by
low-income households. Dietary guidelines, based on a pyramid of relatively costly
foods, may not be the best approach to population-based interventions in public health.
There is a need for more studies on the relationship between socioeconomic factors, diet
quality, and diet costs.

Drewnowski, A., and Specter, S. E. (2004). Poverty and obesity: the role of energy density and
energy costs. American Journal of Clinical Nutrition, 79(1), 6-16.

Many health disparities in the United States are linked to inequalities in education and
income. This review focuses on the relation between obesity and diet quality, dietary
energy density, and energy costs. Evidence is provided to support the following points.

Drohan, S. H. (2002). Primary care approaches. Managing early childhood obesity in the primary
care setting: a behavior modification approach. Pediatric Nursing, 28(6), 599-610.

The purpose of this article is to encourage primary care pediatric nurses to begin
behavioral-based obesity treatment efforts as early as the preschool years. By examining
the critical periods for obesity development and how the formation of food and activity
behaviors interacts with those critical periods during the preschool years, the value of
initiating early obesity treatment will be highlighted. Furthermore, the theory of behavior
 80

modification is presented and core principles are applied to early childhood weight
management efforts.

Drummond, S. (1998). Getting to grips with obesity. Journal of Community Nursing, 12(10), 4,
6.

Dr. Sandra Drummond discusses ways in which community nurses can work towards
detecting and preventing obesity in their clients.

Duncan, L., and Simmons, M. (1996). Health practices among Russian and Ukrainian
immigrants. Journal of Community Nursing, 13(2), 129-137.

Since 1990, due to political and legislative changes, immigration from the former Soviet
Union to the United States has increased significantly. Population reports from 1988
indicate that there were approximately 406,000 Soviet immigrants in the United States at
that time. This number is expected to increase due to the Immigration Reform Act of
1990, which raised the Soviet refugee ceiling to 50,000 per year. Currently, very little is
known about the health status and health practices of this population, although some
published data indicate that life expectancy and infant mortality rates compare poorly
with those of the general population in the United States.

Dupen, F., Bauman, A. E., and Lin, R. (1999). The sources of risk factor information for general
practitioners: is physical activity under-recognised? The Medical Journal of Australia, 171(11-
12), 601-604.

The amount of material on physical acitivity, hypercholesterolemia, hypertension, the

management of smoking, in journals and magazines frequently read by this group was
investigated through qualitative study of the total number of articles and advertisements.
Only 6% of the cardiovascular disease (CVD) risk factors articles in the Medline search
and 5% in the medical magazine search covered prescribing exercise or ways to start and
keep up exercise programs.

Dzien, A., Pfeiffer, K. P., Dzien, B. C., Hoppichler, F., and Lechleitner, M. (2003). The
influence of obesity on the frequency and distribution of medication. Acta Medica Austriaca,
30(2), 51-54.

Obesity is a serious health problem in industrialized countries and is associated with a

significant increase in total health care costs. Only few data are available about the costs
of drug therapies in patients with an increased body weight treated under clinical routine
procedures. Such data could support efforts to intensify obesity prevention and treatment
programmes in order to reduce comorbidities and costs.

Eberle, S. G. (2001). Avoiding winter weight gain. Running and fitnews, 19(11), 1.

Strategies for runners to put in place in the winter to avoid packing on excessive pounds.
 81

Edwards, K., Pryor, S., Campbell, J., Jacobsen, S., and Booton Hiser, D. (2000). Calorie use and
obesity among diabetic and non-diabetic Mvskoke Indians. Journal of Cultural Diversity, 7(2),
36-40.

Type 2 diabetes is a major cause of death among American Indians and obesity and
physical inactivity are modifiable risk factors in the development of type 2 diabetes.
Physical activity may have both a preventive effect and a secondary preventive effect of
lessening insulin resistance in persons with type 2 diabetes. Moreover, for some
individuals participation in daily regimens of physical activity is very difficult. Culture-
specific physical activity may be an intervention to reduce obesity and prevent diabetes-
related complications.

Ekvall, S. (2003). Obesity in children with special health care needs. Part II. Exceptional Parent,
(EXCEPTIONAL-PARENT) 2003 Jun; 33(6): 102-5. 33: 102-105

Information and suggestions to assist in the prevention of obesity in children with special
health care needs.

Elkins, W. L., Cohen, D. A., Koralewicz, L. M., and Taylor, S. N. (2004). After school activities,
overweight, and obesity among inner city youth. Journal of Adolescence, 27(2), 181-189.

We examined the association of adolescent obesity with participation in sports among

5489 low-income, inner city public high school students.

Elliot, M. A., Copperman, N. M., and Jacobson, M. S. (2004). Pediatric obesity prevention and
management. Minerva Pediatrica, 56(3), 265-276.

Obesity has reached epidemic proportions worldwide in turn redirecting the goals of the
Paediatric well care visit. There is no effective pharmacological or surgical treatment
available for this entity but if left unaddressed it can lead to detrimental medical
complications. Several known contributors to obesity exist which allow the development
of successful prevention programs. Prior to initiating such a program, a paediatric
practitioner should be equipped with the skills of identification of overweight and its risk
factors as well as strong knowledge of treatment options. We attempt to provide the
appropriate guidelines for childhood obesity prevention in this review.

Entrala-Bueno, A., Iglesias, C., and De Jesus, D. (2003). Diet and physical activity: a helpful
binomial. European Journal of Clinical Nutrition, 57(9), S63-S69.

Individual health status is the result of a combination of different factors such as genetics,
dowry, age, nutritional status, physical activity, as well as environmental factors,
hygiene, salubrity, stress and tobacco consumption. The existence of bad food habits and
other risk factors leads to an increase in the development of chronic diseases, obesity,
diabetes, cardiovascular disease, osteoporosis and certain types of cancer. Such diseases
occupy greater rates of morbidity and mortality in European countries.
 82

Epstein, L. H., Coleman, K. J., and Myers, M. D. (1996). Exercise in treating obesity in children
and adolescents. Medicine and Science in Sports and Exercise, 28(4), 428-435.

This paper reviews the use of exercise programs with obese children and adolescents.
Studies included for review met two criteria: 1) children or adolescents were defined as
obese using objective criteria for obesity, and 2) obese children or adolescents were
provided either different types of exercise programs or an exercise program compared
with a no-exercise control condition. Thirteen controlled outcome studies were identified.
Experimental design, methods, and outcomes are presented and evaluated for each study.

Epstein, L. H., and Goldfield, G. S. (1999). Physical activity in the treatment of childhood
overweight and obesity: current evidence and research issues. Medicine and Science in Sports
and Exercise, 31(11 Suppl), S553-S559.

This paper reviews the utility of exercise as a treatment for overweight and obese
children and adolescents. Computer database searches identified 13 studies that met the
following criteria for inclusion: 1) obese children or adolescents were provided either
different types of exercise programs or an exercise program compared with a no-exercise
control, 2) subjects were randomly assigned to groups or assigned by matching on
demographic and anthropometric variables, and 3) the exercise program was at least 2
months in duration.

Epstein, L. H., Myers, M. D., Raynor, H. A., and Saelens, B. E. (1998). Treatment of pediatric
obesity. Pediatrics, 101(3), 554-570.

This review of paediatric obesity treatment, using predominantly randomized, controlled

studies, highlights important contributions and developments in primarily dietary, activity
and behaviour change interventions, and identifies characteristics of successful treatment
and maintenance interventions.

Epstein, L. H., Paluch, R. A., Kilanowski, C. K., and Raynor, H. A. (2004). The effect of
reinforcement or stimulus control to reduce sedentary behavior in the treatment of pediatric
obesity. Health Psychology, 23(4), 371-380.

Obese children were randomly assigned to a family-based behavioral treatment that

included either stimulus control or reinforcement to reduce sedentary behaviors.
Significant and equivalent decreases in sedentary behavior and high energy density foods,
increases in physical activity and fruits and vegetables, and decreases in standardized
body mass index (z-BMI) were observed.

Epstein, L. H., Paluch, R. A., and Raynor, H. A. (2001). Sex difference in obese children and
siblings in family-based obesity treatment. Obesity Research, 9(12), 746-753.

The primary goal was to evaluate sex differences in child weight control programs that
targeted increasing physical activity (increase) or the combination of reducing sedentary
 83

behavior and increasing physical activity (combined). A second goal was to evaluate the
benefits of family-based interventions on nontargeted siblings.

Epstein, L. H., Paluch, R. A., Saelens, B. E., Ernst, M. M., and Wilfley, D. E. (2001). Changes in
eating disorder symptoms with pediatric obesity treatment. Journal of Pediatrics, 139(1), 58-65.

To evaluate the effects of behavioral, family-based treatment on disordered eating and

child behavior problems for obese 8- to 12-year-old children.

Epstein, L. H., Roemmich, J. N., Paluch, R. A., and Raynor, H. A. (2005). Influence of changes
in sedentary behavior on energy and macronutrient intake in youth. American Journal of Clinical
Nutrition, 81(2), 361-6.

Changes in sedentary behavior may be related to changes in energy intake. The purpose
of this study was to investigate how experimental changes in the amount of sedentary
behaviors influence energy intake.

Ernsberger, P., and Koletsky, R. J. (1999). Biomedical rationale for a wellness approach to
obesity: An alternative to a focus on weight loss. Journal of Social Issues, 55(2), 221-259.

Addresses the prevailing view of obesity as a major threat to public health. The authors
found that this paradigm is based on incomplete consideration of the evidence. A
wellness approach which focuses on a healthy lifestyle, positive attitude to health and
self-care, and a disregarding of predetermined weight standards in favor of preventing
further weight gain and reducing risk factors is offered. This new approach should
improve the physical and mental well being of obese patients.

Ewing, R., Schmid, T., Killingsworth, R., Zlot, A., and Raudenbush, S. (2003). Relationship
Between Urban Sprawl and Physical Activity, Obesity, and Morbidity. American Journal of
Health Promotion, 18(1), 47-57.

The study aims to determine the relationship between urban sprawl, health, and health-
related behaviors. Cross-sectional analysis using hierarchical modeling to relate
characteristics of individuals and places to levels of physical activity, obesity, body mass
index (BMI), hypertension, diabetes, and coronary heart disease. Setting. U.S. counties
(448) and metropolitan areas (83). 206,992 adults pooled from the 1998, 1999, and 2000
Behavioral Risk Factor Surveillance System (BRFSS). Sprawl indices, derived with
principal components analysis from census and other data, served as independent
variables. Self-reported behavior and health status from BRFSS served as dependent
variables. After controlling for demographic and behavioral covariates, the county sprawl
index had small but significant associations with minutes walked, obesity, BMI, and
hypertension. Residents of sprawling counties were likely to walk less during leisure
time, weigh more, and have greater prevalence of hypertension than residents of compact
counties. At the metropolitan level, sprawl was similarly associated with minutes walked
 84

but not with the other variables. This ecologic study reveals that urban form could be
significantly associated with some forms of physical activity and some health outcomes.

Fabricatore, A. N., and Wadden, T. A. (2003). Psychological functioning of obese individuals.

Diabetes Spectrum, 16(4), 245-252.

This review found that obese individuals in the general population have essentially
normal psychological functioning. Obese women, however, are at greater risk than obese
men of depression and related complications. Binge eating and extreme obesity further
increase the likelihood of patients reporting emotional complications. Pharmacotherapy
and psychotherapy may be of benefit in this subset of individuals.

Fagard, R. H. (1999). Physical activity in the prevention and treatment of hypertension in the
obese. Medicine and Science in Sports and Exercise, 31(11 Suppl), S624-S630.

The purpose of this paper was to assess the value of physical exercise in the prevention
and treatment of hypertension with particular attention to possible interactions with
relative weight. We describe epidemiological studies and report meta-analyses of
randomized intervention trials, i.e., randomized controlled trials on dynamic physical
training and randomized comparative trials of exercise and diet. Epidemiological studies
show an inverse relationship between physical activity or fitness and the incidence of
hypertension, which was either independent of body size or more pronounced in the
overweight. The weighted net reduction of blood pressure in response to dynamic
physical training averages 3.4/2.4 mm Hg (P < 0.001), which appears to be unrelated to
the initial body mass index (BMI) and to its training-induced changes. Exercise is less
effective than diet in lowering blood pressure (P < 0.02), and adding exercise to diet does
not appear to further reduce blood pressure. Future studies should observe scientific
criteria more strictly, address the truly obese (BMI greater than or equal to 30 kg.m-2)
and attempt to resolve the blood pressure lowering mechanisms. Physical activity
contributes to the control of blood pressure in overweight as well as in lean subjects.

Faith, M. S., Scanlon, K. S., Birch, L. L., Francis, L. A., and Sherry, B. (2004). Parent-Child
Feeding Strategies and Their Relationships to Child Eating and Weight Status. Obesity Research,
12(11), 1711-1722.

Parental feeding styles may promote overeating or overweight in children. A

comprehensive literature review was undertaken to summarize the associations between
parental feeding styles and child eating and weight status. Twenty-two studies were
identified. We systematically coded study attributes and outcomes and tested for patterns
of association. Nineteen studies (86%) reported at least one significant association
between parental feeding style and child outcome, although study methodology and
results varied considerably. Studies measuring parental feeding restriction, as opposed to
general feeding control or another feeding domain, were more likely to report positive
associations with child eating and weight status. Certain associations differed by gender
and by outcome measurement (e.g. rate of eating as opposed to total energy intake).
 85

Parental feeding restriction, but no other feeding domain, was associated with increased
child eating and weight status.

Fanning, E. L. (2004). Evidence-based disease management: its role in cardiovascular risk

reduction. Disease Management, 7 Suppl 1, S7-10.

Cardiovascular disease remains the most pressing healthcare problem in the United
States. Traditional risk factors--hypertension, obesity, and diabetes-are still unresolved
issues; and new risk factors--pre-diabetes, insulin resistance, and pediatric and adolescent
diabetes-have emerged.

Feingold, R. (2002). Making a case. F.I.E.P. Bulletin, 72(1/2/3), 6-13.

This article presents and discusses research evidence in support of the importance of
physical activity for people of all ages. Studies over the last 20-30 years have shown the
benefits of physical activity in preventing cardiovascular diseases, diabetes, colon and
breast cancer, and osteoporosis. It has been found that an active life contributes to
improve health conditions and reduce obesity in children and adolescents, and has a
direct effect in their later years. Important mental health benefits such as depression and
stress reduction have been reported. Research still being conducted suggests that physical
activity may have a great impact on cognitive function, improving academic
performance. Besides the benefits to one's physical and mental health, physical activity is
also considered to play a role in the development of social interaction skills through the
practice of planned and controlled games and sports.

Fernandes, J. K., Klein, M. J., Ater, J. L., Kuttesch, J. F., and Vassilopoulou-Sellin, R. (2002).
Triiodothyronine supplementation for hypothalamic obesity. Metabolism, 51(11), 1381-1383.

Patients with suprasellar lesions develop profound hypothalamic obesity and listlessness
with no effective treatment. We added triiodothyronine (T sub(3)) supplementation in 3
such patients and present their response. All had previous nutritional counseling without
benefit. All were treated for diabetes insipidus (DI) and hypopituitarism; serum free
thyroxine (T sub(4)) level was normal.

Fernstrom, M. H., and Fernstrom, J. D. (2002). The new role of pharmacotherapy for weight
reduction in obesity. International Journal of Clinical Practice, 56(9), 683-686.

Obesity is associated with an increased risk for a wide variety of chronic health
conditions. Despite this fact, less than half of obese patients are advised by healthcare
professionals to lose weight. Creating a viable plan for losing weight and maintaining
weight loss is difficult. Lifestyle change is always the cornerstone of treatment, but two
new therapeutic agents approved for long-term use, sibutramine and orlistat, can help
maximise success. Increased weight loss can lead to reductions in the risk of obesity-
related co-morbidities. Sibutramine and orlistat offer new weight reduction opportunities
for obese patients.
 86

Ferreira, I., Twisk, J. W., van Mechelen, W., Kemper, H. C., and Stehouwer, C. D. (2005).
Development of fatness, fitness, and lifestyle from adolescence to the age of 36 years:
determinants of the metabolic syndrome in young adults: the amsterdam growth and health
longitudinal study. Arch Intern Med, 165(1), 42-8.

Among young adults, the metabolic syndrome is an increasingly frequent risk factor for
cardiovascular disease. Its determinants are, however, incompletely understood. We
investigated the time course, from adolescence (age, 13 years) to young adulthood (age,
36 years), of important potential determinants (body fatness and fat distribution,
cardiopulmonary fitness, and lifestyle) in 364 individuals (189 women).

Field, A. E., Austin, S. B., Gillman, M. W., Rosner, B., Rockett, H. R., and Colditz, G. A.
(2004). Snack food intake does not predict weight change among children and adolescents.
International Journal of Obesity and Related Metabolism Disorders, 28(10), 1210-1216.

To assess whether intake of snack foods was associated with weight change among
children and adolescents. Methods: Prospective study of 8203 girls and 6774 boys, 9-14y
of age in 1996, in an ongoing cohort study who completed at least two questionnaires
between 1996 and 1999. Intake of snack foods was assessed in 1996-1998 with a
validated food frequency questionnaire designed specifically for children and
adolescents.

Field, A. E., Austin, S. B., Taylor, C. B., Malspeis, S., Rosner, B., Rockett, H. R., Gillman, M.
W., and Colditz, G. A. (2003). Relation between dieting and weight change among
preadolescents and adolescents. Pediatrics, 112(4), 900-906.

To assess whether dieting to control weight was associated with weight change among
children and adolescents. METHODS: A prospective study was conducted of 8203 girls
and 6769 boys who were 9 to 14 years of age in 1996, were in an ongoing cohort study,
and completed at least 2 annual questionnaires between 1996 and 1999. Dieting to control
weight, binge eating, and dietary intake were assessed annually from 1996 through 1998
with instruments designed specifically for children and adolescents. The outcome
measure was age- and sex-specific z score of body mass index (BMI).

Field, A. E., Gillman, M. W., Rosner, B., Rockett, H. R., and Colditz, G. A. (2003). Association
between fruit and vegetable intake and change in body mass index among a large sample of
children and adolescents in the United States. International Journal of Obesity and Related
Metabolism Disorders, 27(7), 821-826.

The objective of the study was to assess whether intake of fruits and vegetables was
associated with change in body mass index (BMI) among a large sample of children and
adolescents in the United States. Prospective cohort study of children and adolescent who
were 9-14y of age in 1996, when the study began. The subjects included 8203 girls and
6715 boys in an ongoing cohort study who completed at least two questionnaires between
1996 and 1999.
 87

Finkelstein, E., French, S., Variyam, J. N., and Haines, P. S. (2004). Pros and Cons of Proposed
Interventions to Promote Healthy Eating. American Journal of Preventive Medicine, 27(Suppl3),
163-171.

The increased prevalence and costs associated with the obesity epidemic have made
preventive efforts a public health priority. Public health has historically relied on a series
of targeted regulations, taxes, and education efforts to curb epidemics, and will rely on
similar strategies to combat obesity. We argue that interventions targeted at youth are
relatively easy to justify on economic grounds due to the additional protections that this
group requires, but that justification for government interventions aimed at curbing
obesity among adults requires additional evidence that private markets are not
functioning properly. We then present seven proposed intervention strategies to promote
healthy eating, and use an economic framework to discuss the relative merits of the
interventions. This evaluation will allow policymakers to make more informed decisions
concerning the relative merits of these strategies in combating the obesity epidemic.

Fitzgerald, S. J., Kriska, A. M., Pereira, M. A., and De Courten, M. P. (1997). Associations
among physical activity, television watching, and obesity in adult Pima Indians. Medicine and
Science in Sports and Exercise, 29(7), 910-915.

This study provided the opportunity to examine the relationship between television
watching, physical activity, and body mass index (BMI) in adult Pima Indians, a
population with a high prevalence of obesity. Hours per day of television watched, past-
year physical activity levels (leisure and occupational combined) and BMI were
measured in 2,452 men and women, aged 21-59 yrs). In adults between the ages of 21
and 39 yrs, TV and physical activity levels were negatively correlated. Weaker
associations were found between TV and BMI. There were no significant relationships
among these variables in older adults (aged 40-59 yrs), possibly because of low reported
levels of physical activity and TV. Multiple linear regression analysis revealed that
physical activity and television watching in men and activity in women were significantly
related to BMI. These data suggest that increasing activity levels and decreasing the time
spent in sedentary behavior such as watching television should both be considered as
potential intervention strategies in obesity prevention programs.

Fitzgerald, T. E., Prochaska, J. O., and Pransky, G. S. (2000). Health risk reduction and
functional restoration following coronary revascularization: a prospective investigation using
dynamic stage typology clustering. International Journal of Rehabilitation and Health, 5(2), 99-
116.

We identified patterns of coronary-prone behavior modification in a prospective cohort

investigation of health risk reduction following coronary artery bypass graft (CABG)
revascularization surgery. Fifty coronary heart disease (CHD) patients scheduled for
bypass answered questions about Transtheoretical Model (TTM) change strategy
(process) use, mood, and quality of life at 1 month prior to CABG and again at 1-month
and 8-month postsurgery.
 88

Fitzgibbon, M. L., Stolley, M. R., Dyer, A., VanHorn, L., and Kaufer Christoffel, K. (2002). A
community-based obesity prevention program for minority children: rationale and study design
for Hip-Hop to Health Jr. Preventive Medicine, 34(2), 289-298.

The increasing prevalence of overweight among children in the United States presents a
national health priority. Higher rates of overweight/obesity among minority women place
their children at increased risk. Although increased rates of overweight are observed in 4-
to 5-year-old children, they are not observed in 2- to 3-year-old children. Therefore, early
prevention efforts incorporating families are critical.

Fitzgibbon, M. L., Stolley, M. R., and Kirschenbaum, D. S. (1995). An obesity prevention pilot
program for African-American mothers and daughters. Journal of Nutrition Education, 27(2), 93-
99.

This study examined the effects of an obesity prevention programme on eating-related

knowledge and behaviour. Subjects included 24 African-American women and their
preadolescent daughters living in a low-income urban housing complex in the USA. The
dyads were randomly assigned to the treatment or control group. The 6-week treatment
addressed the identification of high- and low-fat foods, how to read food labels and
calculate percentage of fat in energy in food, risks of high-fat eating, low-fat food
planning and preparation, and the problems associated with obesity in general and within
the African-American community in particular. Pre- and post-treatment measures
included assessment of nutrition knowledge, nutrition attitudes and food intake. Results
showed that the treatment group, compared to controls, decreased their intake of fat in
grams and in percentage of total energy. Additionally, differences within dyads showed
that the mothers significantly improved their eating patterns (fat g and fat percentage
intake), more so than the daughters. A significant increase over time in nutrition
knowledge was noted for the treatment group. Furthermore, although not significant, a
trend for a greater increase in knowledge for the treatment group, compared with
controls, was observed. These preliminary findings support the importance and
effectiveness of parent-child prevention programmes in high-risk communities.

Fitzner, K., Caputo, N., Trendell, W., French, M. V., Bondi, M. A., and Jennings, C. (2003).
Recent tax changes may assist treatment of obesity. Managed Care Interface, 16(1), 47-51, 55.

The U.S. Surgeon General's Call to Action on Overweight and Obesity 2001 proposes
inclusion of health care providers in prevention efforts and suggests classification of
obesity as a disease category for reimbursement coding. Physician counseling on and
referral for physical activity is generally recognized as a component of obesity treatment,
but data on the effectiveness of these measures remain inconclusive. Recent changes in
the interpretation of the federal tax law may influence physicians' and health plans' roles
in promoting physical activity.

Flegal, K. M., Troiano, R. P., and Ballard-Barbash, R. (2001). Aim for a healthy weight: What is
the target? Journal of Nutrition, 131(2), 440S.
 89

The first guideline statement of the Year 2000 edition of Nutrition and Your Health:
Dietary Guidelines for Americans is "Aim for a healthy weight." The purpose of this
paper is to describe the evolution of the weight guideline and discuss some issues related
to it. We reviewed current and previous editions of the Dietary Guidelines and the
corresponding advisory committee reports.

Fletcher, B., and Lemendola, C. (2004). Insulin resistance syndrome. Journal of Cardiovascular
Nursing, 19(5), 339-345.

Insulin resistance syndrome, also referred to as the metabolic syndrome, affects 1 in 3 to

4 adults older than 20 years. This syndrome consists of a clustering of metabolic
abnormalities that put people at risk for type 2 diabetes and cardiovascular disease. These
clinical abnormalities include dyslipidemia, specifically elevated triglycerides and low
high-density lipoprotein cholesterol, elevated glucose, and hypertension. The incidence of
this morbid syndrome is expected to continue to grow both in the United States and
worldwide, and thus is of tremendous interest to nurses seeking to measure their impact
on patient outcomes. The key lifestyle interventions essential to treating this syndrome
are weight loss and physical activity. The purpose of this article is to (1) describe the
insulin resistance syndrome and discuss the current focuses for inquiry in major outcome
areas (eg, mortality, morbidity, costs); (2) describe the status of specific lifestyle
interventions (weight loss, diet, and exercise); (3) identify outcomes that nurses could
measure to assess their impact on patient care; and (4) identify areas for future nursing
research.

Flodmark, C. E., Lissau, I., Moreno, L. A., Pietrobelli, A., and Widhalm, K. (2004). New
insights into the field of children and adolescents' obesity: the European perspective.
International Journal of Obesity, 28(10), 1189-1196.

The awareness of childhood obesity as a major health problem and an uncontrolled

worldwide epidemic has to be increased in the society. DESIGN: In order to improve the
quality of the health care and to minimize the cost it is important to investigate and
standardize pediatric obesity prevention and treatment and to adapt to social and cultural
aspects.

Flynn, M. A. T. (1997). Fear of fatness and adolescent girls: implications for obesity prevention.
Proceedings of the Nutrition Society, 56(1B), 305-317.

This review discusses some of the social, economic and psychological aspects of
adolescent obesity

Fobi, M. A. L. (2004). Surgical Treatment of Obesity: A Review. Journal of the National

Medical Association, 96(1), 61-75.

Obesity is a chronic disease due to excess fat storage, a genetic predisposition, and strong
environmental contributions. This problem is worldwide, and the incidence is increasing
 90

daily. There are medical, physical, social, economic, and psychological comorbid
conditions associated with obesity. There is no cure for obesity except possibly
prevention. Currently, surgery offers the only viable treatment option with long-term
weight loss and maintenance for the morbidly obese. Surgeries for weight loss are called
bariatric surgeries. Gastric bypass operations are the most common operations currently
used. Because there are inherent complications from surgeries, bariatric surgeries should
be performed in a multidisciplinary setting. The laparoscopic approach is being used by
some surgeons in performing the various operations.

Fontaine, K. R., and Cheskin, L. J. (1999). Optimism and obesity treatment outcomes. Journal of
Clinical Psychology, 55(1), 141-144.

To examine the ability of the personality dimension dispositional

optimism to predict short-term obesity treatment outcomes (weeks of
program attendance and weight loss), 177 consecutive persons seeking
outpatient treatment at a university-based weight management center
completed the revised Life Orientation Test (LOT-R; Scheier, Carver, &
Bridges, 1994) and underwent a comprehensive medically monitored
weight loss program. The overall LOT-R and optimism subscales did not
correlate with either attendance or weight loss. However, the
pessimism subscale was positively associated with weeks of attendance.

Fontanarosa, P. B. (1999). Patients, physicians, and weight control. JAMA: Journal of the
American Medical Association, 282(16), 1581.

Doctors can do more to encourage their patients to control their weight. About half of US
women and one-third of US men say they are trying to lose weight. But despite the
proliferation of health clubs, fitness centers, and health food stores, more Americans are
overweight than ever before. Two 1999 articles report that many doctors do not
encourage their obese patients to lose weight. People who did receive such advice were
three times more likely to try to lose weight.

Ford, E. S., Mokdad, A. H., Giles, W. H., Galuska, D. A., and Serdula, M. K. (2005).
Geographic variation in the prevalence of obesity, diabetes, and obesity-related behaviors.
Obesity Research, 13(1), 118-22.

To examine the variation in the prevalences of obesity and type 2 diabetes in weight loss
counseling by health providers and in other potential obesity-related determinants in 100
metropolitan statistical areas in the United States.

Foreyt, J. P., and Poston, W. S. C., II. (1998). The role of the behavioral counselor in obesity
treatment. Journal of the American Dietetic Association, S27-S30.

This review summarizes the role of behavioral counselors in obesity treatment.

Behavioral counselors, who are often also registered dietitians provide multidisciplinary
 91

treatment teams with expertise in the modification of diet and physical activity behaviors.
Behavioral counselors use a variety of behavior-change strategies aimed at modifying
obesity-related behaviors. The first step is to establish a collaborative alliance that will
facilitate adherence and behavior change. Then, multiple intervention-related strategies
can be used to further enhance adherence to treatment and elicit behavior change. These
strategies include self-monitoring, stimulus control, cognitive restructuring, stress
management, social support, physical activity, and relapse prevention. Interventions that
incorporate these strategies are effective in producing gradual and moderate weight loss
in persons with obesity.

Forman-Hoffman, V. (2004). High prevalence of abnormal eating and weight control practices
among U.S. high-school students. Eating Behavior, 5(4), 325-36.

This study sought to determine the prevalence and to identify correlates of abnormal
eating and weight control practices in U.S. high-school students.

Forman, A. (2001). Shape Up America! hosts DIABESITY conference. March 2001. Alexandria,
VA. Nutrition Today, 36(5), 266-271.

The prevalence of obesity and diabetes in the United States is spreading at an alarming
rate. In response to this phenomenon, Shape Up America! recently launched the first
phase of its DIABESITY public health initiative with a unique and stimulating 2-day
conference. A distinguished panel of speakers addressed the factors contributing to the
increase in type 2 diabetes among people of all ages, including children, and suggested
practical measures for prevention and intervention that can be implemented now.

Forman, A. (2004). The Second National Conference on Diabesity in America. Nutrition Today,
39(6), 245-256.

The prevalence of obesity and diabetes in America is a growing public health threat,
affecting people of all ages, including children, all racial groups, and both genders. At a
recent conference on Diabesity(R) in America, experts addressed the connection between
obesity and diabetes from both a basic science and clinical practice perspective. They
discussed the causal pathways between obesity and type 2 diabetes, identified prevention
and treatment modalities, examined environmental factors contributing to obesity, and
explored the role of the food industry, private sector, schools, and community in
establishing intervention programs to reduce the growing prevalence of obesity and
diabetes.

Fossati, M., Amati, F., Haenni, C., Reiner, M., Nguyen, M., and Golay, A. (2002). Cognitive-
behavioral therapy with simultaneous nutritional and physical exercise in obese patients.
International Journal of Obesity, 26(1).

The most important problem in cognitive-behavioral therapies (CBT) for obese patients is
to initiate weight loss without reinforcing the eating-behavioral disorders. We propose to
 92

assess the CBT in obese patients suffering from eating disorders with or without
combining nutritional and physical exercise approach.

Foster, G. D., Phelan, S., Wadden, T. A., Gill, D., Ermold, J., and Didie, E. (2004). Promoting
More Modest Weight Losses: A Pilot Study. Obesity Research, 12(8), 1271-1277.

This pilot study assessed the short- and long-term effects of a modified cognitive
behavioral treatment designed to facilitate obese patients' acceptance of a 5% to 10%
reduction in initial weight.

Foster, G. D., Wadden, T. A., Makris, A. P., Davidson, D., Sanderson, R. S., Allison, D. B., and
Kessler, A. (2003). Primary care physicians' attitudes about obesity and its treatment. Obesity
Research, 11(10), 1168-1177.

This study was designed to assess physicians' attitudes toward obese patients and the
causes and treatment of obesity. working on weight management issues if their time was
reimbursed appropriately.

Foster, G. D., Wadden, T. A., Swain, R. M., Anderson, D. A., and Vogt, R. A. (1999). Changes
in resting energy expenditure after weight loss in obese African American and white women.
American Journal of Clinical Nutrition, 13-17.

Previous studies showed that resting energy expenditure (REE) is lower in obese African
American women than in obese white women. It is unknown, however, whether there are
racial differences in how REE responds to weight loss and energy restriction. We
assessed REE, body composition, and respiratory quotient before and after weight loss in
obese black and white women.

Foster, G. D., Wadden, T. A., Swain, R. M., Anderson, D. A., and Vogt, R. A. (1999). Changes
in resting energy expenditure after weight loss in obese African American and white women.
American Journal of Clinical Nutrition, 69(1), 13-17.

Previous studies showed that resting energy expenditure (REE) is lower in obese African
American women than in obese white women. It is unknown, however, whether there are
racial differences in how REE responds to weight loss and energy restriction. We
assessed REE, body composition, and respiratory quotient before and after weight loss in
obese black and white women.

Foster, G. D., Wadden, T. A., Swain, R. M., Stunkard, A. J., Platte, P., and Vogt, R. A. (1998).
The Eating Inventory in obese women: clinical correlates and relationship to weight loss.
International Journal of Obesity and Related Metabolism Disorders, 778-785.

Describe the physical and psychological correlates of the Eating Inventory (EI) (also
known as the Three-Factor Eating Questionnaire) factors in an obese sample, and
determine the relationship between the three factors and weight loss.
 93

Fowler-Brown, A., and Kahwati, L. C. (2004). Prevention and treatment of overweight in

children and adolescents. American Family Physician, 69(11), 2591.

Overweight in childhood and adolescence is an important public health issue because of

its rapidly increasing prevalence and associated adverse medical and social
consequences. Recent studies have estimated that 15 percent of children in the United
States are at risk for overweight, and an additional 15 percent are overweight. Important
predictors of overweight include age, sex, race/ethnicity, and parental weight status.
Generally, school-based prevention programs are not successful in reducing the
prevalence of obesity.

Francis, G. A., Fayard, E., Picard, F., and Auwerx, J. (2003). Nuclear receptors and the control
of metabolism. Annual Review of Physiology, 65, 261-311.

The metabolic nuclear receptors act as metabolic and toxicological sensors, enabling the
organism to quickly adapt to environmental changes by inducing the appropriate
metabolic genes and pathways. Ligands for these metabolic receptors are compounds
from dietary origin, intermediates in metabolic pathways, drugs, or other environmental
factors that, unlike classical nuclear receptor ligands, are present in high concentrations.

Frank, L. D., Andresen, M. A., and Schmid, T. L. (2004). Obesity Relationships with
Community Design, Physical Activity, and Time Spent in Cars. American Journal of Preventive
Medicine, 27(2), 87-96.

Obesity is a major health problem in the United States and around the world. To date,
relationships between obesity and aspects of the built environment have not been
evaluated empirically at the individual level. To evaluate the relationship between the
built environment around each participant's place of residence and self-reported travel
patterns (walking and time in a car), body mass index (BMI), and obesity for specific
gender and ethnicity classifications. Body Mass Index, minutes spent in a car, kilometers
walked, age, income, educational attainment, and gender were derived through a travel
survey of 10,878 participants in the Atlanta, Georgia region. Objective measures of land
use mix, net residential density, and street connectivity were developed within a 1-
kilometer network distance of each participant's place of residence.

Frazao, E., and Allshouse, J. (2003). Strategies for intervention: Commentary and debate.
Journal of Nutrition, 133(3), 844S-847S.

The typical American diet is top-heavy in comparison with the Food Guide Pyramid-high
in added sugars and fats at the Pyramid's tip, and low in most other food components at
the Pyramid's base, especially fruit and green leafy vegetables. Improving the
healthfulness of the diet would therefore require not only a major reduction in the
consumption of fats and sweets but also a sharp increase in the consumption of
vegetables and fruit. This report discusses the potential effects on diet quality of three
general dietary strategies for obesity prevention and treatment: (a) reducing the fat
content of foods, (b) increasing nutrition knowledge and (c) manipulating food prices. It
 94

concludes that improving food choices may require a combination of strategies and
interventions carefully targeted at changing specific behaviors among diverse population
groups.

Freedman, M. R., and Stern, J. S. (2004). The role of optimal healing environments in the
management of childhood obesity. Jo Altern Complement Med, 10 Suppl 1, S231-44.

The prevalence of childhood and adolescent obesity has increased steadily over the past
three decades such that obesity is now a major worldwide pediatric health risk factor.
Pediatric obesity is associated with significant health problems, and is an important early
risk factor for adult morbidity and mortality. This paper focuses on the role and
components of optimal healing environments (OHEs) that may be useful in the
management of childhood obesity: healing intention, healing relationships, health
promotion and disease prevention, and healing spaces. Diet, physical activity, and
behavior modification strategies used in the treatment of childhood obesity are also
reviewed.

Fried, M., and Peskova, M. (1997). Gastric banding in the treatment of morbid obesity. Hepato-
Gastroenterology, 44(14), 582-587.

Obese patients who underwent "laparoscopic" gastric banding were followed up 1, 5 and
10 years after the operation.

Frohlich, J. (2002). Obesity in pregnancy. MIDIRS Midwifery Digest, 12(1), 39-43.

In the Western world we are getting heavier. The prevalence of obesity, especially in
developed countries, has dramatically increased in recent years with the trend most
marked among women. Obesity has become a pressing public health concern, reaching
epidemic proportions. Obesity is associated with several serious health problems,
notably, diabetes and hypertension. During pregnancy, obesity can predispose to
gestational diabetes, an increase in perinatal mortality, an adverse effect on fetal growth
and development, and an increase in caesarean section and instrumental vaginal delivery.

Fry, T. (2002). 20% men and 25% women obese by 2005. Journal of Family Health Care, 12(1),
5.

Last month's House of Commons' Public Accounts Committee Report Tackling Obesityin
England was a wake-up call for action on this major UK epidemic. Its publication was
timed to precede a conference on obesity organised by the National Audit Office.

Fulton, J. E., Garg, M., Galuska, D. A., Rattay, K. T., and Caspersen, C. J. (2004). Public health
and clinical recommendations for physical activity and physical fitness: special focus on
overweight youth. Sports Medicine, 34(9), 581-599.

Numerous physical activity and physical fitness recommendations exist for youth. To
date, however, no investigator has systematically reviewed these public health and
 95

clinical guidelines to determine whether the recommendations address overweight youth.

This review examines youth-oriented physical activity and physical fitness
recommendations for both the public health community and the clinical community, and
assesses how overweight youth are specifically targeted by each of these two groups.

Fulton, J. E., McGuire, M. T., Caspersen, C. J., and Dietz, W. H. (2001). Interventions for weight
loss and weight gain prevention among youth: current issues. Sports Medicine, 31(3), 153-165.

The recent increase in the prevalence of paediatric obesity is one of the most pressing
public health concerns today because of the immediate and long term health
consequences associated with this often intractable disease. Efforts are currently being
made to reduce the prevalence of paediatric obesity. Youth weight loss studies have
produced significant long term results. Most of these programmes included behaviour
modification, diet and exercise. Studies have suggested that lifestyle exercise
programmes may produce the best long term results.

Furuyashiki, T., Nagayasu, H., Aoki, Y., Bessho, H., Hashimoto, T., Kanazawa, K., and Ashida,
H. (2004). Tea catechin suppresses adipocyte differentiation accompanied by down-regulation of
PPARgamma2 and C/EBPalpha in 3T3-L1 cells. Biosci Biotechnol Biochem, 68(11), 2353-9.

Obesity is a serious health problem, and its prevention is promoted through life style
including diet and exercise. In this study, we investigated the suppressive effects of tea
catechin on the differentiation of 3T3-L1 preadipocytes to adipocytes. (-)-Catechin 3-
gallate (CG), (-)-epigallocatechin (EGC), (-)-epicatechin 3-gallate, and (-)-
epigallocatechin 3-gallate at 5 muM suppressed intracellular lipid accumulation.

Gaesser, G. A. (2004). Weight loss for the obese: panacea or pound-foolish? Quest, 56(1), 12-27.

Despite increasing prevalence of dieting, Americans continue to get fatter. Because

traditional weight loss programs have poor long-term efficacy, a non-weight-centered
paradigm might be more effective for improving the health of individuals considered
overweight or obese. Many obesity-related health conditions can be ameliorated via
physical activity and improved nutrition, independent of weight loss.

Gasbarrini, A., and Piscaglia, A. C. (2005). A natural diet versus modern Western diets? A new
approach to prevent "well-being syndromes". Dig Dis Sci, 50(1), 1-6.

Obesity is the most common nutritional disorder in the Western world. Actually, 250
million adults are obese, and 500 million adults and 22 million children under 5 years of
age are overweight. Obesity is a complex trait, depending upon interactions between
multiple genes and the environment, but its recent rise and "epidemic proportions" are,
above all, the consequences of dramatic changes in lifestyle, socioeconomic progress, and
political and cultural trends. Eating behavior has strong extraphysiological determinants,
being influenced by neuroendocrine, nutritional, environmental, and cognitive stimuli,
able to modify the body weight set-point.
 96

Gibson, S. A. (2000). Associations between energy density and macronutrient composition in the
diets of pre-school children: sugars vs starch. International Journal of Obesity and Related
Metabolism Disorders, 633-638.

To investigate the associations between energy density (ED) and macronutrient

composition in the National Diet and Nutrition Survey of Children aged 1 1/2- 4 1/2 y,
hypothesizing that high-ED diets tend to be high in sugars as well as fat.

Gill, T. (1997). Key issues in the prevention of obesity. British Medical Bulletin, 53(2), 359-388.

The rationale and logistics behind obesity prevention are reviewed, followed by an
account of various obesity prevention strategies. The application of universal (targeting
whole population), selective (targeting high-risk groups) and indicated (targeting those
individuals with existing weight problems) prevention schemes are considered. Areas of
priority for preventive action are identified, including prevention of obesity during
childhood, and public health approaches to obesity prevention. The integration of obesity
prevention into management and the reluctance of the medical profession to embrace the
idea of obesity prevention is discussed. Key points for clinical practice are summarized.
It is concluded that obesity needs to be tackled at a population level, and requires public
health programmes that deal with societal and environmental factors which contribute to
lack of physical activity and increased energy intake.

Gillis, L., McDowell, M., and Bar-Or, O. (2005). Relationship between summer vacation weight
gain and lack of success in a pediatric weight control program. Eating Behavior, 6(2), 137-43.

The purpose was to measure the effect of holidays or season on changes in body weight
to determine if this was the reason for the low success rate of weight control program
participants. Changes in percent ideal body weight were gathered on 73 overweight youth
(average age: 10.5+/-2.8 years; percent ideal body weight: 150+/-28%) over 2-month
intervals in a 1-year time span. There was a statistically significant gain in percentage of
body weight during July-August compared to January-February at p<0.004, March-April
at p<0.04, May-June at p<0.001 and September-October at p<0.04. Sixty-six percent of
subjects gained weight during the summer months. When the subjects who lost weight in
the summer period were removed from the analysis, the average weight gain was 2.8% of
ideal body weight.

Gingras, J. R. (1998). Perspectives in practice. Body image dissatisfaction: a framework of

development and recommendations for dietitians. Canadian Journal of Dietetic Practice and
Research, 59(3), 132-137.

Body image dissatisfaction is a serious, prevalent condition in western culture. It is

estimated that 50% of women dislike their bodies and fear being overweight; two
manifestations of a negative body image. There has been a trend in recent years for more
and more individuals to experience a discontent with their bodies. Body image
dissatisfaction is not simply a dislike of personal appearance, but the negative emotions,
thoughts and attitudes associated with perceived appearance.
 97

Giovannucci, E. (2003). Diet, body weight, and colorectal cancer: a summary of the
epidemiologic evidence. Journal of Women's Health, 12(2), 173-182.

Colorectal cancer is the second leading cause of cancer death in the United States, and the
number of new cases annually is approximately equal for men and women. Several
nutritional factors are likely to have a major influence on risk of this cancer. Physical
inactivity and excessive adiposity, especially if centrally distributed, clearly increase the
risk of colon cancer. Hyperinsulinemia may be an important underlying risk factor. In
conjunction with obesity and physical inactivity, which induce a state of insulin
resistance, certain dietary patterns that stimulate insulin secretion, including high intakes
of red and processed meats, saturated and trans-fats, and highly processed carbohydrates
and sugars, may increase the risk of colon cancer. There is evidence suggesting that some
component of red meat may independently increase the risk of colorectal cancer, and
some micronutrients may be important as protective agents.

Gittelsohn, J., Evans, M., Helitzer, D., Anliker, J., Story, M., Metcalfe, L., Davis, S., and Iron
Cloud, P. (1998). Formative research in a school-based obesity prevention program for Native
American school children (Pathways). Health Education Research, 13(2), 251-265.

This paper describes how formative research was developed and implemented to produce
obesity prevention interventions among school children in six different Native American
nations that are part of the Pathways study. The formative assessment work presented
here was unique in several ways: (1) it represents the first time formative research
methods have been applied across multiple Native American tribes; (2) it is holistic,
including data collection from parents, children, teachers, administrators and community
leaders; and (3) it was developed by a multi-disciplinary group, including substantial
input from Native American collaborators. The paper describes the process of developing
the different units of the protocol, how data collection was implemented and how
analyses were structured around the identification of risk behaviors. An emphasis is
placed on describing which units of the formative assessment protocol were most
effective and which were less effective.

Gittelsohn, J., Evans, M., Story, M., Davis, S. M., Metcalfe, L., Helitzer, D. L., and Clay, T. E.
(1999). Multisite formative assessment for the pathways study to prevent obesity in American
Indian schoolchildren. American Journal of Clinical Nutrition, 69(Supplement 4), 767S-772S.

The formative assessment process, using an approach based on social learning theory, for
the development of a school-based obesity-prevention intervention into which cultural
perspectives are integrated is presented. The feasibility phase of the Pathways study was
conducted in multiple settings in 6 American Indian nations. The Pathways formative
assessment collected both qualitative and quantitative data. The qualitative data identified
key social and environmental issues and enabled local people to express their own needs
and views. The quantitative, structured data permitted comparison across sites. Both
types of data were integrated by using a conceptual and procedural model. The formative
assessment results were used to identify and rank the behavioural risk factors that were to
 98

become the focus of the Pathways intervention and to provide guidance on developing
common intervention strategies that would be culturally appropriate and acceptable to all
sites.

Gittelsohn, J., Merkle, S., Story, M., Stone, E. J., Steckler, A., Noel, J., Davis, S., Martin, C. J.,
and Ethelbah, B. (2003). School climate and implementation of the Pathways study. Preventive
Medicine, 37(6), S97-S106.

Pathways was a multisite school-based study to prevent obesity in American Indian

school children by encouraging healthy eating and physical activity.

Gittelsohn, J., Toporoff, E. G., Story, M., Evans, M., Anliker, J., Davis, S., Sharma, A., and
White, J. (2000). Food perceptions and dietary behavior of American-Indian children, their
caregivers, and educators: formative assessment findings from pathways. Journal of Nutrition
Education, 2-13.

Dietary findings from a school-based obesity prevention project (Pathways) are reported
for children from six different American-Indian nations. A formative assessment was
undertaken with teachers, caregivers, and children from nine schools to design a
culturally appropriate intervention, including classroom curriculum, food service,
physical education, and family components. This assessment employed a combination of
qualitative and quantitative methods (including direct observations, paired-child in-depth
interviews, focus groups with child caregivers and teachers, and semistructured
interviews with caregivers and foodservice personnel) to query local perceptions and
beliefs about foods commonly eaten and risk behaviors associated with childhood obesity
at home, at school, and in the community. An abundance of high-fat, high-sugar foods
was detected in children's diets described by caregivers, school food-service workers, and
the children themselves. Although children and caregivers identified fruits and vegetables
as healthy food choices, this knowledge does not appear to influence actual food choices.
Frequent high-fat/high-sugar food sales in the schools, high-fat entrees in school meals,
the use of food rewards in the classroom, rules about finishing all of one's food, and
limited family resources are some of the competing factors that need to be addressed in
the Pathways intervention.

Glass, J. N., Miller, W. C., Szymanski, L. M., Fernhall, B., and Durstine, J. L. (2002).
Physiological responses to weight-loss intervention in inactive obese African-American and
Caucasian women. Journal of Sports Medicine and Physical Fitness, 42(1), 56-64.

The physiological responses of inactive obese premenopausal African-American and

Caucasian women to the identical exercise training and behavior modification program
were compared.

Going, S., Thompson, J., Cano, S., Stewart, D., Stone, E., Harnack, L., Hastings, C., Norman, J.,
and Corbin, C. (2003). The effects of the Pathways Obesity Prevention Program on physical
activity in American Indian children. Preventive Medicine, 37(6 Part 2), S62-S69.
 99

Inadequate opportunities for physical activity at school and overall low levels of activity
contribute to the high prevalence of overweight and obesity in American-Indian children.

Going, S., Thompson, J., Cano, S., Stewart, D., Stone, E., Harnack, L., Hastings, C., Norman, J.,
and Corbin, C. (2003). Impact of the Pathways intervention on dietary intakes of American
Indian schoolchildren. Preventive Medicine, 27(6), S55-S61.

Inadequate opportunities for physical activity at school and overall low levels of activity
contribute to the high prevalence of overweight and obesity in American-Indian children.

Golan, M., and Crow, S. (2004). Targeting Parents Exclusively in the Treatment of Childhood
Obesity: Long-Term Results. Obesity Research, 12(2), 357-361.

To report the long-term change in children's overweight following a family-based health-

centered approach where only parents were targeted compared with a control intervention
where only children were targeted.

Golay, A., Fossati, M., Deltraz, M., Luzy, F. d., Howles, M. N., and Ybarra, J. (2003).
Multidisciplinary approach to obesity treatment. Diabetes, Obesity and Metabolism, 5(5), 274-
279.

A cognitive-behavioural-nutritional programme featuring physical exercise and

sophrology sessions in the long-term management of obesity is proposed. The different
approaches including pedagogical, nutritional, psychological-cognitive-behavioural,
sophrology and physical exercise are discussed in detail. An evaluation of the programme
is also included.

Goldberg, G. (2003). FLAIR-FLOW 4: synthesis report on obesity for health professionals.

Nutrition Bulletin, 28(4), 343-354.

One of the activities of FLAIR-FLOW Europe 4 (http://www.flair-flow.com) is the

production of synthesis reports. This report on obesity is the third in a series of six
synthesis reports written for health professionals. Obesity is a condition in which
abnormal or excessive fat accumulation in adipose tissue impairs health.

Gordon, L. P., Griffiths, P., Bentley, M. E., Ward, D. S., Kelsey, K., Shields, K., and
Ammerman, A. (2004). Barriers to physical activity - Qualitative data on caregiver-daughter
perceptions and practices. American Journal of Preventive Medicine, 27(3), 218-223.

There is little research on household and physical environment barriers to physical

activity, particularly in minority populations at high risk for obesity and inactivity. Few
studies include data on caregiver and daughter dyads. Formative data were used to
develop intervention strategies and pathways for the Girls Rule! obesity prevention
intervention, in under-studied high-risk pre-adolescents.
 100

Gorin, A., Phelan, S., Tate, D., Sherwood, N., Jeffery, R., and Wing, R. (2005). Involving
Support Partners in Obesity Treatment. Journal of Consulting and Clinical Psychology, 73(2),
341-343.

In this study, the authors examined whether the number or success of weight loss partners
influences participants' outcomes in behavioral weight loss treatment. Overweight
participants (n = 109) assigned to an exercise intensive group in a larger trial were
encouraged to invite up to 3 partners to attend treatment. Weight losses at 6, 12, and 18
months were not associated with the number of partners (0-3) but were associated with
the weight loss success of the partners. Participants with at least 1 successful partner
(weight loss >=10% at 6 months) lost significantly (p =.004) more weight at 6, 12, and 18
months than those with no successful partners and those without partners.

Gotfredsen, A., Hendel, H. W., and Andersen, T. (2001). Influence of orlistat on bone turnover
and body composition. International Journal of Obesity and Related Metabolism Disorders,
1154-1160.

To investigate the influence of the pancreas lipase inhibitor orlistat (OLS) on calcium
metabolism, bone turnover, bone mass, bone density and body composition when given
for obesity as adjuvant to an energy- and fat-restricted diet.

Gottesman, I. (2004). Managing obesity and glycemic control in insulin-using patients: clinical
relevance and practice recommendations. Diabetes Research and Clinical Practice, 65, S17-S22.

In a number of large-scale studies, intensive therapy regimens have improved glycemic

control while reducing the microvascular complications of type 2 diabetes. However,
insulin use has been associated with weight gain, thereby hampering patient compliance
with intensive insulin therapy. As the prevalence of type 2 diabetes and obesity continues
to increase worldwide, health care providers must incorporate the management of weight
gain in therapeutic strategies that promote glycemic control. The central component in
any such strategy is a tailored program of medical nutrition therapy (MNT), which
includes a healthy diet, physical activity, and education. This article reviews several
dietary options within a MNT program, including the uses of liquid meal replacements,
low-glycemic index carbohydrates, and foods rich in monounsaturated fatty acids. It also
provides several practice recommendations to encourage compliance in patients with type
2 diabetes who wish to manage their weight while receiving insulin therapy.

Grant, A. M., Ferguson, E. L., Toafa, V., Henry, T. E., and Guthrie, B. E. (2004). Dietary factors
are not associated with high levels of obesity in New Zealand Pacific preschool children. Journal
of Nutrition, 134(10), 2561-2565.

Pacific children living in New Zealand (NZ) are prone to excessive weight gain. In this
study, we assessed the anthropometric status of 2- to 5-y-old Pacific children (n = 60) in
relation to their macronutrient intakes. Measurements of height (n = 56), weight (n = 60),
midarm circumference, and triceps skinfold thickness (n = 58), and 2-d weighed food
records (n = 60) and demographic data were collected.
 101

Graves, K. D., and Miller, P. M. (2003). Behavioral medicine in the prevention and treatment of
cardiovascular disease. Behavior Modification, 27(1), 3-25.

Cardiac behavioral medicine is the application of behavioral and psychosocial principles

to the prevention and treatment of heart disease. Most biomedical cardiovascular risk
factors (e.g., high blood lipids, high blood pressure, diabetes) require behavioral and
medical interventions. Other risks, including obesity, high-fat eating patterns, smoking,
and inactivity, clearly require lifestyle change. Behavioral medicine screening and
intervention have been applied to psychosocial risk factors such as depression, hostility,
and social isolation. Appropriate assessment of risk factors is essential because research
has demonstrated successful prevention of heart disease and reduction of morbidity and
mortality in patients with existing disease. Behavioral interventions have been beneficial
in improving cardiac outcomes by enhancing compliance with medication taking and
dietary/exercise recommendations. Future needs include the study of psychosocial factors
in women and ethnic minorities with heart disease and the integration of behavioral
medicine with newer medical technologies designed to detect subclinical biomarkers of
heart disease.

Green, J., Waters, E., Haikerwal, A., O'Neill, C., Raman, S., Booth, M. L., and Gibbons, K.
(2003). Social, cultural and environmental influences on child activity and eating in Australian
migrant communities. Child: Care, Health and Development, 29(6), 441-448.

This study set out to examine the socio-cultural, familial and environmental factors
influencing health, eating habits and patterns of physical activity contributing to child and
adolescent overweight and obesity. METHODS: Semi-structured, community-based
interviews were conducted with contrasting key informant three-generation families; and
generation by generation focus groups of grandparents, parents and children from four
cultural communities in the state of Victoria, Australia.

Green, S., and O'Kane, M. (2001). Obesity. Practice Nurse, 22(3), 20, 22, 24.

Practice nurses can do a great deal to support people with obesity by offering dietary
advice. Sue Green and Mary O'Kane explain how.

Green, S. M., and Passway, T. J. (1998). Focus on nutrition. Management of obesity in the
primary care setting. British Journal of Community Nursing, 3(5), 244-249.

The prevalence of obesity in the UK population is increasing. Management of obesity

commonly takes place in the primary healthcare sector. This article reviews the role of
the dietitian and community nursing professionals in the treatment of obesity in the
community. With the guidance of the dietitian, community nursing professionals can give
advice on dietary and lifestyle changes that promote weight loss. Dietitians can also
improve the knowledge, skills and confidence of community nursing professionals in
dietary and lifestyle counselling of people with obesity through education, training and
support. Community nursing professionals are in a good position, through group work or
 102

on a one-to-one basis, to provide psychological support and follow-up consultations for

people with obesity who are trying to lose weight.

Greenway, F. L., and Smith, S. R. (2000). The future of obesity research. Nutrition, 16(10), 976-
983.

As endocrinologists, we view better treatment as the goal of obesity research. The ideal
obesity treatment would reduce body fat substantially, with preferential loss from the
visceral compartment, and preserve lean tissue with a minimum of side effects. Obesity
has been recognized as a chronic disease since 1985. Chronic diseases recognized before
obesity may predict the future of obesity research. Initial treatments of chronic diseases
commonly arise from empirical observations. These observations often stimulate basic
research into the physiologic mechanisms responsible. Such cross-fertilization between
the clinic and basic science is desirable and expected.

Grey, M., Berry, D., Davidson, M., Galasso, P., Gustafson, E., and Melkus, G. (2004).
Preliminary testing of a program to prevent type 2 diabetes among high-risk youth. Journal of
School Health, 74(1), 10-15.

Type 2 diabetes is increasing among youth, with minority youth at highest risk. This
preliminary study tested the feasibility of a school-based program to prevent type 2
diabetes in youth at risk.

Grieve, F. G., and Vander-Weg, M. W. (2002). Desire to eat high- and low-fat foods following a
low-fat dietary intervention. Journal of Nutrition Education, 98-99.

This study examined changes in desires to eat high-fat and low-fat foods across an
obesity treatment program. The hypotheses under examination were (1) preferences for
low-fat foods would increase across time and (2) preferences for high-fat foods would
decrease across time.

Grummer Strawn, L. M., and Mei, Z. (2004). Does breastfeeding protect against pediatric
overweight? Analysis of longitudinal data from the Centers for Disease Control and Prevention
Pediatric Nutrition Surveillance System. Pediatrics, 113(2), 81-86.

To examine whether increasing duration of breastfeeding is associated with a lower risk

of overweight in a low-income population of 4-year-olds in the United States.

Grundy, S. M. (1998). Multifactorial causation of obesity: implications for prevention.

proceedings of a symposium held at The University of Texas Southwestern Medical Center,
Dallas, April 22-23, 1996. American Journal of Clinical Nutrition, 67(3S), 563S-572S.

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
 103

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.

Gudelj, J. M. (2002). Does exercise in combination with food combining low-calorie diet
produce greater weight loss than diet only? International Journal of Obesity, 26(1).

The effects of dietary change alone (D) or dietary change plus moderate intensity
exercise (DE) on weight loss were studied in 40 healthy overweight women. Subjects
aged 20-60y were matched on the basis of body mass index (BMI) and percentage of
body fat and assigned to diet alone or diet and exercise for two months. Body
composition assessment and physical examination were performed at the beginning of the
study and after 8 weeks of proposed regimen. Diet recommendations included modest
energy restriction (500-750KCal/d), low fat (20-25% of energy), moderate protein (15-
25%) and high carbohydrate (60%) intake together with food combining plan (proteins
and carbohydrates eaten in separate meals).

Guernelli, J., Wainapel, S. F., Pack, S., and Miranda Lama, E. (1999). Morbidly obese patients
with pulmonary disease -- a retrospective study of four cases: a brief report. American Journal of
Physical Medicine and Rehabilitation, 78(1), 60-65.

Morbid obesity is a common chronic condition that predisposes affected individuals to a

decrease in functional status. The purpose of this case series is to highlight the benefit of
institutional rehabilitation for this subgroup of patients. A 6-mo retrospective review of
117 consecutive admissions to the rehabilitation unit of a municipal hospital center was
conducted. A total of four patients (3.4%) met the criteria for morbid obesity. We present
the brief case histories of these four subjects. All showed significant functional
improvement and were able to return home after a mean length of stay of 61 days. They
each required specialized rehabilitation intervention and specialized equipment such as
extra large beds and oversize walkers. All four subjects had obstructive pulmonary
disease, accounting for their initial hospital admission.

Guesry, P. R. (2005). Impact of 'functional food'. Forum Nutrition, (57), 73-83.

'Functional Food' is not a new concept but it became more important recently due to the
collapse of most social health system because 'Functional Foods' allow low cost
prevention of numerous diseases. 'Functional Foods' are different from 'Neutraceuticals'
which remain drug based with poor taste whereas 'Functional Foods' remain good food
 104

which could be consumed for years, but in addition have a disease prophylactic function.
They are becoming particularly important for the prevention of food allergy in 'at risk'
population, obesity, osteoporosis, cardiovascular diseases and particularly high blood
pressure and atherosclerosis, but also for cancer prevention. The newest trend is that
governments and health authorities allow food manufacturers to make health prevention
related claims on mass media.

Guest, T. (2000). Using the Eating Disorder Examination in the assessment of bulimia and
anorexia: issues of reliability and validity. Social Work in Health Care, 31(4), 71-83.

The Eating Disorder Examination will be assessed according to its reliability and validity
in the assessment of anorexia nervosa and bulimia nervosa.

Gunzerath, L., Faden, V., Zakhari, S., and Warren, K. (2004). National Institute on Alcohol
Abuse and Alcoholism Report on Moderate Drinking. Alcoholism: Clinical and Experimental
Research, 28(6), 829-847.

In support of the 2005 update of the U.S. Department of Agriculture/U.S. Department of

Health and Human Services Dietary Guidelines, the National Institute on Alcohol Abuse
and Alcoholism was asked to assess the strength of the evidence related to health risks
and potential benefits of moderate alcohol consumption, with particular focus on the
areas of cardiovascular disease, breast cancer, obesity, birth defects, breastfeeding, and
aging. The findings were reviewed by external researchers with extensive research
backgrounds on the consequences and benefits of alcohol consumption.

Gutin, B., Barbeau, P., and Yin, Z. (2004). Exercise interventions for prevention of obesity and
related disorders in youths. Quest, 56(1), 120-141.

Already in childhood, (a) high general and visceral fatness and poor cardiovascular (CV)
fitness are linked with dyslipidemia, elevated blood pressure, and insulin resistance; (b)
higher fatness is associated with low amounts of vigorous physical activity (PA) and
relatively low energy intake; (c) higher CV fitness is more clearly associated with
vigorous PA than with moderate PA; (d) higher levels of PA are associated with higher
bone density only in youths with relatively high calcium intakes. Physical training in
youths has favorable effects on total body and visceral adiposity, bone density, CV
fitness, and some risk factors for CV disease and type 2 diabetes. Thus, vigorous PA
during childhood may help to prevent some major "adult" health problems.

Hahn, R. A., Heath, G. W., and Chang, M. (1998). Cardiovascular disease risk factors and
preventive practices among adults -- United States, 1994: a behavioral risk factor atlas.
(MMWR-MORB-MORTAL-WKLY-REP) 1998 Dec 11; 47(SS-5): 35-48 (50 ref).

Cardiovascular disease (CVD), including coronary heart disease (CHD) and stroke, is the
leading cause of death in the United States, and state rates of CVD vary by state and by
region of the country. Several behavioral risk factors (i.e., overweight, physical
inactivity, smoking, hypertension, and diabetes mellitus) and preventive practices (i.e.,
 105

weight loss and smoking cessation) are associated with the development of CVD and also
vary geographically.

Hainer, V., and Kunesova, M. (2002). Obesity management approaches in Europe. International
Journal of Obesity, 26(1).

The EASO Obesity Management Task Force conducted a survey on obesity management
in Europe. Responses were obtained from the national obesity associations. None of the
responders declared the quality of care of obese patients provided by GPs as appropriate.
The main reasons of the unsatisfactory situation in primary care: discouraging results of
the treatment, time consuming care and a bad knowledge about obesity.

Haire Joshu, D., and Nanney, M. S. (2002). Prevention of overweight and obesity in children:
Influences on the food environment. Diabetes Educator, 28(3), 415-423.

There is an epidemic of pediatric overweight and obesity leading to type 2 diabetes in

youth. The purpose of this review is to describe the multiple paths of influence on the
food environment of youth and to identify diabetes education strategies focused on early
prevention of overweight and obesity.

Hall, A. (2001). Chiropractic influence on childhood obesity. Topics in Clinical Chiropractic,

8(4), 67-69.

The purpose of this paper is to provide resources and practical recommendations for
parents who have overweight or obese children. Method: This article is based on a
qualitative review of relevant clinical literature and government Web sites. One of the
goals of Healthy People 2010 is to reduce child and adolescent obesity from 11 % to 5%
by the year 20 t0. As chiropractors who promote preventive care and optimal health,
recommendations for reducing overweight through diet and exercise can be an integral
part of patient care.

Halsted, C. H. (1999). The relevance of clinical nutrition education and role models to the
practice of medicine. Eur J Clin Nutr, 53 Suppl 2, S29-34.

Clinical nutrition is concerned with the diagnosis and treatment of diseases that affect the
intake, absorption, and metabolism of dietary constituents and with the promotion of
health through the prevention of diet related diseases. Adult diseases of clinical nutrition
encompass the most common causes of mortality in the developed world and include
obesity with its co-morbidities of hypertension, diabetes, dyslipidemias, increased risks
of cardiovascular disease, some cancers, and pulmonary failure; intestinal disorders
related to inadequate nutrient absorption; eating disorders; and malnutrition associated
with chronic illness and surgical trauma.

Hambleton, H. (2004). Fit 4 Fun. Community Practitioner, 77(10), 367-368.

 106

Healthy snacks, energy balance, the benefits of fruit and vegetables - HELEN
HAMBLETON, school nurse manager Hertfordshire Partnership NHS Trust describes an
innovative partnership approach to tackling obesity in school-age children

Hamilton, M. (2002). Strategies for the management of patients with obesity. Treatments in
Endocrinology, 1(1), 21-37.

The prevalence of overweight and obesity is increasing worldwide. During the last two
decades, the prevalence of adults in the higher body mass index (BMI) categories in the
US has increased the most, as much as 300 for those with a BMI above 40kg/m. In
children and adolescents, a doubling of the prevalence of severe overweight poses a
serious health risk to future generations of young adults who may develop chronic
diseases normally associated with aging. The simple definition of obesity, an imbalance
between energy intake and energy expenditure, ignores the complexity of, and largely
unknown interactions between, genes, food intake and physical activity, which together
determine bodyweight and fat distribution.

Han, S. (2000). Research on ultrasonic cardiogram of simple obesity children and serum
estradiol --Discussion on new ways to lose weight by exercise training. Journal of Beijing
University of Physical Education, 23(2), 177-180.

Exercise training was carried out in the obesity children for 3 months. During this period
their diet composition was controlled and their life habit was rectified. The
cardiorespiratory function, the skinfold thickness and the estradiol contents of the obesity
children were determined before and after training, respectively. These indexes were
compared with those of the normal children. At the same time, a simple but useful way to
lose weight by exercise training was explored. The results showed that the new way to
lose weight by exercise training, that is aerobic exercises + mental training + flexibility
training, was of remarkable effect on the prevention from children obesity.

Hansen, K., Shriver, T., and Schoeller, D. (2005). The effects of exercise on the storage and
oxidation of dietary fat. Sports Medicine, 35(5), 363-73.

Obesity has become a worldwide problem of pandemic proportions. By definition,

obesity is the accumulation of excess body fat and it represents the long-term results of
positive energy and fat balance. The failures in the regulatory mechanisms leading to the
development of obesity are still not well understood, but there is growing evidence that
exercise is an important element in obesity prevention. Exercise promotes energy/fat
balance while providing beneficial alterations to obesity/overweight-related
comorbidities and mortality. Also, exercise, in large part, influences whether the fate of
dietary fat is storage or oxidation. Many factors including intensity, duration and type
(aerobic vs anaerobic) of exercise, energy expended during exercise and individual
fitness level impact the amounts of fat oxidised at any given time. Evidence suggests that
moderate-intensity exercise yields the most cumulative (during and post-exercise) fat
grams used for substrate in the average individual. All intensities of exercise, however,
promote fat oxidation during the post-exercise period. We suggest that it is the effects of
 107

exercise on 24-hour fat balance that are most important in understanding the role of
exercise in the prevention of fat accumulation and obesity.

Hansen, M. J., Schioth, H. B., and Morris, M. J. (2005). Feeding responses to a melanocortin
agonist and antagonist in obesity induced by a palatable high-fat diet. Brain Research, 1039(1-2),
137-145.

Hypothulamic melanocortins arc critical for the control of food intake, and alterations in
POMC mRNA have been described in genetic models of obesity. However, the time
course of changes in brain transmitters over the development of dietary obesity is less
clear. Therefore, we examined the effect of diet-induced obesity on hypothalamic alpha -
MSH content and feeding responsiveness lo synthetic melanocortins. Mule Sprague-
Dawley rats fed a high-fat cafeteria diet (30% fat) or chow (5% fat) for 4 or 12 weeks
were implanted with intracercbroventricular cannulae and feeding responses lo the
MC3/4R agonist MTU (0.5 nmol) and the selective MC4R antagonist 11S014 (0.8 nmol)
were determined. MTII had a long-lasting inhibitory effect on food intake.

Hardy, L. R. (2002). Evaluation of federal school meal programs: more than just laws. Journal of
Nursing Law, 8(3), 31-38.

Good nutrition is essential to helping children learn and aids in preventing childhood and
adult disease. Federal legislation provides funding to subsidize state school meal
programs. These laws stipulate that federally funded programs provide a healthy meal
choice for school children. While schools may comply with the letter of the law, children
still have available and make nutritionally poor food choices.

Harnack, L., Himes, J. H., Anliker, J., Clay, T., Gittelsohn, J., Jobe, J. B., Ring, K., Snyder, P.,
Thompson, J., and Weber, J. L. (2004). Intervention-related bias in reporting of food intake by
fifth-grade children participating in an obesity prevention study. American Journal of
Epidemiology, 160(11), 1117-1121.

Data collected as part of Pathways, a school-based trial for the primary prevention of
obesity in American Indian children conducted between 1997 and 2000, were analyzed to
examine possible intervention-related bias in food reporting. The authors hypothesized
that children in the intervention schools may have systematically underreported their
dietary intake relative to children in the control schools. Nutrient intake estimates for
lunch derived from record-assisted 24-hour dietary recalls were compared with intake
estimates from observed lunch intakes.

Harnack, L., Story, M., Rock, B. H., Neumark-Sztainer, D., Jeffery, R., and French, S. (1999).
Nutrition beliefs and weight loss practices of Lakota Indian adults. Journal of Nutrition, 31(1),
10-15.

In-person interviews were conducted with a total of 219 Lakota Indian adults (aged 19-47
years) from 2 reservations in South Dakota, USA [date not given]. Overall, 55.5% of the
sample was overweight. When asked how they perceived their body weight, 6% felt they
 108

were "too thin," 43.4% thought they were "about right," and 50.2% felt they were "too
fat."

Harrison, B. (2004). Nursing considerations in psychotropic medication-induced weight gain.

Clinical Nurse Specialist, 18(2), 80-87.

The purpose of this clinical project is to emphasize the importance of

prevention/treatment of psychotropic medication-induced weight gain. Professionals who
work with patients taking psychotropic medications should provide a weight management
program specifically designed to address the unique needs of the mentally ill patient.

Hart, K. H., Herriot, A., Bishop, J. A., and Truby, H. (2003). Promoting healthy diet and exercise
patterns amongst primary school children: A qualitative investigation of parental perspectives.
Journal of Human Nutrition and Dietetics, 16(2), 89-96.

Parents represent a potentially powerful intermediary in behaviour change strategies

aimed at improving the lifestyle behaviours of young children. However, to fulfil this
role, parents need to have the necessary knowledge and motivation to assimilate dietary
guidelines. This study aimed to assess these psychosocial constructs, and subsequent
parental receptiveness to nutrition education, through investigation of the barriers and
benefits perceived by parents to the provision of a healthy diet and adequate exercise for
their children.

Harvey Berino, J., Pintauro, S., Buzzell, P., DiGiulio, M., Gold, B. C., Moldovan, C., and
Ramirez, E. (2002). Does the Internet facilitate the maintenance of weight loss? International
Journal of Obesity, 26(9), 1254-1260.

The purpose of this study was to investigate the effectiveness of a weight maintenance
programme conducted over the Internet.

Harvey Berino, J., Pintauro, S., Buzzell, P., and Gold, E. C. (2004). Effect of Internet Support on
the Long-Term Maintenance of Weight Loss. Obesity Research, 12(2), 320-329.

To investigate the efficacy of an Internet weight maintenance program. Research

Harvey Berino, J., and Rourke, J. (2003). Obesity prevention in preschool Native-America
children: a pilot study using home visiting. Obesity Research, 11(5), 606-611.

To determine whether maternal participation in an obesity prevention plus parenting

support (OPPS) intervention would reduce the prevalence of obesity in high-risk Native-
American children when compared with a parenting support (PS)-only intervention. A
home-visiting program focused on changing lifestyle behaviors and improving parenting
skills showed promise for obesity prevention in high-risk Native-American children.

Hash, R. B., Munna, R. K., Vogel, R. L., and Bason, J. J. (2003). Does physician weight affect
perception of health advice? Preventive Medicine, 36(1), 41-44.
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Obesity is considered a growing health threat in the United States. Although physicians
have an important role in counseling their patients for obesity prevention and treatment,
physicians themselves are often overweight. There are few data regarding how physician
body weight might affect patient receptiveness to obesity counseling.

Hasler, G., Buysse, D. J., Klaghofer, R., Gamma, A., Ajdacic, V., Eich, D., Rossler, W., and
Angst, J. (2004). The Association Between Short Sleep Duration and Obesity in Young Adults:
A 13-Year Prospective Study. Sleep: Journal of Sleep and Sleep Disorders Research, 27(4), 661-
666.

Obesity has become a major health problem with increasing prevalence. Given the
limited availability of effective treatment of weight problems, the identification of
potentially modifiable risk factors may lead to preventive approaches to obesity. The
objective of this study was to test the hypothesis that short sleep duration is associated
with obesity and weight gain during young adulthood.

Hassink, S. (2003). Problems in childhood obesity. Primary Care: Clinics in Office Practice,
30(2), 357-374.

Clearly, obesity prevention should be at the forefront of our approach to this epidemic
problem and the goal of health care providers, public health officials, community, and
families. The problems of the obese child are no longer solely those of increased risk for
disease, but of disease itself. Health care providers are increasingly challenged to provide
evaluation and treatment for the serious comorbidities and complications of obesity in
childhood. Many of these comorbidities and complications are "invisible" and require
careful and focused history and laboratory evaluation to elicit. Treatment of the
complication and comorbidity should be focused on preventing progression, reversing the
disease process, and, ultimately, achieving control of obesity with family-based lifestyle
changes that will allow the child to maintain a healthy balance between his or her genetic
predisposition and the environment. Copyright (c) 2003 by Elsevier Science (USA)

Hauner, H. (2001). Current pharmacological approaches to the treatment of obesity. International

Journal of Obesity and Related Metabolism Disorders, S102-S106.

Although comprehensive obesity treatment programmes were shown to induce weight

loss and to improve risk factors and comorbidities, the weight reduction is moderate and
most patients will rapidly regain weight. For these reasons, drugs have been developed or
are in development to support and maintain weight loss. At present, two drugs are
available for the adjunct treatment of obesity. Sibutramine is a centrally acting inhibitor
of noradrenaline and serotonine reuptake, thereby decreasing caloric intake and
increasing energy expenditure. Orlistat is a specific lipase inhibitor that impairs fat
absorption, thereby reducing fat uptake. Both drugs have been found to be effective and
safe in a number of clinical studies for up to two years. The current experience with these
drugs raises questions related to the long-term efficacy with particular reference to
cardiovascular end-points. In addition, other current and future pharmacological
 110

principles for weight reduction are discussed. There is no doubt that an evidence-based
rational pharmacological treatment of obesity is still in an early stage.

Hawkes, C., Eckhardt, C., Ruel, M., and Minot, N. (2004). Diet quality, poverty and food policy:
a new research agenda for obesity prevention in developing countries. SCN News, (29), 20-22.

This article discusses the dual burden of malnutrition (undernutrition and obesity) in
developing countries, and the development of food policies to combat this problem. The
importance of the development and promotion of better diets is emphasized.

Hawks, S. R., and Gast, J. (1998). Weight loss management: a path lit darkly. Health Education
and Behavior, 25(3), 371-382.

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.

Hawks, S. R., and Madanat, H. N. (2003). Stemming racial and ethnic disparities in the rising
tide of obesity. American Journal of Health Education, 34(2), 90-96.

At the national level, obesity and obesity-related illnesses are increasing dramatically. As
with many other public health problems, some racial and ethnic populations are
disproportionately affected. This article presents current information on the prevalence
and consequences of obesity for racial and ethnic groups in the United States and
evaluates race/culture-specific causes of obesity for these populations. After analysis of
various interventions that attempt to address this problem, a full-spectrum, three-pronged
model for eliminating racial and ethnic disparities in obesity is presented and discussed. It
is argued that a comprehensive population model, with a balance between downstream,
midstream, and upstream interventions is necessary.

Hawley, J. A., and Houmard, J. A. (2004). Introduction - preventing insulin resistance through
exercise: a cellular approach. Medicine and Science in Sports and Exercise, 36(7), 1187-1190.

Insulin resistance is a progressive metabolic disorder associated with inactivity, ageing,

genetic predisposition and environmental factors, and is a hallmark feature of a variety of
disease states including obesity, dyslipidemia, hypertension, polycystic ovarian
syndrome, arteriosclerosis and noninsulin dependent (Type 2) diabetes mellitus. The
primary defect in the development of whole body insulin resistance remains unclear.
However, during the past decade major advances have been made in our understanding of
the molecular and cellular mechanisms regulating the entry of glucose into insulin-
sensitive tissues. Such an understanding is critical in the identification of specific
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glucoregulatory biochemical/molecular sites that can be targeted by treatment strategies

(i.e. exercise training) in the prevention and treatment of insulin resistance.

Hayamizu, K., Ishii, Y., Kaneko, I., Shen, M., Okuhara, Y., Shigematsu, N., Tomi, H., Furuse,
M., Yoshino, G., and Shimasaki, H. (2003). Effects of Garcinia cambogia (Hydroxycitric Acid)
on Visceral Fat Accumulation: A Double-Blind, Randomized, Placebo-Controlled Trial. Current
Therapeutic Research, 64(8), 551-567.

The primary end point of this study was the effects of 12 weeks of G. cambogia extract
administration on visceral fat accumulation. This study was performed according to a
double-blind, randomized, placebo-controlled, parallel-group design.

Hayes, J. T., Boucher, J. L., Pronk, N. P., Gehling, E., Spencer, M., and Waslaski, J. (2001). The
role of the certified diabetes educator in telephone counseling. including commentary by
Chalmers K. Diabetes Educator, 27(3), 377-386.

This paper describes a telephone-based, outcomes-focused approach to diabetes

education provided by certified diabetes educators (CDEs).

Hayman, L. L., Meininger, J. C., Coates, P. M., and Gallagher, P. R. (1995). Nongenetic
influences of obesity on risk factors for cardiovascular disease during two phases of
development. Nursing Research, 44(5), 277-283.

Matched-pair analyses of twins were used to examine nongenetic influences of obesity on

the lipid profile and systolic and diastolic blood pressure (cross-sectionally) during two
phases of development -- the school-age years (n = 73 twin pairs) and adolescence (n =
56 twin pairs) and -- (longitudinally) in the transition between these two developmental
phases. Data were collected during an early morning home visit. Results of the matched-
pair t tests indicated significant environmental influences on obesity in both phases and in
the transition (change in obesity) between these two phases. Intraindividual associations
of obesity (kg/m3) and atherogenic lipids (total and LDL cholesterol) emerged during the
school-age years. In adolescence, obesity was associated with HDL cholesterol and total
triglyceride. Change in obesity (kg/m3) from the school-age years to adolescence was
associated with total triglyceride.

Hayne, C. L., Moran, P. A., and Ford, M. M. (2004). Regulating environments to reduce obesity.
Journal of Public Health Policy, 25(3-4), 391-407.

The marked increase in the prevalence of obesity appears to be attributable to

environmental conditions that implicitly discourage physical activity while explicitly
encouraging the consumption of greater quantities of energy-dense, low-nutrient foods. In
the United States food environment, consumers are bombarded with advertising for
unhealthy food, and receive inadequate nutritional information, especially at restaurants.
In the US school environment children have access to sugary sodas and unhealthy a la
carte foods in their cafeterias, at the same time getting inadequate physical activity and
nutrition education. In the built environment, sprawl has reduced active living. We
 112

describe these environments and explore the potential effects of regulatory measures on
these environments. In the United States, regulatory opportunities exist at the national,
state and local levels to mandate action and to allocate funds for promising health-
promoting strategies.

He, Y., Bai, W., Yao, Y., and Cong, B. (1998). Effects of long-term exercise on the
intrabdominal visceral fat accumulation and the obesity gene expression. Sports Science, 18(4),
69-72.

Some metabolic disorders induced by abdominal obesity have become the major risk
factors for cardiovascular disease (CVD), and the prevention and cure of CVD by
reducing body weight and fat has become one of the important tasks in medical and
exercise physiological science. Practical studies reported that leptin, the product of the
obesity gene, could reduce body weight and fat. The purpose of this study was to
investigate the effects of long-term swimming exercise on the intrabdominal visceral fat
accumulation and on obesity mRNA expression level in white fat pads and to make a
primary study on the molecularbiological mechanism of body fat loss by exercise.
Results showed that reduction of intrabdominal viseral fat accumulation by exercise was
highly related to the high level of obesity mRNA after long-term swimming exercise.

Heber, D. (2003). Herbal preparations for obesity: are they useful? Primary Care: Clinics in
Office Practice, 30(2), 441-463.

The opportunities for additional research in this area are plentiful. Unfortunately, there
has been relatively limited funding for research on herbal supplements compared with the
amount of funding that is available for research on pharmaceuticals. Botanical dietary
supplements often contain complex mixtures of phytochemicals that have additive or
synergistic interactions. For example, the tea catechins include a group of related
compounds with effects that are demonstrable beyond those that are seen with
epigallocatechin gallate, the most potent catechin.

Heber, D., and Bowerman, S. (2001). Practical obesity management for primary care physicians.
Family Practice Recertification, 23(1), 23-26, 31-32, 34.

About half of all patients seen in primary care settings are overweight or obese. Many
physicians are reluctant to address this problem, citing lack of time and resources. Studies
have shown that even brief education and counseling on risk reduction from primary care
physicians can be effective. Management begins by assessing the degree of obesity and
determining the individual's readiness to change. Diet, exercise, and other lifestyle
modifications are the mainstays of treatment.

Helitzer, D., Yoon, S., Wallerstein, N., and Garcia Velarde, L. D. (2000). The role of process
evaluation in the training of facilitators for an adolescent health education program. Journal of
School Health, 70(4), 141-147.
 113

This article reports on the process evaluation of the training of facilitators for the
Adolescent Social Action Program, a health education program in Albuquerque, New
Mexico that trained college students and adult volunteers to work with middle school
students. From the process evaluation data collected throughout a four-year period (1995-
1998), data relevant to training are described: facilitator characteristics, facilitator
training, curriculum implementation, and use of the program's model designed to promote
critical thinking and dialogue.

Henry, L. L. (2005). Childhood obesity: what can be done to help today's youth? Pediatric
Nursing, 31(1), 13-6.

Childhood obesity is at epidemic proportions in the United States today. This epidemic
has created a public health crisis. Although several initiatives are under way to address
childhood obesity, including legislative bills before Congress and a call by the National
Academy of Sciences for society to band together to stop the rise in the rates of childhood
obesity, none of these efforts address what can be done today to help those youth that are
considered morbidly obese and who have failed to find solutions with the standard
medical treatment plan. This article discusses the use of bariatric surgery as a possible
solution, presents a case study to illustrate the impact bariatric surgery can have on youth
who are morbidly obese, and defines the pediatric nurse's role in helping to assure that
youth are included in the current legislative process.

Hesketh, K., Waters, E., Green, J., Salmon, L., and Williams, J. (2005). Healthy eating, activity
and obesity prevention: a qualitative study of parent and child perceptions in Australia. Health
Promotion International, 20(1), 19-26.

Preventative health strategies incorporating the views of target participants have

improved the likelihood of success. This qualitative study aimed to elicit child and parent
views regarding social and environmental barriers to healthy eating, physical activity and
child obesity prevention programmes, acceptable foci, and appropriate modes of delivery.

Heymsfield, S. B., van Mierlo, C. A. J., van der Knaap, H. C. M., Heo, M., and Frier, H. I.
(2003). Weight management using a meal replacement strategy: meta and pooling analysis from
six studies. International Journal of Obesity, 27(5), 537-549.

Although used by millions of overweight and obese consumers, there has not been a
systematic assessment on the safety and effectiveness of a meal replacement strategy for
weight management. The aim of this study was to review, by use of a meta- and pooling
analysis, the existing literature on the safety and effectiveness of a partial meal
replacement (PMR) plan using one or two vitamin/mineral fortified meal replacements as
well as regular foods for long-term weight management.

Hill, J. (2004). Physical activity and obesity. Lancet, 363(9404), 182.

Comments on the article by John Reilly and colleagues (see record 2004-19393-002).
Their article has an important implications for the future weight and health of individuals
 114

within the UK. These researchers conclude that "Modem British children establish a
sedentary lifestyle at an early age". With this revelation, they essentially forecast an
epidemic of obesity in the UK that will probably rival that already underway in the USA.
The increasingly sedentary nature of UK children is not unique and is being seen in most
countries around the world. The modern environment is one in which technological
advances have eliminated many reasons for physical activity.

Hill, J. O., Hauptman, J., Anderson, J. W., Fujioka, K., O'Neil, P. M., Smith, D. K., Zavoral, J.
H., and Aronne, L. J. (1999). Orlistat, a lipase inhibitor, for weight maintenance after
conventional dieting: a 1-y study. American Journal of Clinical Nutrition, 1108-1116.

Long-term maintenance of weight loss remains a therapeutic challenge in obesity

treatment. This multicenter, double-blind, placebo-controlled study was designed to test
the hypothesis that orlistat, a gastrointestinal lipase inhibitor, is significantly more
effective than a placebo in preventing weight regain.

Hill, J. O., and Peters, J. C. (1998). Environmental contributions to the obesity epidemic.
Science, 280(5368), 1371-1374.

Discusses environmental factors that promote overeating, including food availability and
portion size, high fat diets, and the energy density of diets. The debate over dietary fat
and obesity is discussed, and specific environmental factors (technology, transportation,
TV, electronic games, computers, sedentary lifestyles, cutbacks in physical education)
that promote physical inactivity are considered.

Hill, K. M. (2003). Update: the pathogenesis and treatment of PCOS. polycystic ovary
syndrome. Nurse Practitioner: American Journal of Primary Health Care, 28(7), 8, 11-13, 16-17.

Irregular menstrual cycles, acne, and hirsutism often cause women to present to a primary
care setting. This article demonstrates how to take a careful history, perform a physical
examination, and order the laboratory tests necessary to diagnose polycystic ovary
syndrome (PCOS). Managing PCOS complaints and maintaining important health issues
are also addressed, as well as when to refer to a specialist.

Hill, M., Calvin, R. L., Bangura, T., Moore, A. N., Maston, K., Azoro, C., Brown, B., and Boyd,
C. (2001). The effects of socioeconomic status and increased body mass index on cardiovascular
disease in African-American women. Journal of National Black Nurses' Association, 12(2), 53-
58.

Today within the United States, CVD is the leading cause of death in women with the
highest mortality being seen in African-American women. A review of literature revealed
that over the last decade, within the United States, there has been an overall reduction in
the death rate due to CVD. However, the rate of decline has been less for women than for
men and less for African-American women than for White women. Findings from some
studies indicate that African-American women have increased risk factors as compared to
other ethnic groups for CVD based upon conditions and behaviors affecting lifestyle.
 115

Fortunately, most of the CVD risk factors are modifiable and their occurrence can be
widely prevented. Therefore, it is imperative that health care providers approach the issue
of risk factors for CVD in African-American women as a heart disease epidemic. This
approach is necessary if the United States is going to improve the health of all
Americans, eliminate disparities, and improve the quality of life.

Himes, J. H., Ring, K., Gittelsohn, J., Cunningham, S. L., Weber, J., Thompson, J., Harnack, L.,
and Suchindran, C. (2003). Impact of the Pathways intervention on dietary intakes of American
Indian schoolchildren. Preventive Medicine, 37(6 Part 2), S55-S61.

The Pathways study was a randomized, 3-year trial of obesity prevention in American
Indian Children. An important goal of the Pathways intervention was to significantly
decrease the percentage of calories eaten as fat by the intervention children, relative to
controls. This paper reports the effects of the Pathways intervention on dietary intake.

Himmelgreen, D. A., Perez, E. R., Martinez, D., Bretnall, A., Eells, B., Peng, Y., and Bernudez,
A. (2004). The longer you stay, the bigger you get: Length of time and language use in the U.S.
are associated with obesity in Puerto Rican women. American Journal of Physical Anthropology,
125(1), 90-96.

This cross-sectional study examined whether length of time in the U.S., language use,
and birthplace (proxy measures of acculturation) were associated with body mass index
(BMI) and obesity in a sample of 174 low-income Puerto Rican women from Hartford,
Connecticut.

Hines, S. E. (2004). Words into action -- promoting successful weight loss in overweight
patients. JAAPA: Journal of the American Academy of Physician Assistants, 17(4), 19-20, 21-
24, 26.

A patient who wants to lose weight is faced with a daunting array of weight-loss options
and conflicting claims. Here's how to sort them all out.

Hohepa, M., Schofield, G., and Kolt, G. (2004). Adolescent obesity and physical inactivity. N Z
Med J, 117(1207), U1210.

Globally, obesity and physical inactivity are two health issues affecting young people. In
New Zealand, the most current statistics indicate that 33.6% of 11 to 14 year olds, and
27% of 15 to 18 year olds, are considered overweight or obese.1,2 Despite these high
prevalence levels, only 38% of young people aged 13 to 17 years in New Zealand are
considered physically inactive.

Holcomb, C. A., Heim, D. L., and Loughin, T. M. (2004). Physical activity minimizes the
association of body fatness with abdominal obesity in white, premenopausal women: results
from the Third National Health and Nutrition Examination Survey. Journal of the American
Dietetic Association, 104(12), 1859-62.
 116

This study explored the association of physical activity with body fatness and abdominal
obesity in 1,004 premenopausal white women who participated in the Third National
Health and Nutrition Examination Survey. Physical activity was classified into four levels
based on fitness criteria from the American College of Sports Medicine.

Holcomb, J. D., Kingery, P. M., Sherman, L. D., Smith, Q. W., Smith, D. W., Cullen, K. W., and
Montgomery, D. H. (1999). Evaluation of a diabetes education program for fifth-grade students.
Journal of health Education, 30(2), 73-84.

Jump Into Action is an instructional program on preventing noninsulin dependent

diabetes mellitus (NIDDM). The primary purpose of Jump Into Action is to help children
develop healthy lifelong habits that decrease the likelihood of obesity and sedentary
lifestyle. An evaluation of Jump Into Action involved a quasi- experimental design with
intervention and control groups including fifth-grade teachers (N=65) and students
(N=1184) in predominately minority elementary schools in metropolitan Houston, TX.

Honea, K. P. (2001). The effects of a 3-hydroxy-3-methylglutaryl coenzyme-A reductase

inhibitor and moderate cardiorespiratory exercise on cholesterol metabolism in obese,
hypercholesterolemic males. Dissertation Abstracts International Part B: Science and
Engineering [Diss. Abst. Int. Pt. B Sci. & Eng.]. Vol., 62(1).

Research indicates that for every 1% reduction in low- density lipoprotein cholesterol
(LDL-C), there is a 1% decrease in mortality. Therefore, the purpose of this double-blind,
placebo-controlled clinical trial was to determine the effects of fluvastatin sub(40mg) and
moderate intensity exercise on cholesterol parameters in obese, hypercholesterolemic
males.

Horowitz, J. F. (2003). Fatty acid mobilization from adipose tissue during exercise. Trends in
Endocrinology and Metabolism, 14(8), 386-392.

By far the largest energy reserve in the human body is adipose tissue triglycerides, and
these reserves are an important source of fuel during prolonged endurance exercise. To
use this rich source of potential energy during exercise, adipose tissue triglycerides must
first be hydrolyzed and the resultant fatty acids delivered to the working muscles. The
aims of this review are to describe how exercise alters lipid mobilization from adipose
tissue, to identify alternative sources of lipids and to discuss some of the key factors
regulating fatty acid mobilization, uptake and oxidation during exercise. The impact of
understanding factors involved in the coordinated regulation of lipid mobilization and
oxidation during exercise goes far beyond its relevance for endurance exercise
performance. A better understanding of the regulation of these processes will facilitate
the development of more effective treatment modalities for obesity-related metabolic
disorders.

Hsieh, C. J., Wang, P. W., Liu, R. T., Tung, S. C., Chien, W. Y., Chen, J. F., Chen, C. H., Kuo,
M. C., and Hu, Y. H. (2005). Orlistat for obesity: benefits beyond weight loss. Diabetes Res Clin
Pract, 67(1), 78-83.
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Orlistat lowers lipids and improves insulin sensitivity, but its effect on other metabolic
syndrome related parameters is not known. To assess its influence on adiponectin, high
sensitive C-reactive protein (hs-CRP) and other metabolic syndrome related parameters,
this study enrolled 106 participants in a weight-reduction program and categorized them
into a group of 51 who had been treated with orlistat 360 mg/day for one year and a
group of 55 age and sex and body mass index (BMI) matched controls.

Hu, F. B. (2003). Overweight and obesity in women: health risks and consequences. Journal of
Women's Health, 12(2), 163-172.

The evidence for the adverse effects of obesity on women's health is overwhelming and
indisputable. Obesity, especially abdominal obesity, is central to the metabolic syndrome
and is strongly related to polycystic ovary syndrome (PCOS) in women. Obese women
are particularly susceptible to diabetes, and diabetes, in turn, puts women at dramatically
increased risk of cardiovascular disease (CVD). Obesity substantially increases the risk of
several major cancers in women, especially postmenopausal breast cancer and
endometrial cancer. Overweight and obesity are associated with elevated mortality from
all causes in both men and women, and the risk of death rises with increasing weight.

Hu, G., Tuomilehto, J., Silventoinen, K., Barengo, N., and Jousilahti, P. (2004). Joint effects of
physical activity, body mass index, waist circumference and waist-to-hip ratio with the risk of
cardiovascular disease among middle-aged Finnish men and women. Eur Heart J, 25(24), 2212-
9.

To assess joint associations of physical activity and different indicators of obesity (body
mass index, waist circumference, and waist-to-hip ratio) with the risk of cardiovascular
disease (CVD).

Huang, T. T. K., Harris, K. J., Lee, R. E., Nazir, N., Born, W., and Kaur, H. (2003). Assessing
Overweight, Obesity, Diet, and Physical Activity in College Students. Journal of American
College Health, 52(2), 83-86.

The authors surveyed 738 college students aged 18 to 27 years to assess overweight,
obesity, dietary habits, and physical activity. They used BMI (body mass index) >= 25
kg/msuperscript 2 or BMI >= 85th percentile and BMI >= 30 kg/msuperscript 2 or BMI
>= 95th percentile to estimate overweight and obesity in those aged <= 19 years.

Hukshorn, C. J., Westerterp-Plantenga, M. S., and Saris, W. H. M. (2003). Pegylated human

recombinant leptin (PEG-OB) causes additional weight loss in severely energy-restricted,
overweight men. American Journal of Clinical Nutrition, 77(4), 771-776.

Increasing evidence suggests that falling leptin concentrations observed during fasting act
as a peripheral signal of starvation, which serves to conserve energy in the face of limited
reserves. An extension of this hypothesis is that exogenous leptin should affect energy
regulation during severe energy restriction.
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Humphreys, J., Martin, H., Roberts, B., and Ferretti, C. (2004). Strengthening an academic
nursing center through partnership. Nursing Outlook, 52(4), 197-202.

Nurse-managed health centers offer holistic health care and patient-centered health
promotion and disease prevention. These goals are particularly well suited to the needs of
children and their families. Few reports in the literature, however, have described such
practices. The purpose of this paper is to describe one practice, Valencia Health Services
(VHS), a nurse-managed, academic health center providing primary care to pediatric and
adolescent patients.

Humphries, M. C., Gutin, B., Barbeau, P., Vemulapalli, S., Allison, J., and Owens, S. (2002).
Relations of adiposity and effects of training on the left ventricle in obese youths. Medicine and
Science in Sports and Exercise, 34(9), 1428-1435.

The purpose of this study is: 1) To determine the relations of left ventricular (LV)
structure and function to total body composition, visceral adipose tissue (VAT), and
hemodynamics in obese children; 2) to determine the effects of 4-month of physical
training (PT) on LV structure and function and hemodynamics; and 3) to explore
determinants of individual variability in response to PT. Measurements included LV
structure/function with echocardiography, total body composition with dual-energy x-ray
absorptiometry, VAT with magnetic resonance imaging (MRI), and resting and
exercising hemodynamics with a Dinamap monitor and Doppler-echocardiography.
Youths were randomly assigned to engage in PT for the first or second 4-month periods
of the 8-month intervention period. Correlation and regression at baseline showed that
elevated LV mass was associated with excess general and visceral adiposity, and elevated
cardiac output.

Hunt, B. P., Bogle, V., Gillentine, A., and Daughtrey, C. (2001). Weight Loss 101: A Healthy
Weight Loss program for college students. American Journal of Health Studies, 17(1).

Obesity and overweight are complex conditions that contribute to many chronic diseases.
Treatment should include a dietary regimen, physical activity, and behavior therapy. This
manuscript describes Weight Loss 101: A Healthy Approach to Weight Loss, a college
student health center based program that is designed to facilitate college students exerting
self-control over their nutritional habits as part of a healthy weight loss process. The
nutrition education covers such issues as a personal diet plan, portion control, and label
reading. Self-monitoring, stimulus control, and problem solving skills are behavior
change techniques included in Weight Loss 101. A step-by-step program model is
provided.

Hurst, S., Blanco, K., Boyle, D., Douglass, L., and Wikas, A. (2004). Bariatric implications of
critical care nursing. Dimensions of Critical Care Nursing, 23(2), 76-83.

The delivery of optimum nursing care to morbidly obese patients in critical care presents
unique challenges in critical thinking, planning, and teamwork. The purpose of this
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article is to review the special needs of this patient population and to provide a template
to guide proactive nursing care planning in critical care settings.

Igarashi, K., Fujita, K., Yamase, T., Morita, N., Okita, K., Satake, K., Kanazawa, N., and
Nishijima, H. (2004). Sapporo Fitness Club Trial (SFCT)--design, recruitment and
implementation of a randomized controlled trial to test the efficacy of exercise at a fitness club
for the reduction of cardiovascular risk factor. Circ J, 68(12), 1199-204.

The annual health check followed by lifestyle recommendations has long been the
standard national strategy to improve cardiovascular disease (CVD) risk factors in Japan.
Exercise at fitness clubs, now widely accessible in major cities, has a novel appeal as a
strategy with the additive effect of CVD risk reduction. The Sapporo Fitness Club Trial
(SFCT) is a randomized controlled trial to compare the efficacy of the national standard
alone (control) with the standard plus exercise at a fitness club (intervention) for the
reduction of CVD risk factors.

Illuzzi, S., and Cinelli, B. (2000). A coordinated school health program approach to adolescent
obesity. Journal of School Nursing, 16(1), 12-19.

Obesity has become one of this country's most significant nutritional diseases. The
prevalence of childhood and adolescent obesity has steadily increased over the past 20
years. The risk of developing health problems increases as the obese child becomes an
obese adolescent and adult. The 1997 Youth Risk Behavior Survey reports adolescents
participate in behaviors that put them at risk for obesity. The recognition of these
unhealthy behaviors among our youth has led to the need for early intervention. The
Coodinated School Health Program is a mechanism to address adolescent obesity at the
school-age level. This program includes an organized set of policies, procedures, and
activities intended to protect and promote the health and well-being of students and staff.
The eight components of a Coordinated School Health Program (CSHP) include school
health services, a healthy school environment, comprehensive school health education,
counseling and guidance, physical education, food service, worksite health promotion,
and the integration of school and community. This paper describes integration of
prevention and treatment strategies for adolescent obesity for each of the eight
components of a CSHP.

Irving, L. M. (2000). Promoting size acceptance in elementary school children: The EDAP
puppet program. Eating Disorders: The Journal of Treatment and Prevention, 8(3), 221-232.

A puppet program for elementary school children was implemented through early
childhood education to promote size acceptance and prevent eating disorders and related
problems. School children (N = 152) completed an evaluation of the program and 45 fifth
grade girls completed the Figure Rating Scale either before or after the program. To
students, the program's most important message was "not to tease others" and "to be a
good friend." Figure Rating Scale data suggest that the program reduces negative
stereotypes about large body shapes. This preliminary report suggests that the puppet
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program achieves its goal of promoting greater acceptance of diverse body shapes by
discouraging teasing and encouraging students to treat everybody well.

Irwin, M. L., Yasui, Y., Ulrich, C. M., Bowen, D., Rudolph, R. E., Schwartz, R. S., Yukawa, M.,
Aiello, E., Potter, J. D., and McTiernan, A. (2003). Effect of exercise on total and intra-
abdominal body fat in postmenopausal women: A randomized controlled trial. JAMA: Journal of
the American Medical Association, 289(3), 323-330.

Examined the effects of exercise on total and intra-abdominal body fat overall and by
level of exercise in postmenopausal women. 173 sedentary, overweight, postmenopausal
women (aged 50 to 75 yrs) participated in this study.

Ishigaki, Y., Katagiri, H., Yamada, T., Ogihara, T., Imai, J., Uno, K., Hasegawa, Y., Gao, J.,
Ishihara, H., Shimosegawa, T., Sakoda, H., Asano, T., and Oka, Y. (2005). Dissipating excess
energy stored in the liver is a potential treatment strategy for diabetes associated with obesity.
Diabetes, 54, 322-32.

Examined whether dissipating excess energy in the liver is a possible therapeutic

approach to high-fat diet-induced metabolic disorders, uncoupling protein-1 (UCP1) was
expressed in murine liver using adenoviral vectors in mice with high-fat diet-induced
diabetes and obesity, and in standard diet-fed lean mice. Once diabetes with obesity
developed, hepatic UCP1 expression increased energy expenditure, decreased body
weight, and reduced fat in the liver and adipose tissues, resulting in markedly improved
insulin resistance and, thus, diabetes and dyslipidemia.

Isnard, P., Michel, G., Frelut, M. L., Vila, G., Falissard, B., Naja, W., Navarro, J., and Mouren,
S. M. C. (2003). Binge eating and psychopathology in severely obese adolescents. International
Journal of Eating Disorders, 34(2), 235-243.

The authors describe binge eating and psychopathology in severely obese adolescents
who are seeking treatment for obesity and search for specific psychological features that
may be associated with binge eating.

Jago, R., and Baranowski, T. (2004). Non-curricular approaches for increasing physical activity
in youth: a review. Preventive Medicine, 39(1), 157-163.

To prevent obesity, the physical activity of youth should be increased. Since time for
school physical education has declined and curricular interventions have had limited
effects, alternative non-curriculum approaches need to be tested.

Jakicic, J. M., Clark, K., Coleman, E., Donnelly, J. E., Foreyt, J., Melanson, E., Volek, J., and
Volpe, S. L. (2001). American College of Sports Medicine position stand: appropriate
intervention strategies for weight loss and prevention of weight regain for adults. Medicine and
Science in Sports and Exercise, 33(12), 2145-2156.
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In excess of 55% of adults in the United States are classified as either overweight (body
mass index = 25-29.9 kg x m(-2)) or obese (body mass index > or = 30 kg x m(-2)). To
address this significant public health problem, the American College of Sports Medicine
recommends that the combination of reductions in energy intake and increases in energy
expenditure, through structured exercise and other forms of physical activity, be a
component of weight loss intervention programs.

Jakicic, J. M., Clark, K., Coleman, E., Donnelly, J. E., Foreyt, J., Melanson, E., Volek, J., and
Volpe, S. L. (2001). Appropriate intervention strategies for weight loss and prevention of weight
regain for adults. Medicine and Science in Sports and Exercise, 33(12), 2145-2156.

In excess of 55 % of adults in the United States are classified as either overweight (body
mass index = 25-29.9 kgDTm-2) or obese (body mass index greater than or equal to 30
kgDTm-2). To address this significant public health problem, the American College of
Sports Medicine recommends that the combination of reductions in energy intake and
increases in energy expenditure, through structured exercise and other forms of physical
activity, be a component of weight loss intervention programs. An energy deficit of 500-
1000 kcalDTd-1 achieved through reductions in total energy intake is recommended.

James, K. S. (2000). A school based intervention to reduce television use decreased adiposity in
children in grades 3 and 4. Evidence Based Nursing, 3(2), 43.

Can a school based intervention aimed at reducing television and videotape viewing and
use of video games decrease adiposity in children in grades 3 and 4?

James, L. C., Folen, R. A., Garland, F. N., Edwards, C., Noce, M., Gohdes, D., Williams, D.,
Bowles, S., Kellar, M. A., and Supplee, E. (1997). The Tripler Army Medical Center LEAN
Program: A healthy lifestyle model for the treatment of obesity. Military Medicine, 162(5), 328-
332.

Provides an overview of the Tripler Army Medical Center LEAN Program, a

multidisciplinary prevention program for overweight active duty service members. The
philosophy behind the program, its major components and preliminary results are
discussed. The LEAN progam is a 3-wk intensive inpatient weight-loss program coupled
with a 1-yr outpatient follow-up, which emphasizes healthy lifestyles, exercise and
emotions, attitudes, and nutrition. The program utilizes a team of 6 psychologists to assist
patients in evaluating the relationships among food, their social environment, body
image, and emotions. Teaching patients self-management techniques and cognitive
coping strategies provides a common link for group and individual therapeutic
interventions. Spouse and family member participation is encouraged in group activities
to provide support for the patients, identify unhealthy family eating behaviors, and reduce
subtle or unconscious sabotage. Re-evaluation at 6-mo intervals for an additional year
and 5-yr follow-up are planned.

James, L. C., Folen, R. A., Page, H., Noce, M., Brown, J., and Britton, C. (1999). The Tripler
LE3AN Program: A two-year follow-up report. Military Medicine, 164(6), 389-395.
 122

This paper provides a review of 2-yr follow-up data on the Tripler Army Medical Center
LEsuperscript 3AN Program for the treatment of obesity in active duty soldiers and
sailors. The LEsuperscript 3AN Program (emphasizing healthy Lifestyles, reasonable
Exercise, realistic Expectations, Emotions, and Attitudes, and Nutrition) provides active
duty service members a treatment strategy that involves a reasonable low-intensity
exercise regimen, behavior modification, intensive nutritional counseling, healthy meal
planing, relapse prevention strategies, cognitive coping strategies, and healthy lifestyle
principals to lose weight and maintain weight loss.

James, S. A. (1999). Primordial prevention of cardiovascular disease among African-Americans:

A social epidemiological perspective. Preventive Medicine, 29(6, Part 2 of 2), S84-S89.

Data from recent national health surveys on Black/White differences in major CVD risk
factors like hypertension, obesity, cholesterol, cigarette smoking, and physical inactivity
were reviewed for the purpose of identifying promising avenues for primordial
prevention research among African-Americans. Cigarette smoking has a delayed onset
among African-Americans compared to Whites. Black/white differences in "vigorous"
leisure-time physical activity (e.g., social dancing and team sports) are not apparent until
around age 40. These findings have relevance for primordial prevention work in Black
communities since they suggest the existence of broad-based, health-relevant cultural
norms which could support primordial prevention programs, such as regular physical
activity, across the life cycle.

Jamison, J. R. (1997). Childhood: a crucial age for health promotion. Topics in Clinical
Chiropractic, 4(4), 19-24, 83-85.

Three areas of behavioral choice in childhood are discussed: social drug use, dietary
habits, and sexual conduct. All may have an impact on later health status. The overall
health impact chiropractors have in caring for children can be enhanced through
awareness and incorporation of health promotion activities.

Janssen, I., Heymsfield, S. B., and Ross, R. (2002). Application of simple anthropometry in the
assessment of health risk: implications for the Canadian Physical Activity, Fitness and Lifestyle
Appraisal. Canadian Journal of Applied Physiology, 27(4), 396-414.

Incremental improvements in our knowledge of the associations between human body

composition and disease have been facilitated by advances in research technology.
Magnetic resonance imaging and computerized tomography are among the technological
advances that have helped unravel the mechanisms that link body composition and
disease. However, because the use of these methods in large-scale studies and field
settings is impractical, the potential relationships between body composition and health
risk rely on the use of anthropometric tools.
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Janz, K. F., Levy, S. M., Burns, T. L., Torner, J. C., Willing, M. C., and Warren, J. J. (2002).
Fatness, Physical Activity, and Television Viewing in Children during the Adiposity Rebound
Period: The Iowa Bone Development Study. Preventive Medicine, 35(6), 563-571.

Understanding the determinants of adiposity in young children may be particularly

critical for preventing adult obesity since the age at which body fatness reaches a
postinfancy low point (typically 4-6 years) is inversely associated with obesity later in
life. We examined cross-sectional associations among fatness, leanness, and physical
activity in 467 children (range 4-6 years). Activity was measured using accelerometry
and parental report of children's TV viewing.

Jayasinghe, S. R. (2004). Yoga in cardiac health. Eur J Cardiovasc Prev Rehabil, 11(5), 369-75.

This review studies the efficacy of yoga in the primary and secondary prevention of
ischaemic heart disease and post-myocardial infarction patient rehabilitation. Yoga is an
unconventional form of physical exercise that has been practised over a long period of
time in the Indian sub-continent. It has gained immense popularity as a form of
recreational activity all over the world. Its possible contributions to healthy living have
been studied and many interesting revelations have been made. Benefits of yoga in the
modification of cardiovascular risk factors and in the rehabilitation of the post-
myocardial infarction patient are areas of significant importance. It is important to assess
the practical significance and the suitability of incorporating yoga into the comprehensive
cardiac rehabilitation programme. Majority of the rehabilitation workers believes that
incorporating nonconventional forms of physical exercise such as yoga definitely would
enhance efficacy and add value. This article attempts to study the history and the science
of yoga and evaluate its effects on cardiovascular health.

Jebb, S., and Sritharan, N. (2005). The nurse's role in promoting weight loss and encouraging
healthier lifestyles. Professional Nurse, 20(7), 25-7, 29.

The increasing incidence of obesity in the UK has prompted a range of initiatives to raise
awareness of the problem. In view of the well-known links between obesity and chronic
disease, the focus is now on addressing the issue as part of patient care by advising adults
and children on weight management and changes in diet and exercise.

Jebb, S. A., and Goldberg, G. R. (1998). Efficacy of very low-energy diets and meal
replacements in the treatment of obesity. Journal of Human Nutrition and Dietetics, 219-225.

Low-energy diets, ideally in combination with increased energy expenditure through

physical activity, are the mainstay of obesity treatment. Very low-energy liquid diets
(VLEDs) were developed to provide a safe alternative to starvation, with only a modest
attenuation in the rate of weight loss. This paper considers the evidence concerning the
efficacy of both commercial and milk-based total liquid diets, which provide a maximum
of 800 kcal/day.
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Jebb, S. A., and Moore, M. S. (1999). Contribution of a sedentary lifestyle and inactivity to the
etiology of overweight and obesity: current evidence and research issues. Medicine and Science
in Sports and Exercise, 31(11 Suppl), S534-S541.

The etiology of overweight and obesity is clearly multifactorial, but ultimately it is

determined by the long-term balance between energy intake and expenditure. This review
will consider the effects on body weight and the risk of obesity of sedentary lifestyles,
within the context of dietary habits. The data from ecological, cross-sectional, and
prospective studies that have assessed physical activity and dietary intake and their
relationship to body weight were reviewed. Ecological analyses imply that the increase in
the prevalence of obesity is more strongly related to lower levels of physical activity than
higher energy intakes.

Jeffery, R., and Wing, R. (1995). Long-term effects of interventions for weight-loss using food
provision and monetary incentives. Journal of Consulting and Clinical Psychology, 63(5), 793-
797.

One hundred seventy-seven men and women who had participated in an 18-month trial of
behavioral interventions involving food provision and financial incentives were examined
12 months later. Food provision, but not financial incentives, led to better weight loss
than standard behavioral treatment during the 18-month trial, but over 12 additional
months of no-treatment follow-up, all treated groups gained weight, maintained only
slightly better weight losses than a no-treatment control group, and did not differ from
each other. Weight loss success during both active treatment and maintenance was
associated with increase in exercise, decrease in percentage of energy from fat, increase
in nutrition knowledge, and decrease in perceived barriers to adherence. Obesity
treatment research should focus on developing better ways to maintain changes in the diet
and exercise behaviors needed for sustained weight loss.

Jeffery, R. W., and French, S. A. (1996). Socioeconomic status and weight control practices
among 20- to 45-year-old women. American Journal of Public Health, 86(7), 1005-1010.

This study examined the relationship between socioeconomic status (SES) and weight
control practices in women.

Jeffery, R. W., Hellerstedt, W. L., French, S. A., and Baxter, J. E. (1995). A randomized trial of
counseling for fat restriction versus calorie restriction in the treatment of obesity. International
Journal of Obesity, 132-137.

To evaluate the effectiveness of dietary counseling focusing on fat reduction (20 g/day)
compared to calorie reduction (1000 to 1200 kcal/day) in promoting long-term weight
loss in moderately obese women.

Jeffery, R. W., Wing, R. R., Sherwood, N. E., and Tate, D. F. (2003). Physical activity and
weight loss: does prescribing higher physical activity goals improve outcome? American Journal
of Clinical Nutrition, 78(4), 684-689.
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Recommending increased physical activity facilitates long-term weight loss, but the
optimal level of physical activity to recommend is unknown. The objective of the study
was to evaluate the efficacy for long-term weight loss of recommendations for much
higher physical activity than those normally used in behavioral treatments.

Jeffrey, S. (2001). The role of the nurse in obesity management. Journal of Community Nursing,
15(3), 20, 22, 26.

Steven Jeffrey discusses how nurses can help patients/clients to maintain a healthy
weight.

Jelalian, E., Boergers, J., Alday, C. S., and Frank, R. (2003). of physician attitudes and practices
related to pediatric obesity. Clinical Pediatrics, 42(3), 235-245.

The purpose of this study was to survey physicians regarding their attitudes and practices
related to the treatment of pediatric obesity in a primary care setting. Surveys were sent to
physicians who were members of the American Academy of Pediatrics and the American
Academy of Family Physicians practicing in the Southern New England area
(Connecticut, Massachusetts, and Rhode Island). additional training and education
regarding safe and efficacious intervention strategies for pediatric obesity, to effectively
integrate the discussion of weight issues into the primary care setting.

Jelalian, E., and Saelens, B. E. (1999). Empirically supported treatments in pediatric psychology:
pediatric obesity. Journal of Pediatric Psychology, 24(3), 223-249.

To review the efficacy of existing interventions for pediatric obesity with reference to the
Chambless criteria.

Jones, K. S., and Burkett, L. N. (2002). A comparison of instructional methods for weight loss in
women. Health Promotion Practice, 3(4), 501-506.

This study tested effects of three methods for delivering a weight-loss education program
for women. Seventy-four predominantly White participants at least 10 pounds over
healthy weight began the program.

Jordan, J. (2005). Effect of water drinking on sympathetic nervous activity and blood pressure.
Curr Hypertens Rep, 7(1), 17-20.

Recent studies suggest that water drinking elicits acute changes in human physiology.
Water drinking profoundly increases blood pressure in patients with autonomic failure.
Water drinking also increases blood pressure in quadriplegic patients, cardiac transplant
recipients, and older healthy subjects, but to a lesser extent. Blood pressure does not
change in healthy young subjects. More recently, water drinking was shown to increase
energy expenditure.
 126

Kain, J., Uauy, R., Albala, Vio, F., Cerda, R., and Leyton, B. (2004). School-based obesity
prevention in Chilean primary school children: Methodology and evaluation of a controlled
study. International Journal of Obesity, 28(4), 483-493.

To assess the impact of a 6 months nutrition education and physical activity intervention
on primary school children through changes in adiposity and physical fitness.

Kalakanis, L. E., Goldfield, G. S., Paluch, R. A., and Epstein, L. H. (2001). Parental Activity as a
Determinant of Activity Level and Patterns of Activity in Obese Children. Research Quarterly
for Exercise and Sport, 72(3), 202-209.

The purposes of this study were to measure the level and pattern of moderate-to-vigorous
physical activity (MVPA = > 4.5 METs) and examine predictors of activity in obese
children. Fifty-one 8-12-year-old children seeking obesity treatment wore accelerometers
for 3 or 4 days. Children averaged 12.2 bouts of MVPA per day that lasted an average of
4.2 min, while parents engaged in 3.9 bouts of MVPA that lasted 4.2 min. Hierarchical
regression models showed parent activity improved the prediction of obese children's
activity levels and the number of bouts of MVPA but not the duration of MVPA. These
results suggest that programs to increase physical activity in obese children should
structure the activity in short bouts and attempt to increase parental physical activity.

Kamphuis, M. M. J. W., Lejeune, M. P. G. M., Saris, W. H. M., and Westerterp-Plantega, M. S.

(2003). Effect of conjugated linoleic acid supplementation after weight loss on appetite and food
intake in overweight subjects. European Journal of Clinical Nutrition, 57(10), 1268-1275.

To study the effects of 13 weeks conjugated linoleic acid (CLA) supplementation in

overweight subjects on bodyweight maintenance, parameters of appetite and energy
intake (El) at breakfast after weight loss.

Kater, K. J., Rohwer, J., and Londre, K. (2002). Evaluation of an upper elementary school
program to prevent body image, eating, and weight concerns. Journal of School Health, 72(5),
199-204.

Preparing young students to resist the sociocultural pressures that contribute to body
image and eating problems in American culture poses a monumental challenge. This
project determined if the 11-lesson "Healthy Body Image: Teaching Kids to Eat and Love
Their Bodies Too!" curriculum would have a positive effect when presented to upper
elementary school children.

Katz, D. L. (2005). Competing dietary claims for weight loss: finding the forest through truculent
trees. Annu Rev Public Health, 26, 61-88.

In response to an accelerating obesity pandemic, competing weight-loss diets have

propagated; those touting carbohydrate restriction are currently most in vogue. Evidence
that sustainable weight loss is enhanced by means other than caloric restriction, however,
is lacking. Whereas short-term weight loss is consistently achieved by any dietary
 127

approach to the restriction of choice and thereby calories, lasting weight control is not.
Competing dietary claims imply that fundamental knowledge of dietary pattern and
human health is lacking; an extensive literature belies this notion.

Katz, D. L., Chan, W., Gonzalez, M., Larson, D., Nawaz, H., Abdulrahman, M., and Yeh, M. C.
(2002). Technical skills for weight loss: Preliminary data from a randomized trial. Preventive
Medicine, 34(6), 608-615.

Compared the effects of conventional dietary counseling with those of an intervention

emphasizing technical food skills on weight loss among overweight females. 75
overweight females (aged 30-65 yrs) who were the primary purchasers and preparers of
household meals completed either a counseling-based (CBI) or a skill-building
intervention (SBI).

Katz, M. L., Gordon, L. P., Bentley, M. E., Kelsey, K., Shields, K., and Ammerman, A. (2004).
"Does skinny mean healthy?" - Perceived ideal, current, and healthy body sizes among, African-
American girls and their female caregivers. Ethnicity and Disease, 14(4), 533-541.

To qualitatively and quantitatively examine body image ideals and perceived weight-
related health among African-American girls and their female caregivers to inform
intervention development for Girls Rule! an obesity prevention pilot program.

Kaukua, J. K., Pekkarinen, T. A., and Rissanen, A. M. (2004). Health-related quality of life in a
randomised placebo-controlled trial of sibutramine in obese patients with type II diabetes.
International Journal of Obesity, 28(4), 600-605.

We evaluated the effects of 12-month treatment with sibutramine 15 mg daily compared

with placebo on health-related quality of life (HRQL) in obese type II diabetes patients.
We examined the associations between the changes in HRQL and in weight, glycaemic
control, and haemodynamic variables. We also explored the predictive value of HRQL
and its changes early during treatment.

Kaur, H., Hyder, M. L., and Poston, W. S. C., II. (2003). Childhood overweight: an expanding
problem. Treatments in Endocrinology, 2(6), 375-389.

Childhood overweight is a significant and growing health problem in the US and other
parts of the world. Secular trend data in the US suggest that children have become
substantially heavier over the last several decades and that their risk for a number of
health problems is increasing as a result. Defining obesity in children has been difficult as
assessing body fat is expensive and impractical.

Kawachi, I., Troisi, R. J., Rotnitzky, A. G., Coakley, E. H., and Colditz, G. A. (1996). Can
physical activity minimize weight gain in women after smoking cessation? American Journal of
Public Health, 86(7), 999-1004.
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The purpose of this study was to examine prospectively whether exercise can modify
weight gain after smoking cessation in women.

Kazaks, A., and Stern, J. S. (2003). Obesity treatments and controversies. Diabetes Spectrum,
16(4), 231-235.

The ideal model of obesity treatment is a comprehensive intervention including dietary,

activity-related, behavioral, pharmacological, and/or surgical components that is geared
toward individual needs, similar to the ideal treatment for diabetes. The main focus of
any obesity intervention should be on health improvement instead of just body weight
reduction. To resolve the controversies surrounding obesity, we must invest much more
in research into the prevention of obesity and to ascertain those lifestyle or medical
approaches that will make it easier for anyone to maintain a healthful energy balance.

Kazaks, A., and Stern, J. S. (2003). Obesity: food intake. Primary Care: Clinics in Office
Practice, 30(2), 301-316.

This article discusses some of the changes in our food environment that have encouraged
overeating and some research that underlies successful weight loss and maintenance of
weight loss. The discussion of these topics will help in the guidance of patients to
develop personalized eating plans and reduce energy intake, in part by recognizing the
contributions of fat, concentrated carbohydrates, and large portion sizes. Copyright (c)
2003 by Elsevier Science (USA

Keller, C., Fleury, J., Gregor Holt, N., and Thompson, T. (1999). Predictive ability of social
cognitive theory in exercise research: an integrated literature review. Online Journal of
Knowledge Synthesis for Nursing, 6(2).

The mechanisms that underlie successful initiation and adherence to physical activity
regimens are not well understood. Few theoretical models have used consistent
explanatory variables that are theory-driven and many findings that use extant models are
equivocal. Social Cognitive Theory (SCT) as presented by Bandura (1986, 1997) appears
to have strong promise as a guide to understanding physical activity behaviors and
developing clinically relevant interventions to promote the initiation and maintenance of
physical activity. This critical systematic review of research using SCT was completed to
determine the predictive ability of model constructs in explaining physical activity
behavior and in identifying key intervention components found to enhance physical
activity initiation and maintenance.

Keller, C., Fleury, J., and Mujezinovic Womack, M. (2003). Healthy People 2010. Managing
cardiovascular risk reduction in elderly adults. Journal of Gerontological Nursing, 29(6), 18-23.

Primary care practitioners must explore the most effective techniques for promoting
cardiovascular risk reduction in older adults. Managing lifestyle modification risk factors,
such as smoking cessation, obesity, sedentary lifestyle, and nutrition is discussed in this
article. Other risk factor modification efforts, often not highlighted, include managing
 129

homocysteinemia, and sedentary behavior. These factors are presented as equally

important modifiable coronary heart disease risks.

Keller, C., and Stevens, K. R. (1996). Assessment, etiology, and intervention in obesity in
children. Nurse Practitioner: American Journal of Primary Health Care, 21(9), 31-32, 34-36, 38.

Obesity is a common nutritional disturbance of children and affects 25% to 30% of

children and adolescents. This paper examines obesity in childhood, the measurement of
obesity in children, and the relationship of obesity to coronary heart disease risks and
discusses weight reduction issues in children. Clinically useful definitions of obesity in
children have not been established, although the body mass index, together with
anthropometric measurements, may provide the practitioner with useful assessment
parameters. Discussions of weight In children must acknowledge the nutritional
requirements of the normally occurring growth process.

Keller, C. S., and Allan, J. D. (2001). Evaluation of selected behavior change theoretical models
used in weight management interventions. Online Journal of Knowledge Synthesis for Nursing,
8(5).

This paper evaluates selected behavior change theoretical models used in weight
reduction interventions and presents recommendations for the use of theory in weight
reduction research. Overweight and obesity are complex problems, requiring long-term
behavioral change. Behavioral treatments for overweight and obesity are as varied as the
elements of behavior, and the long-term efficacy of most approaches is poor. Because of
the complexity of both the problem and its treatment, investigations must target the
development of cause-effect explanations.

Kelley, D. E., and Goodpaster, B. H. (1999). Effects of physical activity on insulin action and
glucose tolerance in obesity. Medicine and Science in Sports and Exercise, 31(11 Suppl), S619-
S623.

The purpose of this paper is to examine the effect of physical activity on glucose
tolerance in relation to obesity. We reviewed current literature, with particular emphasis
on randomized clinical trials, to prepare an evidence-based evaluation of the effects of
physical activity on glucose intolerance in obesity. This literature review indicates that
physical activity has favorable effects on reducing insulin resistance in obesity and
among patients with type 2 diabetes mellitus. Improvement in glucose tolerance is less
consistently observed and is related to intensity of exercise, collateral changes in
adiposity, the interval between exercise and testing of glucose tolerance, and the baseline
severity of glucose intolerance. A review of currently published clinical trial data
supports the conclusion that physical activity can reduce insulin resistance and improve
glucose intolerance in obesity.
 130

Kelly, K. T. (2004). The behavior and psychology of weight management. JAAPA: Journal of
the American Academy of Physician Assistants, 17(4), 29-32.

Clinicians who know the multiple factors involved in achieving behavioral change can
better assess a patient's true readiness for a major lifestyle adjustment.

Kemper, H. C. G. (2004). Getting physical: the importance of physical activity in the prevention
of overweight and obesity in youth. Youth studies Australia, 23(1), 27-34.

In this article Han C.G. Kemper presents an overview of recent research findings
regarding the international epidemic of overweight and obesity in young people. The
research includes his own longitudinal studies conducted on young people in the
Netherlands. Professor Kemper suggests possible causes of weight gain in the population
and recommends measures to combat the trend.

Kennedy, E., and Offutt, S. E. (2000). Government. Healthy lifestyles for healthy Americans:
report on USDA's year 2000 behavioral nutrition roundtable. Nutrition Today, 35(3), 84-88.

In January 2000, the Research, Education, and Economics (REE) mission area of the U.S.
Department of Agriculture (USDA) sponsored a round table in New Orleans to address
behavioral nutrition. The impetus for the round table was a question recently asked by
Agriculture Secretary Glickman: "Why, when we have a greater base of understanding
about diet and nutrition than ever before, is obesity on the rise? There isn't an adult
American with a pulse that doesn't know, for example, about the dangers of high
cholesterol. And yet, we can't seem to convert increased nutrition information into
changes in behavior." Participants, representing such diverse fields as economics,
nutrition, public health, medicine, psychology, neuroendocrinology, and marketing
research, discussed the determinants of food choices and activity levels and identified
research needs, gaps, and priorities related to improving consumer eating behavior and
activity levels. High-lights of the discussions, chaired by Dr. Eileen Kennedy, are
summarized in this article.

Kenney, J. J. (2000). To snack or not to snack. Communicating Food for Health, 13, 17.

Eating smaller, more frequent meals is your best bet for lower cholesterol and weight
control. But skipping breakfast and snacking when you are not hungry, is a mistake.

Kimm, S. Y. S. (1995). The role of dietary fiber in the development and treatment of childhood
obesity. Pediatrics, 96(5), 1010-1015.

Increasing the fiber content of childrens' diets may help control childhood obesity. The
prevalence of childhood obesity appears to be growing in the US. Obesity may be linked
to genetic factors, diet, and lack of exercise. Obesity is rare in developing countries
where a large proportion of the diet is vegetable foods high in fiber. This suggests a link
between such foods and obesity prevention, although many other factors such as low fat
content, inadequate calories, and increased activity may be involved. Nonetheless, fiber-
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rich foods generally supply fewer calories and speed transit time through the digestive
tract, and water-soluble fiber blunts the insulin response to carbohydrates. Also, fiber-rich
diets tend to be carbohydrate-rich and low in fat. Increasing dietary fiber in children's
diets could therefore be a preventative measure, and while evidence is inconclusive, some
studies have shown modest benefits for using dietary fiber in treating childhood obesity.

King, D. E., Mainous, A. G., 3rd, and Taylor, M. L. (2004). Clinical use of C-reactive protein for
cardiovascular disease. Southern Medical Journal, 97(10), 985-8.

Recent evidence supports an association between elevation of inflammatory markers,

such as C-reactive protein, and subsequent cardiovascular disease risk. The American
Heart Association released guidelines in 2003 to help clinicians know when to use such
markers. Because inflammatory markers are associated with diabetes, obesity, and
hypertension, knowledge of the role of such markers is extremely important for
prevention and chronic disease management. Newer studies published after the
guidelines, and another recent review provide further documentation of the growing role
of inflammation in cardiovascular risk. Based on the available literature, this article
reviews the new guidelines, more recent evidence since the guidelines, and forms
recommendations for primary care clinical practice.

Kirk, S. (1999). Treatment of obesity: theory into practice. Proceedings of the Nutrition Society,
58(1), 53-58.

A review outlining the current situation in the management of obesity in adults.

Suggestions are made as to how health professionals involved in obesity treatment can
address the growing problem.

Kirk, S. (2003). Continuing professional development: obesity. Diet and weight management.
Nursing Standard, 17(49), 47-55.

The prevalence of obesity has increased dramatically over recent years and the health
risks associated with obesity are well known. The author discusses the dietary
management of obesity in adults and children. She suggests that nurses have a key role to
play in obesity prevention and management, and that health professionals need to
recognise that obesity is a chronic condition requiring long-term intervention.

Kirk, S. F. L., Harvey, E. L., McConnon, A., Pollard, J. E., Greenwood, D. C., Thomas, J. D.,
and Ransley, J. K. (2003). A randomised trial of an internet weight control resource: the UK
weight control trial. BMC Health Services Journal, 3(19).

Obesity treatment is notoriously unsuccessful and one of the barriers to successful weight
loss reported by patients is a lack of social support. The Internet offers a novel and fast
approach to the delivery of health information, enabling 24-hour access to help and
advice. However, much of the health information available on the Internet is unregulated
or not written by qualified health professionals to provide unbiased information. The
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proposed study aims to compare a web-based weight loss package with traditional dietary
treatment of obesity in participants. The project aims to deliver high quality information
to the patient and to evaluate the effectiveness of this information, both in terms of
weight loss outcomes and cost-effectiveness.

Kirk, T., Crombie, N., and Cursiter, M. (2000). Promotion of dietary carbohydrate as an
approach to weight maintenance after initial weight loss: a pilot study. Journal of Human
Nutrition and Dietetics, 13(4), 277-285.

To test a novel approach to weight management based on positive advice to eat more
carbohydrate-rich foods.

Klauer, J., and Aronne, L. J. (2002). Managing overweight and obesity in women. Clinical
Obstetrics and Gynecology, 45(4), 1080-1088.

Concerns are raised regarding the increased incidence of obesity and overweight among
women in the USA. The health implications of obesity and corresponding issues in body
image are discussed. Guidelines in treating obesity are presented. Obesity treatment
involves proper evaluation and planning of treatment; encouraging increased physical
activity and dietary, behaviour and lifestyle modifications; pharmacological therapy
(including orlistat, sibutramine, topiramate); and/or surgical procedures.

Klinger, D. (2002). The overeater self and the healthy self within. Eating Disorders: The Journal
of Treatment and Prevention, 10(1), 87-91.

This article describes a psycho-educational class, called "The Overeater Self and the
Healthy Self Within", that the author teaches in a residential program for obesity. The
author asserts that clients attempting to eliminate problematic eating behavior without
understanding what their use of food has been doing to them is unworkable. It is
concluded that helping individuals with eating disorders to be on their own teams, to
make an about face and view behavior that they have ben despising for so long in a
positive light, is difficult, but that once they are able to turn that mental corner, a door is
opened to the beginnings of psychic reconciliation, of compassion for themselves, of
healing. (PsycINFO Database Record (c) 2004 APA, all rights reserved)

Kolagotla, L., and Adams, W. (2004). Ambulatory management of childhoos obesity. Obesity
Research, 12(2), 275-283.

Childhood obesity is one of the most challenging issues facing healthcare providers
today. The aims of this study were to describe the ambulatory management of childhood
obesity by pediatricians (PDs) and family physicians (FPs) and to evaluate knowledge of
and adherence to published recommendations.
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Kopecky, J., Rossmeisl, M., Flachs, P., Brauner, P., Sponarova, J., Matejkova, O., Prazak, T.,
Ruzickova, J., Bardova, K., and Kuda, O. (2004). Energy metabolism of adipose tissue -
Physiological aspects and target in obesity treatment. Physiological Research, 53(Suppl. 1),
S225-S232.

Body fat content is controlled, at least in part, by energy charge of adipocytes. In vitro
studies indicated that lipogenesis as well as lipolysis depend on cellular ATP levels.
Respiratory uncoupling may, through the depression of ATP synthesis, control lipid
metabolism of adipose cells. Expression of some uncoupling proteins (UCP2 and UCP5)
as well as other protonophoric transporters can be detected in the adipose tissue.

Kopelman, P. G. (2005). Clinical treatment of obesity: are drugs and surgery the answer?
Obesity Research, 64(1), 65-72.

Obesity treatment remains a `Cinderella' of all clinical management programmes, but

generally without a happy ending. The great expectation for new therapeutic agents has
not been fulfilled in clinical practice, whilst the restriction of eating through surgical
division of the upper bowel seems strange in an age of advanced and sophisticated
technology. The better understanding of the neuro-regulation of appetite, and its
application as part of evidence-based clinical interventions, could lead to a more coherent
approach to obesity treatment. Nevertheless, investigation of potential neuroendocrine
targets for appetite suppression suggests redundancy in the systems, which make
development of effective agents against single receptors impractical.

Koplan, J. P., and Dietz, W. H. (1999). Caloric imbalance and public health policy. JAMA:
Journal of the American Medical Association, 282(16), 1579. The

US must develop a national obesity prevention strategy. More than half of US adults are
overweight, and 22% are obese. The number of overweight and obese Americans has
increased dramatically and genes alone are not responsible. More likely, Americans are
simply eating more calories and exercising less. The best approach is to prevent obesity
in children. The best way to do this is to bring back physical education in the schools.
Adults also need to become more physically active, but this may involve re-designing
communities so there are more walking and biking trails.

Korner, J., and Aronne, L. J. (2003). The emerging science of body weight regulation and its
impact on obesity treatment. Journal of Clinical Investigation, 111(5), 565-570.

This review describes the regulation of energy homeostasis and the energetics of body
weight regulation. The pharmacological (sibutramine, orlistat and noradrenergic-
releasing agents), nonpharmacological behaviour therapy, exercise and energy restricted
diets) and surgical treatment of obesity are discussed.
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Korsten-Reck, U., Rudloff, C., Kayser, R., Esser, K. J., Grupe, M., Emunds, U., Kromeyer-
Hauschild, K., Rucker, G., Wolfarth, B., and Berg, A. (2002). Freiburg intervention program for
ambulatory therapy of obesity in childhood (FITOC). Versicherungsmedizin, 54, 21-25.

In this study we first try to answer the question, whether it is possible to make a
successful treatment for obese children in an interdisciplinary program. Second it is asked
whether a transfer of this program to further regions in Germany leads to comparable
results. In FITOC children from the age of 8-11 years and over the 97. BMI- percentile
are integrated in this program. The goals weight management, increased physical fitness
and improvement of the cardiac risk profile are checked by weight, height, fasting blood
serum, a standardized cycle ergometry and a medical measurement at the beginning, after
treatment and at all check-ups.

Korsten-Reck, U., Wolfarth, B., Bonk, M., Keul, J., and Berg, A. (2000). The Freiburg
Intervention Trial for Obesity in Chidren (FITOC). Z Arztl Fortbild Qualitatssich, 94(8), 677-81.

Freiburg Intervention Trial for Obese Children (FITOC) is an interdisciplinary treatment

program for obese children, which is established in Freiburg since 1987. Obese children
at the age of 8-11 are treated in an eight months intensive period and a follow-up period
of 4 months or more. Since 1990 data from 283 children coming out of 15 treatment
groups (about 2 groups per year) were collected and analyzed. The program consists of
regular physical training (3 times a week), comprehensive nutrition and behaviour
training (overall 7 parents evenings each 4 to 6 weeks and 7 cookery courses for the kids
in the same time scale).

Kottke, T. E., Clark, M. M., Aase, L. A., Brandel, C. L., Brekke, M. J., Brekke, L. N., DeBoer,
S. W., Hayes, S. N., Hoffman, R. S., Menzel, P. A., and Thomas, R. J. (2002). Self-reported
weight, weight goals, and weight control strategies of a midwestern population. Mayo Clinic
Proceedings, 77(2), 114-121.

To elicit from individuals in a population their current weight and height, weight goals,
and weight control strategies to aid in design of effective interventions to prevent and
treat obesity.

Kremers, S. P. J., Visscher, T. L. S., Brug, J., Paw, M. J. M. C. A., Schouten, E. G., Schuit, A. J.,
Seidell, J. C., Baak, M. A. v., Mechelen, W. v., Kemper, H. C. G., Kok, F. J., Saris, W. H. M.,
and Kromhout, D. (2005). Netherlands Research programme weight gain prevention (NHF-
NRG): rationale, objectives and strategies. European Journal of Clinical Nutrition, 49(4), 498-
507.

A study was conducted to outline the rationale, objectives and strategies used in a
systematically designed research programmme to study specific weight gain-inducing
behaviours, their psychosocial as well as environmental determinants, and the effects of
interventions aimed at the prevention of weight gain. Design: The evidence for potential
behavioural determinants and strategies to prevent weight gain was reviewed, and the
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methods applied within the Netherlands Research programme weight gain prevention
(NHF-NRG) project were described.

Krempf, M., Louvet, J. P., Allanic, H., Miloradovich, T., Joubert, J. M., and Attali, J. R. (2003).
Weight reduction and long-term maintenance after 18 months treatment with orlistat for obesity.
International Journal of Obesity, 27(5), 591-597.

To determine the effect of orlistat on weight reduction and the long-term maintenance of
this weight loss when associated with a continuous mildly reduced energy diet.

Krinick, G. B. (2000). Evaluation of weight resistance training as a component of exercise in the

behavioral treatment of obesity. Dissertation Abstracts International Part B: Science and
Engineering. Vol., 61(02).

Behavior therapy is considered the "treatment of choice" for mild to moderate obesity.
Exercise, in conjunction with a reduced calorie diet is an important component of a
weight reduction program. While calorie restricted diets are efficacious for weight loss,
dieting without exercise results in loss of both fat and fat-free mass (FFM). Resting
metabolic rate (RMR) is also lowered during dieting, as a result of the body adapting to
periods of famine, RMR correlates highly with FFM, and the decline in RMR may be due
in part to the loss of FFM.

Kruger, J., Galuska, D. A., Serdula, M. K., and Kohl, H. W., 3rd. (2005). Physical activity
profiles of U.S. adults trying to lose weight: NHIS 1998. Med Sci Sports Exerc, 37(3), 364-8.

Physical activity is an integral part of weight control programs, but recommended

amounts vary. The objectives of this study were to describe the prevalence and
characteristics of those who reported using exercise as a weight loss strategy and to
determine the prevalence of meeting various institutionally recommended levels of
physical activity (N=8538) among that population.

Kumanyika, S., Jeffery, R. W., Morabia, A., Ritenbaugh, C., and Antipatis, V. J. (2002). Obesity
prevention: the case for action. International Journal of Obesity, 26(3), 425-436.

This report analyses the prevalence, trends, economic aspects and global burden of
obesity. Targets for action, potential solutions and surveillance outcomes are presented.
The action agenda presented highlights the need for correcting the societal causes of
obesity; intervention and commitment to action at all levels (from the individual to
international players); links between independent policies and processes in different
settings and sectors; and strategies for the population as a whole.
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Kumanyika, S., and Obarzanek, E. (2003). Pathways to obesity prevention: report of a National
Institutes of Health workshop. Obesity Research, 11(10), 1263-1274.

There is an extensive research base on obesity treatment and on the health benefits of
weight loss, but relatively little research has focused on obesity prevention. This article
summarizes results of a workshop conducted by investigators funded under a National
Institutes of Health initiative designed to stimulate novel research for obesity prevention.
The 20 pilot studies funded under this initiative involved study populations that were
diverse with respect to life stage and ethnicity, were conducted in a variety of natural and
research settings, and involved a mix of interventions, including face-to-face group and
individual counseling, as well as mail, telephone, and internet-based approaches.

Kumanyika, S. K. (2001). Minisymposium on obesity: overview and some strategic

considerations. Annual Review of Public Health, 22, 293-308.

The high and still increasing prevalence of obesity in children from the USA,
adolescents, and adults poses a major economic and health threat to our society. The three
reviews in this minisymposium on obesity explore the health issues by: (1) describing the
public health impact of obesity; (2) examining the multiple and complex environmental
influences on eating and physical activity patterns; and (3) considering how the
development of obesity during childhood and adolescence can be prevented through
interventions in school, family, and primary care settings.

Lacey, J. M., Tershakovec, A. M., and Foster, G. D. (2003). Acupuncture for the treatment of
obesity: a review of the evidence. International Journal of Obesity, 27(4), 419-427.

Although acupuncture is being utilized to treat a variety of important health problems, its
usefulness in obesity management has not yet been fully evaluated. The aim of this
review paper was to survey and critically evaluate the descriptive and controlled trials of
acupuncture for enhancing weight loss.

LaFontaine, T. (2002). Preventing obesity and type 2 diabetes in youth: call to action. Strength
and Conditioning Journal, 24(6), 53-56.

Presents a review of the literature on the epidemic trends of obesity and type 2 diabetes
mellitus in the United States and discusses how National Strength and Conditioning
Association members can help prevent and address this growing trend.

Lalich, R. A. (2001). An initiative to retain reserve soldiers failing to meet weight and physical
fitness standards: the Wisconsin Army National Guard experience. Military Medicine, 166(3),
204-207.

This paper presents the Wisconsin Army National Guard's attempt to retain soldiers
failing to meet weight and annual physical fitness test standards. Soldiers failing or at risk
of failing weight and fitness standards attend a wellness program one weekend per month
for three consecutive months. Instruction includes topics in exercise training, nutrition,
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general wellness, stress reduction, and motivational lectures. A total of 324 soldiers who
completed the program were evaluated for retention rates. At 48 months, graduates of the
program had a 55% retention rate. This program is cost effective and soldier caring.

Lamerz, A., Kuepper-Nybelen, J., Wehle, C., Bruning, N., Trost-Brinkhues, G., Brenner, H.,
Hebebrand, J., and Herpertz-Dahlmann, B. (2005). Social class, parental education, and obesity
prevalence in a study of six-year-old children in Germany. International Journal of Obesity and
Related Metabolism Disorders, 29(4), 373-80.

To assess the association between socioeconomic status (SES) and childhood obesity, and
which factor in particular stands out in relation to obesity.

Lang, T., Rayner, G., Rayner, M., Barling, D., and Millstone, E. (2005). Policy councils on food,
nutrition and physical activity: the UK as a case study. Public Health Nutrition, 8(1), 11-9.

International experience of Policy Councils on food and nutrition has developed over
recent decades but they have not received the attention that is due to them. The 1992
International Conference on Nutrition recommended that governments create Food Policy
Councils but few have been created. There has been more experience in local and sub-
national policy councils, particularly in North America.

Langnase, K., Asbeck, I., Mast, M., and Muller, M. J. (2004). The influence of socio-economic
status on the long-term effect of family-based obesity treatment intervention in prepubertal
overweight children. Health Education, 104(6), 336-344.

The objective of this paper is to assess the effect of the socio-economic status (SES) on
long-term outcomes of a family-based obesity treatment intervention in prepubertal
children. A total of 52 overweight and 26 normal weight children were investigated.
Nutritional status, intake of fruit, vegetables and low fat foods, in-between meals, sports
club membership, frequency of exercise and daily television viewing were measured
before intervention (t0 and after a mean period of 1.3 years (t1. The result obtained
indicate that a low SES may serve as a barrier against family-based intervention. The data
provide evidence for the idea that there is need for social stratification of future measures
of health promotion within families.

Lantz, H., Peltonen, M., Agren, L., and Torgerson, J. S. (2003). A dietary and behavioural
programme for the treatment of obesity. A 4-year clinical trial and a long-term posttreatment
follow-up. Journal of Internal Medicine, 254(3), 272-279.

To evaluate weight loss maintenance after 4 years of nonpharmacological, nonsurgical

obesity treatment, including a very low calorie diet (VLCD), diet and behavioural
support. Furthermore, to assess weight development amongst completers and
noncompleters beyond the active 4-year treatment period.
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Larsen, P. J., Vrang, N., and Tang-Christensen, M. (2003). Central pre-proglucagon derived
peptides: opportunities for treatment of obesity. Current Pharmaceutical Design, 9(17), 1373-
1382.

Modern societies have moved from famine to feast and obesity and its co-morbidities
now sweep the world as a global epidemic. Numerous scientific laboratories and
pharmaceutical companies have taken the challenge and are now exploiting novel
molecular targets for treatment of obesity.=

Larsen, T. M., Toubro, S., Van Baak, M. A., Gottesdiener, K. M., Larson, P., Saris, W. H. M.,
and Astrup, A. (2002). Effect of a 28-d treatment with L-796568, a novel beta sub(3)-adrenergic
receptor agonist, on energy expenditure and body composition in obese men. American Journal
of Clinical Nutrition, 76(4), 780-788.

Stimulation of energy expenditure (EE) with selective thermogenic beta -adrenergic

agonists may be a promising approach for treating obesity. We analyzed the effects of the
highly selective human beta sub(3)-adrenergic agonist L-796568 on 24-h EE, substrate
oxidation, and body composition in obese, weight-stable men.

Larson, D. E., Ferraro, R. T., Robertson, D. S., and Ravussin, E. (1995). Energy metabolism in
weight-stable postobese individuals. American Journal of Clinical Nutrition, 735-739.

A low metabolic rate for a given body size and body composition and a low ratio of fat to
carbohydrate oxidation predict body weight gain. Such metabolic traits could also
explain, in part, the propensity of previously obese (postobese) individuals to regain
weight after dieting.

Larsson, U. E., and Mattsson, E. (2003). Influence of weight loss programmes on walking speed
and relative oxygen cost (%VO2max) in obese women during walking. Journal of Rehabilitation
Medicine, 35(2), 91-97.

The objective was to investigate effects of dieted weight reduction on walking ability in
obese women. METHODS: Fifty-seven obese women 44.1 +/- 10.7 years, body mass
index 37.1 +/- 3.4 kg x m(-2) performed an indoor walking test. Speed, oxygen
consumption and heart rate were measured, perceived exertion and pain graded and
oxygen cost calculated. Maximum oxygen uptake (VO2max/kg) was predicted from a
submaximum bicycle ergometry test.

Lattimore, D. L., Bowles, H. R., Kirtland, K. A., and Hooker, S. P. (2005). Self-reported
physical activity among South Carolina adults trying to maintain or lose weight. Southern
Medical Journal, 98(1), 19-22.

The obesity epidemic is related to widespread physical inactivity in the United States.
This study determined the proportion of South Carolinians trying to maintain or lose
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weight and within that subpopulation, the number who practiced a restricted diet and
engaged in physical activity.
Lau, P. (2001). Growth and maturation: the connection with physical activity to obese children.
Journal of Physical Education and Recreation, 7(1), 42-48.

Childhood obesity is expected more serious in the 21st century. The etiology of obesity
has been investigated for more than decades and nobody will argue that physical
inactivity and high-energy intake are the two core factors. For the sake of prevention and
treatment, it is imperative to look into the nature and health-related effects of physical
activity towards obesity management. The objective of this chapter is to clarify the
effects of physical activity participation on adolescents' body changes and avoid
unrealistic expectations from it.

Lauber, R. P., and Sheard, N. F. (2001). The American Heart Association Dietary Guidelines for
2000: A summary report. Nutrition Reviews, 59(9), 298.

Recently, the American Heart Association published a revision of its dietary guidelines.
The recommendations are based on new scientific findings, and address the contribution
of growing rates of obesity, hypertension, and diabetes to heart disease in the United
States. The guidelines for the general public are similar to dietary recommendations made
by other health-related groups and government agencies and, therefore, place a greater
emphasis on the adoption of healthy eating patterns and behaviors rather than a singular
focus on dietary fat intake.

Lavie, C. J., Kuruvanka, T., Milani, R. V., Prasad, A., and Ventura, H. O. (2004). Exercise
capacity in adult African-Americans referred for exercise stress testing: is fitness affected by
race? Chest, 126(6), 1962-8.

To determine the factors associated with exercise capacity. DESIGN: Retrospective

evaluation of large stress-testing database. SETTING: Multispecialty tertiary care center.

Lavie, C. J., and Milani, R. V. (1996). Effects of cardiac rehabilitation and exercise training in
obese patients with coronary artery disease. Chest, 109(1), 52-56.

To determine the effects of cardiac rehabilitation and exercise training in obese coronary
patients. DESIGN: We compared data before and after cardiac rehabilitation between
obese and nonobese patients. SETTING: Two large teaching institutions.

Lawlor, D. A., Taylor, M., Bedford, C., and Ebrahim, S. (2002). Is housework good for health?
Levels of physical activity and factors associated with activity in elderly women. Results from
the British Women's Heart and Health Study. Journal of Epidemiology and Community Health,
56(6), 473-478.

To determine the prevalence of achieving new recommended levels of physical activity,

the types of activity involved, and their determinants among elderly British women.
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Lawrence, H. P., Romanetz, M., Rutherford, L., Cappel, L., Binguis, D., and Rogers, J. B.
(2004). Effects of a community-based prenatal nutrition program on the oral health of Aboriginal
preschool children in northern Ontario. Probe, 38(4), 172-182, 184-186, 188.

Aboriginal preschool children across Canada are at increased risk for Early Childhood
Caries (ECC) when compared with their non-Aboriginal age cohorts. Current research
indicates that dental public health programs fail to prevent ECC because intervention
often arrives too late.

Lawrence, S. A., Zittel-Palmara, K. M., Wodarski, L. A., and Wodarski, J. (2003). Behavioral
health: treatment and prevention of chronic disease and the implications for social work
practices. Journal of Health and Social Policy, 17(2), 49-65.

The public health problems in the new millennium are largely related to lifestyle. The
illness industry has seen a large growth in the USA with health care expenditure
accounting for 14% of the gross national product. The field of behavioural medicine
seeks to include individual responsibility in the prevention of chronic diseases. There are
great possibilities for lifestyle change through behavioural interventions. This manuscript
outlines various applications of behavioural techniques and interventions utilized for
smoking and obesity. Prevention paradigms and implications for social workers are also
outlined.

Lawrence, V., and Coppack, S. (2002). Obesity treatment -- benefits and risks with special
reference to type 2 diabetes mellitus. Practical Diabetes International, 19(4), 114-118.

Obesity and its complications pose one of the most important challenges to 21st century
health care. Although its exponential rise in prevalence undoubtedly represents a major
threat to the health of the population, treatment must be tailored to the individual
concerned. Exclusive reliance on body mass index (BMI) alone to define management
goals is not sufficient.

Lazar, M. A. (2002). Becoming fat. Genes and Development, 16(1), 1-5.

Most people do not wish to become fat, for cosmetic as well as medical reasons. Despite
this, there is an international epidemic of obesity fueled by sedentary life-styles and high
caloric consumption among people living in industrialized societies. Obesity is
characterized by excess adipose tissue, and rational intervention requires an
understanding of adipocyte genes, development, and function. The peroxisome
proliferator activated receptor gamma (PPAR gamma), a member of the large family of
nuclear hormone receptors, has received enormous attention as its role has emerged in the
formation of adipose tissue, as well in the pathogenesis and treatment of diabetes,
cardiovascular disease, and cancer. In this issue of Genes & Development, Rosen et al.
(2002) and Ren et al. (2002) provide answers to two fundamental questions regarding the
role of PPAR gamma in the making of a fat cell.
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Lazarus, R., Baur, L., Webb, K., and Blyth, F. (1996). Body mass index in screening for
adiposity in children and adolescents: systematic evaluation using receiver operating
characteristic curves. American Journal of Clinical Nutrition, 63(4), 500-506.

Body mass index (BMI) has been recommended for use in adolescent screening programs
to select subjects with excess body fat for appropriate interventions. No systematic
evaluation of BMI in screening for high degrees of adiposity was available when these
recommendations were formulated. The purpose of this paper was to evaluate the
screening performance of BMI using appropriate epidemiologic methods.

Leddy, J. J., Epstein, L. H., Jaroni, J. L., Roemmich, J. N., Paluch, R. A., Goldfield, G. S., and
Lerman, C. (2004). Influence of Methylphenidate on Eating in Obese Men. Obesity Research,
12(2), 224-232.

Rapid synaptic dopamine transport or reduced brain dopamine receptor signaling may
influence energy intake. Methylphenidate, a dopamine reuptake inhibitor, increases brain
synaptic dopamine and produces anorexia, suggesting that it may reduce energy intake.
We investigated the effects of two doses of short-acting methylphenidate on energy
intake over one meal in obese adult males.

Lederman, S. A. (2001). Pregnancy weight gain and postpartum loss: avoiding obesity while
optimizing the growth and development of the fetus. Journal of the American Medical Women's
Association, 56(2), 53-58.

Weight gain during pregnancy may contribute to obesity development. Concerns about
possible adverse effects of pregnancy weight gain on later maternal weight and on labor
and delivery must be rigorously evaluated in light of possible benefits for fetal growth
and development. Birth-weight rises with increased pregnancy weight gain, and perinatal
and neonatal mortality fall as birthweight increases in both preterm and term infants. The
lowest mortality is observed at 3500 to 4500 g in infants of white women. Although often
thought to be at high risk, infants termed "macrosomic" include infants of the lowest
mortality rate. Thus, restricting weight gain may be detrimental to the baby. Weight gain
that is optimal for the mother and the baby differs according to the mother's prepregnancy
weight.

Lederman, S. A., Alfasi, G., and Deckelbaum, R. J. (2002). Pregnancy-associated obesity in

black women in New York City. Maternal and Child Health Journal, 6(1), 37-42.

To determine weight gain during pregnancy and weight changes postpartum in first-time
mothers delivering at or near term.
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Leermakers, E. A., Perri, M. G., Shigaki, C. L., and Fuller, P. R. (1999). Effects of exercise-
focused versus weight-focused maintenance programs on the management of obesity. Addictive
Behaviors, 24(2), 219-227.

Examined the effects of two maintenance programs on exercise participation, energy

expenditure, energy consumption, and weight change in 67 obese adults (mean age 50
yrs) undergoing behavioral weight-loss treatment. Following an initial 6-month treatment
phase which produced a mean weight loss of 8.8 kg, Ss were assigned to an exercise-
focused or to a weight-focused maintenance program. Both maintenance programs
included 6 months of biweekly group sessions. The exercise-focused program included
group walking sessions, individual and group contingencies for exercise completion, and
relapse prevention training targeted specifically at the maintenance of physical activity.

Legge, A. (2000). Approaches to preventing an epidemic of obesity. Community Nurse, 6(8), 13-
14.

A new group, the National Obesity Forum, is one of several initiatives aiming to help
improve weight control in primary care. Adam Legge discovers how.

Leibbrand, R., and Fichter, M. M. (2002). Maintenance of weight loss after obesity treatment: Is
continuous support necessary? Behavior Research and Therapy, 40(11), 1275-1289.

This study examined outcome differences of 109 obese subjects, who participated in a
10-week cognitive-behavioral inpatient treatment followed by either a weight
maintenance program or a follow-up period without professional support.

Lewis, V., and Hoeger, K. (2005). Prevention of coronary heart disease: a nonhormonal
approach. Semin Reprod Med, 23(2), 157-66.

Coronary heart disease (CHD) is a common and serious health problem facing women as
they move beyond the reproductive years. Until recently, many postmenopausal women
and their physicians relied heavily on hormone therapy to prevent cardiovascular disease,
neglecting the well-recognized nonhormonal aspects of cardiovascular health. Simple
lifestyle changes--exercise, diet, weight control, and avoidance of tobacco--can
significantly reduce the chance of heart disease and its major risk factors, which are
essentially the same for men and women. As with men, obesity, hypertension,
hyperlipidemia, and diabetes are the major risk factors for heart disease in women. This
review discusses the epidemiologic studies linking these risk factors to CHD in women,
the guidelines for screening, and a brief overview of treatment recommendations.

Liburd, L. C., Anderson, L. A., Edgar, T., and Jack, L., Jr. (1999). Body size and body shape:
perceptions of Black women with diabetes. Diabetes Educator, 25(3), 382-388.

This qualitative study was conducted to explore perceptions of body size and shape in a
group of black women with Type 2 diabetes.
 143

Licence, K. (2004). Promoting and protecting the health of children and young people. Child:
Care, Health and Development, 30(6), 623-635.

The health-related behaviours adopted by children and young people can have both
immediate and long-term health effects. Health promotion interventions that target
children and young people can lay the foundations of a healthy lifestyle that may be
sustained into adulthood. This paper is based on a selective review of evidence relating to
health promotion in childhood, carried out to support the external working group on the
'Healthy Child' module of the Children's National Service Framework.

Lieber, C. S., Leo, M. A., Mak, K. M., Xu, Y., Cao, Q., Ren, C., Ponomarenko, A., and DeCarli,
L. M. (2004). Model of nonalcoholic steatohepatitis. American Journal of Clinical Nutrition,
79(3), 502-509.

Obesity and diabetes are frequently associated with nonalcoholic steatohepatitis (NASH),
but studies have been hampered by the absence of a suitable experimental model. Our
objective was to create a rat model of NASH.

Liebman, M., Pelican, S., Moore, S. A., Holmes, B., Wardlaw, M. K., Melcher, L. M., Liddil, A.
C., Paul, L. C., Dunnagan, T., and Haynes, G. W. (2003). Dietary intake, eating behavior, and
physical activity-related determinants of high body mass index in rural communities in
Wyoming, Montana, and Idaho. International Journal of Obesity, 27(6), 684-692.

To assess the relation between body mass index (BMI) levels and various lifestyle
variables related to physical activity and specific characteristics of a healthy eating
pattern, using baseline cross-sectional data from the Wellness IN the Rockies project.

Lindroos, A. K., and Torgerson, J. S. (2001). Obesity treatment: an overview with a dietary
perspective. Scandanavian Journal of Nutrition, 45(1), 2-7.

We are facing a rapid increase in the prevalence of obesity that is mainly related to
behavioural changes in modern society. Lifestyle changes, and above all, dietary changes
are thus essential components in all obesity treatment programmes and in the present
article an outline is given of different dietary treatment strategies. The role played by
specific macronutrients, especially fat and carbohydrates, is also discussed. Many studies
have been undertaken to evaluate the effects of different therapeutic approaches. In spite
of this, knowledge about the design and implementation of dietary treatment programmes
is rather limited, mainly due to methodological shortcomings. However, some features
seem common to successful interventions. A multicomponent strategy including a low
energy diet, increased physical activity and behaviour therapy seems more efficient than
treatment programmes using just one or two of these modalities. Furthermore, obesity is a
chronic disorder and long-term treatment improves weight loss and maintenance.
 144

Lindstrom, J., Peltonen, M., and Tuomilehto, J. (2005). Lifestyle strategies for weight control:
experience from the Finnish Diabetes Prevention Study. Proceedings of the Nutrition Society,
64(1), 81-8.

Currently, in many European countries more than half the adult population is overweight;
it hass become 'abnormal' to be of 'normal weight'. The risk of type 2 diabetes, CVD,
hypertension and certain forms of cancer increase with increasing weight. Biological
evolution has produced body-fat-regulating mechanisms that are more powerful in
protecting against weight loss than against weight gain. The current environment offers
constant availability of affordable palatable energy-rich foods, with no need to consume
the energy through physical activity. The 'obesogenic' environment is to some extent a
political issue, but it has been shown that the healthcare system can also have a role in
preventing obesity-related morbidity. The Finnish Diabetes Prevention Study was the
first controlled randomised study to show that individualised lifestyle counselling of
individuals with high risk of developing type 2 diabetes can influence diet, physical
activity and body weight, and that type 2 diabetes can be prevented, or at least postponed.
Most importantly, lifestyle changes do not have to be extreme. If the population would
adopt a lifestyle in line with the official nutrition recommendations, the obesity and
diabetes trend could at least be stabilised.

Linneman, C., Hessler, K., Nanney, S., Steger May, K., Huynh, A., and Haire Joshu, D. (2004).
Parents are accurate reporters of their preschoolers' fruit and vegetable consumption under
limited conditions. Journal of Nutrition Education and Behavior, 36(6), 305-308.

To assess the accuracy of parents as reporters of both their own and their 2- to 5-year-old
children's fruit and vegetable intake.

Liskova, S., Moravcova, A., Kytnarova, J., and Hosek, P. (2002). Long-term effectiveness of
obesity intervention program in children. International Journal of Obesity, 26(1).

The obesity thanks to increasing incidence becomes a significant socioeconomic and

medical risk factor in Czech Republic, affecting more and more children and adolescents.
The presented project intends to extend the accredited methods of obesity therapy and to
integrate in-patients care in spas, directed on education, diet and physical exercise
intervention with follow-up methods focused on behavioral therapy.

Liu, S., Willett, W. C., Manson, J. E., Hu, F. B., Rosner, B., and Colditz, G. (2003). Relation
between changes in intakes of dietary fiber and grain products in weight and development of
obesity among middle-aged women. American Journal of Clinical Nutrition, 78(5), 920-928.

Although increased consumption of dietary fiber and grain products is widely

recommended to maintain healthy body weight, little is known about the relation of
whole grains to body weight and long-term weight changes. We examined the
associations between the intakes of dietary fiber and whole- or refined-grain products and
weight gain over time.
 145

Liu, X., Kim, J. K., Li, Y., Li, J., Liu, F., and Chen, X. (2005). Tannic acid stimulates glucose
transport and inhibits adipocyte differentiation in 3T3-L1 cells. Journal of Nutrition, 135(2), 165-
71.

Obesity is a major risk factor for Syndrome X and type II diabetes (T2D). However, most
antidiabetic drugs that are hypoglycemic also promote weight gain, thus alleviating one
symptom of T2D while aggravating a major risk factor that leads to T2D. Adipogenesis,
the differentiation and proliferation of adipocytes, is a major mechanism leading to
weight gain and obesity. It is highly desirable to develop pharmaceuticals and treatments
for T2D that reduce blood glucose levels without inducing adipogenesis in patients.

Livingston, E. H., and Ko, C. Y. (2004). Socioeconomic characteristics of the population eligible
for obesity surgery. Surgery, 135(3), 288-296.

Obesity is increasing in the American population in epidemic proportions. Weight

reduction surgery results in sustained weight loss for morbidly obese individuals-a group
of patients refractory to nonsurgical obesity treatment.

Lofshult, D. (2003). Action for healthy kids. IDEA Health and Fitness Source, 21(6), 1.

Discusses the Action for Healthy Kids (AFHK) which strives to combat health challenges
facing youth.

Lofshult, D. (2003). Gatorade sponsors: new kids' anti-obesity campaign. IDEA Health and
Fitness Source, 21(8), 1.

Briefly announces the partnership between the Gatorade Company and the University of
North Carolina to create a new program, "Get Kids in Action", designed to reduce and
prevent childhood obesity.

Lofshult, D. (2003). What businesses are doing to fight obesity. IDEA Health and Fitness
Source, 21(10), 1.

Briefly reports on results from recent United States surveys that indicate that more and
more business are affording their employees opportunities for weight loss and physical
fitness in order to combat the rising cost of health insurance.

Lofshult, D. (2004). Drinking milk can reduce childhood obesity. IDEA Fitness Journal, 1(1), 1.

Reports on a study linking milk consumption in children to a reduction in childhood

obesity.
 146

Lohman, T., Thompson, J., Going, S., Himes, J. H., Caballero, B., Norman, J., Cano, S., and
Ring, K. (2003). Indices of changes in adiposity in American Indian children. Preventive
Medicine, 37(6 Part 2), S91-S96.

Pathways, a randomized trial, evaluated the effectiveness of a school-based obesity

prevention program on body composition changes in American Indian children. Several
body composition methods were compared in intervention and control schools for
assessing body composition changes.

Longjohn, M. M. (2004). Chicago project uses ecological approach to obesity prevention.

Pediatric Annals, 33(1), 55-63.

The immediate need for overweight prevention efforts to be developed and implemented
on a large scale in the US is discussed. An ecological model for obesity prevention that
conceptualizes the relationships among overweight risk factors is also presented, as well
as a local overweight prevention initiative in Chicago (Illinois, USA) which was
developed in a manner consistent with the ecological model. The prevention programme
is called the Consortium to Lower Obesity in Chicago Children.

Loredo, G., St. Jeor, S., and Plodkowski, R. (2004). A physician extension model for
diabetes/obesity treatment (DOTM). Journal of the American Dietetic Association, 104(8), A23.

Dietary patterns play an important role in the control of body weight. The aim of this
study was to verify whether changes in some dietary patterns over a 6-y follow-up period
would be associated with weight changes.

Love, C. (1999). A focused review of nursing and the effectiveness of preventative measures for
deep vein thrombosis. Journal of Orthopaedic Nursing, 3(2), 73-80.

This article describes the natural history of deep vein thrombosis highlighting its
prevalence in the orthopaedic patient. It emphasizes the important and unique position of
the orthopaedic nurse in its assessment and prevention. The current ranges of
preventative measures are critically reviewed. Guidance on best practice is given based
on the present, somewhat scanty, evidence.

Lowe, M. R., Annunziato, R., Riddell, L., Butryn, M., Crerand, C., Didie, L., Lucks, D., Ochner,
C., and McKinney, S. (2002). Controlled trial of a nutrition-focused treatment for weight loss
maintenance. International Journal of Obesity, 26(1).

Tested the hypothesis that high relapse rates found in obesity treatment programs are in
part due to insufficient qualitative changes in dietary intake. Overweight (M = 85.4 kg)
participants in all groups lost weight on identical low-calorie diets. The control group
received traditional cognitive-behavior therapy (CBT) treatment for 22 sessions. The
Enhanced Food Monitoring Accuracy (EFMA) group received CBT and techniques to
improve the consistency and accuracy of their food diaries.
 147

Lowe, M. R., Foster, G. D., Kerzhnerman, I., Swain, R. M., and Wadden, T. A. (2001).
Restrictive dieting vs. "undieting": Effects on eating regulation in obese clinic attenders.
Addictive Behaviors, 26(2), 253-266.

Tested predictions from restraint theory and the 3-factor model of dieting using an eating
regulation paradigm. Ss were 42 female, obese, nonbinge eaters (aged 24-66 yrs)
assigned to either a weight loss group (restrictive dieters [RDs]) or a group designed to
eliminate dieting ("undieters" or [UDs]). Ss took part in an ostensible ice cream taste test
with or without a preload, both before and after the weight control intervention. At
pretest, restraint theory's prediction that participants would engage in counter-regulatory
eating was not supported. At posttest, after 8 wks of the dieting interventions, RDs
increased and UDs decreased their intake following a preload, a pattern most consistent
with the predictions of restraint theory. This counter-regulatory trend was observed in
spite of a significant decrease in RDs' Disinhibition scale scores following treatment.
Implications of these findings for restraint theory, the 3-factor model of dieting, and
relapse in obesity treatment were discussed.

Ludwig, D. S. (2003). Dietary glycemic index and the regulation of body weight. Lipids, 38(2),
117-121.

Prevalence rates of overweight and obesity have risen precipitously in the United States
and other developed countries since the 1960s, despite comprehensive public health
efforts to combat this problem. Although considerable attention has been focused on
decreasing dietary fat and increasing physical activity level, the potential relevance of the
dietary glycemic index to obesity treatment has received comparatively little scientific
notice. This review examines how the glycemic and insulinemic responses to diet may
affect body weight regulation, and argues for the potential utility of low glycemic index
diets in the prevention and treatment of obesity and related complications.

Ludwig, D. S. (2003). Novel treatments for Obesity. Asia Pacific Journal of Clinical Nutrition,
12 Suppl, S8.

Excessive fat consumption is commonly believed to cause obesity and, for this reason,
conventional approaches to weight loss have focused on decreasing dietary fat. However,
the relationship between dietary fat and adiposity has been questioned for several
reasons: 1) weight loss on low-fat diets is characteristically modest in nature; 2)
prospective epidemiological studies have not consistently found that individuals eating
the most fat are heavier than those eating the least fat; and 3) obesity prevalence has risen
markedly since the 1970s in the US despite a significant decrease in fat consumption as a
percent of total energy. As dietary fat has decreased, carbohydrate consumption has
increased in a compensatory fashion, and most of this increase has been in the form of
refined starchy food and concentrated sugar that are high in glycemic index (GI) and/or
glycemic load (GL).
 148

Lugari, R., Cas, A. D., Ugolotti, D., Barilli, A. L., Camellini, C., Ganzerla, G. C., Luciani, A.,
Salerni, B., Mittenperger, F., Nodari, S., Gnudi, A., and Zandomeneghi, R. (2004). Glucagon-
like peptide 1 (GLP-1) secretion and plasma dipeptidyl peptidase IV (DPP-IV) activity in
morbidly obese patients undergoing biliopancreatic diversion. Hormone and Metabolic Research,
36(2), 111-115.

The physiological inhibitory control of glucagon-like Peptide 1 (GLP-1) on gastric

emptying and the contribution of this peptide in the regulation of food intake as a satiety
factor suggest that impaired secretion and/or activity of GLP-1 may be involved in the
pathogenesis of obesity.

Luke, B., Hediger, M. L., Nugent, C., Newman, R. B., Mauldin, J. G., Witter, F. R., and
O'Sullivan, M. J. (2003). Body mass index-specific weight gains associated with optimal birth
weights in twin pregnancies. Journal of Reproductive Medicine, 48(4), 217-224.

To formulate maternal weight gain guidelines, by maternal pregravid body mass index
(BMI) status, associated with optimal fetal growth and birth weight in twins.

Lynch, G. (2001). Obese proportions. World of Irish Nursing, 9(7), 29-31.

If nurses are to prevent further health complications due to obesity, they must take a look
at preventative health, writes Grainne Lynch.

Lyznicki, J. M., Young, D. C., Riggs, J. A., and Davis, R. M. (2001). Obesity: assessment and
management in primary care. American Family Physician, 63(11), 2115-2117.

Obesity is a complex, multifactorial condition in which excess body fat may put a person
at health risk. National data indicate that the prevalence of obesity in the United States is
increasing in children and adults. Reversing these trends requires changes in individual
behavior and the elimination of societal barriers to healthy lifestyle choices.

Macaulay, A. C., Paradis, G., Potvin, L., Cross, E. J., Saad Haddad, C., McComber, A.,
Desrosiers, S., Kirby, R., Montour, L. T., Lamping, D. L., Leduc, N., and Rivard, M. (1997). The
Kahnawake Schools Diabetes Prevention Project: Intervention, evaluation, and baseline results
of a diabetes primary prevention program with a native community in Canada. Preventive
Medicine, 26(6), 779-790.

Describes the Kahnawake Schools Diabetes Prevention Project, a 3-yr community-based,

primary prevention program for non-insulin-dependent diabetes mellitus in a Mohawk
community near Montreal, Canada. Objectives are to improve healthy eating and
encourage more physical activity among elementary school children.
 149

MacAulay, J., and Newsome, R. (2004). Solving the obesity conundrum. Food Technology,
58(6), 32-37.

The Research Summit of the Institute of Food Technologist(IFT) for identification of

actions for food-related solution to obesity epidemic was held on February 15-17, 2004 in
New Orleans. The keynote address by Claude Bouchard, executive director of
Pennington Biomedical Research Center, emphasized on several hypotheses for the
obesity epidemic including behavioral, physical environment and biological approaches.

MacKenzie, N. R. (2000). Childhood obesity: strategies for prevention. Pediatric Nursing, 26(5),
527-530.

The prevalence of childhood obesity has been steadily increasing over the past several
decades. Because obesity is not readily amenable to treatment, prevention is very
important. Children's growth should be monitored using the body mass index (BMI) and
risk factors assessed through a dietary and physical activity history. For children at risk,
developmentally-based prevention strategies include establishing a positive feeding
relationship, encouraging healthy eating habits, and maintaining physical activity.

Magnusson, M. B., Hulthen, L., and Kjellgren, K. I. (2005). Obesity, dietary pattern and physical
activity among children in a suburb with a high proportion of immigrants. Journal of Human
Nutrition and Dietetics, 18(3), 187-94.

Obesity among children is a growing problem. Interventions should be planned to meet

needs in different cultural settings. The objective of this study was to explore dietary
patterns, physical activity and perceptions of relationships between life-style and health
among children in a suburb with low socio-economic status and a high proportion of
immigrants and refugees.

Maki, K. C., Davidson, M. H., Tsushima, R., Matsuo, N., Tokimitsu, I., Umporowicz, D. M.,
Dicklin, M. R., Foster, G. S., Ingram, K. A., Anderson, B. D., Frost, S. D., and Bell, M. (2002).
Consumption of diacylglycerol oil as part of a reduced-energy diet enhances loss of body weight
and fat in comparison with consumption of a triacylglycerol control oil. American Journal of
Clinical Nutrition, 76(6), 1230-1236.

Diacylglycerol is a natural component of edible oils that has metabolic characteristics that
are distinct from those of triacylglycerol. We assessed the efficacy of an oil containing
mainly 1,3-diacylglycerol in reducing body weight and fat mass when incorporated into a
reduced-energy diet.

Marion, A. W., Baker, A. J., and Dhawan, A. (2004). Fatty liver disease in children. Archives of
Disease in Childhood, 89(7), 648-652.

NAFLD/NASH is now recognised as an increasing clinical problem in children and

adolescents. Risk factors include obesity, insulin resistance, and hypertriglyceridaemia.
Drug hepatoxicity and genetic or metabolic diseases that can cause hepatic steatosis must
 150

be excluded. Affected children are usually asymptomatic although a few may complain
of malaise, fatigue, or vague recurrent abdominal pain. Liver biopsy is the gold standard
for diagnosis, and is important in determining disease severity and prognosis. The natural
history of childhood NASH may be progressive liver disease for a significant minority.

Marr, L. (2004). Viewpoint. Soft drinks, childhood overweight, and the role of nutrition
educators: let's base our solutions on reality and sound science. Journal of Nutrition Education
and Behavior, 36(5), 258-265.

The percentage of overweight children in the United States and other countries has now
reached epidemic proportions. Both physical activity and food intake contribute to the
energy equation, but research increasingly points to physical inactivity as the primary
culprit in weight gain. Singling out and restricting specific foods and beverages are
unlikely to be effective in reducing the prevalence of overweight children. Nutrition
educators need to emphasize overall lifestyle, including physical activity, as well as
caloric intake, in childhood overweight intervention efforts.

Martinez-Valls, J. F., Moreno, B., Formiguera, X., Genis, M., and Azpeitia, A. (2002). Effect of
weight loss with orlistat on cardiovascular risk prediction in clinical practice. The Obeso study.
Spain. International Journal of Obesity, 26(1).

Overweight and obesity are closely associated with coronary heart disease (CHD) risk
factors. We examine the effects of weight loss with orlistat on 10-year CHD risk in
clinical practice.

Matheson, D. M., Killen, J. D., Wang, Y., Varady, A., and Robinson, T. N. (2004). Children's
food consumption during television viewing. American Journal of Clinical Nutrition, 79(6),
1088-1094.

Television viewing is associated with childhood obesity. Eating during viewing and
eating highly advertised foods are 2 of the hypothesized mechanisms through which
television is thought to affect children's weight. Our objectives were to describe the
amounts and types of foods that children consume while watching television, compare
those types with the types consumed at other times of the day, and examine the
associations between children's body mass index (BMI) and the amounts and types of
foods consumed during television viewing.

Matheson, D. M., Varady, J., Varady, A., and Killen, J. D. (2002). Household food security and
nutritional status of Hispanic children in the fifth grade. American Journal of Clinical Nutrition,
76(1), 210-217.

Food insecurity is a critical variable for understanding the nutritional status of low-
income populations. However, limited research is available on the relation between
household food insecurity and children's nutritional status. Our objective was to examine
the relations among household food insecurity, household food supplies, and school-age
children's dietary intakes and body mass indexes (BMIs).
 151

Maziekas, M. T., LeMura, L. M., Stoddard, N. M., Kaercher, S., and Martucci, T. (2003). Follow
up exercise studies in paediatric obesity: implications for long term effectiveness. British Journal
of Sports Medicine, 37(5), 425-429.

To examine the effects of exercise training on paediatric obesity immediately after

training and at a one year follow up and to provide recommendations for future research.

Mazur, R. E., Marquis, G. S., and Jensen, H. H. (2003). Diet and food insufficiency among
Hispanic youths: acculturation and socioeconomic factors in the third National Health and
Nutrition Examination Survey. American Journal of Clinical Nutrition, 78(6), 1120-1127.

Low socioeconomic status is associated with poor diet, food insufficiency, and poor child
health. Hispanic households have disproportionately low incomes. Acculturation-related
changes may augment the effects of poverty on children's diet and health. The goal was
to determine the associations that acculturation, measured by parents' language use, and
income have with dietary intakes and food insufficiency among Hispanic youths.

McCance, K. L., and Jones, R. E. (2003). Estrogen and insulin crosstalk: breast cancer risk
implications. Nurse Practitioner: American Journal of Primary Health Care, 28(5), 12-13, 16-18,
21-25.

The incidence of breast cancer may be running parallel to the high insulin levels that
occur with diabetes mellitus and atherosclerosis. Estrogens are known to increase the risk
of breast cancer, and there is increasing evidence for interactions between estrogen and
intracellular growth factor signaling pathways. This article includes recommendations to
lower bioavailable estrogen and insulin through lifestyle changes.

McCarter Spaulding, D. (2004). The importance of breastfeeding in improving the health of

African-Americans: a health policy perspective. Journal of Multicultural Nursing and Health,
10(3), 24-28.

The objective of this paper is to recommend health policy changes that will support
efforts to increase breastfeeding among African-Americans.

McCarty, M. F. (2005). Up-regulation of PPARgamma coactivator-1alpha as a strategy for

preventing and reversing insulin resistance and obesity. Medical Hypotheses, 64(2), 399-407.

Excessive accumulation of triglycerides and certain fatty acid derivatives in skeletal

muscle and other tissues appears to mediate many of the adverse effects of insulin
resistance syndrome. Although fatty diets and obesity can promote such accumulation,
deficient capacity for fatty acid oxidation can also contribute in this regard. Indeed, in
subjects who are insulin resistant, diabetic, and/or obese, fatty acid oxidation by skeletal
muscle tends to be inefficient, reflecting decreased expression of mitochondria and
mitochondrial enzymes in muscle. This phenomenon is not corrected by weight loss, is
 152

not simply reflective of subnormal physical activity, and is also seen in lean first-degree
relatives of diabetics; thus, it appears to be primarily attributable to genetic factors.

McCrone, S., Dennis, K., Tomoyasu, N., and Carroll, J. (2000). A profile of early versus late
onset of obesity in postmenopausal women. Journal of Women's Health and Gender Based
Medicine, 9(9), 1007-1013.

Obesity is a serious health problem among women across the life span. Although people
can become obese at any age, there is a large proportion of older women who have been
obese since childhood. The purpose of this study was to determine whether
postmenopausal women with an early versus late onset of obesity manifested differences
in body habitus, eating behaviors, and mood. One hundred thirty-five postmenopausal
women with obesity responded to self-report questionnaires on weight history, weight
loss and maintenance expectancy, eating behaviors, and mood. Women with an early
onset of obesity had a significantly higher body mass index (BMI), waist circumference,
and highest attained adult body weight than women with a late onset of obesity. They had
attempted a significantly larger number of diets and had lost more weight on any single
diet. The groups also differed significantly on binge eating and overeating in response to
negative affect. There was a tendency for women with an early onset to have more
depressive and anxious symptoms. Postmenopausal women with an early onset of obesity
differed physiologically and psychologically from those with a late onset. Tailoring
dietary and behavioral interventions to profiles of postmenopausal women based on onset
of obesity may improve the overall efficacy of weight loss programs.

McCrory, M. A. (2000). Nutrition and the life cycle. The role of diet and exercise in postpartum
weight management. Nutrition Today, 35(5), 175-182.

This paper reviews the role of diet and exercise in postpartum weight management, citing
evidence from both observational and experimental studies in lactating and nonlactating
women. Issues regarding the safety of exercise during lactation will also be covered.
Finally, practical advice, including guidelines for weight loss in the postpartum period,
will be given. It should be noted that in this paper the terms "exercise" and "physical
activity" will be used interchangeably.

McDonald, P. W. (1995). A case for the treatment of obesity. Journal of the Canadian Dietetic
Association, 56(3), 131-136.

Although obesity increases the risk of some of the most prevalent diseases in the western
world, a growing number of practitioners have been led to believe that not only are
attempts to modify weight through exercise and dietary modifications doomed to failure,
but that repeated attempts to treat obesity may actually increase an individual's risk of
illness. This paper reviews the literature associated with most common arguments
espoused by critics of obesity treatment and demonstrates how these conclusions are
either invalid or premature. It is argued that given the clinical utility of professionally
monitored treatment programs and that even modest weight loss results in substantial net
 153

benefits to physical, psychological and social health, it would be unethical to withhold

treatment.

McElroy, S. L., Arnold, L. M., Shapira, N. A., Keck, P. E., Jr., Rosenthal, N. R., Karim, M. R.,
Kamin, M., and Hudson, J. I. (2003). Topiramate in the Treatment of Binge Eating Disorder
Associated With Obesity: A Randomized, Placebo-Controlled Trial. American Journal of
Psychiatry, 160(2), 255-261.

Binge eating disorder is associated with obesity. Topiramate is an antiepileptic agent

associated with weight loss. The objective of this study was to evaluate topiramate in the
treatment of binge eating disorder associated with obesity.

McGarvey, E., Keller, A., Forrester, M., Williams, E., Seward, D., and Suttle, D. E. (2004).
Feasibility and benefits of a parent-focused preschool child obesity intervention. American
Journal of Public Health, 94(9), 1490-1495.

This field study tested the feasibility and benefits of a program to promote 6 targeted
parental behaviors to prevent obesity in children served by the Special Supplemental
Nutrition Program for Women, Infants, and Children (WIC).

McInnis, K. J. (2003). Diet, exercise, and the challenge of combating obesity in primary care.
Journal of Cardiovascular Nursing, 18(2), 93-102.

Obesity has reached epidemic proportions in the United States and in most industrialized
nations. More than 60% of US adults are now overweight or obese, predisposing over 97
million Americans to a host of chronic lifestyle diseases, particularly cardiovascular
disease. Despite the existence of explicit evidence-based consensus reports on the health
risks of obesity and the health benefits of even moderate amounts of weight loss, many
patients do not receive advice from their health care providers to lose weight or on how to
do so effectively. Even modest physical activity and small incremental healthy dietary
changes when incorporated into one's lifestyle have a positive effect on weight loss and
promote the maintenance of favorable body weight and body composition changes with
advancing age. This article describes elements of effective counseling and practical
guidelines for developing a healthy lifestyle approach for overweight and obese
individuals.

McInnis, K. J., Franklin, B. A., and Rippe, J. M. (2003). Counseling for physical activity in
overweight and obese patients. American Family Physician, 67(6), 1249-1256, 1266-1288, 1180-
1181.

Obesity has reached epidemic proportions in the United States. More than 60 percent of
U.S. adults are now overweight or obese (defined as at least 30 lb [13.6 kg] overweight),
predisposing more than 97 million Americans to a host of chronic diseases and
conditions. Physical activity has a positive effect on weight loss, total body fat, and body
fat distribution, as well as maintenance of favorable body weight and change in body
composition. Many of the protective aspects of exercise and activity appear to occur in
 154

overweight persons who gain fitness but remain overweight. Despite the well-known
health and quality-of-life benefits of regular physical activity, few Americans are
routinely active.

McKenna, J., and York, Z. (2004). Support from primary care for losing weight: The role of
patient intentionality. Journal of Sports Sciences, 22(3).

Weight gain creates a strong medical concern and is a biomarker for differential medical
treatment. The long-term success of this treatment hinges on sustaining changes in diet
and physical activity, and how health professionals approach patients is seen as important
in achieving these effects. In contrast, the model of intentionality of medical
consultations (IMC) shows that patients have different approaches towards these
meetings. The IMC model has three main features: (1) intentionality of symptoms, which
support how individuals present themselves and their condition (IS); (2) reflections on
those symptoms (RS); and (3) intentionality within the communicative act (ICA). These
issues are rarely considered within exercise and health sciences, yet they are central to
delivering a patient-centred service, which is a hallmark of quality in contemporary
public health. In this study, ethically approved by the North West Devon Health Trust,
we explored IMC in overweight volunteers.

McLean, N., Griffin, S., Toney, K., and Hardeman, W. (2003). Family involvement in weight
control, weight maintenance and weight-loss interventions: a systematic review of randomised
trials. International Journal of Obesity and Related Metabolism Disorders, 27(9), 987-1005.

To conduct a descriptive systematic review into the nature and effectiveness of family
involvement in weight control, weight maintenance and weight-loss interventions.

McLennan, J. (2004). Clinical practice. Obesity in children: tackling a growing problem.

Australian Family Physician, 33, 33-36.

Childhood and adolescent obesity has increased dramatically over the past 25 years in
Australia. Currently over 20% of Australian children are overweight or obese. The
National Health and Medical Research Council has recently developed the 'Clinical
practice guidelines for the management of overweight and obesity in children and
adolescents'. This article discusses the assessment and management of childhood and
adolescent overweight and obesity.

McMahan, S., Hampl, J., and Chikamoto, Y. (2003). A "fat" tax: knowledge and attitudes of
snack food taxing among college students. American Journal of Health Education, 34(6), 329-
336.

The economic cost for the United States from heart disease, diabetes, and cancer is
estimated at $71 billion annually. Along with this trend, the prevalence of obesity in the
United States has reached epidemic proportions. To date, all interventions related to the
prevention and treatment of obesity have failed. We must find anew way to prevent this
epidemic from spreading. How then can we best encourage people to make lower fat,
 155

more appropriate food choices? What if a tax was applied to unhealthy, fat-laden foods?
Among those most affected by such a policy are college-age students.

McMurray, R. G., Ainsworth, B. E., Harrell, J. S., Griggs, T. R., and Williams, O. D. (1998). Is
physical activity or aerobic power more influential on reducing cardiovascular disease risk
factors? Medicine and Science in Sports and Exercise, 30(10), 1521-1529.

This study determined the relationship between aerobic power (VO2max), physical
activity (PA), and cardiovascular disease (CVD) risk factors. The study also determined
how increased VO2max and increased PA levels influence CVD risk factors of 576 low-
fit adults (VO2max less than 30 mL.kg-1.min-1).

McQuade, R. D., Stock, E., Marcus, R., Jody, D., Gharbia, N. A., Vanveggel, S., Archibald, D.,
and Carson, W. H. (2004). A comparison of weight change during treatment with olanzapine or
aripiprazole: results from a randomized, double-blind study. Journal of Clinical Psychiatry, 65
Suppl 18, 47-56.

Weight gain is a side effect of therapy with many atypical antipsychotics and may have
important clinical repercussions with respect to long-term health and treatment
compliance. The primary objective of this double-blind study was to compare the safety
and tolerability of aripiprazole and olanzapine in patients with schizophrenia as
evidenced by the percentage of patients exhibiting significant weight gain.

McTigue, K. M., Harris, R., Hemphill, B., Lux, L., Sutton, S., Bunton, A. J., and Lohr, K. N.
(2003). Screening and interventions for obesity in adults: Summary of the evidence for the U.S.
Preventive Services Task Force. Annals of Internal Medicine, 139(11), 933-949.

Obesity poses a considerable and growing health burden. This review examines evidence
for screening and treating obesity in adults.

Melanson, K. J. (2004). Food intake regulation in body weight management: a primer. Nutrition
Today, 39(5), 203-215.

Food intake regulation involves a complex integration of hormonal, neuronal,

physiologic, and metabolic controls. In humans, such regulation is especially complex
because many nonphysiologic factors may also influence it, and the environment may
promote overeating.

Melanson, K. J., Dell'Olio, J., Carpenter, M. R., and Angelopoulos, T. J. (2004). Changes in
multiple health outcomes at 12 and 24 weeks resulting from 12 weeks of exercise counseling
with or without dietary counseling in obese adults. Nutrition, 20(10), 849-856.

We compared health outcomes in obese adults who underwent 12 wk of exercise

counseling with or without dietary counseling, followed by 12 wk of observational
monitoring.
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Mendlein, J. M., Baranowski, T., and Pratt, M. (2000). Physical activity and nutrition in children
and youth: Opportunities for performing assessments and conducting interventions. Preventive
Medicine, 31(2,Pt.2), S150-S153.

The Physical Activity and Nutrition (PAN) in Children program is one of the first large-
scale efforts to focus on improving understanding of the roles of physical activity (PA)
and nutrition in the health and well-being of children. This effort is especially needed to
address the US nationwide epidemic of obesity that has emerged during the past 2
decades. The authors writing in this issue of Preventive Medicine have advanced the
PAN program's goals by cataloguing and describing state-of-the art tools for assessing
PA and nutrition, by reviewing intervention strategies among children and adolescents,
and by recommending applied research to address gaps in knowledge and practice.

Mensah, G. A., Goodman, R. A., Zaza, S., Moulton, A. D., Kocher, P. L., Dietz, W. H.,
Pechacek, T. F., and Marks, J. S. (2004). Law as a tool for preventing chronic diseases:
expanding the range of effective public health strategies. Prev Chronic Dis, 1(1), A13.

Law, which is a fundamental element of effective public health policy and practice,
played a crucial role in many of public health's greatest achievements of the 20th century.
Still, conceptual legal frameworks for the systematic application of law to chronic disease
prevention and control have not been fully recognized and used to address public health
needs. Development and implementation of legal frameworks could broaden the range of
effective public health strategies and provide valuable tools for the public health
workforce, especially for state and local health department program managers and state
and national policy makers. In an effort to expand the range of effective public health
interventions, the Centers for Disease Control and Prevention will work with its partners
to explore the development of systematic legal frameworks as a tool for preventing
chronic diseases and addressing the growing epidemic of obesity, heart disease, stroke,
and other chronic diseases and their risk factors.

Mensah, G. A., Mokdad, A. H., Ford, E., Narayan, V., Giles, W. H., Vinicor, F., and Deedwania,
P. C. (2004). Obesity, metabolic syndrome, and type 2 diabetes: emerging epidemics and their
cardiovascular implications. Cardiology Clinics, 22(4), 485-504.

As we enter the twenty-first century, the burden of chronic diseases, such as obesity, type
2 diabetes, and CVDs, is expected to increase dramatically. These diseases are a
consequence of several factors that include an aging population,changes in demographic
composition, and an excess of contemporary lifestyle. The prevention and control of
overweight, obesity, metabolic syndrome, and diabetes pose special challenges for
clinical and public heath practice as well as for basic, clinical, and population science
research. Copyright (2004 by Elsevier Science (USA).
 157

Mercer, S. L., Green, L. W., Rosenthal, A. C., Husten, C. G., Khan, L. K., and Dietz, W. H.
(2003). Possible lessons from the tobacco experience for obesity control. American Journal of
Clinical Nutrition, 77, 1073S-1082S.

Although obesity is increasing to epidemic proportions in many developed countries,

some of these same countries are reporting substantial reductions in tobacco use. Unlike
tobacco, food and physical activity are essential to life. Yet similar psychological, social,
and environmental factors as well as advertising pressures influence the usage patterns of
all 3. These similarities suggest that there may be commonalities between factors
involved in controlling obesity and tobacco.

Merrick, J., and Vardi, G. (2004). Handbook of preventive interventions for children and
adolescents. International Journal of Adolescent Medicine and Health, 16(3), 286-287.

Reviews the book Handbook of Preventive Interventions for Children and Adolescents
edited by L.A. Rapp-Paglicci, C.N. Dulmus, and J.S. Wodarski. This book's 20 chapters,
written by contributors from the fields of social work, public health, and psychology, are
divided into five parts: introduction, preventive intervention for emotional problems,
health problems, social problems, and conclusion. Morbidity in childhood and
adolescence has changed and the new disease pattern is dominated by obesity, diabetes,
teen pregnancy, substance abuse, school violence and child abuse. The editors have
chosen to use the primary prevention model in which the focus is on interventions to
prevent the onset of a disorder or problem.

Mertens, D. J., Kavanagh, T., Campbell, R. B., and Shephard, R. J. (1998). Exercise without
dietary restriction as a means to long-term fat loss in the obese cardiac patient. Journal of Sports
Medicine and Physical Fitness, 38(4), 310-316.

To examine the effects of a 12-month daily walking program without dietary restriction
on the metabolic rate, body composition and blood lipid profile of overweight and
moderately obese patients following myocardial infarction.

Metzger, B. L., Jarosz, P. A., and Noureddine, S. (2000). The effect of a high-fat diet and
exercise on the expression of genetic obesity. Western Journal of Nursing Research, 22(6), 736-
748.

In the United States, there are 300,000 obesity-related premature deaths each year.
Furthermore, no current obesity treatment program results in consistent weight
reductions. Obesity is thought to be caused by complex genetic-environmental
interactions. We studied the effect of two environmental factors, high-fat diet and non-
weight-bearing exercise, on obesity expression. Young adult, female, genetically obese
(fa/fa) rats (n = 52) and their lean (Fa/fa) littermates (n = 24) were studied using an
experimental 2 x 2 x 2 factorial design (diet type, genetics, and exercise). Repeated
measures ANOVA and secondarily stepwise regressions were used to analyze the data.
The authors discovered that the effect of appetite on obesity expression is more limited
 158

than expected, and there may be critical stages when obesity expression is amenable to
environmental modification.

Mezitis, S. G. E., and Aronne, L. J. (1997). Pharmacotherapy of obesity. Current Opinion in

Endocrinology and Diabetes, 4(6), 407-411, B121-B214.

Obesity is a major health problem affecting more than one third of adult Americans. It is
increasing in prevalence and is associated with many comorbid conditions including
cardiovascular disease, certain forms of cancer, diabetes mellitus, degenerative disease of
the weight-bearing joints, and sleep apnea. Our improved understanding of the molecular
mechanisms underlying obesity has encouraged the use of currently available antiobesity
drugs, even though the long-term safety and efficacy of these drugs have not been
completely examined.

Mikkelsen, P. B., Toubro, S., and Astrup, A. (2000). Effect of fat-reduced diets on 24-h energy
expenditure: comparisons between animal protein, vegetable protein, and carbohydrate.
American Journal of Clinical Nutrition, 72(5), 1135-1141.

Single-meal tests have shown that protein has greater thermogenic and satiating effects
than does carbohydrate, which may be relevant for the prevention and treatment of
obesity if these effects can be maintained over 24 h. The effects of pork-meat protein, soy
protein, and carbohydrate on 24-h energy expenditure were compared.

Miller, E. C., and Maropis, C. G. (1998). Nutrition and diet-related problems. Primary Care:
Clinics in Office Practice, 25(1), 193-210.

Adolescence is a period of remarkable change. Nutrient requirements increase to promote

physical growth and development and adolescents begin to make lifelong diet choices.
These choices are often influenced by family, peers, and individual nutrition beliefs. This
article addresses typical problems and recommendations for normal adolescent nutrition
as well as nutrient needs for special conditions such as obesity, athletics, and
vegetarianism.

Miller, J., Gold, M. S., and Silverstein, J. (2003). Pediatric overeating and obesity: An epidemic.
Psychiatric Annals, 33(2), 94-99.

Pediatric obesity has become a problem of epidemic proportions. Factors affecting the
childhood and adolescent obesity epidemic include social and cultural changes involving
food intake, decreased exercise, and family history of obesity. Obesity that starts in
childhood has many physical and psychiatric morbidities. Prevention and treatment of
obesity, like the treatment of addiction, requires changes in daily lifestyle and in diet and
exercise. (PsycINFO Database Record (c) 2004 APA, all rights reserved)

Miller, W. C. (2001). Effective Diet and Exercise Treatments for Overweight and
Recommendations for Intervention. Sports Medicine, 31(10), 717-724.
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Traditional diet and exercise treatments for obesity have been ineffective in reducing the
prevalence of overweight in the population. Treatment outcomes for overweight can be
measured in terms of physical parameters (e.g. bodyweight, percentage body fat, body
mass index), medical terms (e.g. blood pressure, blood glucose control, blood lipid
levels), psychological terms (e.g. eating pathology, self-esteem, mood state) and
behavioural terms (e.g. frequency of exercise, eating patterns, self healthcare).

Miller, W. C., and Jacob, A. V. (2001). The health at any size paradigm for obesity treatment:
the scientific evidence. Obesity Reviews, 2(1), 37-46.

Traditional weight loss (TWL) treatments have been unsuccessful at reducing the
prevalence of obesity in the population. Health-care professionals and consumers have
criticized TWL treatments as being detrimental to the obese persons health.
Consequently, an alternative approach to obesity treatment, the health at any size
(H@AS) paradigm, has been proposed. The HAS paradigm is based on the philosophy
that once diet restrictions and barriers to activity have been removed, the individual will
develop healthier eating and activity patterns that lead to a naturally healthy body weight.
This paper reviews the philosophical foundation and the scientific data that support and
oppose the H@AS paradigm and compares it with that of TWL treatments.

Miller, Y. D., and Dunstan, D. W. (2004). The effectiveness of physical activity interventions for
the treatment of overweight and obesity and type 2 diabetes. Journal of Science and Medicine in
Sport, 7(1), 52-59.

This review summarises current evidence relating to the effectiveness of physical activity
(PA) interventions for treating overweight and obesity and type 2 diabetes. Interventions
to increase PA for the treatment of overweight and obesity in both children and adults
have primarily consisted of health education and behaviour modification strategies in
clinical settings or with selected families or individuals. Although evidence is limited,
strategies to reduce sedentary behaviours appear to have potential for reducing obesity
among children and adolescents.

Mishra, L. C., and Singh, B. B. (2000). Scientific basis for therapeutic uses of guggul
(Commiphora mukul). Topics in Clinical Chiropractic, 7(2), 51-56, 68-70.

Commiphora mukul (CM), popularly known as guggul, has been used in the Ayurvedic
System of Medicine as an active ingredient in dietary supplements for the management of
musculoskeletal disorders, obesity, skin diseases, serious wounds, and inflammation for
thousands of years. Uses and the scientific basis of guggul are provided.
 160

Misigoj-Durakovic, M., Durakovic, Z., Ruzic, L., and Findak, V. (2004). Gender differences in
cardiovascular diseases risk for physical education teachers. Coll Antropol, 28 Suppl 2, 251-7.

The aim of the study was to evaluate the level of habitual physical activity in Croatian
physical education (PE) teachers, as well as the existence of some other risk factors for
the development of cardiovascular diseases (CVD).

Mitka, M. (2003). Economist takes aim at "big fat" US lifestyle. JAMA: Journal of the American
Medical Association, 289(1), 33-35.

An economist at the University of Chicago believes that society must find economic
ways of preventing obesity. He believes the low cost of food and the sedentary nature of
most jobs causes obesity. Taxes on food would make it more expensive but would affect
mostly poor people. Tax credits or subsidies for engaging in physical activity may be
more effective.

Miura, K., and Nakagawa, H. (2005). Can dietary changes reduce blood pressure in the long
term? Curr Opin Nephrol Hypertens, 14(3), 253-7.

Recent dietary guidelines for the prevention and treatment of hypertension emphasized a
healthy eating pattern called the Dietary Approaches to Stop Hypertension (DASH) diet,
in addition to avoidance of obesity, high salt intake, and excessive alcohol intake. Our
new challenge is to examine the long-term efficacy and effectiveness of dietary change,
including the DASH diet, on blood pressure in the general population, or in a high-risk
population.

Mo suwan, L., Pongprapai, S., Junjana, C., and Puetpaiboon, A. (1998). Effects of a controlled
trial of a school-based exercise program on the obesity indexes of preschool children. American
Journal of Clinical Nutrition, 68(5), 1006-1011.

Exercise has been found to be effective for prevention of weight gain and maintenance of
a stable weight in adults. The objective of this study was to evaluate the effect of a
school-based aerobic exercise program on the obesity indexes of preschool children.
Subjects were 292 second-year elementary school pupils from 2 kindergartens in Hat Yai
municipality, Songkhla province, southern Thailand.

Moag Stahlberg, A. (2004). Action for Healthy Kids: focus on state teams: current initiatives for
sound nutrition and physical activity programs in schools. Topics in Clinical Nutrition, 19(1), 41-
44.

Nutrition professionals face a growing challenge: severe overweight and obesity among
children and adolescents. The problems of overweight, sedentary lifestyles, and
undernourishment in youth are entrenched in American culture. These problems make it
vital for nutrition professionals to work in partnership with a multidisciplined team to
find solutions and reverse this trend. They can join representatives from education,
physical activity, and health who are working for change through Action for Healthy
 161

Kids (AFHK), which has mobilized 51 state teams to initiate and sustain action at the
state, school district, and building levels.

Mobley, C. C. (2004). Lifestyle interventions for "diabesity": the state of the science. Compend
Contin Educ Dent, 25(3), 207-8, 211-2, 214-8; quiz 220.

Lifestyle is an expression of individual choices and their interaction with the environment
and is closely associated with risks for obesity, diabetes, and cardiovascular disorders. If
taken cumulatively this syndrome may be referred to as "diabesity." The escalating
prevalence of obesity among both children and adults is one modifiable dominant risk
factor in this triad.

Montague, M. C., and Broadnax, P. A. (2004). Health consequences of excess weight and
obesity. Journal of National Black Nurses' Association, 15(1), 24-31.

Excess weight and obesity are major public health challenges in this country. Over 97
million adults are overweight or obese and it is rapidly reaching epidemic proportions
among younger individuals.

Monteiro, C. A., Moura, E. C., Conde, W. L., and Popkin, B. M. (2004). Socioeconomic status
and obesity in adult populations of developing countries: a review. Bulletin of the World Health
Organization, 82(12), 940-946.

A landmark review of studies published prior to 1989 on socioeconomic status (SES) and
obesity supported the view that obesity in the developing world would be essentially a
disease of the socioeconomic elite. The present review, on studies conducted in adult
populations from developing countries, published between 1989 and 2003, shows a
different scenario for the relationship between SES and obesity. Although more studies
are necessary to clarify the exact nature of this relationship, particularly among men,
three main conclusions emerge from the studies reviewed: 1. Obesity in the developing
world can no longer be considered solely a disease of groups with higher SES. 2. The
burden of obesity in each developing country tends to shift towards the groups with lower
SES as the country's gross national product (GNP) increases. 3. The shift of obesity
towards women with low SES apparently occurs at an earlier stage of economic
development than it does for men.

Montgomery, C., Reilly, J. J., Jackson, D. M., Kelly, L. A., Slater, C., Paton, J. Y., and Grant, S.
(2004). Relation between physical activity and energy expenditure in a representative sample of
young children. American Journal of Clinical Nutrition, 80(3), 591-596.

Strategies for the prevention and treatment of childhood obesity require a better
understanding of the relation between the pattern of free-living physical activity and total
energy expenditure (TEE).

Montgomery, K. S. (2004). Nutrition column. New resource from the CDC to prevent obesity:
perinatal implications. Journal of Perinatal Education, 13(3), 58-60.
 162

Research has identified pregnancy as a trigger to obesity among women; therefore,

childbirth educators are encouraged to include the topic of weight gain in their classes.
The Centers for Disease Control and Prevention recently published a guide on obesity
that may serve as an excellent resource for both educators and their clients.

Morabia, A., and Costanza, M. C. (2004). Does walking 15 minutes per day keep the obesity
epidemic away? Simulation of the efficacy of a populationwide campaign. American Journal of
Public Health, 94(3), 437-440.

Small physical activity increases may prevent weight gain in most populations. Geneva
residents completed validated quantitative physical activity frequency questionnaires
from 1997 to 2001. Fifteen minutes per day of moderate or brisk walking, or 30 minutes
per day of slow walking, could increase physical activity at the population level;
however, if the specific goal is to approach expending 420 kJ/d (100 kcal/d) through
walking, the duration should be closer to 60 minutes for slow walking and 30 minutes for
moderate or brisk walking.

Moreno-Aliaga, M. J., Santos, J. L., Marti, A., and Martinez, J. A. (2005). Does weight loss
prognosis depend on genetic make-up? Obesity Reviews, 6(2), 155-68.

The prevalence of obesity is rising throughout the world. Indeed, obesity has reached
epidemic proportions in many developed and transition countries. Obesity is a complex
disease with multifactorial origin, which in many cases appears as a polygenic condition
affected by environmental factors. Treatment or prevention of obesity is necessary to
reverse or avoid the onset of type 2 diabetes and other obesity-related diseases. Weight
loss is a complex trait that depends on many environmental, behavioural and genetic
influences.

Morin, K. H., Stark, M. A., and Searing, K. (2004). Clinical issues. Obesity and nutrition in
women throughout adulthood. JOGNN: Journal Obstetric Gynecologic and Neonatal Nursing,
33(6), 823-832.

Nutritional challenges are particularly relevant to women. Almost 62% of women are
overweight; of these women, 33% are obese. The incidence of obesity is even greater in
non-Hispanic Black and Mexican American women. Women who are overweight or
obese experience a greater number of adverse health outcomes, including an increased
incidence of cardiovascular disease and breast and colon cancer. Dietary patterns
influence health outcomes, with a heart-healthy pattern having the most positive health
outcomes. Health care providers should encourage women to consume a diet high in
fruits and vegetables and low in total and saturated fats.

Morin, K. H., Stark, M. A., and Searing, K. (2004). Obesity and nutrition in women throughout
adulthood. JOGNN: Journal Obstetric Gynecologic and Neonatal Nursing, 33(6), 823-32.
 163

Nutritional challenges are particularly relevant to women. Almost 62% of women are
overweight; of these women, 33% are obese. The incidence of obesity is even greater in
non-Hispanic Black and Mexican American women. Women who are overweight or
obese experience a greater number of adverse health outcomes, including an increased
incidence of cardiovascular disease and breast and colon cancer. Dietary patterns
influence health outcomes, with a heart-healthy pattern having the most positive health
outcomes. Health care providers should encourage women to consume a diet high in
fruits and vegetables and low in total and saturated fats.

Morris, S. E., Lean, M. E. J., Hankey, C. R., and Hunter, C. (1999). Who gets what treatment for
obesity? a survey of GPs in Scotland. Eur j clin nutr. Basingstoke, S44-S48.

To describe the types and delivery of obesity treatment currently favoured by General
Practitioners (GPs) working in Scotland. Design: Representative cross-sectional survey
using a postal questionnaire which included case stories as stimuli for questions about the
GPs' nutrition guidance to overweight female patients.

Moyad, M. A. (2003). Complementary and preventive medicine. Lifestyle changes to prevent

BPH: heart healthy = prostate healthy. Urologic Nursing, 23(6), 439-441.

Benign prostatic hyperplasia (BPH) is one of the most prevalent conditions found in men,
and increases with age. Drug, surgical, and phytotherapy tend to dominate the medical
literature when discussing potential treatments for this condition. These treatments have
demonstrated remarkable effectiveness for the various degrees of BPH. However, the
potential for lifestyle changes to actually prevent this disease or reduce the severity of
this condition when used as an adjunct to conventional treatment is not only intriguing
but is strongly supported by past limited studies. More research is needed, but the time is
ripe to discuss with patients the potential lifestyle changes that could influence risk.
Obesity, a lack of physical activity, dyslipidemia, diabetes, hypertension, a heart
unhealthy diet, and other factors may significantly increase the risk of BPH. Patients
should be told that factors that increase the risk of cardiovascular disease seem to be
associated with an increased risk of BPH or a greater severity of BPH.

Moyad, M. A. (2003). Osteoporosis part III -- not just for bone loss: potential benefits of calcium
and vitamin D for overall general health. Urologic Nursing, 23(1), 69-74.

The potential benefits of dietary or supplemental calcium and vitamin D for osteoporosis
prevention have been well reviewed. However, less well known is the potential of these
two compounds to reduce the risk of recurrence of a number of overall general health
conditions. For example, calcium may play a role in increasing levels of high-density
lipoprotein, preventing colon polyp formation, reducing blood pressure in some
hypertensive individuals, reducing kidney stone recurrence, promoting weight loss, and
reducing the symptoms of premenstrual syndrome.
 164

Muller, M. J., Asbeck, I., Mast, M., Langnase, K., and Grund, A. (2001). Prevention of obesity--
more than an intention. Concept and first results of the Kiel Obesity Prevention Study (KOPS).
International Journal of Obesity and Related Metabolism Disorders, S66-S74.

Obesity prevention is necessary to address the steady rise in the prevalence of obesity.
Although all experts agree that obesity prevention has high priority there is almost no
research in this area. The effectiveness of different intervention strategies is not well
documented. There is also no structured framework for obesity prevention.

Muller, M. J., Mast, M., Asbeck, I., Langnase, K., and Grund, A. (2001). Prevention of obesity -
is it possible? Obesity Reviews, 2(1), 15-29.

Obesity prevention is necessary to address the steady rise in the prevalence of obesity.
Although all experts agree that obesity prevention has high priority there is almost no
research in this area. There is also no structured framework for obesity prevention. The
effectiveness of different intervention strategies is not well documented. Regarding
universal prevention little rigorous evaluation has been carried out in larger populations.
Obesity prevention has been integrated into community-wide programmes preventing
coronary heart disease.

Munro, R. (2002). A walk on the healthy side. Nursing Times, (NURS-TIMES) 2002 Oct 8-14;
98(41): 15. 98: 15

Driving children to school increases traffic congestion and hurts the health and fitness of
pupils. Walking and cycling are options that could curb obesity and heart disease, says
Robert Munro.

Murray, C. (2004). Ghrelin: hungry for more? Gastrointestinal Nursing, 2(5), 10-13.

Discovered only five years ago, the peptide ghrelin is secreted from the sotmach and,
among its other actions on the body, triggers eating through its effects on the brain. Dr
Charlie Murray examines whether this new peptide is the Holy Grail of anti-obesity
research.

Myers, S., and Vargas, Z. (2000). Parental perceptions of the preschool obese child. Pediatric
Nursing, 26(1), 23-30.

Childhood obesity is a serious public health problem today with many potential
complications and adverse outcomes for children. How parents view their children's
weight is an important consideration for nurses. The purpose of this study was to increase
staff understanding of parents' views so that interventions could be developed to achieve
improved outcomes in attenuating the rate of weight gain in obese children. A
questionnaire was administered to 200 parents, mostly Hispanic, of obese children to
determine the parents' perceptions of their child's obesity. The study revealed that 35% of
parents did not believe their obese child was overweight and 53% had no problem
controlling what their child eats.
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Nagao, T., Komine, Y., Soga, S., Meguro, S., Hase, T., Tanaka, Y., and Tokimitsu, I. (2005).
Ingestion of a tea rich in catechins leads to a reduction in body fat and malondialdehyde-
modified LDL in men. American Journal of Clinical Nutrition, 81(1), 122-9.

Catechins, the major component of green tea extract, have various physiologic effects.
There are few studies, however, on the effects of catechins on body fat reduction in
humans. It has been reported that the body mass index (BMI) correlates with the amount
of malondialdehyde and thiobarbituric acid-reactive substances in the blood. We
investigated the effect of catechins on body fat reduction and the relation between
oxidized LDL and body fat variables.

Nam, S. Y., Kim, K. R., Cha, B. S., Song, Y. D., Lim, S. K., Lee, H. C., and Huh, K. B. (2001).
Low-dose growth hormone treatment combined with diet restriction decreases insulin resistance
by reducing visceral fat and increasing muscle mass in obese type 2 diabetic patients.
International Journal of Obesity, 25(8), 1101-1107.

To evaluate the effects of low-dose growth hormone (GH) therapy combined with diet
restriction on changes in body composition and the consequent change in insulin
resistance in newly-diagnosed obese type 2 diabetic patients. .

Nawaz, H., Adams, M. L., and Katz, D. L. (1999). Public health briefs. Weight loss counseling
by health care providers. American Journal of Public Health, 89(5), 764-767.

This study explores the pattern of weight loss counseling by health care providers in
Connecticut and the associated weight loss efforts by patients.

Nawaz, H., and Katz, D. (2001). American College of Preventive Medicine practice policy
statement: Weight management counseling of overweight adults. American Journal of Preventive
Medicine, 21(1), 73-78.

On the basis of a review of the current literature and recommendations, the American
College of Preventive Medicine presents a practice policy statement on weight
management counseling of overweight adults. To briefly summarize the literature: there
is conclusive evidence that obesity is associated with increased morbidity and mortality
and imposes a substantial economic burden both at the individual and societal level.
Weight reduction, at least in the short term, has been shown in small prospective cohort
and randomized controlled trials to confer beneficial health effects. However, there is no
convincing evidence for the consistent effectiveness of any single, currently used weight-
loss method.
 166

Nemet, D., Barkan, S., Epstein, Y., Friedland, O., Kowen, G., and Eliakim, A. (2005). Short- and
long-term beneficial effects of a combined dietary-behavioral-physical activity intervention for
the treatment of childhood obesity. Pediatrics, 115(4), e443-9.

Obesity has become the most common pediatric chronic disease in the modern era. Early
prevention and treatment of childhood and adolescent obesity is mandated. Surprisingly,
however, only a minor fraction of obese children participate in weight reduction
interventions, and the longer-term effects of these weight-reduction interventions among
children have not been elucidated. To examine prospectively the short- and long-term
effects of a 3-month, combined dietary-behavioral-physical activity intervention on
anthropometric measures, body composition, dietary and leisure-time habits, fitness, and
lipid profiles among obese children.

Neumark Sztainer, D. (1996). School-based programs for preventing eating disturbances. Journal
of School Health, 66(2), 64-71.

This paper describes a framework for involving schools in primary and secondary
prevention of eating disturbances. The issues of why, what, who, and how are considered.
Research on the prevalence and consequences of obesity, anorexia and bulimia nervosa,
unhealthy dieting, and behaviors such as binge eating and purging indicates why
prevention is necessary. Research on the etiology of eating disturbances also provided a
basis for determining what factors need to be addressed. However, research has not
adequately addressed the question of who should be targeted for prevention and how the
topic of prevention should be approached.

Neumark Sztainer, D. (2003). Obesity and eating disorder prevention: an integrated approach?
Adolescent Medicine, 14(1), 159-173.

This article provides a rationale for interventions aimed at the prevention of eating
disorders and obesity, an overview of some of the questions and controversies currently
facing the fields of eating disorder and obesity prevention, and a discussion of the
potential for integrated prevention approaches that address the broad spectrum of weight-
related disorders. A rationale for utilizing an integrated approach, the challenges inherent
to developing such an approach, and suggestions for working toward integrated
approaches aimed at preventing the broad spectrum of weight-related disorders are
discussed.

Neumark Sztainer, D., Goeden, C., Story, M., and Wall, M. (2004). Associations between Body
Satisfaction and Physical Activity in Adolescents: Implications for Programs Aimed at
Preventing a Broad Spectrum of Weight-Related Disorders. Eating Disorders: The Journal of
Treatment and Prevention, 12(2), 125-137.

This study examined associations among body satisfaction and physical and sedentary
activities in 4, 746 adolescents. Boys with lower body satisfaction reported significantly
less physical activity and more TV viewing than boys with higher body satisfaction. In
girls, trends were similar, but associations were not statistically significant. Associations
 167

were similar among overweight youth. In no instances, were lower levels of body
satisfaction significantly associated with higher physical activity levels.

Neumark Sztainer, D., Martin, S. L., and Story, M. (2000). School-based programs for obesity
prevention: What do adolescents recommend? American Journal of Health Promotion, 14(4),
232-235.

Examined student recommendations for school-based obesity prevention programs. 203

adolescents in 7th-12th grades participated in gender-segregated focus groups discussing
development of a program comprising healthy eating, exercise, and weight control.
Recommendations comprised the areas of program activities, environment, leader
qualities, program structure, possible barriers, and situations to avoid.

Neumark Sztainer, D., Rock, C. L., Thornquist, M. D., Cheskin, L. J., Neuhouser, M. L., and
Barnett, M. J. (2000). Weight-control behaviors among adults and adolescents: associations with
dietary intake. Preventive Medicine, 30(5), 381-391.

This study aimed to assess the prevalence of weight-control behaviors and their
associations with overall dietary intake among adults and adolescents.

Neumark Sztainer, D., and Story, M. (1997). Recommendations from overweight youth
regarding school-based weight control programs. Journal of School Health, 67(10), 428-433.

This study aimed to obtain recommendations from overweight youth on the development
of school-based weight control programs; to determine their level of interest in
participation; and to learn about the outcomes they desired from such a program. Because
obesity is prevalent among youth of certain minority groups and low socioeconomic
backgrounds, and since few programs address the needs of these youth, the study
population was selected from inner city public schools with high percentages of youth
from minority groups and low socioeconomic backgrounds. Sixty-one overweight
adolescents participated in semi-structured, in-depth individual interviews, which were
audiotaped, transcribed, coded, and analyzed.

Neumark Sztainer, D., Story, M., Hannan, P. J., and Rex, J. (2003). New Moves: a school-based
obesity prevention program for adolescent girls. Preventive Medicine, 37(1), 41-51.

This study tests the feasibility of an innovative school-based program for obesity
prevention among adolescent girls. New Moves was implemented as a multicomponent,
girls-only, high-school physical education class.

Neumark Sztainer, D., Story, M., Hannan, P. J., Tharp, T., and Rex, J. (2003). Factors associated
with changes in physical activity: a cohort study of inactive adolescent girls. Archives of
Pediatrics and Adolescent Medicine, 157(8), 803-810.
 168

To identify factors associated with changes in physical activity in adolescent girls at risk
for sedentary lifestyles and obesity.

Neumark Sztainer, D., Story, M., and Harris, T. (1999). Beliefs and attitudes about obesity
among teachers and school health care providers working with adolescents. Journal of Nutrition
Education, 3-9.

The aim of the present study was to assess and describe obesity-related beliefs and
attitudes among school staff. Mailed surveys were completed by 115 science, health,
home economics, and physical education teachers, school nurses, and school social
workers from all junior and senior high schools (n = 17) within a large urban school
district (response rate = 66%).

Neumark Sztainer, D., Story, M., Resnick, M. D., and Blum, R. W. (1997). Psychosocial
concerns and weight control behaviors among overweight and nonoverweight Native American
adolescents. Journal of the American Dietetic Association, 598-604.

To compare the psychosocial and weight-related concerns and weight control, eating, and
exercise behaviors of overweight and nonoverweight Native American adolescents living
on or near reservations. A cross-sectional survey assessed psychosocial, health, and
weight-specific concerns; disordered eating; and health-promoting behaviors. The study
population included 11,868 Native American youth in grades 7 through 12.

Nicklas, B. J., Ambrosius, W., Messier, S. P., Miller, G. D., Penninx, B., Loeser, R. F., Palla, S.,
Bleecker, E., and Pahor, M. (2004). Diet-induced weight loss, exercise, and chronic
inflammation in older, obese adults: a randomized controlled clinical trial. American Journal of
Clinical Nutrition, 79(4), 544-551.

Persistent, low-grade inflammation is an independent predictor of several chronic

diseases and all-cause mortality. Objective: The intention of this study was to determine
the independent and combined effects of diet-induced weight loss and exercise on
markers of chronic inflammation.

Nicklas, T. A., Yang, S. J., Baranowski, T., Zakeri, I., and Berenson, G. (2003). Eating patterns
and obesity in children: The Bogalusa Heart Study. American Journal of Preventive Medicine,
25(1), 9-16.

Childhood obesity is a growing public health problem. This study examined the
association between eating patterns and overweight status in children who participated in
the Bogalusa Heart Study. A single 24-hour dietary recall was collected on a cross-
sectional sample of 1562 children aged 10 years (65% Euro-American [EA], 35%
African American [AA]) over a 21-year period.

Nies, M. A., Artinian, N. T., Schim, S. M., Vander Wal, J. S., and Sherrick Escamilla, S. (2004).
Health risk assessment in an urban Hispanic community. Clinical Nurse Specialist, 18(6), 302-
307.
 169

This study describes the health risks of urban Hispanic adults and compares the health
risks of persons who identified themselves as "not overweight" with those who identified
themselves as "overweight."

Nonas, C. A. (1998). A model for chronic care of obesity through dietary treatment. Journal of
the American Dietetic Association, S16-S22.

Obesity is rapidly increasing to epidemic proportions. At the same time, obesity is not
well accepted us a disease among health professionals or insurance companies. The
primary care physician is often forced to ignore the obesity and treat the associated risks,
and the dietitian is often compelled to treat the disease for only short periods and for little
reimbursement. Therefore, to treat obesity more effectively both clinically and
economically, it is necessary to create a health care team. This can be done by joining the
dietitian and the primary care physician, even if each health professional sees patients at a
different site.

Norton, D. E., Froelicher, E. S., Waters, C. M., and Carrieri Kohlman, V. (2003). Parental
influence on models of primary prevention of cardiovascular disease in children. European
Journal of Cardiovascular Nursing, 2(4), 311-322.

Lifestyle behaviors such as overeating and physical inactivity contribute significantly to

CVD, the leading cause of morbidity and mortality among adults globally. CVD risk
factors that begin in children often track into adulthood. Parents are believed to influence
the health behaviors of their children. To review the literature on parental influence on
children's health beliefs and behaviors, particularly eating and exercise behaviors as
indicators of CV health, school-based CVD risk reduction programs, and racial/ethnic,
gender and socioeconomic considerations for models of primary prevention of CVD in
children.

Nothwehr, F., and Stump, T. (2002). Weight control behaviors of low-income, African American
women. Health Promotion Practice, 3(2), 207-216.

Obesity is extremely common among African American women, and many women
express interest in losing weight. To better understand current weight management
practices in this population, this study measured behaviors and attitudes believed
important to successful weight management. Data were obtained via telephone survey.
The study involved 155 low-income African American women aged 30 to 69 identified
through an urban primary care clinic. Results were compared between those women
currently trying to lose weight (n = 80) and those who were not (n = 75). Those women
trying to lose weight were more likely to engage in goal setting and dieting strategies
categorized as planning and preparation, communication about diet, and cognitive
strategies. Among those currently trying to lose weight, considerable room for
improvement in the degree to which the women used the various strategies remained.
Public health communications and health care provider interactions may need to deliver a
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broader, stronger message about healthy and successful weight management for this
population.

Nowicki, E. M., Billington, C. J., Levine, A. S., Hoover, H., Must, A., and Naumova, E. (2003).
Overweight, obesity, and associated disease burden in the Veterans Affairs ambulatory care
population. Military Medicine, 168(3), 252-256.

This report describes the prevalence of overweight and obesity and estimates the disease
burden associated with excess weight in ambulatory Veterans Affairs (VA) patients.

Nupponen, R., and Laukkanen, R. (1998). How to develop a group curriculum: developing an
exercise programme for overweight adults. Patient Education and Counseling, 33, S77-S85.

This paper reports on work to develop introductory exercise courses for sedentary,
moderately overweight adults. The aim is to offer a safe and motivating programme of
physical exercise and, through experiential learning, to encourage and facilitate increased
physical activity. The core of the programme is a course of 10-20 weekly exercise
classes. The classes include a variety of physical exercises adapted to the special needs of
overweight adults (BMI 28-34 kg/m2) and a number of health-related fitness tests. We
outline the underlying principles of the exercise courses, their structure and contents, the
guidelines of instruction, and the use of formative evaluation. In addition, we report on
the implementation of five weight-reduction courses and six exercise courses involving a
total of 209 participants. A fairly high level of programme acceptability (in terms of
attendance rates and personal commitment) and programme feasibility (in terms of
acceptability, changes in personal orientation towards health and weight reduction, and
satisfaction among participants) was achieved. (c) 1998 Elsevier Science Ireland Ltd.

O'Donnell, M. (2004). Health-promotion behaviors that promote self-healing. Journal of

Alternative and Complementary Medicine, 10, S49-S60.

A large body of evidence has shown that health-promotion programs in smoking

cessation, stress management, fitness, nutrition, weight control, and medical self care
have been successful in helping people improve their health practices and related health
conditions. However, the impact of these programs on promoting self-healing among
people with acute and chronic diseases is mixed. The purpose of this paper is to identify
research opportunities important to fostering a better understanding of health promotion
behaviors that promote self healing. To provide context, the health-promotion concept is
discussed, as is the literature on workplace health-promotion programs provided to
overtly healthy people.

O'Meara, S., and Glenny, A. (1997). Practice. What are the best ways of tackling obesity?
Nursing Times, 93(22), 50-51.

A systematic review of the literature on the treatment and prevention of obesity carried
out by the NHS Centre for Reviews and Dissemination (CRD) demonstrates that the
prevalence of excess weight and obesity are on the increase. The review indicated that
 171

certain interventions in primary care can be effective, while surgery appears to be most
effective in severe obesity. It highlights limitations in the available research in the area.

O'Toole, M. L., Sawicki, M. A., and Artal, R. (2003). Structured diet and physical activity
prevent postpartum weight retention. Journal of Women's Health, 12(10), 991-998.

Postpregnancy weight retention contributes to the near-epidemic prevalence of obesity in

the United States. This study examines the impact of an individualized, structured diet
and physical activity intervention on weight loss in overweight women during the first
year postpartum.

Obarzanek, E., and Pratt, C. A. (2003). Girls health Enrichment Multi-site Studies (GEMS): New
approaches to obesity prevention among young African-American girls. Ethnicity and Disease,
13(Supplement 1), S1-5.

The Girls health Enrichment Multi-site Studies (GEMS) is an obesity prevention research
program sponsored by the National Heart, Lung, and Blood Institute (NHLBI), targeting
young African-American girls. Expert groups have suggested that the high prevalence of
obesity in African-American women could be a contributing factor to their excess
morbidity and mortality from cardiovascular disease compared to women from other
ethnic groups. To address the issue of obesity and its origins in African-American
women, the NHLBI Growth and Health Study (NGHS) was initiated to investigate
factors related to the development of obesity and associated cardiovascular disease risk
factors in a cohort of young African-American and White girls, aged 9 and 10 years.

Onis, M. d. (2004). The use of anthropometry in the prevention of childhood overweight and
obesity. SCN News, (29), 27-32.

This paper reviews concepts and proposes measures related to the use of anthropometry
for the early identification of excessive weight gain. Potential measures involve:
monitoring anthropometric indicators; monitoring the growth of all children up to 18
years of age; use of prescriptive reference data to interpret growth measurements; and
obesity prevention and early intervention.

Orbach, P., and Lowenthal, D. T. (1998). Evaluation and treatment of hypertension in active
individuals. Medicine and Science in Sports and Exercise, 30(10 Suppl), S354-S366.

Hypertension is a very common vascular disease. It is seen in adolescents, obese persons,

postmenopausal women, and the elderly. A nonpharmacologic approach to treatment is a
critical first step in management. The modalities include a diet low in salt and saturated
fat, exercise, less than 2 ounces of alcohol daily, and abstinence from smoking. Dynamic
(aerobic) exercise is effective in lowering blood pressure (BP) only if performed
regularly.
 172

Oshiro, C., Maskarinec, G., Petitpain, D., Hebshi, S., and Novotny, R. (2004). Soy intervention
in adolescent girls: design and implementation. Journal of Nutrition Education and Behavior,
36(4), 204-208.

The purpose of this study was to explore the feasibility of implementing a soy
intervention in female adolescents. Twenty girls, ages 8 to 14, were recruited to consume
1 daily serving of soymilk or soy nuts. They also provided 9 weekly urine samples over a
2-month period. Information about the study foods and procedures was collected through
post-study questionnaires. Adherence to the intervention was successful using strategies
that addressed both girls' and mothers' needs. The use of conveniently packaged soy
foods, activities to maintain motivation, and frequent contact maintained participation.

Ottley, C. (2003). Clinical practice. Health and fitness series -- 4. Getting children to develop a
healthy relationship with food: helping parents, empowering children. Journal of Family Health
Care, 13(4), 95-96.

The author, a dietitian, discusses the trend in the UK towards children developing
unhealthy relationships with food. This is manifested as overeating leading to overweight
or obesity, or a desire, even among younger children, to follow slimming diets that can
adversely affect growth and development. Rather than food restriction, a healthy
relationship with food involves young people being able to self-regulate their intake and
enjoy all the components of a balanced diet..

Ottley, C. (2004). What do we know about. childhood obesity? Journal of Family Health Care,
14(1), 8-10.

The incidence of obesity among children in the UK has been increasing since the 1980s
and is a "hot topic" among health professionals, Government, the media and some
parents. It is an emotive subject which often attracts instant opinions and hasty solutions.
To provide sound, balanced advice it is important that health professionals are aware of
current evidence about the prevention and management of obesity in children, and
differences between child and adult obesity. This article summarises the evidence and
offers some practical tips. It also considers child obesity in the context of the family.

Owens, S., Gutin, B., Allison, J., Riggs, S., Ferguson, M., Litaker, M., and Thompson, W.
(1999). Effect of physical training on total and visceral fat in obese children. Medicine and
Science in Sports and Exercise, 31(1), 143-148.

Children with high levels of total body fat mass (TFM) and visceral adipose tissue (VAT)
have elevated levels of certain risk factors for coronary artery disease and non-insulin-
dependent diabetes mellitus. We tested the hypothesis that controlled physical training,
without dietary intervention, would have a favorable impact on VAT and percent body fat
(%BF) in obese children.
 173

Padden, D. L. (2002). The role of the advanced practice nurse in the promotion of exercise and
physical activity. Topics in Advanced Practice Nursing, 2(1), 6.

The Surgeon General has reported that regular participation in moderate physical activity
is an essential component of a healthy lifestyle. Despite evidence of the benefits of
physical activity -- both physiological and psychological -- few Americans engage in
regular exercise. It is essential that all healthcare providers routinely assess and counsel
patients about the frequency, duration, type, and intensity of their physical activity.
Advanced practice nurses (APNs) can take an active role in meeting the nation's goals of
Healthy People 2010 to improve health, fitness, and quality of life through daily activity.
APNs can inspire patients to adopt positive attitudes about the value of physical activity
and exercise -- attitudes that will ultimately translate into health benefits across the life
span.

Paez, C. J., and Kravitz, L. (2002). Exercise Vs. Diet in Weight Loss. IDEA Personal Trainer,
13(3), 15-17.

According to the National Institutes of Health, National Heart, Lung and Blood Institute
(1998), 55 percent of the adult population in the United States are either obese or
overweight. Obesity substantially increases an individual's risk of suffering from chronic
diseases such as hyper-tension, coronary artery disease and diabetes. In an attempt to
define the role of exercise in the treatment and prevention of obesity, the American
College of Sports Medicine (ACSM) held a scientific roundtable. Following the meeting,
ACSM released several consensus statements regarding physical activity and public
health. Two statements are of particular interest to the applied exercise professional: 1.
The addition of exercise to a diet with restricted caloric intake promotes fat loss and helps
maintain fat-free mass. 2. Physical activity, without caloric restriction, minimally affects
fat loss, if at all. However, other research on exercise as a weight loss method suggests
that the latter ACSM statement was based upon studies that do not effectively compare
caloric-restriction programs to increased energy-expenditure programs.

Papamandjaris, A. A., MacDougall, D. E., and Jones, P. J. H. (1998). Medium chain fatty acid
metabolism and energy expenditure: obesity treatment implications. Life Sciences, 62(14), 1203-
1215.

This review examines medium chain fatty acid (MCFA) intermediary metabolism and the
effects of MCFA on thermogenesis and total energy expenditure.

Parizkova, J., and Chin, M. K. (2003). Obesity prevention and health promotion during early
periods of growth and development. Journal of Exercise Science and Fitness, 1(1), 1-14.

The achievement of positive health, a status of full physical, mental and social well-
being, is assumed to be the right of each individual, beginning as early as the prenatal
period. The prevalence of obesity has become a global epidemic not only in the adult
population, but also in children and adolescents. Potential environmental strategies and
 174

modified lifestyle, including balanced diet and physical activity, since the very beginning
of life are considered to have an important impact on obesity prevention. It was shown
that even the recommended dietary allowances of World Health Organizations for first
three years of life are higher by 10-15 % than required. This implication applied
especially to children and adolescents who reported spontaneously high levels of physical
activity during the period of development followed by, positive energy balance which
lead to an increased accumulation of fat.

Paschal, A. M., Lewis, R. K., Martin, A., Dennis Shipp, D., and Simpson, D. S. (2004). Baseline
Assessment of the Health Status and Health Behaviors of African Americans Participating in the
Activities-for-Life Program: A Community-Based Health Intervention Program. Journal of
Community Health: The Publication for Health Promotion and Disease Prevention, 29(4), 305-
318.

Obesity is a serious problem in the United States and is associated with hypertension,
diabetes, and other health problems. There is a higher prevalence of being overweight
among African American adults than among their Caucasian counterparts. The objective
of this study was to assess baseline health behaviors and health status (hypertension, body
mass indices, cholesterol and blood sugar levels) of African Americans participating in a
community-based health education and physical fitness program.

Patel, A. V., Rodriguez, C., Bernstein, L., Chao, A., Thun, M. J., and Calle, E. E. (2005).
Obesity, recreational physical activity, and risk of pancreatic cancer in a large U.S. Cohort.
Cancer Epidemiol Biomarkers Prev, 14(2), 459-66.

Obesity and physical activity, in part through their effects on insulin sensitivity, may be
modifiable risk factors for pancreatic cancer.

Patel, D. (2005). Super-Sized Kids: Using the Law to Combat Morbid Obesity in Children.
Family Court Review, 43(1), 164-177.

Morbid obesity is an unfortunate problem that is only becoming worse everyday. The
alarming aspect of it is that it is affecting people at a much earlier age; thus, young
children are becoming morbidly obese and are experiencing the same health problems as
middle-aged adults.

Pawloski, L. R., and Davidson, M. R. (2003). Physical activity and body composition analysis of
female baccalaureate nursing students. Nurse Education in Practice, 3(3), 155-162.

Although nursing students are educated about the importance of healthy diets and the
benefits of exercise, many do not engage in health promotion behaviors. This study
longitudinally examined specific indicators of obesity among a group of female nursing
students who incorporated an exercise program into their normal weekly routine.
Indicators for obesity were identified using anthropometric data that included weight,
body mass index (BMI), and percentage of body fat. Blood pressure, pulse data, and a
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physical activity level assessment were performed at the beginning and at the conclusion
of the study period.

Peach, H. G. (2002). Obesity, smoking and hazardous drinking among men admitted to the
surgical wards of a regional hospital. Australian Journal of Rural Health, 10(6), 273-277.

The purpose of the study was to determine the prevalence of obesity, smoking and
hazardous drinking, and identify opportunities for their reduction, among men admitted
to the surgical wards of a regional hospital.

Pearce, L. C. (2003). Metabolic syndrome & obesity: co-epidemics could overwhelm home
health care. Caring, 22(6), 24-26, 28, 30.

Our nation's battle with the bulge has contributed to the current co-epidemics of obesity
and metabolic syndrome. The US Surgeon General's office reports that these disease risks
may soon cause as much disease and death as cigarette smoking (HHS, 2001). In the
United States, one in four adults has metabolic syndrome, which includes about 15
million persons with type 2 diabetes (Ford, 2002).

Pearson, D. (2003). Continuing professional development: weight management. Primary Health

Care, 13(10), 43-50.

Obesity has a major impact on individual health and wellbeing. This article describes
how nurses can assist patients in weight management.

Pearson, D. (2003). Tackling obesity in the community. Journal of Community Nursing, 17(6),
19-20, 22.

Dympna Pearson outlines the health benefits of reducing levels of obesity in the general
population.

Peate, I. (2005). Male obesity: a gender-specific approach to nurse management. British Journal
of Nursing, 14(3), 134-8.

Android or male obesity is increasing. With greater understanding of the causes,

development and outcomes of being obese and overweight, the nurse can begin to help
men by using a gender-specific approach towards challenging this increasing global
epidemic. This article provides a definition of overweight and obesity using the World
Health Organization classification. The prevalence of obesity among men in the UK is
outlined, and inequalities are highlighted and discussed. Some men from certain social,
economic and ethnic groups are predisposed to developing obesity or becoming
overweight. The human and financial implications of obesity and overweight are
described and the healthy outcomes associated with the disease are discussed.
 176

Peltonen, M., Lindroos, A. K., and Torgerson, J. S. (2003). Musculoskeletal pain in the obese: A
comparison with a general population and long-term changes after conventional and surgical
obesity treatment. Pain, 104(3), 549-557.

Obesity is associated with musculoskeletal pain and osteoarthritis. This study compares
the prevalence of work-restricting musculoskeletal pain in an obese and a general
population and investigates changes in the incidence of and recovery from
musculoskeletal pain after bariatric surgery or conventional obesity treatment. A random
sample of 1135 subjects from a general population was compared with 6328 obese
subjects in the Swedish obese subjects (SOS) study.

Pennington, J. A. T., Obarzanek, E., Silsbee, L. M., Harris, T., Starke Reed, P. E., Kusek, J.,
Kurinij, N., and Garfield, S. A. (2000). Clinical trials. Update: diet-related trials and
observational studies supported by the National Institutes of Health. Nutrition Today, 35(4), 158-
160.

The following are brief descriptions of current or recently completed NIH trials that
include nutrition-related measures of various population groups.

Pereira, M. A., Swain, J., Goldfine, A. B., Rifai, N., and Ludwig, D. S. (2004). Effects of a Low-
Glycemic Load Diet on Resting Energy Expenditure and Heart Disease Risk Factors During
Weight Loss. JAMA: Journal of the American Medical Association, 292(20), 2482-2490.

Weight loss elicits physiological adaptations relating to energy intake and expenditure
that antagonize ongoing weight loss. To test whether dietary composition affects the
physiological adaptations to weight loss, as assessed by resting energy expenditure.

Perna, F., Bryner, R., Donley, D., Kolar, M., Hornsby, G., Sauers, J., Ullrich, I., and Yeater, R.
(1999). Effect of diet and exercise on quality of life and fitness parameters among obese
individuals. Journal of Exercise Physiology, 2(2).

Use of very-low-calorie-diets (VLCD) for treatment of obesity has been adversely related
to quality of life (QOL). Because exercise is known to alter mood and self-beliefs in a
positive direction, it may offset the negative impact of dieting. The present investigation
evaluated the physical and QOL effects of a 12-week VLCD and exercise program.

Perri, M. G. (1998). The maintenance of treatment effects in the long-term management of

obesity. Clinical Psychology: Science and Practice, 5(4), 526-543.

Reviews the efficacy of strategies designed to improve the maintenance of treatment

effects in the long-term management of obesity. Included are the results from controlled
trials that evaluated strategies such as extended therapy, relapse prevention training,
monetary incentives, food provision, and peer support as well as the use of very-low-
calorie diets and pharmacotherapy. Improved maintenance of weight loss was observed in
behavior therapy extended beyond 6 months and in long-term pharmacotherapy
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(dexfenfluramine or the combination of fenfluramine plus phentermine) used in

conjunction with behavior therapy or dietary counseling.

Perri, M. G., Nezu, A. M., McKelvey, W. F., Shermer, R. L., Renjilian, D. A., and Viegener, B.
J. (2001). Relapse prevention training and problem-solving therapy in the long-term management
of obesity. Journal of Consulting and Clinical Psychology, 69(4), 722-726.

This study compared 2 extended therapy programs for weight management with standard
behavioral treatment (BT) without additional therapy contacts.

Perrin, E. M., Flower, K. B., Garrett, J., and Ammerman, A. S. (2005). Preventing and Treating
Obesity: Pediatricians' Self-Efficacy, Barriers, Resources, and Advocacy. Ambul Pediatr, 5(3),
150-156.

With respect to obesity prevention and treatment, to determine pediatricians' 1) treatment

self-efficacy; 2) perceived barriers and relationships to management self-efficacy; 3)
desired resources; and 4) willingness to be involved in advocacy.

Pescatello, L. S., Volpe, S. L., and Clark, N. (2004). Which is more effective for maintaining a
healthy body weight: diet or exercise? ACSM's Health and Fitness Journal, 8(5), 35-37.

As a nation, America continues to get heavier. While both diet and exercise are important
strategies for maintaining a health body weight, the authors address the debate over
which strategy is more important.

Peters, J. C. (2004). Social change and obesity prevention: where do we begin? Nutrition Today,
39(3), 112-117.

Obesity in the United States has reached epidemic proportions in both adults and
children. Multi-factorial causes are responsible, including social, economic, and other
environmental forces acting on a susceptible genetic heritage. Halting and reversing the
epidemic will require multi-factorial solutions, including implementing cognitive coping
strategies and mounting an effective social change movement.

Peterson, J. A. (2003). 10 constructive ways to help fight the obesity epidemic in America.
ACSM's Health and Fitness Journal, 7(6), 1.

Describes ways in which obesity in the United States can be prevented such as
encouraging people to be physically active, change public attitudes concerning exercise
and encourage support of physical education in the school system.

Petty, R. G. (2004). Obesity, diabetes, and hyperlipidemia: exploring the link to antipsychotic
medications. includes discussion. Advanced Studies in Nursing, 2(3), 81-92, 123-125.

The rates of overweight and obesity in the general population are of epidemic
proportions. Only 39% of the US population is deemed to have a normal weight. An
 178

association between obesity and an array of illnesses is extremely well recognized.

Featured prominently among these illnesses are the metabolic or insulin resistance
syndrome and type 2 diabetes. People with major mental illness are at an increased risk
for physical ill health and premature mortality.

Pietrobelli, A. (2004). Outcome measurements in paediatric obesity prevention trials.

International Journal of Obesity, 28(Supplement 3), S86-S89.

OObesity in children impacts on their health in both the short and long term. Having an
accurate and precise body composition assessment, it may be possible to control growth
process and predict adult status in order to reduce the risk factors for various diseases.

Pimentel, D., and Pimentel, M. (2003). Sustainability of meat-based and plant-based diets and
the environment. Fourth International Congress on Vegetarian Nutrition: proceedings of a
symposium held in Loma Linda, CA, April 8-11, 2002. American Journal of Clinical Nutrition,
78(3S), 660S-663S.

Worldwide, an estimated 2 billion people live primarily on a meat-based diet, while an

estimated 4 billion live primarily on a plant-based diet. The US food production system
uses about 50% of the total US land area, 80% of the fresh water, and 17% of the fossil
energy used in the country. The heavy dependence on fossil energy suggests that the US
food system, whether meat-based or plant-based, is not sustainable. The use of land and
energy resources devoted to an average meat-based diet compared with a
lactoovovegetarian (plant-based) diet is analyzed in this report. In both diets, the daily
quantity of calories consumed are kept constant at about 3533 kcal per person. The meat-
based food system requires more energy, land, and water resources than the
lactoovovegetarian diet.

Pinkowish, M. D. (1998). Obesity -- a chronic disease. Patient Care for the Nurse Practitioner,
1(8), 33-43.

Extra body weight is a risk factor for diabetes, cancer, and heart disease among other
conditions, and obesity itself is now considered a chronic disease. Help your patients
make the most of their hard-fought battles to lose weight and keep it off.

Plaza, C. I. (2004). State policy watch. States' public health initiatives address nutrition, obesity,
and physical education. Healthcare Financial Management, 58(9), 16, 18.

Over the past three years, the media, food and beverage industry, public health advocates,
and federal and state policymakers have devoted significant attention to the growing
American obesity epidemic.

Ponto, M. (1995). The relationship between obesity, dieting and eating disorders. Professional
Nurse, 10(7), 422-425.
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Western society seems preoccupied with weight and dieting. The issues surrounding
obesity and eating disorders are examined and the question is raised whether knowledge
of psychology can help when dealing with clients with obesity or anorexia. Current
thinking on behavioral programmes for such clients is also explored.

Popkin, B. M. (2001). Nutrition in transition: the changing global nutrition challenge. Asia
Pacific Journal of Clinical Nutrition, 10 Suppl, S13-8.

The rapid shift in the stage of nutrition towards a pattern of degenerative disease is
accelerating in the developing world. Data from China, as shown by the China Health and
Nutrition Survey, between 1989 and 1993, are illustrative of these shifts. For example, an
increase from 22.8 to 66.6% in the proportion of adults consuming a higher-fat diet, rapid
shifts in the structure of diet as income changes, and important price relationships are
examples that are presented. There appears to reflect a basic shift in eating preferences,
induced mainly by shifts in income, prices and food availability, but also by the modern
food industry and the mass media.

Poston, W. S. C., II, Foreyt, J. P., Borrell, L., and Haddock, C. K. (1998). Challenges in obesity
management. Southern Medical Journal, 91(8), 710-720.

Current and emerging therapies and outcome data from a large clinical practice are
reviewed, and the challenges for physicians and researchers involved in obesity treatment
are discussed. It is concluded that therapies that combine psychosocial interventions,
drugs and extended maintenance appear to have the most promising long-term benefits.
Broader definitions of treatment outcome and success, including improvements in
comorbid conditions, physical activity and quality of life are needed.

Poston, W. S. C., II, Haddock, C. K., Olvera, N. E., Suminski, R. R., Reeves, R. S., Dunn, J. K.,
Hanis, C. L., and Foreyt, J. P. (2001). Evaluation of culturally appropriate intervention to
increase physical activity. American Journal of Health Behavior, 25(4), 396-406.

To evaluate a culturally appropriate intervention to increase activity in overweight

Mexican American women.

Poston, W. S. C., Reeves, R. S., Haddock, C. K., Stormer, S., Balasubramanyam, A., Satterwhite,
O., Taylor, J. E., and Foreyt, J. P. (2003). Weight loss in obese Mexican Americans treated for 1-
year with orlistat and lifestyle modification. International Journal of Obesity, 27(12), 1486-1493.

To evaluate the effectiveness of a culturally appropriate lifestyle intervention combined

with orlistat in producing weight loss with obese Mexican-American women.

Pratt, C. A., Nosiri, I., and Pratt, C. B. (1997). Michigan physicians' perceptions of their role in
managing obesity. Perceptual and Motor Skills, 84(3), 848-851.
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In a random sample of 211 primary-care physicians in Michigan, about 33% (n = 70)

perceived their role in the prevention of obesity as coordinating and 39% (n = 82) as
cooperative and of equal importance to that of other professionals. Perceived barriers to
prevention of obesity were inadequate time to educate patients, method of
reimbursement, and inadequate training in management of obesity. These results suggest
that physicians' involvement in managing obesity can improve if they work closely with
other health professionals.

Presnell, K., and Stice, E. (2003). An experimental test of the effect of weight-loss dieting on
bulimic pathology: Tipping the scales in a different direction. Journal of Abnormal Psychology,
112(1), 166-170.

Although it is widely accepted that dieting increases the risk for bulimic pathology, this
hypothesis has not been tested in a randomized experiment. Accordingly, the authors
conducted an experimental test of the dietary restraint model by randomly assigning
nonobese women (N = 82) to either a 6-week, low-calorie diet or a waitlist control
condition. The diet intervention resulted in significant weight loss, confirming that
dieting was successfully manipulated.

Price, S. (2005). NT clinical. Understanding the importance to health of a balanced diet. Nursing
Times, 101(1), 30-31.

Obesity is one of the fastest-developing public health problems. The general population
needs to have a balanced, healthy diet as it provides the energy and nutrients required to
survive and stay healthy. Combining a healthy diet with an active lifestyle has huge
health benefits and helps reduce the risk of major health problems such as heart disease,
cancer and obesity.

Price, S. (2005). Understanding the importance to health of a balanced diet. Nursing Times,
101(1), 30-1.

Obesity is one of the fastest-developing public health problems. The general population
needs to have a balanced, healthy diet as it provides the energy and nutrients required to
survive and stay healthy. Combining a healthy diet with an active lifestyle has huge
health benefits and helps reduce the risk of major health problems such as heart disease,
cancer and obesity.

Proimos, J. (2001). Childhood obesity: the role of physical activity. International Journal of
Sports Medicine, 5(2).

Obesity is increasing in children and adolescents globally. Although there is little

doubt that promoting physical activity in children and adolescents can have an
important role in preventing obesity, the aetiology of obesity is complex and
multifactorial in nature. The research shows that many gaps exist, particularly in
the establishment of guidelines for appropriate levels of physical activity in
children and adolescents.
 181

Pucher, J., and Dijkstra, L. (2003). Public health matters. Promoting safe walking and cycling to
improve public health: lessons from the Netherlands and Germany. American Journal of Public
Health, 93(9), 1509-1516.

We examined the public health consequences of unsafe and inconvenient walking and
bicycling conditions in American cities to suggest improvements based on successful
policies in The Netherlands and Germany.

Qi, B. B., and Dennis, K. E. (2000). The adoption of eating behaviors conducive to weight loss.
Eating Behavior, 1(1), 23-32.

Given the plethora of eating behaviour techniques that obese individuals might adopt for
weight loss, it is not likely that they could, or would be willing to, adopt all of them.
Therefore, the purpose of this study was to identify the specific eating behaviours
conducive to weight loss adopted during the behavioural treatment of obesity, and to
distinguish those that were deemed beneficial from the ones that were not.

Qidwai, W., and Azam, S. I. (2004). Knowledge, attitude and practice regarding obesity among
patients, at Aga Khan University Hospital, Karachi. Jo Ayub Med Coll Abbottabad, 16(3), 32-4.

Obesity is a major public health problem and responsible for significant morbidity and
mortality among our patients. It is important to study the knowledge, attitude and
practices with regard to obesity among patients, in order to devise interventional
strategies.

Quarry Horn, J. L., Evans, B. J., and Kerrigan, J. R. (2003). Type 2 diabetes mellitus in youth.
Journal of School Nursing, 19(4), 195-203.

In the United States, the incidence of type 2 diabetes mellitus (DM) in children and
adolescents has been increasing at an alarming rate. Early recognition and intervention
can delay the onset of type 2 DM and prevent the long-term complications. School nurses
have an essential role in implementing the American Diabetes Association (ADA)
recommended screening guidelines to identify youth at high risk for type 2 DM and in
implementing student health programs that focus positively on the importance of physical
activity and healthy eating habits.

Quatromoni, P. A., Copenhafer, D. L., D'Agostino, R. B., and Millen, B. E. (2002). Dietary
patterns predict the development of overweight in women: the Framingham nutrition studies.
Journal of the American Dietetic Association, 102(9), 1240-1246.

To investigate relationships between dietary patterns and the development of overweight.

Raben, A. (2003). Jumbosize Europe? European Union conference on obesity calls for
immediate action. Scandinavian Journal of Nutrition, 47(1), 29-38.
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The average prevalence of obesity in Europe is now 15-20%, with increasing rates in
most countries. The prevalence of both overweight and obesity is as high as 50-65%, and
childhood obesity is also increasing at an alarming pace. The epidemic has been followed
by a simultaneous rise in type II diabetes. Action is therefore urgently needed.

Ramey, S. L., Franke, W. D., and Shelley, M. C., II. (2004). Relationship among risk factors for
nephrolithiasis, cardiovascular disease, and ethnicity: focus on a law enforcement cohort.
AAOHN-Journal, 52(3), 116-121.

This cross-sectional study determined the prevalence of nephrolithiasis and common

cardiovascular disease (CVD) risk factors in a law enforcement officer (LEO) cohort and
evaluated the relationship of nephrolithiasis with several CVD risk factors, including the
possible effect of ethnicity.

Ramos, E. J., Meguid, M. M., Campos, A. C., and Coelho, J. C. (2005). Neuropeptide Y, alpha-
melanocyte-stimulating hormone, and monoamines in food intake regulation. Nutrition, 21(2),
269-79.

Obesity is increasing in severity and prevalence in the United States and represents a
major public health issue. No effective pharmacologic treatment leading to sustained
weight loss currently exists. The growing interest in the regulation of food intake stems
from the current drug treatments for obesity, almost all of which interfere with the
monoamine system.

Rauramaa, R., and Vaisanen, S. B. (1999). Physical activity in the prevention and treatment of a
thrombogenic profile in the obese: current evidence and research issues. Medicine and Science in
Sports and Exercise, 31(11 Suppl), S631-S634.

To evaluate the impact of regular physical activity on thrombogenic profile in obese

individuals. Medline-based literature search with emphasis on controlled randomized
clinical trials. The focus was on the impact of physical activity on platelet aggregation,
fibrinogen, and plasminogen activator inhibitor-1 (PAI-1) in overweight and obese
subjects. Physical activity increases acutely 1) platelet number and activity, 2) activation
of coagulation leading to a thrombin generation, and 3) simultaneous activation of
fibrinolysis.

Ravens-Sieberer, U., Redegeld, M., and Bullinger, M. (2001). Quality of life after in-patient
rehabilitation in children with obesity. International Journal of Obesity and Related Metabolism
Disorders, S63-S65.

Treating obesity concerns not only medical concomitants and future complications but
also quality of life. The study was planned to investigate the effect of obesity and obesity
treatment on quality of life in children.
 183

Raynor, H. A., Jeffery, R. W., Tate, D. F., and Wing, R. R. (2004). Relationship between
changes in food group variety, dietary intake, and weight during obesity treatment. International
Journal of Obesity, 28(6), 813-820.

Experimental studies show diets with greater variety in energy-dense foods increase
consumption and body weight. Reducing variety in energy-dense food groups may
decrease energy and dietary fat intake, promoting weight loss. This study examined
changes in food group variety during obesity treatment and the relation between changes
in food group variety, dietary intake, and weight.

Raynor, H. A., Kilanowski, C. K., Esterlis, I., and Epstein, L. H. (2002). A cost-analysis of
adopting a healthful diet in a family-based obesity treatment program. Journal of the American
Dietetic Association, 645-650.

To assess dietary costs during a family-based pediatric obesity intervention.

Regber, S., Grufman, M., Jochens, P., and Marild, S. (2002). Gender-related coping strategies in
obese children and adolescents. International Journal of Obesity, 26(1).

To describe health and lifestyle indices in obese children and adolescents and compare
with control subjects and a reference group.

Reicks, M., Mills, J., and Henry, H. (2004). Qualitative study of spirituality in a weight loss
program: contribution to self-efficacy and locus of control. Journal of Nutrition Education and
Behavior, 36(1), 13-19.

The purpose of this qualitative study was to examine how spirituality affects
intrapersonal characteristics associated with a weight loss program.

Reilly, J. J., and McDowell, Z. C. (2003). Physical activity interventions in the prevention and
treatment of pediatric obesity: systematic review and critical appraisal. Proceedings of the
Nutrition Society, 62(3), 611-619.

Interventions for prevention and treatment of childhood obesity typically target increases
in physical activity and, more recently, reductions in physical inactivity (sedentary
behaviour such as television viewing). However, the evidence base for such strategies is
extremely limited. The main aim of the present review was to update the systematic
review and critical appraisal of evidence in the light of the recent rapid expansion of
research in this area.

Reilly, J. J., Ventham, J. C., Newell, J., Aitchison, T., Wallace, W. H. B., and Gibson, B. E. S.
(2000). Risk factors for excess weight gain in children treated for acute lymphoblastic
leukaemia. International Journal of Obesity and Related Metabolism Disorders, 1537-1541.

To test whether excess weight gain in patients treated for childhood acute lymphoblastic
leukaemia (ALL) was predictable using patient characteristics at diagnosis.
 184

Reinehr, T., Wollenhaupt, A., Chahda, C., Kersting, M., and Andler, W. (2002). Ambulant
training programs for obese children. Criterions of comparison for the development of valid
therapy recommendations. Klinische Padiatrie, 214, 83-88.

Valid knowledge concerning structure and contents of an ambulant training program for
obese children and adolescents suggested by experts is still missing. In 1999/2000, we
assessed a survey based on defined criterions in the "Arbeitsgemeinschaft fur padiatrische
Diathetik (APD)" and investigated the literature to cover and to compare based on
defined criterions the spectrum of ambulant treatment models in Germany to advance
guidelines for therapy in obese children.

Reusser, M. E., DiRienzo, D. B., Miller, G. D., and McCarron, D. A. (2003). Adequate nutrient
intake can reduce cardiovascular disease risk in African Americans. Journal of the National
Medical Association, 95(3), 188-193.

Cardiovascular disease kills nearly as many Americans each year as the next seven
leading causes of death combined. The prevalence of cardiovascular disease and most of
its associated risk factors is markedly higher and increasing more rapidly among African
Americans than in any other racial or ethnic group. Improving these statistics may be
simply a matter of improving diet quality.

Riccardi, G., Aggett, P., Brighenti, F., Delzenne, N., Frayn, K., Nieuwenhuizen, A., Pannemans,
D., Theis, S., Tuijtelaars, S., and Vessby, B. (2004). PASSCLAIM -- body weight regulation,
insulin sensitivity and diabetes risk. Process for the Assessment of Scientific Support for Claims
on Foods. European Journal of Clinical Nutrition, 43, 56 Suppl 2.

Insulin sensitivity is a key function in human metabolism because it has a crucial role in
the development of disease that are increasingly common in modern society. Impaired
insulin sensitivity is an important determinant of type 2 diabetes; moreover, it has been
proposed as an independent risk factor for cardiovascular disease. Thus, reduced insulin
sensitivity is strongly associated with the metabolic syndrome, which represents a
cluster of metabolic abnormalities and cardiovascular risk factor. Insulin sensitivity can
be modulated by different environmental factors, including dietary habits. Obesity,
especially if associated with abdominal adiposity, impairs insulin-sensitivity while
physical activity can improve it; however, the composition of the habitual diet is clearly
an important regulator of this function.

Rigby, N. J., Kumanyika, S., and James, W. P. (2004). Confronting the epidemic: the need for
global solutions. Journal of Public Health Policy, 25(3-4), 418-34.

The epidemic of obesity is global and legal actions to stem the epidemic must become
global. We address the prevalence of overweight and obesity: the cope and size of the
epidemic, and how food marketing has aggravated the problem. The metabolic syndrome,
a new feature of the epidemic now threatens health in the US and other industrial
countries. Government subsidies contribute to excessive consumption. Economic costs of
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obesity are enormous, and routinely understated. The IOTF has encouraged the new
WHO strategy on diet, physical activity, and health, but endorsement by WHO of
national policies may not be sufficient to turn the tide globally. We note that lawsuits in
the US and regulation elsewhere are alerting people to the epidemic.

Rippe, J. M., Crossley, S., and Ringer, R. (1998). Obesity as a chronic disease: modern medical
and lifestyle management. Journal of the American Dietetic Association, S9-S15.

The United States is in the midst of an epidemic of obesity involving more than one third
of the adult population. The prevalence of obesity increased by 40% between 1980 and
1990. Obesity is a chronic disease with a multifactorial etiology including genetics,
environment, metabolism, lifestyle, and behavioral components. A chronic disease
treatment model involving both lifestyle interventions and, when appropriate, additional
medical therapies delivered by an interdisciplinary team including physicians, dietitians,
exercise specialists, and behavior therapists offers the best chance for effective obesity
treatment. Lifestyle factors such as proper nutrition, regular physical activity, and
changes in eating behaviors should be coordinated by this team.

Rippe, J. M., and Hess, S. (1998). The role of physical activity in the prevention and
management of obesity. Journal of the American Dietetic Association, S31-S38.

The United States is facing 2 major lifestyle-related epidemics that are intricately linked:
an epidemic of obesity and an epidemic of inactivity. Multiple interactions exist between
lack of physical activity and obesity. Increased physical activity lowers the risk of
obesity, may favorably influence distribution of body weight, and confers a variety of
health-related benefits even in the absence of weight loss. Physical activity is important
for achieving proper energy balance, which is needed to prevent or reverse obesity. Not
only is energy expended during physical activity, physical activity also has a positive
effect on resting metabolic rate. Regular physical activity can improve body
composition.Numerous studies have shown that the combination of proper nutrition and
regular physical activity is the most effective intervention for weight loss and
maintenance of weight loss. Walking is the most convenient and logical way most obese
persons can increase their physical activity. Physical activity plays multiple roles in the
prevention and treatment of obesity.

Rippe, J. M., McInnis, K. J., and Melanson, K. J. (2001). Physician involvement in the
management of obesity as a primary medical condition. Obesity Research, 9(Supplement 4),
302S-311S.

As the obesity epidemic escalates, increasing numbers of patients present with serious
comorbidities related to excess body weight. Obesity should be recognized and treated as
a primary medical condition that is progressive, chronic and relapsing. Effective
treatment of obesity has been shown to reduce cardiovascular risk factors and comorbid
conditions. Physician involvement is necessary for medical assessment, management,
counselling and coordination of multidisciplinary obesity treatment. Obese patients who
receive counselling and weight management from physicians are significantly more likely
 186

to undertake weight management programmes than those who do not. Obesity treatment
guidelines and materials are available from various health organizations. A
comprehensive weight management programme must include dietary adjustments,
increased physical activity and behavioural modification.

Rissanen, A., and Fogelholm, M. (1999). Physical activity in the prevention and treatment of
other morbid conditions and impairments associated with obesity: current evidence and research
issues. Medicine and Science in Sports and Exercise, 31(11 Suppl), S635-S645.

To evaluate the current status of knowledge concerning the effects of physical activity in
the treatment and prevention of obesity-related problems, including cancers of the colon,
breast, uterus, and prostate; gallstones; osteoarthritis; back pain; sleep apnea;
reproductive abnormalities; and impaired health-related quality of life. A Medline
literature search on the effects of physical activity in the above conditions was conducted.
Only studies with some measure of weight and a description of the type of physical
activity were included. No controlled randomized trails of exercise in the treatment of
any of the studied conditions in obese patients were identified.

Rissanen, A., Lean, M., Roessner, S., Segal, K. R., and Sjoestroem, L. (2003). Predictive value
of early weight loss in obesity management with orlistat: an evidence-based assessment of
prescribing guidelines. International Journal of Obesity, 27(1), 103-109.

To assess the clinical usefulness of published guidelines for the use of orlistat, by
studying whether weight loss greater than or equal to 2.5 kg during a 4 week dietary lead-
in period, and weight losses of greater than or equal to 5% after 12 weeks and greater
than or equal to 10% after 6 months of drug therapy predict weight loss and risk factor
changes after 2 years.

Roberts, S. O. (2000). The role of physical activity in the prevention and treatment of childhood
obesity. Pediatric Nursing, 26(1), 33-36, 39-43.

Obesity is epidemic in the United States today and on the rise in children. The
consequences of physical inactivity, poor diet, and excessive television produce obese
children. Lack of regular physical exercise contributes to a child's likelihood to be obese,
while a program of exercise can reverse an unhealthy lifestyle.

Robertson, A. M., Broom, J., McRobbie, L. J., and MacLennan, G. S. (2002). Low carbohydrate
diets in overweight patients with type 2 diabetes. International Journal of Obesity, 26(1).

To assess the efficacy of a low carbohydrate (<40g day), high protein diet as an
alternative dietary treatment for overweight patients with type 2 diabetes.

Robinson, T. N. (1999). Reducing children's television viewing to prevent obesity: A

randomized controlled trial. JAMA: Journal of the American Medical Association, 282(16),
1561-1567.
 187

Conducted a school-based trial of reducing 192 3rd- and 4th-grade (mean age 8.9 yrs)
children's media (TV, videotape, and video game) use to assess the effects on adiposity,
physical activity, and dietary intake. The authors hypothesized that intervention-group
(IG) children would significantly decrease their adiposity levels.

Robinson, T. N., and Sirard, J. R. (2005). Preventing childhood obesity: a solution-oriented

research paradigm. American Journal of Preventive Medicine, 28(2 Suppl 2), 194-201.

Past research has identified social and environmental causes and correlates of behaviors
thought to be associated with obesity and weight gain among children and adolescents.
Much less research has documented the efficacy of interventions designed to manipulate
those presumed causes and correlates. These latter efforts have been inhibited by the
predominant biomedical and social science problem-oriented research paradigm,
emphasizing reductionist approaches to understanding etiologic mechanisms of diseases
and risk factors.

Robison, J. I. (1999). Weight, health, and culture: shifting the paradigm for alternative health
care. Alternative Health Practitioner, 5(1), 45-69.

Promoting weight loss through dietary restriction and behavior modification rarely
succeeds, often results in weight cycling (repeated bouts of weight loss and regain) with
the potential for serious physical and psychological health risks and contributes to a
growing epidemic of dangerous eating disorders. Therefore, continuing to promote such
approaches for the purpose of improving health is scientifically indefensible and ethically
unacceptable.

Rodrigues, E. M., Minicucci, W. J., Martins, M. F. S., Severino, S., Lamas, J. L. T., and Mueller,
R. C. L. (2002). Results of the treatment of obese adolescents: A multidiscipline approach.
International Journal of Obesity, 26(1).

This study was done to evaluating the effect of the treatment of a group of obese
adolescents through a multidisciplinary team (physicians, nutritionist, nurses and social
worker). This work is a prospective and descriptive research conducted in a Obesity
Adolescents Ambulatory. 10 patients were object of study, ages 11 trough 17, males and
females, Body Mass Index above 95%. (Must e col.), without endocrinopathy and
neurological diseases. There was the participation of at least one of the parents, during a
eight month period. The thematic consisted of nutritional education, stimulus to physical
activity and psychological aspects related to obesity.

Roizen, N. J. (2003). The early interventionist and the medical problems of the child with Down
syndrome. Infants and Young Children, 16(1), 88-95.

Infants and young children with Down syndrome are frequently among the youngest
children enrolled in early intervention programs, providing interventionists with
experience with this population of children. Infants and children with Down syndrome
have an increased incidence of a variety of medical problems. For optimal developmental
 188

progress and participation in early intervention, the child with Down syndrome must have
any such problems identified early, and managed appropriately. Early intervention
providers who are knowledgeable about the particular medical problems that occur more
frequently in children with Down syndrome can be of great assistance to families.

Rolland Cachera, M. F., Thibault, H., Souberbielle, J. C., Soulie, D., Carbonel, P., Deheeger, M.,
Roinsol, D., Longueville, E., Bellisle, F., and Serog, P. (2004). Massive obesity in adolescents:
Dietary interventions and behaviours associated with weight regain at 2y follow-up. International
Journal of Obesity, 28(4), 514-519.

To compare the influence of weight-reducing diets containing different amounts of

protein and CHO on body composition in obese adolescents and to examine dietary and
physical activity behaviours during follow-up.

Rolls, B. J. (2003). The supersizing of America: portion size and the obesity epidemic. Nutrition
Today, 38(2), 42-54.

Although we are just beginning to understand how environmental factors such as portion
size affect eating behavior, the available data suggest that large portions of energy-dense
foods are contributing to the obesity epidemic. Several possible strategies for adjusting
portions to bring intake back in line with energy requirements are discussed. The
continuing rise in the rates of obesity calls for urgent action.

Roos, G. (2005). Media debate on obesity prevention in the UK and Sweden. Scandanavian
Journal of Nutrition, 49(1), 38-39.

Current media debates in UK and Sweden on obesity and its prevention were analysed.
Internet versions of one of the main newspapers in both countries were selected as data
sources. The internet archives of the newspapers over one year (September 2003 to
August 2004) were searched for articles using the keyword, 'obesity.' All articles that had
information on causes, prevention strategy and key actors in the prevention programmes
were included. The preliminary search of 'The Guardian' (UK publication) resulted in 810
news articles, of which 199 fulfilled the selection criteria; the 'Dagens Nyheter' (Swedish
publication) had 24 news articles, all fulfilling the criteria. Obesity seems currently to be
a bigger media topic in the UK than in Sweden.

Rosenbaum, M., Leibel, R. L., and Hirsch, J. (1997). Obesity. New England Journal of Medicine,
337(6), 396-407.

This paper reviews the pathogenesis of obesity as well as other important aspects of this
topic. Topics include regulation of energy storage, intake and expenditure; the
neurophysiology of feeding; metabolic effects of weight perturbation; energy balance
regulation by metabolic cycles; chemical mediators of energy homeostasis; genetic
factors in obesity; and treatment of obesity by lifestyle modification, drug therapy and
surgical therapy.
 189

Ross, R., and Janssen, I. (1999). Is abdominal fat preferentially reduced in response to exercise-
induced weight loss? Medicine and Science in Sports and Exercise, 31(11 Suppl), S568-S572.

It is known that a preferential deposition of fat in the abdominal region is the obesity
phenotype that conveys the greatest health risk. Although physical activity is commonly
prescribed to reduce obesity, the influence of exercise-induced weight loss on abdominal
fat is unclear. This review was undertaken to clarify whether abdominal fat is
preferentially reduced consequent to weight loss induced by regular exercise. A literature
search (Medline, 1966-1998) was performed using appropriate keywords to identify
studies reporting changes in both whole body and abdominal fat in response to exercise.
At present there are no randomized controlled trials (RCT) wherein it was clear that
exercise alone induced weight loss.

Rossner, S. (1998). Intermittent vs continuous VLCD therapy in obesity treatment. International

Journal of Obesity and Related Metabolism Disorders, 190-192.

The role of intermittent very low calorie diet (VLCD) in obesity treatment has received
little attention. Since such programs can be carried out with limited medical resources,
they may offer an additional therapeutic tool.

Rossner, S. (1999). Physical activity and prevention and treatment of weight gain associated with
pregnancy: current evidence and research issues. Medicine and Science in Sports and Exercise,
31(11 Suppl), S560-S563.

The purpose of this study was to examine the evidence in the literature for a relationship
between physical activity and weight development during and after pregnancy. A
retrospective analysis of the literature, mainly based on an extended MEDLINE search
and the Pregnancy and Childbirth Database (Cochrane), was conducted. Weight
development during pregnancy is the result of numerous interacting factors, with physical
activity being one important determinant of weight outcome and eventually also
overweight and obesity.

Rotenberg, K. J., Carte, L., and Speirs, A. (2005). The effects of modeling dietary restraint on
food consumption: do restrained models promote restrained eating? Eating Behavior, 6(1), 75-
84.

Sixty-nine female undergraduates completed the restraint scale, a dieting checklist, and
the Eating Attribution Style Questionnaire (EASQ). The participants were exposed either
to no model, a peer model who behaviorally demonstrated dietary restraint, or a peer
model who behaviorally and verbally demonstrated dietary restraint. The participants had
an opportunity to consume food as part of a taste test. The findings revealed that
attribution style, but not restraint or current dieting status, moderated the effects of
exposure to the peer models. Females who had an internal attribution style for indulgent
food consumption decreased their consumption of food as a function of the dietary
restraint of the models, whereas females who had an external attribution style for
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indulgent food consumption increased their consumption of food as a function of the

dietary restraint of the models.

Rugg, K. (2004). Childhood obesity: its incidence, consequences and prevention. Nursing Times,
100(3), 28-30.

In 1998 the World Health Organization declared childhood obesity a 'global epidemic'
(WHO, 1998). The Department Of Health has identified that prevention must be aimed at
children to address its rise in future generations (DoH, 2002). Childhood obesity is
recognised as a predictor of adolescent and adult obesity (Smith, 2002; Parseons et al,
1999; Whitaker et al, 1997).

Ryan, D. H. (2003). Use of sibutramine to treat obesity. Primary Care: Clinics in Office Practice,
30(2), 405-426.

Medications are useful adjuncts to diet and exercise and may help patients lose weight
and maintain significant weight loss (5%-10% from baseline). Pharmacologic approaches
are indicated in those patients who have had prior weight-loss attempts, who have a body
mass index greater than or equal to 30 kg/m2 or greater than or equal to 27 kg/m2 with
comorbidity, and who are motivated and ready to undertake dietary and physical activity
changes. This article provides a treatment algorithm to help physicians measure
meaningful weight loss and proposes conservative blood pressure limits to guide the
long-term prescription of sibutramine. Sibutramine can be a useful tool in the obesity
treatment toolbox if used by knowledgeable practitioners. Copyright (c) 2003 by Elsevier
Scien (USA).

Ryan, Y. M., Gibney, M. J., and Flynn, M. A. T. (1998). The pursuit of thinness: a study of
Dublin schoolgirls aged 15 y. International Journal of Obesity and Related Metabolism
Disorders, 485-487.

Despite increasing trends in the prevalence of overweight and obesity, fatness phobia is
common during female adolescence. This study has demonstrated a high level of
dissatisfaction with body weight in a sample of Dublin schoolgirls aged 15 y. Of 420
subjects, 59% reported that they wanted to be slimmer and 68% had previously tried to
lose weight. Contrary to expectations, overweight girls were not found to hold the
monopoly on such dissatisfactions. Normal weight and even underweight girls also
expressed a desire to be thinner and reported using unhealthy weight control practices
including random avoidance of staple foods, fasting, smoking and purging, in their
pursuit of the 'perfect' female figure. Obesity prevention programmes which target
adolescent girls at risk of overweight and obesity, must take cognizance of their profound
fear of fatness, otherwise the use of harmful slimming strategies may be further increased
as teenage girls frantically try to lose weight and to avoid the stigma associated with
female fatness.
 191

Ryttig, K. R., Flaten, H., and Rssner, S. (1997). Long-term effects of a very low calorie diet
(Nutrilett(R)) in obesity treatment. A prospective, randomized, comparison between VLCD and a
hypocaloric diet+behavior modification and their combination. International Journal of Obesity,
21(7), 574-579.

Weight loss on a balanced hypoenergetic diet was compared to that on a very low energy
diet [very low energy diet] (VLCD) after 2 months of treatment. Also, 26 months of
weight maintenance with or without VLCD assistance was examined in obese patients.
81 obese patients of both genders with a body mass index more than or equal to 30
kg/m² were recruited from the Swedish University's out-patient obesity
clinic. 27 patients (group A) were randomized to a balanced diet of 6720 kJ/day during
the whole treatment period. The other patients were randomized to VLCD (Nutrilett(R))
1764 kJ/day diet during the first 2 months.

Sabate, J. (2003). The contribution of vegetarian diets to human health. Forum Nutrition, 56,
218-20.

Our knowledge is far from complete regarding the relationship between vegetarian diets
and human health. However, scientific advances in the last decades have considerably
changed the role that vegetarian diets may play in human nutrition. Components of a
healthy vegetarian diet include a variety of vegetables, fruits, whole grain cereals,
legumes and nuts. Numerous studies show important and quantifiable benefits of the
different components of vegetarian diets, namely the reduction of risk for many chronic
diseases and the increase in longevity.

Sabin, M., Crowne, E., and Shield, J. (2002). NTplus. Childhood obesity and type 2 diabetes.
Nursing Times, 98(19), 49-50.

Bristol doctors have identified the first cases of type 2 diabetes in Caucasian children
with obesity, raising concerns of an epidemic of diabetes and cardiovascular disease.
Matt Sabin, Elizabeth Crowne and Julian Shield explain what they found and what must
be done to combat obesity.

Sacher, P. M., Chadwick, P., Wells, J. C. K., Williams, J. E., Cole, T. J., and Lawson, M. S.
(2005). Assessing the acceptability and feasibility of the MEND Programme in a small group of
obese 7-11-year-old children. Journal of Human Nutrition and Dietetics, 18(1), 3-5.

An uncontrolled, pilot study to evaluate feasibility and acceptability of a new community

based childhood obesity treatment programme. The mind, exercise, nutrition and diet
(MEND) programme was held at a sports centre, twice-weekly, for 3 months. The
programme consists of behaviour modification, physical activity and nutrition education.
The primary outcome measure was waist circumference. Secondary outcomes were body
mass index (BMI), cardiovascular fitness (heart rate, blood pressure and number of steps
in 2 min), self-esteem and body composition.
 192

Sadler, C. (2001). Weight watchers. Community Practitioner, 74(8), 286-288.

The recent sharp rise in childhood obesity has been overshadowed to some extent by
growing concern over the comparatively low number of young people with eating
disorders like anorexia. Catharine Sadler examines the issues of childhood obesity,
changing lifestyle patterns and the impact of healthy school initiatives.

Sadler, M. (2004). Diet and heart health symposium II. British Journal of Cardiology, 11, S1-S8
Suppl 1.

Cardiovascular disease is still the leading cause of death across Europe, responsible for
two million deaths each year in people below the age of 75. Michael Livingston, Director
of H.E.A.R.T UK, introduced the symposium by saying that diet plays an important role
in the causation of cardiovascular disease even though we have drugs that effectively
lower plasma cholesterol.

Saiki, S., Sato, T., Kohzuki, M., Kamimoto, M., and Yosida, T. (2001). Changes in serum
hypoxanthine levels by exercise in obese subjects. Metabolism, 50(6), 627-630.

To study on effect of obesity on changes in serum hypoxanthine with exercise, exercise

stress testing with treadmill was performed on 7 obese subjects (body mass index [BMI],
30.6 plus or minus 3.2 kg/m super(2)) and 16 healthy volunteers (BMI, 21.5 plus or
minus 2.10 kg/m super(2)). Expiratory gas analysis during exercise showed that peak Vo
sub(2) was significantly lower in the obese group than in the control group (28.1 plus or
minus 4.0 v 37.1 plus or minus 4.7 mL/kg/min; P <.001). Furthermore, the obese group
had lower anaerobic threshold (AT) values (P <.005), respiratory quotient at AT (P
=.003), and exercise capacity reserve (P =.002) than the control group.

Saklad, S. R. (2004). The pharmacology of metabolic complications due to weight gain. includes
discussion. Advanced Studies in Nursing, 2(3), 93-100.

There is strong evidence to show that patients with severe mental illness are at increased
risk for overweight/obesity and diabetes. Most, but not all, atypical antipsychotic drugs
lead to clinically significant weight gain. Neither the mechanisms behind the metabolic
changes with antipsychotic agents nor the complex feedback mechanisms to control
weight and satiety are completely defined.

Salisbury, C. (1996). The role of health psychology post-myocardial infarction. Nursing

Standard, 10(39), 43-46.

This article examines the part health psychology has to play in underpinning care
strategies and supporting professional practice during the process of rehabilitation
following a myocardial infarction.
 193

Salisbury, H. (1995). Maintaining lifestyle change after myocardial infarction: part 2. Health
Visitor, 68(11), 460-463.

In the second of two articles on the role of health visitors in myocardial infarction
rehabilitation, HELEN SALISBURY examines the factors which influence the
rehabilitation process and how clients can be helped to adopt and maintain preventive
health behaviours.

Salmon, J., Ball, K., Crawford, D., Booth, M., Telford, A., Hume, C., Jolley, D., and Worsley, A.
(2005). Reducing sedentary behaviour and increasing physical activity among 10-year-old
children: overview and process evaluation of the 'Switch-Play' intervention. Health Promotion
International, 20(1), 7-17.

Overweight and obesity has doubled among children in Australia. There is an urgent need
to develop primary prevention strategies to prevent current and future unhealthy weight
gain. The aims of this paper are to describe a randomized controlled trial ('Switch-Play')
developed to prevent unhealthy weight gain among 10-year-old children and to report the
findings of the process evaluation.

Sanders, T. A. B. (2004). Diet and general health: dietary counselling. Caries Research, 38, 3-8
Suppl 1.

Dietary guidelines are designed to maintain an adequate intake of nutrients and to protect
against diet-related disease, particularly cardiovascular disease and obesity. Current
population dietary guidelines advocate a reduction in total fat intake, particularly
saturated fat intake, to 25-35% of the energy intake and an increased intake of
carbohydrate to more than 55% of the dietary energy intake, which should mainly be
derived from starch. There is a positive relationship between total sugar intake and the
incidence of dental caries where dental hygiene is poor and exposure to fluoride is low.

Sangster, J., Cooke, L., and Eccleston, P. (2004). 'What's to eat?' -- Nutrition and food safety
needs in and out-of-school hours care. Nutrition and Dietetics: Journal of the Dietitians
Association of Australia, 61(3), 172-176.

Investigate the nutrition and food safety needs of out-of-school hours care (OSHC)
services.

Saper, R. B., Eisenberg, D. M., and Phillips, R. S. (2004). Common dietary supplements for
weight loss. American Family Physician, 70(9), 1731-1738.

Over-the-counter dietary supplements to treat obesity appeal to many patients who desire
a "magic bullet" for weight loss. Asking overweight patients about their use of weight-
loss supplements and understanding the evidence for the efficacy, safety, and quality of
these supplements are critical when counseling patients regarding weight loss. A schema
for whether physicians should recommend, caution, or discourage use of a particular
weight-loss supplement is presented in this article.
 194

Saris, W. H. M. (1995). Exercise with or without dietary restriction and obesity treatment.
International Journal of Obesity and Related Metabolism Disorders, S113-S116.

If short term weight loss is the main treatment objective, it is clear that exercise does not
give any success. Dietary restriction can potentially induce much faster rates of weight
loss. Adding exercise and especially weight training, to a diet-induced weight loss
programme induces small improvements in the change in FFM/FM and possible RMR
after a relatively long period. Exercise treatment alone is an option for longterm treatment
with relatively small changes in body weight and body composition.

Sarlio Laehteenkorva, S. (2002). The society's view on obesity and the quality of life among the
obese. International Journal of Obesity, 26(1).

Obesity is currently a well-recognised medical and social problem. However, seeing

obesity as a problem is also connected to cultural norms of beauty, normality and
acceptable behaviour. Preferred body shapes may vary within population groups and
attitudes towards overweight have changed many times throughout the history. In modern
societies, however, negative attitudes toward obesity have been documented in several
studies.

Sarlio Lahteenkorva, S. (1998). Relapse stories in obesity. European Journal of Public Health,
8(3), 203-209.

The tendency for obese people to relapse and regain the weight they have lost constitutes
a serious problem in obesity treatment. The present study is an attempt to analyse obesity
narratives to characterize the complex interrelationship between relapses and
sociocultural factors. In-depth interviews were obtained from 90 obese subjects who were
applying for weight loss programmes or seeking help for obesity-related problems. The
social constructionist version and application of grounded theory was used to analyse the
stories told, by the subjects about their obesity experiences.

Saunders, C. S. (2001). Diet and nutrition in your practice. Intervening in the obesity epidemic.
Patient Care for the Nurse Practitioner, 4(8), 12-14, 16, 18.

Help overweight patients with the new NHLBI guidelines on treating obesity, interactive
Internet food diaries, and multipatient weight-loss sessions.

Saunders, C. S. (2001). Intervening in the obesity epidemic. Patient Care for the Nurse
Practitioner, 35(15), 92-94, 99, 103-107.

Help overweight patients with the new NHLBI guidelines on treating obesity, interactive
Internet food diaries, and multipatient weight-loss sessions.

Scheen, A. J., and Van Gaal, L. F. (2002). Abdominal obesity and cardiovascular risk markers in
type 2 diabetic patients: The Belgian OCAPI study. International Journal of Obesity, 26(1).
 195

The OCAPI (Optimize CArdiovascular Prevention in dIabetics) study aimed at

determining the global cardiovascular (CV) risk of 1001 consecutive type 2 diabetic
patients. Body mass index (BMI), waist circumference (WC), arterial blood pressure,
HbA sub(1e) and fasting lipids (central lab) were determined. LDL cholesterol was
calculated using the Friedewald formula, and the 10-year CV risk was estimated using the
Framingham formula.

Schmitz, K. H., Jensen, M. D., Kugler, K. C., Jeffery, R. W., and Leon, A. S. (2003). Strength
training for obesity prevention in midlife women. International Journal of Obesity, 27(3), 326-
333.

The primary goal of this study was to assess whether increases in fat-free mass (FFM)
and decreases in total and percentage fat mass from 15 weeks of twice weekly supervised
strength training would be maintained over 6 months of unsupervised exercise in a
randomized controlled trial.

Schneider, D. (2000). International trends in adolescent nutrition. Soc Sci Med, 51(6), 955-67.

This paper addresses international trends in adolescent nutrition by reviewing the

literature from English-language indexed journals and online sources from around the
world. Information is presented by geographic region and by nation within region. The
literature shows that malnutrition remains a significant problem for adolescents,
worldwide, but that the types of nutritional problems impacting this group have changed
significantly over the past two decades. While undernutrition and wasting are reported,
these conditions, as well as growth stunting, seem to be on the decline.

Schroder, H., Marrugat, J., Vila, J., Covas, M. I., and Elosua, R. (2004). Adherence to the
traditional mediterranean diet is inversely associated with body mass index and obesity in a
spanish population. Journal of Nutrition, 134(12), 3355-61.

The Mediterranean diet is a healthy eating pattern with protective effects on chronic
diseases. The purpose of this study was to assess the relation between BMI and obesity
and the level of adherence to the traditional Mediterranean diet.

Schupp, C., Olano Martin, E., Gerth, C., Morrissey, B. M., Cross, C. E., and Werner, J. S.
(2004). Lutein, zeaxanthin, macular pigment, and visual function in adult cystic fibrosis patients.
American Journal of Clinical Nutrition, 79(6), 1045-1052.

Pancreatic insufficiency in cystic fibrosis (CF), even with replacement pancreatic enzyme
therapy, is often associated with decreased carotenoid absorption. Because the macular
pigment of the retina is largely derived from 2 carotenoids, lutein and zeaxanthin, the
decreased serum concentrations seen in CF may have consequences for ocular and retinal
health Our aims were to determine plasma carotenoid concentrations, determine
 196

absorption and distribution of macular pigment, and assess retinal health and visual
function in CF patients.

Schwartz, M. B., and Puhl, R. (2003). Childhood obesity: a societal problem to solve. Obesity
Reviews, 4(1), 57-71.

In contrast to other threats to American children's health, the treatment and prevention of
childhood obesity are considered the responsibility of individual children and their
parents. This pressure exists in the context of the societal stigmatization of overweight
children and the powerful environmental inducements aimed directly at children to eat
nutritionally poor foods. Parents of overweight children are left in the difficult position of
fearing the social and health consequences of their child's obesity, and fighting a losing
battle against the omnipotent presence of the media and constant exposure to unhealthy
foods. This paper brings together several literatures to provide a comprehensive
examination of the major challenges facing obese children and their families.

Schwartz, M. W., and Niswender, K. D. (2004). Adiposity signaling and biological defense
against weight gain: absence of protection or central hormone resistance? Jo Clin Endocrinol
Metab, 89(12), 5889-97.

An abundant and compelling literature supports the existence of a homeostatic system

that dynamically adjusts energy intake and energy expenditure to promote stability of
body fat mass. In the context of this system, the ease with which many individuals gain
weight is difficult to explain. Some have argued that energy homeostasis operates
primarily to defend against weight loss and that, over the course of evolution, biological
defense against weight gain was not selected for.

Scollan Koliopoulos, M. (2004). Consideration for legacies about diabetes and self-care for the
family with a multigenerational occurrence of type 2 diabetes. Nursing and Health Sciences,
6(3), 223-227.

Type 2 diabetes mellitus is a familial disorder that is fast becoming epidemic in the USA.
It is possible that nurses will care for entire families with diabetes in the near future. In
multiple studies, family functioning, a family systems variable, has been correlated with
self-management and glycemic outcomes. Most persons with diabetes live with family
members who might facilitate or inhibit self-management tasks or skills.

Scott, J. G., Cohen, D., DiCicco Bloom, B., Orzano, A. J., Gregory, P., Flocke, S. A., Maxwell,
L., and Crabtree, B. (2004). Speaking of weight: how patients and primary care clinicians initiate
weight loss counseling. Preventive Medicine, 38(6), 819-827.

Obesity is epidemic in the US and other industrialized countries and contributes

significantly to population morbidity and mortality. Primary care physicians see a
substantial portion of the obese population, yet rarely counsel patients to lose weight.
 197

Sea, M. M.-M., Woo, J., Tong, P. C.-Y., Chow, C.-C., and Chan, J. C.-N. (2004). Associations
between Food Variety and Body Fatness in Hong Kong Chinese Adults. Journal of the American
College of Nutrition, 23(5), 404-413.

Food variety is reported to be closely associated with body fatness in Caucasians. The
association has not been examined in a Chinese population. OBJECTIVE: To examine
the association between food variety and body fatness in Hong Kong Chinese adults.

Seeley, R. J., and Schwartz, M. W. (1999). Neuroendocrine regulation of food intake. Acta
Paediatr Suppl, 88(428), 58-61.

Maintenance of appropriate stores of metabolic fuels depends on carefully matching

caloric intake to caloric expenditure. Achieving such 'energy balance' is a product of
complex interactions of peripheral hormones with effector systems in the central nervous
system (CNS) that regulate food intake and energy expenditure. Leptin is a hormone that
is made in the adipocytes, circulates in the blood and interacts with receptors in the CNS.
These receptors can be found in two different types of systems.

Seidell, J. C., Nooyens, A. J., and Visscher, T. L. (2005). Cost-effective measures to prevent
obesity: epidemiological basis and appropriate target groups. Proceedings of the Nutrition
Society, 64(1), 1-5.

Cost-effective prevention strategies to prevent weight gain and the development of

obesity should be based on appropriate knowledge of the determinants of weight gain.
The body of evidence on the dietary determinants of weight gain is, however,
fragmentary at best, partly because inappropriate research methods are used to study the
determinants of obesity under normal circumstances. Evidence from studies using
experimental diets have shortcomings because of their short duration and selection of
highly-motivated subjects and because the outcomes can be easily influenced by the
choice of foods to be used in the intervention.

Selig, S. (2003). Exercise as primary treatment modality in the prevention and rehabilitation of
cardiac disease. Journal of Science and Medicine in Sport, 6(4).

Physical inactivity is now a stand-alone risk factor for cardiovascular disease. Exercise
training, comprising either or both aerobic and strength training of 30-60 minutes per day
for 3-7 days per week, is effective in primary and secondary prevention. In the age of re-
vascularisation therapy, exercise has been shown to prevent the progression of coronary
atherosclerosis and even promote plaque regression.

Senekal, M., Albertse, E. C., Momberg, D. J., Groenewald, C. J., and Visser, E. M. (1999). A
multidimensional weight-management program for women. Journal of the American Dietetic
Association, 99(10), 1257-64.

Real and imagined overweight and obesity, and resulting weight-reduction efforts, are
associated with the development of a variety of health problems and eating disorders. For
 198

many years, research and practice in the field of weight management have been based
largely on a unidimensional, simplistic, weight-loss paradigm. The long-term success rate
for persons using this paradigm has been low. This article presents a multidimensional
paradigm that focuses on all aspects of the prevention, treatment, and management of
weight-related problems.

Serdula, M. K., Khan, L. K., and Dietz, W. H. (2003). Weight loss counseling revisited. JAMA:
Journal of the American Medical Association, 289(14), 1747-1750.

By adapting the treatment model used for smoking cessation into National Health
Institutes of Health evidence-based guidelines for obesity management, a practical tool
for organizing information around weight loss counseling was developed. This weight-
loss counseling tool uses the 5 A's: (1) Assess obesity risk, (2) Ask about readiness to
lose weight, (3) Advise in designing a weight-control program, (4) Assist in establishing
appropriate intervention, and (5) Arrange for follow-up. Each of these steps is discussed.

Serra Majem, L., Ngo de la Cruz, J., Ribas, L., and Tur, J. A. (2003). Olive oik and the
Mediterranean diet: beyond the rhetoric. European Journal of Clinical Nutrition, 57(9), S2-S8.

The purpose of this study was to analyze the association of food, nutrient and energy
intakes with olive oil consumption in Spain.

Shangold, M. M. (1996). An active menopause: using exercise to combat symptoms. Physician

and Sports Medicine, 24(7), 30-32.

There's no better time than the years surrounding menopause for a woman to start or
renew an exercise program. Exercise may reduce the immediate symptoms of
menopause, and it decreases the long-term risk of cardiovascular disease, osteoporosis,
and obesity. The exercise prescription includes aerobic exercise, resistance training, and
stretching components, and should be individualized according to the woman's exercise
history.

Sharman, K. (2004). From compliance to concordance: a psychological approach to weight

management. HCPJ, 4(4), 19-22.

Learning from her own experiences, and listening to her clients' stories, Kath Sharman
has developed an innovative approach to weight management which mainly focuses on
psychological interventions. The core philosophy of the course is self-empowerment.
With obesity a growing public health problem and pressure on PCTs to do something
about it, counsellors could become more involved with weight loss programmes.

Sharman, K., and Moravej, H. (2003). Patient empowerment: an innovative approach to weight
loss. HCPJ, 3(1), 14-16.

Obesity is one of the largest and fastest growing public health problems in the world. In
the UK, 17 per cent of men and 20 per cent of women are currently obese and over half
 199

the adult population are overweight. The prevalence rates appear to be increasing, and by
the year 2010, it is expected that more than 25 per cent of British adults will be obese.
This has serious financial consequences for the NHS, with obesity treatment estimated to
account for six to eight per cent of the nation's direct health care costs, possibly in excess
of C3.5 billion to the wider economy (National Audit Office Report, 2001)

Sheehan, J. (2004). Fighting childhood obesity. American Baby: For Expectant and New Parents,
Prenatal Ed. 66: 62, 64, 66.

The rates are soaring. But you can get baby on the right track from the beginning.

Sheehan, T. J., DuBrava, S., DeChello, L. M., and Fang, Z. (2003). Rates of weight change for
black and white Americans over a twenty year period. International Journal of Obesity, 27(4),
498-504.

To examine the rate of weight gain over time among Americans by age, gender, and race.

Shephard, R. J. (2004). Role of the Physician in Childhood Obesity. Clinical Journal of Sport
Medicine, 14(3), 161-168.

To suggest the role of the practicing physician in examining and treating childhood
obesity. How should obesity be determined at clinical examination? Is there an obesity
epidemic? What is the likely influence of obesity upon current and future health? What
are the causes of obesity, and what does this imply for prevention and treatment? Data
Sources: Relevant articles in Medline and personal files.

Sherwood, N. E., Beech, B. M., Klesges, L. M., Story, M., Killen, J., McDonald, T., Robinson,
T. N., Pratt, C., Zhou, A., Cullen, K., and Baranowski, J. (2004). Measurement characteristics of
weight concern and dieting measures in 8-10-year-old African-American girls from GEMS pilot
studies. Preventive Medicine, 38(Suppl. S), S50-S59.

Reliability and validity were established for weight concern measures completed by 8-
10-year-old African-American girls participating in a pilot obesity prevention program.

Sherwood, N. E., Story, M., Beech, B., Klesges, L., Mellin, A., Neumark, S. D., and Davis, M.
(2003). Body image perceptions and dieting among African-American pre-adolescent girls and
parents/caregivers. Ethnicity and Disease, 13(2), 200-207.

This study describes body image and weight concern attitudes of pre-adolescent African-
American (AA) girls and their parent/caregivers. Cross-sectional survey data were
collected from 189 low-income 8- to 10-year-old AA girls and 179 parents/caregivers of
AA girls from 2 urban areas, Memphis and Minneapolis/St. Paul. Results demonstrated
that most AA girls were either happy with their weight, or did not think about it at all.
However, 20% of girls would like to be larger than their current size, and 50% would like
to be smaller. Girls in Minneapolis/St. Paul were more likely than Memphis girls to
 200

report weight dissatisfaction. One third of parents reported concerns that their daughters
were too heavy. Seventy-two percent of parents reported that they were trying to lose
weight. Discussions include possible regional differences in weight concern among AA
girls, and implications for obesity prevention programs.

Sherwood, N. E., Story, M., Neumark-Sztainer, D., Adkins, S., and Davis, M. (2003).
Development and implementation of a visual card-sorting technique for assessing food and
activity preferences and patterns in African American girls. Journal of the American Dietetic
Association, 103(11), 1473-1479.

Card-sorting tasks for assessing food and activity preferences and patterns among African
American girls were developed. Associations among food preference and intake
frequency, activity preference and frequency, and body mass index were examined.

Shortt, J. (2004). Obesity -- a public health dilemma. AORN Journal, 80(6), 1069-1076, 1078.

OBESITY NOW IS recognized as a national epidemic. An estimated 64% of the US

population is classified as overweight or obese. Environmental factors, such as increased
food portions and sedentary lifestyles, have contributed to this epidemic.

Sidney, S., Sternfeld, B., Haskell, W. L., Quesenberry, C. P., Crow, R. S., and Thomas, R. J.
(1998). Seven-year change in graded exercise treadmill test performance in young adults in the
CARDIA study. Medicine and Science in Sports and Exercise, 30(3), 427-433.

Most studies of physical fitness change have been relatively small, not population-based,
and lacking in women and nonwhites. The purpose of this analysis was to evaluate the 7-
yr change in physical fitness in a biracial (black and white) population of young men and
women.

Siebold, E. S., Knal, K., and Grey, M. (2003). The family context of an intervention to prevent
type 2 diabetes in high-risk teens. Diabetes Educator, 29(6), 997-1004.

This research describes the family context of eating and mealtime patterns in young
adolescents at high risk for type 2 diabetes and the implications for preventing this
disease.

Simkin Silverman, L. R., Gleason, K. A., King, W. C., Weissfeld, L. A., Buhari, A., Boraz, M.
A., and Wing, R. R. (2005). Predictors of weight control advice in primary care practices: patient
health and psychosocial characteristics. Preventive Medicine, 40(1), 71-82.

Past research has surveyed primary care physicians (PCP) about their attitudes and
practices towards obese patients, yet less is known about the patients receiving advice.

Skidmore, P. M., and Yarnell, J. W. (2004). The obesity epidemic: prospects for prevention.
Qjm, 97(12), 817-25.
 201

Some 20-25% of UK adults are obese according to the WHO criterion (BMI >/=30
kg/m(2)). Type 2 diabetes, increasingly recognized as a major complication of
overweight and obesity, is beginning to appear in UK adolescents, following the trends in
the US. Epidemiological data indicate that the prevalence of overweight and obesity has
doubled or tripled in the past few decades in the US, in Europe, and even in many
developing countries. Thus obesity is increasingly seen as a public health problem
requiring concerted action by both governmental and non-governmental organizations. A
sound understanding of the root causes is crucial, if strategies for the prevention and
treatment of this epidemic are to be developed.

Skybo, T. A., and Ryan Wenger, N. (2002). A school-based intervention to teach third grade
children about the prevention of heart disease. Pediatric Nursing, 28(3), 223-229, 235-257.

Coronary heart disease continues to be a leading cause of death in adults. Because many
risk factors for heart disease make their first appearance in childhood, early intervention
is an attractive strategy for this disease. A convenience sample of 58 third grade children
participated in a year-long, quasi-experimental study to compare a school-based
educational program, HeartPower! to the standard health education curriculum. Variables
examined included knowledge, hypercholesterolemia, obesity, sedentary lifestyle,
hypertension, exposure to cigarette smoke, and parental participation. The students who
participated in the HeartPower! Program showed improvement (p < 0.05) in their
knowledge of healthy lifestyles. Modest improvements in hypertension and exposure to
tobacco smoke were observed. These results indicate that focused instruction on
important health issues may be preferable to a broad approach.

Slattery, M. L. (2004). Physical activity and colorectal cancer. Sports Medicine, 34(4), 239-252.

Physical activity has been shown to reduce risk of colon cancer. Some studies have
shown site-specific associations while others have not. The inverse association between
physical activity and colon cancer is consistent although only 7 of 13 studies that have
collected both colon and rectal cancer data in the same manner report reduced risk for
rectal cancer; four of these studies detected statistically significant inverse associations.
The frequency, duration and intensity of activity are important components of a public
health message to reduce risk of colon cancer through performance of physical activity.
However, difficulties in estimating the exact amount of activity needed and frequency
and intensity of activity result in only crude estimates of dose needed for a protective
effect.

Smith, A. M., Lopez-Jimenez, F., McMahon, M. M., Thomas, R. J., Wellik, M. A., Jensen, M.
D., and Hensrud, D. D. (2005). Action on obesity: report of a mayo clinic national summit. Mayo
Clinic Proceedings, 80(4), 527-32.

In May 2004, representatives from local, state, and national public and private
organizations met in Rochester, Minn, for the Action on Obesity Summit hosted by Mayo
Clinic. The overall goal of this summit was to identify creative and effective strategies to
 202

Increase the US population's physical activity and improve nutrition to reverse the
increasing prevalence of obesity. Ideas generated from selected abstract presentations and
breakout sessions were prioritized and incorporated into an action model (available at
www.actiononobesity.org) deemed feasible for implementation into most communities.

Smith, M. (2001). Pathogenesis of type 2 diabetes and effect of lifestyle changes. Journal of
Diabetes Nursing, 5(4), 123-127.

The huge societal, financial, and clinical costs of diabetes could be alleviated by the
adoption of lifestyle measures. This article gives an overview of the pathogenesis of
impaired glucose tolerance and type 2 diabetes. Both are a direct result of insulin
resistance and "insulin deficiency, which lead to hyperglycaemia, and, in the long-term,
to neuropathy and vascular diabetic complications.

Snelling, A. M., and Stevenson, M. O. (1999). Obesity: treating an American epidemic. JAAPA:
Journal of the American Academy of Physician Assistants, 12(9), 23-24, 28, 30.

By focusing on three primary areas of weight management -- dietary intervention,

behavioral change, and increased activity -- you may get patients to lose weight and keep
it off.

Solomon, H. S. (2002). Weight loss: New medications, and managing the health of the
overweight woman. Journal of Women's Health & Gender Based Medicine, 11(3).

The effective management of obesity remains elusive. In no other area of health

promotion do we see more exploitation of frustrated, hopeful people than in the treatment
of overweight and obesity. As Americans become heavier, the effective treatment of this
problem, by draconian "lifestyle change" or medication, remains barely effective short-
term success is unlikely longer term. In the current medical economic climate, physicians
are especially ill-suited to the task of behavioral modification, because they have so little
time to give, so we turn to dieticians, commercial weight loss programs.

Sondike, S. B., Cooperman, N. M., and Jacobson, M. S. (2000). Bringing a formidable opponent
down to size. Contemporary Pediatrics, 17(5), 132-134, 136-140, 143-144.

Obesity is on the rise and hard to treat. Whenever possible, you, your patient, and the
family should face the problem and deal with it before it assumes awesome proportions.
For a moderately obese child, not gaining for a while may be all that's needed.

Sothern, M. S. (2004). Obesity prevention in children: physical activity and nutrition. Nutrition,
20(7/8), 704-708.

The current environmental experience of young children includes few opportunities for
physical activity and an overabundance of high calorie foods. Sedentary lifestyles and
poor nutrition challenge children who are predisposed to metabolic disorders. Obesity is a
logical response to this challenge. To prevent clinically significant obesity and later
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metabolic disease in predisposed youth, all sectors of society must work together to
support strategies to change public opinion and behavior across the life span.

Spark, A. (2001). Health at any size: the size-acceptance nondiet movement. Journal of the
American Medical Women's Association, 56(2), 69-71.

A controversial new approach to obesity treatment has emerged during the last two
decades in response to traditional programs that do not result in sustained reductions in
weight. Goals of the size-acceptance nondiet movement include improving self-image,
normalizing eating behavior, and increasing physical activity independent of body
weight. This commentary presents the basic tenets and early voices in the movement,
reviews government weight recommendations, and suggests strategies for the size-
sensitive physician.

Sproul, A. D., Canter, D. D., and Schmidt, J. B. (2003). Does point-of-purchase nutrition
labeling influence meal selections? A test in an Army cafeteria. Military Medicine, 168(7), 556-
560.

This study assessed the effectiveness of nutrition labeling on sales of targeted entrees and
measured the perceived influence that factors such as taste, quality, appearance, fat
content, calorie content, and price had on meal selection behavior within an Army
cafeteria.

St Jeor, S. T., Howard, B. V., Prewitt, T. E., Bovee, V., Bazzarre, T., and Eckel, R. H. (2001).
Dietary protein and weight reduction: a statement for healthcare professionals from the Nutrition
Committee of the Council on Nutrition, Physical Activity, and Metabolism of the American
Heart Association. Circulation, 104(15), 1869-74.

High-protein diets have recently been proposed as a "new" strategy for successful weight
loss. However, variations of these diets have been popular since the 1960s. High-protein
diets typically offer wide latitude in protein food choices, are restrictive in other food
choices (mainly carbohydrates), and provide structured eating plans. They also often
promote misconceptions about carbohydrates, insulin resistance, ketosis, and fat burning
as mechanisms of action for weight loss.

St. Onge, M. P. (2005). Dietary fats, teas, dairy, and nuts: potential functional foods for weight
control? American Journal of Clinical Nutrition, 81(1), 7-15.

Functional foods are similar to conventional foods in appearance, but they have benefits
that extend beyond their basic nutritional properties. For example, functional foods have
been studied for the prevention of osteoporosis, cancer, and cardiovascular disease. They
have yet to be related to the prevention of obesity, although obesity is one of the major
health problems today.
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St. Onge, M. P., Bourque, C., Jones, P. J. H., Ross, R., and Parsons, W. E. (2003). Medium-
versus long-chain triglycerides for 27 days increases fat oxidation and energy expenditure
without resulting in changes in body composition in overweight women. International Journal of
Obesity, 27(1), 95-102.

To determine the effects of long-term consumption of medium chain (MCT) versus long
chain triglycerides (LCT) on energy expenditure (EE), substrate oxidation and body
composition. MCT consumption will not result in greater EE, substrate oxidation, and
body weight loss compared with LCT consumption.

St. Onge, M. P., and Jones, P. J. H. (2002). Physiological effects of medium-chain triglycerides:
potential agents in the prevention of obesity. Journal of Nutrition, 132(12), 329-333.

Medium chain fatty acids (MCFA) are readily oxidized in the liver. Animal and human
studies have shown that the fast rate of oxidation of MCFA leads to greater energy
expenditure (EE). Most animal studies have also demonstrated that the greater EE with
MCFA relative to long-chain fatty acids (LCFA) results in less body weight gain and
decreased size of fat depots after several months of consumption. Furthermore, both
animal and human trials suggest a greater satiating effect of medium-chain triglycelides
(MCT) compared with long-chain triglycerides (LCT). The aim of this review is to
evaluate existing data describing the effects of MCT on EE and satiety and determine
their potential efficacy as agents in the treatment of human obesity.

Staten, L. K., Teufel-Shone, N. I., Steinfelt, V. E., Ortega, N., Halverson, K., Flores, C., and
Lebowitz, M. D. (2005). The school health index as an impetus for change. Prev Chronic Dis,
2(1), A19.

The increase in childhood obesity and prevalence of chronic disease risk factors
demonstrate the importance of creating healthy school environments. As part of the
Border Health Strategic Initiative, the School Health Index was implemented in public
schools in two counties along the Arizona, United States-Sonora, Mexico border.
Developed in 2000 by the Centers for Disease Control and Prevention, the School Health
Index offers a guide to assist schools in evaluating and improving opportunities for
physical activity and good nutrition for their students. Between 2000 and 2003, a total of
13 schools from five school districts in two counties participated in the School Health
Index project despite academic pressures and limited resources.

Stear, S. (2003). Exercise and health. Health and fitness series -- 1. The importance of physical
activity for health. Journal of Family Health Care, 13(1), 10-11, 13.

Physical inactivity is recognised as a significant, common and preventable risk factor for
heart disease, obesity, type II diabetes and osteoporosis. Regular physical activity helps
avoid weight gain and plays a part in increasing wellbeing by reducing stress, anxiety and
feelings of depression. The author outlines some of the specific health effects of exercise
 205

and explains the significance of diet, especially carbohydrates. The article includes some
practical health education tips.

Steckler, A., Ethelbah, B., Martin, C. J., Stewart, D., Pardilla, M., Gittelsohn, J., Stone, E., Fenn,
D., Smyth, M., and Vu, M. (2003). Pathways process evaluation results: A school-based
prevention trial to promote healthful diet and physical activity in American Indian third, fourth,
and fifth grade students. Preventive Medicine, 37(6, Pt 2), S80-S90.

Pathways was a large-scale, multisite, 3-year, study testing a school-based intervention

designed to lower percent body fat in American Indian children. At the 21 intervention
schools process evaluation data were collected for training of school personnel;
implementation of the classroom and physical activity curricula; implementation of the
project's food service guidelines in the school cafeterias; adult participation in the family
events; and, students' perceived exposure to the Pathways interventions.

Stefanick, M. L. (1999). Physical activity for preventing and treating obesity-related

dyslipoproteinemias. Medicine and Science in Sports and Exercise, 31(11 Suppl), S609-S618.

The clinical trial data were reviewed on effects of physical activity on obesity-related
dyslipoproteinemias (specifically low HDL-cholesterol (HDL-C), elevated triglycerides
(TG), and high total and LDL-cholesterol (TC and LDL-C)) in adult men and women.
Effort was made to identify all randomized clinical trials (RCT), with exercise
intervention programs of at least 4 months' duration, which had lipoprotein outcomes.

Steinbeck, K. (2001). Obesity in children -- the importance of physical activity. proceedings of

the Kellogg's Nutrition Symposium 2000, Sydney, 8 August 2000. Australian Journal of
Nutrition and Dietetics, S28-S32 Suppl 1.

The focus of this paper is the role of energy output, i.e. physical activity, in the
prevention and management of childhood obesity. However, this does not mean that the
other side of the energy balance equation, food intake, is not important. An excess fat
gain is the result of an imbalance between energy intake (food) and energy output
(physical activity). There is evidence that physical activity is declining for the whole
population, including children, and that this decline is a major factor in the increasing
prevalence of obesity. Many childhood leisure activities, including viewing television,
increase sedentariness. Active time may be limited by safety concerns, lack of suitable
environments and lack of family time.

Steinbeck, K. S. (2001). The importance of physical activity in the prevention of overweight and
obesity in childhood: a review and an opinion. Obesity Reviews, 2(2), 117-131.

The prevalence of childhood obesity is increasing and there are a number of theoretical
reasons as to why intervention may be more effective in childhood. There are certain risk
times for the development of obesity in childhood, which provide a basis for targeted
intervention. In addition, tracking data supports the persistence of obesity, at least in later
childhood, as well as cardiovascular risk factors. Physical activity is the discretionary
 206

component of energy expenditure and there is evidence that falling levels of physical
activity are contributing to the obesity epidemic.

Steptoe, A., Kerry, S., Rink, E., and Hilton, S. (2001). The impact of behavioral counseling on
stage of change in fat intake, physical activity, and cigarette smoking in adults at increased risk
of coronary heart disease. American Journal of Public Health, 91(2), 265-269.

This study assessed stages of change in fat intake, physical activity, and cigarette
smoking during a randomized controlled trial of behavioral counseling.

Stern, J. S., Gades, M. D., Wheeldon, C. M., and Borchers, A. T. (2001). Calorie restriction in
obesity: prevention of kidney disease in rodents. Journal of Nutrition, 913S-917S.

The incidence of end-stage renal disease (ESRD) has risen considerably in the past two
decades. This trend is partly due to the alarming rise in the incidence of type 2 diabetes
over the same period, which in turn might be linked to the staggering increase in
overweight and obesity. If these trends continue, ESRD can be expected not only to cause
suffering of ever growing numbers of patients, but also to become an increasing financial
as well as logistical burden on the health care system. Therefore, it is imperative not only
to gain a better understanding of the molecular, cellular and metabolic mechanisms
involved in renal pathology, but also to uncover treatment modalities, including lifestyle
changes, that can help prevent and/or slow the progression of kidney pathogenesis.

Stern, J. S., Kazaks, A., and Downey, M. (2005). Future and implications of reimbursement for
obesity treatment. Journal of the American Dietetic Association, 105(5 Pt 2), 104-9.

Obesity has been defined as a distinct disease by the World Health Organization,
National Institutes of Health, Centers for Disease Control and Prevention, and the
American Dietetic Association. In the United States, a major reimbursement challenge is
to promote acceptance of obesity as a chronic disease and acceptance of its treatment by
health management organizations, private insurers, and the government. The United
States health care system is focused on treating individual obesity-related diseases, but
does not treat obesity as the underlying cause.

Stettler, N., Stallings, V. A., Troxel, A. B., Zhao, J., Schinnar, R., Nelson, S. E., Ziegler, E. E.,
and Strom, B. L. (2005). Weight gain in the first week of life and overweight in adulthood: a
cohort study of European American subjects fed infant formula. Circulation, 111(15), 1897-903.

Successful prevention of obesity and related cardiovascular risk factors requires a clear
understanding of its determinants over the life course. Rapid infancy weight gain is
associated with childhood obesity, whereas low infancy weight is associated with
coronary heart disease. Our aim was to identify during which periods in infancy weight
gain is associated with adult obesity.
 207

Stevens, J., Story, M., Ring, K., Murray, D. M., Cornell, C. E., Juhaeri, and Gittelsohn, J. (2003).
The impact of the Pathways intervention on psychosocial variables related to diet and physical
activity in American Indian schoolchildren. Preventive Medicine, 37, S70-S79.

The purpose of this study was to examine the impact of the Pathways intervention on
pychosocial variables related to physical activity and diet in American Indian children.

Stolley, M. R., and Fitzgibbon, M. L. (1997). Effects of an obesity prevention program on the
eating behavior of African American mothers and daughters. Health Education and Behavior,
24(2), 152-164.

Cardiovascular disease (CVD) is the number one cause of death in the United States.
Obesity is highly related to CVD risk, especially in African American women. This study
explored the efficacy of a culturally specific obesity prevention program. Designed for
low-income, inner-city African American girls and their mothers, the program addressed
the importance of eating a low-fat, low-cholesterol diet and increasing activity.

Stolley, M. R., Fitzgibbon, M. L., Dyer, A., Horn, L. v., Kaufer Christoffel, K., and Schiffer, L.
(2003). Hip-Hop to Health Jr., an obesity prevention program for minority preschool children:
baseline characteristics of participants. Preventive Medicine, 36(3), 320-329.

The prevalence of obesity in the United States is a significant public health problem.
Many obesity-related risk factors are more prevalent in minority populations. Given the
recalcitrant nature of weight loss interventions for adults, prevention of overweight and
obesity has become a high priority. The present study reports baseline data from an
obesity prevention intervention developed for minority preschool children.

Stone, E. J., Norman, J. E., Davis, S. M., Stewart, D., Clay, T. E., Caballero, B., Lohman, T. G.,
and Murray, D. M. (2003). Design, implementation, and quality control in the Pathways
American-Indian multicenter trial. Preventive Medicine, 37(6 Part 2), S13-S23.

Pathways was the first multicenter American-Indian school-based study to test the
effectiveness of an obesity prevention program promoting healthy eating and physical
activity. Methods: Pathways employed a nested cohort design in which 41 schools were
randomized to intervention or control conditions and students within these schools were
followed as a cohort (1,704 third graders at baseline). The study's primary endpoint was
percent body fat.

Story, M., Evans, M., Fabsitz, R. R., Clay, T. E., Rock, B. H., and Broussard, B. (1999). The
epidemic of obesity in American Indian communities and the need for childhood obesity-
prevention programs. American Journal of Clinical Nutrition, 69(Supplement 4), 747S-754S.

The epidemiology, aetiology and health affects of obesity in American Indian populations
is discussed with reference to strategies for treatment and prevention, especially in
children.
 208

Story, M., Sherwood, N. E., Himes, J. H., Davis, M., Jacobs, D. R., Jr., Cartwright, Y., Smyth,
M., and Rochon, J. (2003). An after-school obesity prevention program for African-American
girls: The Minnesota GEMS pilot study. Ethnicity and Disease, 13(Supplement 1), S1-64.

This paper describes the development of an after-school obesity-prevention program for

African-American girls, and presents findings from a 12-week pilot trial conducted by the
University of Minnesota. This study was part of the GEMS project, created to test
interventions designed to reduce excess weight gain in African-American girls.

Story, M., Stevens, J., Himes, J., Stone, E., Rock, B. H., Ethelbah, B., and Davis, S. (2003).
Obesity in American-Indian children: Prevalence, consequences, and prevention. Preventive
Medicine, 37(6 Part 2), S3-S12.

American Indians of all ages and both sexes have a high prevalence of obesity. The
health risks associated with obesity are numerous and include Type 2 diabetes mellitus,
hypertension, dyslipidemia, and respiratory problems. Obesity has become a major health
problem in American Indians only in the past few generations and it is believed to be
associated with the relative abundance of high-fat, high-calorie foods and the rapid
change from active to sedentary lifestyles.

Story, M., Strauss, K. F., Zephier, E., and Broussard, B. A. (1998). Nutritional concerns in
American Indian and Alaska Native children: transitions and future directions. Journal of the
American Dietetic Association, 170-176.

The nutritional health of American Indian and Alaska Native children has changed
dramatically over the past 30 years. The prevention and treatment of malnutrition
(primarily undernutrition) was a major health issue until the mid to late 1970s. Now, a
generation later, obesity in American Indian and Alaska Native children is a major health
threat.

Story, M. T., Neumark-Stzainer, D. R., Sherwood, N. E., Holt, K., Sofka, D., Trowbridge, F. L.,
and Barlow, S. E. (2002). Management of child and adolescent obesity: attitudes, barriers, skills,
and training needs among health care professionals. Pediatrics, 110(1 part2), 210-214.

The primary aim of this study was to evaluate among health care professionals their
attitudes, perceived barriers, perceived skill level and training needs in the management
of child and adolescent obesity.

Stouffer, K., and Dorman, S. M. (1999). Childhood obesity: a multifaceted etiology.

International Electronic Journal of Health Education, 2(2), 66-72.

This paper presents a multifaceted etiology of childhood obesity regarding energy

consumption, energy expenditure, behavioral factors, and psychosocial factors related to
the disorder. Recommendations are presented for health educators to approach this
problem from a holistic perspective involving assistance from parents and teachers and
 209

assisting children in making lifestyle changes. Also, challenges and future directions for
research are given.

Striegel Moore, R. H. (2001). The impact of pediatric obesity treatment on eating behavior and
psychologic adjustment. Journal of Pediatrics, 139(1), 13-14.

The results of a study on obesity treatment are discussed. The study investigated whether
weight loss interventions put children at risk for the development of disordered eating.

Struber, J. C. (2004). Considering physical inactivity in relation to obesity. Internet Journal of

Allied Health Sciences and Practice, 2(1), 1-11.

Physical inactivity and obesity contribute enormously to the current burden of disease in
Australia, as in all Western Countries. Although diet and exercise have been linked to
health since antiquity, the connection has recently experienced a revival of interest.

Stubbs, R. J., Sepp, A., Hughes, D. A., Johnstone, A. M., King, N., Horgan, G., and Blundell, J.
E. (2002). The effect of graded levels of exercise on energy intake and balance in free-living
women. International Journal of Obesity, 26(6), 866-869.

We assessed the effect of graded increases in exercised-induced energy expenditure (EE)

on appetite, daily energy intake (EI), total daily EE and body weight in six lean women
using a within-subject, repeated measures design.

Stubbs, R. J., Whybrow, S., King, N., Hughes, D., Johnstone, A., Mazlan, N., Horgan, G., and
Blundell, J. (2002). Interactions between diet and physical activity in the development and
treatment of obesity. International Journal of Obesity, 26(1).

There is an urgent need to develop new approaches to weight management (AWM), using
aspects of diet and physical activity, in two ways:- weight control (preventing the
development of obesity) and sustained weight reduction (in order to treat obesity).
Current AWM are remarkably rudimentary, largely prescriptive and generally of limited
success. It is now widely accepted that diet composition effects energy intake (EI) and
energy balance (EB). Specific nutrients involved and mechanisms by which they operate
are more controversial. Increases in fat, energy density and the sugar content of foods
appear to facilitate excess EI.

Stunkard, A. J., Faith, M. S., and Allison, K. C. (2003). Depression and obesity. Biological
Psychiatry, 54(3), 330-337.

Investigated the functional relationship between depression and obesity. This report used
the moderator/mediator distinction to approach this question. Moderators, such as
severity of depression, severity of obesity, gender, socioeconomic status (SES), gene-by-
environment interactions and childhood experiences, specify for whom and under what
conditions effects of agents occur. Mediators, such as eating and physical activity,
teasing, disordered eating and stress, identify why and how they exert these effects.
 210

Major depression among adolescents predicted a greater body mass index in adult life
than for persons who had not been depressed.

Sutherland, R., Gill, T., and Binns, C. (2004). Do parents, teachers and health professionals
support school-based obesity prevention? Nutrition & Dietetics, 61(3), 137-144.

This study aimed to investigate the attitudes of parents, teachers and health professionals
on factors contributing to childhood obesity and the role of the school in preventing
childhood obesity. The prevalence of overweight and obesity was also assessed to
compare to current national figures.

Suzuki, D. (2004). Worth quoting: Instant 'cures' - or solutions? Active living, 13(6), 1.

Makes the point that obesity can only be cured with lifestyle changes, such as walking
more, and that treatment options such as stomach stapling, sugar substitutes and weight
loss drugs only treat the symptoms.

Swinburn, B., Gill, T., and Kumanyika, S. (2005). Obesity prevention: a proposed framework for
translating evidence into action. Obesity Reviews, 6(1), 23-33.

Obesity as a major public health and economic problem has risen to the top of policy and
programme agendas in many countries, with prevention of childhood obesity providing a
particularly compelling mandate for action. There is widespread agreement that action is
needed urgently, that it should be comprehensive and sustained, and that it should be
evidence-based. While policy and programme funding decisions are inevitably subject to
a variety of historical, social, and political influences, a framework for defining their
evidence base is needed. This paper describes the development of an evidence-based,
decision-making framework that is particularly relevant to obesity prevention.

Tanofsky Kraff, M., and Yanovski, S. Z. (2004). Eating disorder or disordered eating? Non-
normative eating patterns in obese individuals. Obesity Research, 12(9), 1361-6.

Binge eating disorder (BED) and night eating syndrome (NES) are putative eating
disorders frequently seen in obese individuals. Data suggest that BED fulfills criteria for
a mental disorder. Criteria for NES are evolving but at present do not require distress or
functional impairment. It remains unclear whether BED and NES, as they are currently
defined, are optimally useful for characterizing distinct patient subgroups. We propose
that a distinction be made between "eating disorders" and "non-normative" eating
patterns without associated distress or impairment. Although non-normative eating
patterns may not be considered mental disorders, they may be very important in terms of
their impact on body weight and health.

Taylor, E., Missik, E., Hurley, R., Hudak, S., and Logue, E. (2004). Obesity treatment:
broadening our perspective. American Journal of Health Behavior, 28(3), 242-249.
 211

To selectively review the dietary literature to broaden perspectives on energy restriction

as the primary determinant of successful obesity treatment.

Taylor, W. C., Baranowski, T., Klesges, L. M., Ey, S., Pratt, C., Rochon, J., and Zhou, A. (2004).
Psychometric properties of optimism and pessimism: results from the Girls' Health Enrichment
Multisite Studies. Preventive Medicine, 38, S69-S77.

This study investigated the relationships among optimism, pessimism, physical activity,
and dietary behaviors among 8- to 10-year-old African-American girls in the Girls'
Health Enrichment Multisite Studies (GEMS).

Taylor, W. C., Sallis, J. F., Dowda, M., Freedson, P. S., Eason, K., and Pate, R. R. (2002).
Activity patterns and correlates among youth: differences by weight status. Pediatric Exercise
Science, 14(4), 418-431.

The purposes of the study were to assess differences in physical activity levels and
correlates of physical activity among overweight (greater than or equal to 85th percentile
of body mass index for their sex and age) and non-overweight (< 85th percentile) youth.

Teachman, B. A., and Brownell, K. D. (2001). Implicit anti-fat bias among health professionals:
is anyone immune. International Journal of Obesity and Related Metabolism Disorders, 1525-
1531.

To investigate whether negative implicit attitudes and beliefs toward overweight persons
exist among health professionals who specialize in obesity treatment, and to compare
these findings to the implicit anti-fat bias evident in the general population.

Teegarden, D. (2003). Calcium intake and reduction in weight or fat mass. Journal of Nutrition,
133(1), 249S-252S.

Obesity is a growing epidemic with subsequent health consequences leading not only to
reduced quality of life but also to increased medical costs. Growing evidence supports a
relationship between increased calcium intakes and reductions in body weight specific to
fat mass. Since the first observations in rats >10 y ago, several recently published clinical
studies support this relationship as well. The impact of calcium intake on weight loss or
prevention of weight gain has been demonstrated in a wide age range of Caucasian and
African-Americans of both genders. This review focuses on the results of clinical trials
that have investigated the impact of calcium and dairy products on prevention of weight
gain, weight loss or development of the insulin resistance syndrome.

Teixeira, P. J., Going, S. B., Sardinha, L. B., and Lohman, T. G. (2005). A review of
psychosocial pre-treatment predictors of weight control. Obesity Reviews, 6(1), 43-65.

Prompted by the large heterogeneity of individual results in obesity treatment, many

studies have attempted to predict weight outcomes from information collected from
participants before they start the programme. Identifying significant predictors of weight
 212

loss outcomes is central to improving treatments for obesity, as it could help

professionals focus efforts on those most likely to benefit, suggest supplementary or
alternative treatments for those less likely to succeed, and help in matching individuals to
different treatments.

Teran, L. M., Belkic, K. L., and Johnson, C. (2002). An exploration of psychosocial

determinants of obesity among Hispanic women. Hispanic Journal of Behavioral Sciences, 24(1),
92-103.

Obesity, a major public health problem among US. Hispanic women, has a psychosocial
cultural context, which the authors explore through quantitative and qualitative methods.
The authors examine, for example, paid and unpaid work, cultural and familial dynamics,
and their relation to eating habits, body mass index (BMI) and general well-being. 23
Hispanic mothers (aged 31-63 yrs) mainly born in Mexico participated.

Teufel, N. I., Perry, C. L., Story, M., Flint-Wagner, H. G., Levin, S., Clay, T. E., Davis, S. M.,
Gittelsohn, J., Altaha, J., and Pablo, J. L. (1999). Pathways family intervention for third-grade
American Indian children. American Journal of Clinical Nutrition, 69(Supplement 4), 803S-
809S.

The goal of the feasibility phase of the Pathways family intervention was to work with
families of third-grade American Indian children to reinforce health behaviours being
promoted by the curriculum, food service, and physical activity components of this
school-based obesity prevention intervention. Family behaviours regarding food choices
and physical activity were identified and ranked according to priority by using formative
assessment and a literature review of school-based programmes that included a family
component.

Thalamas, C., Galitzky, J., Senard, J. M., Lafontan, M., Montastruc, J. L., Berlan, M., and Barbe,
P. (2000). Glucose-induced sympathetic activity and energy expenditure during acute alpha2-
adrenergic antagonism in obese subjects. International Journal of Obesity and Related
Metabolism Disorders, 695-700.

To determine the effect of an alpha2-adrenoceptor antagonist, idazoxan, on the

sympathetic nervous system and on energy expenditure responses after an oral glucose
load, in obese patients. (idazoxan acts as an indirect sympathomimetic drug through
blockade of presynaptic alpha2-adrenoceptors).

Thew, J. (2004). American idle. Nursing Spectrum, 16(16), 26-27.

Poor lifestyle choices are causing childhood obesity to surge, but it's not too late to teach
kids healthy living.

Thomas, D. (1998). RCN continuing education. Managing obesity: the nutritional aspects.
Nursing Standard, 12(18), 49-52, 54-55.
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This article discusses the nutritional aspects of obesity and the role of the nurse in helping
patients to achieve optimum weight levels.

Thomas, K. T. (2004). Riding to the rescue while holding on by a thread: physical activity in the
schools. Quest, 56(1), 150-170.

The public health burden of obesity, overweight, and physical inactivity suggests schools
be actively involved in prevention and treatment. Schools were challenged to take action
by the Surgeon General in 2001. Few resources have been allocated to support the
schools and in the presence of budget and high stakes testing pressure, resources are
decreasing. Sources of support (research, professional organizations, government,
coalitions/foundations) often criticize schools and teachers while providing erroneous
information and no support. Teachers have responded to recommendations by including
lifetime activities, health related fitness, and increasing MVPA. Approximately half the
recommended minutes per week are provided in schools where there is any PE, many (5-
33%) schools have no PE for their students.

Thompson, J. L., Davis, S. M., Gittelsohn, J., Going, S., Becenti, A., Metcalfe, L., Stone, E.,
Harnack, L., and Ring, K. (2001). Patterns of physical activity among American Indian children:
An assessment of barriers and support. Journal of Community Health: The Publication for Health
Promotion and Disease Prevention, 26(6), 407-421.

As part of an initiative to develop and test a school-based obesity prevention program,

this study investigated patterns, supports, and barriers to physical activity in a sample of
American Indian children. Nine schools from communities representing 6 different tribal
groups participated in this study.

Thompson, L. S., and Grey, M. (2002). Fighting childhood obesity with university-community
partnerships. Nursing Leadership Forum, 7(1), 20-24.

This article describes how two Robert Wood Johnson (RWJ) Executive Nurse Fellows
used their leadership competencies to inspire and lead change within the community to
fight the growing problem of childhood obesity. A model of University-Community
partnership is proposed which incorporated the core leadership competencies of the RWJ
program--interpersonal and communication effectiveness; risk-taking and creativity; self-
knowledge; skills in creating change; and, strategic vision. Leadership lessons learned are
provided for nurses interested in leading efforts to improve the health status of
communities.

Thompson, L. S., and Story, M. (2003). Perceptions of overweight and obesity in their
community: findings from focus groups with urban, African-American caretakers of preschool
children. Journal of National Black Nurses' Association, 14(1), 28-37.

Focus groups were conducted with parents, other caretakers, and teachers of urban,
African American preschool children attending Head Start. The research goal, congruent
with the concept of cultural humility, was to elicit target population members'
 214

perspectives on the nature, importance, prevalence, and causes of overweight and obesity
in their community, with an emphasis on childhood obesity. Themes that emerged
revealed that participants defined obesity as a more extreme state than the medical
definition, these same participants had a complex view of the relationships of weight and
health, stressed numerous environmental factors contributing to obesity. Moreover, these
participants tended to offer suggestions for health professionals and those designing
nutrition education interventions.

Thompson, O. M., Ballew, C., Resnicow, K., Must, A., Bandini, L. G., Cyr, H., and Dietz, W. H.
(2004). Food purchased away from home as a predictor of change in BMI z-score among girls.
International Journal of Obesity and Related Metabolism Disorders, 28(2), 282-289.

The aim of this study is to assess the relationship between eating food purchased away
from home (FAH) and longitudinal change in body mass index (BMI) z-score among
girls, and to assess the longitudinal tracking of eating FAH from childhood through
adolescence.

Thompson, V. J., Baranowski, T., Cullen, K. W., Rittenberry, L., Baranowski, J., Taylor, W. C.,
and Nicklas, T. (2003). Influences on diet and physical activity among middle-class African-
American 8- to 10-year old girls at risk of becoming obese. Journal of Nutrition Education and
Behavior, 35(3), 115-123.

To understand diet, physical activity, and inactivity influences among preadolescent

African American girls at risk of becoming obese. Design: Interviews and group
qualitative discussions were conducted separately with 8- to 10-year-old African
American girls and their parents.

Thorne, A., Lonnqvist, F., Apelman, J., Hellers, G., and Arner, P. (2002). A pilot study of long-
term effects of a novel obesity treatment: omentectomy in connection with adjustable gastric
banding. International Journal of Obesity and Related Metabolism Disorders, 193-199.

To determine whether visceral fat reduction in connection with bariatric surgery could
improve weight loss and metabolic profile of obese subjects.

Tilghman, J. (2003). Obesity and diabetes in African American women. ABNF-Journal, 14(3),
66-68.

Obesity has reached near epidemic proportions in the United States. The prevalence of
obesity is high among African Americans, particularly African American women. The
risk of diabetes is significantly related to obesity. The risks of morbidity and mortality
associated with diabetes poses serious problems for the African American community. It
is vital that nurses be at the forefront in initiating research studies, developing strategies
for use in practice and providing education to the public about the potentially deadly
consequences of obesity.
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Tillotson, J. E. (2002). We're fat and getting fatter! What is the food industry's role? Nutrition
Today, 37(3), 136-138.

Is the food business to blame for the fattening of America? Can nutrition professionals
play the blame game and get themselves off the hook? Some perspectives on the strategy
and tactics of the war against obesity.

Tillotson, J. E. (2004). Pandemic obesity: what is the solution? Nutrition Today, 39(1), 6-9.

"What is the practical solution to the obesity problem?" is the perceptive question I was
recently asked by Linda Hirsh, Field Producer for the Peter Jennings' Show. She was
preparing a television show on the American obesity problem for fall viewing on ABC.
This column looks at whether there is a practical solution yet, and, if there is, what is it?
Here goes!

Tilson, E. C., McBride, C. M., Albright, J. B., and Sargent, J. D. (2001). Attitudes toward
smoking and family-based health promotion among rural mothers and other primary caregivers
who smoke. Journal of School Nursing, 71(10), 489-494.

The family milieu provides a potential context for integrating smoking cessation and
prevention activities to complement school-based efforts. In this study, surveys were
mailed to caregivers of elementary school children to assess demographics, smoking
characteristics and attitudes, and receptivity to and preferred format for health promotion
programs. Fifty-three percent (n = 276) of 501 caregivers responded. Among smokers,
most did not want their children to smoke, and they wanted to quit themselves; 91%
considered it important to involve their children in their smoking cessation attempts; and
70% expressed willingness to participate in health promotion for the entire family.
Written materials either mailed home or brought home from school were the preferred
program formats. These findings suggest the feasibility of a program in which adults and
children work together at home on smoking cessation and prevention activities that might
increase the effectiveness of school-based smoking prevention messages.

Timmerman, G. M., and Gregg, E. K. (2003). Dieting, perceived deprivation, and preoccupation
with food. Western Journal of Nursing Research, 25(4), 405-418.

A prospective study using 14-day food diaries was conducted to determine whether
perceived deprivation and preoccupation with food correspond to actual caloric and fat
intake, using a sample of 121 adult women who were binge eating without purging or
were currently dieting. Caloric and fat intake were not significantly related to perceived
deprivation. Only weight cycling and Revised Restraint Scale was significantly correlated
with perceived deprivation with 11% of the variation explained by the Revised Restraint
Scale scores. These findings support the contention that psychological deprivation occurs
regardless of caloric intake. For preoccupation with food, only fat intake and Revised
Restraint Scale scores were significantly correlated with 15% of the variance explained
by the Revised Restraint Scale scores.
 216

Timmerman, G. M., Reifsnider, E., and Allan, J. D. (2000). Weight management practices
among primary care providers. Journal of the American Academy of Nurse Practitioners, 12(4),
113-116.

This pilot study examined how primary care providers manage patients with weight
problems, an important component of primary care. A convenience sample of 17 nurse
practitioners and 15 physicians were surveyed about assessments and interventions used
in practice for weight management along with perceived barriers to providing effective
weight management. Practice patterns between gender, profession and practice setting of
the nurse practitioners were compared.

Timperio, A., Cameron-Smith, D., Burns, C., and Crawford, D. (2000). The public's response to
the obesity epidemic in Australia: weight concerns and weight control practices of men and
women. Public Health Nutrition, 3(4), 417-424.

To assess weight perceptions, weight concerns and weight control behaviours and related
beliefs in a representative sample of adults from the state of Victoria, Australia. The
survey was conducted between October and December 1997.

Tokimitsu, I. (2004). Effects of tea catechins on lipid metabolism and body fat accumulation.
Biofactors, 22(1-4), 141-3.

Long-term feeding of tea catechins suppressed body fat accumulation in high-fat diet-
induced obesity in mice, and that their effects might be attributed, at least in part, to the
activation of hepatic lipid metabolism. Consecutive intake of tea catechins (588 mg/day)
reduced body fat, especially abdominal fat in humans. These results demonstrate that
intake of tea catechins is beneficial for body fat accumulation.

Tonstad, S., and Graff-Iversen, S. (2001). Action levels for obesity treatment in 40 to 42-y-old
men and women compared with action levels for prevention of coronary heart disease.
International Journal of Obesity and Related Metabolism Disorders, 1698-1704.

Guidelines for treating overweight and obesity have been suggested by the World Health
Organization and other expert groups. We asked whether most men and women targeted
in obesity guidelines would already be included in existing clinical recommendations for
the prevention of coronary heart disease (CHD) or whether a new group of patients would
be added to current workloads.

Topping, P., Gross, S., and Todd, K. (1997). Obesity: manage as chronic disease or behavioral
problem? JAAPA: Journal of the American Academy of Physician Assistants, 10(10), 38-40, 45-
46, 48.

What is a realistic approach to weight loss? What are the best methods to use? This
article identifies the probably causes of obesity and provides new insights for treatment.
 217

Torgerson, J. S. (2003). Low-carbohydrate dieting: what's going on? Scandinavian Journal of

Nutrition, 47(4), 167-169.

Low-carbohydrate diets have become increasingly popular in recent years. A review of

available clinical trials indicates that there is not enough information on efficacy and
safety to make clear recommendations for or against the use of such diets in obesity
treatment. Unfortunately, too many published studies have methodological shortcomings,
making interpretation of data difficult.

Torgerson, J. S., Lindroos, A. K., Naslund, I., and Peltonen, M. (2003). Gallstones, gallbladder
disease, and pancreatitis: Cross-sectional and 2-year data from the Swedish Obese Subjects
(SOS) and SOS reference studies. American Journal of Gastroenterology, 98(5), 1032-1041.

Obesity and weight loss have been associated with gallstone disease. There is also an
association between gallstones and pancreatitis. We investigated cross-sectional
relationships between body mass index (BMI), body fat distribution, and prevalence of
gallstones, gallbladder disease, and pancreatitis in men and women. Furthermore, 2-yr
incidences of these disorders were examined in relation to changes in weight and body fat
distribution after surgical and conventional obesity treatment.

Torgerson, J. S., and Sjostrom, L. (2001). The Swedish Obese Subjects (SOS) study--rationale
and results. International Journal of Obesity and Related Metabolism Disorders, S2-S4.

Obesity is associated with increased morbidity and mortality. Several observational

epidemiological studies have indicated that weight gain and weight loss, even in the
obese, is also related to an increased mortality. The Swedish Obese Subjects (SOS) study
was initiated in 1987 as an attempt to elucidate this paradox.

Torti, D. C., and Matheson, G. O. (2004). Exercise and prostate cancer. Sports Medicine, 34(6),
363-369.

Prostate cancer is a leading cause of cancer morbidity and mortality in men. In addition to
improved treatments, strategies to reduce disease risk are urgently required. This review
summarises the literature that examines the association between exercise and prostate
cancer risk. Between 1989 and 2001, 13 cohort studies were conducted in the US and
internationally. Of these, nine showed an association between exercise and decreased
prostate cancer risk.

Toth, M. J., Beckett, T., and Poehlman, E. T. (1999). Physical activity and the progressive
change in body composition with aging: current evidence and research issues. Medicine and
Science in Sports and Exercise, 31(11 Suppl), S590-S596.

The purpose was to review studies that have examined the effect of aerobic (AEX) or
resistance exercise (REX) on body composition in older individuals (> 55 yr). Our goal
 218

was to examine the effect of these two exercise paradigms on fat mass and fat-free mass
and to consider those factors that may explain variability in findings among studies.

Tremblay, A., and Drapeau, V. (1999). Physical activity and preference for selected
macronutrients. Medicine and Science in Sports and Exercise, 31(11 Suppl), S584-S589.

The impact of physical exercise on macronutrient preferences was examined with a

perspective to improve preventive and therapeutic strategies of obesity. The literature was
reviewed pertaining to the acute effects of physical activity and the short-term and
chronic effects of exercise training on macronutrient preferences. The presently available
literature does not permit to establish a consensus regarding the impact of physical
activity, be it acute or long-term, on macronutrient selection. However, one observation
stands out and that is the fact that dietary fat intake needs to be controlled in order for
exercise to produce a negative energy and fat balance. Because active individuals do not
systematically choose foods that are low in fat content, it is important to provide
nutritional guidelines in a context where physical activity aims at reducing or better
controlling body weight.

Trent, L. K., and Thieding Cancel, D. (1995). Effects of chromium picolinate on body
composition. Journal of Sports Medicine and Physical Fitness, 35(4), 273-278.

This study explored the efficacy of chromium picolinate as a fat-reduction aid for obese
individuals enrolled in a physical exercise program.

Trincia, V., and Biondi, M. (2003). Some atypical therapeutic effects of SSRI / Alcuni effetti
terapeutici atipici degli SSRI. Rivista di Psichiatria, 38(2), 59-70.

Several studies published in the recent years, propose that SSRI could be useful in
pathologies different from psychiatric disorders. Various studies, in which the majority of
the cases have been conducted in a controlled manner with random double-blind
selection, put emphasis on the advantage of using several SSRI (paroxetine, fluoxetine,
fluvoxamine, sertraline) in a wide range of disorders like headache due to stress and
tension, migraine prevention, treatment of pain, premenstrual syndrome and premature
ejaculation.

Tseng, M. C., Lee, M. B., Chen, S. Y., Lee, Y. J., Lin, K. H., Chen, P. R., and Lai, J. S. (2004).
Response of Taiwanese obese binge eaters to a hospital-based weight reduction program. Journal
of Psychosomatic Research, 57(3), 279-285.

To investigate the characteristics and prevalence of binge eating among overweight

Taiwanese and to determine the effect of binge eating on outcome of weight loss
treatment.

Tudor Locke, C., Ainsworth, B. E., and Popkin, B. M. (2001). Active commuting to school: an
overlooked source of childrens'(sic) physical activity? Sports Medicine, 31(5), 309-313.
 219

The assessment and promotion of children's healthful physical activity is important: (i) to
combat the international obesity epidemic that extends to childhood; and (ii) to establish
an early habit of lifestyle physical activity that can be sustained into adolescence and
adulthood. The primary focus of both assessment and promotion efforts has been on in-
school physical education classes and, to a lesser extent, out-of-school structured
exercise, sport and play.

Tuttle, C. R., Derrick, B., and Tagtow, A. (2003). A new vision for health promotion and
nutrition education. American Journal of Health Promotion, 18(2), 186-191.

Increased integration and collaboration of health promotion and nutrition education

professionals to effectively engage consumers, debunk nutrition and health information,
and mitigate the effect of chronic diseases is the vision presented for success in the
future. Current and optimal roles of educators are discussed in relation to societal trends
and their inherent opportunities and barriers. Recommendations for strengthening the role
of health promotion in settings where nutrition educators work are provided and include
the need for strong academic preparation, field-based training, and continual professional
development.

Tyler, D. O. (2004). Overweight and perceived health in Mexican American children: a pilot
study in a central Texas community. Journal of School Nursing, 20(5), 285-292.

This study assessed actual and perceived health status of overweight Mexican American
clients at a central Texas school-based health center in a predominantly Hispanic school
district. It also explored the participants' interest in making lifestyle changes to promote a
healthy weight. A medical records review indicated that of the Hispanic children between
the ages of 7 and 12 years, 38% had a weight status at or above the 85th percentile.

Uauy, R., and Kain, J. (2002). The epidemiological transition: need to incorporate obesity
prevention into nutrition programmes. Public Health Nutrition, 5(1), 223-230.

Trends in the nutritional status for developing countries that are undergoing rapid
economic growth indicate a decrease in protein-energy malnutrition (PEM) with an
associated rise in obesity prevalence.Objective: This paper analyses how supplementary
feeding programmes may contribute to rising obesity trends, what factors may explain
this phenomenon, and potential strategies to avoid obesity in malnutrition prevention
efforts.

Unger, J. B., Reynolds, K., Shakib, S., Spruijt-Metz, D., Sun, P., and Johnson, C. A. (2004).
Acculturation, physical activity, and fast-food consumption among Asian-American and
Hispanic adolescents. Journal of Community Health, 29(6), 467-81.

Previous studies have implicated acculturation to the US as a risk factor for unhealthy
behaviors among Hispanic and Asian-American adolescents, including substance use,
violence, and unsafe sex. This study examined the association between acculturation and
 220

obesity-related behaviors-physical activity and fast-food consumption-among 619 Asian-

American and 1385 Hispanic adolescents in Southern California.

Utter, A. C., Nieman, D. C., Shannonhouse, E. M., Butterworth, D. E., and Nieman, C. N.
(1998). Influence of diet and/or exercise on body composition and cardiorespiratory fitness in
obese women. International Journal of Sport Nutrition, 8(3), 213-222.

The purpose of this study was to measure the influence of diet, exercise, or both on body
composition and cardiorespiratory fitness in obese women. Ninety-one obese subjects
were randomized into one of four groups: diet (D) (4.19-5.44 MJ or 1,200-1,300
kcal/day), exercise (E) (five 45-min sessions at 78.5 plus/minus 0.5 percent maximum
heart rate), exercise and diet (ED), and controls (C). Maximal aerobic power and body
composition were measured in all subjects before and after a 12-week diet intervention
period.

Uusitupa, M. I. J. (1996). Early lifestyle intervention in patients with non-insulin-dependent

diabetes mellitus and impaired glucose tolerance. Annals of Medicine, 28(5), 445-449.

One-year dietary and exercise intervention on 86 40-64 yr old obese patients with newly
diagnosed noninsulin-dependent diabetes mellitus (NIDDM) in Kuopio, Finland resulted
in a better metabolic control and a moderate reduction in cardiovascular risk factors as
compared to the conventional treatment group.

Van Baak, M. A., Van Mil, E., Astrup, A. V., Finer, N., Van Gaal, L. F., Hilsted, J., Kopelman,
P. G., Roessner, S., James, W. P., and Saris, W. H. M. (2003). Leisure-time activity is an
important determinant of long-term weight maintenance after weight loss in the Sibutramine
Trial on Obesity Reduction and Maintenance (STORM trial). American Journal of Clinical
Nutrition, 78(2), 209-214.

The success rate of long-term maintenance of weight loss in obese patients is usually low.
To improve the success rate, determinants of long-term weight maintenance must be
identified. The objective of the study was to identify determinants of long-term success in
weight maintenance in obese subjects who completed the Sibutramine Trial on Obesity
Reduction and Maintenance (n = 261), a multicenter European study of weight loss and
weight maintenance in obesity that combines sibutramine treatment with dietary
restriction and advice on exercise and behavior.

Van der Meyden, J., Toennesmann, U., Mueller, J., Roecker, L., and Franz, I. W. (2002). Does
body weight reduction and physical activity alone and in combination with ACE-inhibition
influence the disturbed balance between coagulation and fibrinolysis in obese hypertensives?
International Journal of Sports Medicine, 23(2).

Body weight reduction and physical activity is generally recommended in obese

hypertensives, but in a former study we could show that this led to an increase in
fibrinogen with a possible alteration in coagulation.
 221

Van der Sande, M. A. B., Walraven, G. E. L., Milligan, P. J. M., Banya, W. A. S., Ceesay, S. M.,
Nyan, O. A., and McAdam, K. P. W. (2001). Family history: an opportunity for early
interventions and improved control of hypertension, obesity and diabetes. (BULL-WORLD-
HEALTH-ORGAN) 2001; 79(4): 321-8 (30 ref).

To examine whether a family history of high-risk groups for major noncommunicable

diseases (NCDs) was a significant risk factor for these conditions among family members
in a study population in the Gambia, where strong community and family coherence are
important determinants that have to be taken into consideration in promoting lifestyle
changes.

Van Gaal, L. F., Rissanen, A. M., Scheen, A. J., Ziegler, O., and Rossner, S. (2005). Effects of
the cannabinoid-1 receptor blocker rimonabant on weight reduction and cardiovascular risk
factors in overweight patients: 1-year experience from the RIO-Europe study. Lancet, 365(9468),
1389-97.

In animal models, cannabinoid-1 receptor (CB1) blockade produces a lean phenotype,

with resistance to diet-induced obesity and associated dyslipidaemia. We assessed the
effect of rimonabant, a selective CB1 blocker, on bodyweight and cardiovascular risk
factors in overweight or obese patients.

van Hooren, R. H., Widdershoven, G. A. M., van den Borne, H. W., and Curfs, L. M. G. (2002).
Autonomy and intellectual disability: the case of prevention of obesity in Prader-Willi syndrome.
Journal of Multicultural Nursing and Health, 46(7), 560-568.

The policy concerning care for people with intellectual disability (ID) has developed
from segregation via normalization towards integration and autonomy. Today, people
with ID are seen as citizens who need to be supported to achieve a normal role in society.
The aim of care is to optimize quality of life and promote self-determination. The
promotion of autonomy for people with ID is not easy and gives rise to ethical dilemmas.
Caregivers are regularly confronted with situations in which there is a conflict between
providing good care and respecting the client's autonomy.

Vansant, G., Hulens, M., Lysens, R., and Muls, E. (2002). Moderate training improves physical
fitness and quality of life in obese women. International Journal of Obesity, 26(1).

To evaluate the effects of a 3-mo moderately intense exercise program, 46 obese women
(21-68 yr, BMI >30 kg/m super(2)) received multidisciplinary treatment for 6 mo.
Anthropometry, physical activity (Baecke questionnaire), assertiveness (Interpersonal
Behavior Scale), Beck Depression Inventory, body image (Body Attitude Scale),
cognitive-behavioral conceptualization of obesity treatment (Master Questionnaire), low
back and knee pain, exercise capacity (VO sub(2)peak using graded maximal ergometer
bicycle), and 6-min walk test were assessed.
 222

Veech, R. L. (2004). The therapeutic implications of ketone bodies: The effects of ketone bodies
in pathological conditions: Ketosis, ketogenic diet, redox states, insulin resistance, and
mitochondrial metabolism. Prostaglandins Leukotrienes and Essential Fatty Acids, 70(3), 309-
319.

The effects of ketone body metabolism suggests that mild ketosis may offer therapeutic
potential in a variety of different common and rare disease states. These inferences follow
directly from the metabolic effects of ketosis and the higher inherent energy present in D-
beta-hydroxybutyrate relative to pyruvate, the normal mitochondrial fuel produced by
glycolysis leading to an increase in the DELTAG' of ATP hydrolysis.

Velasquez Mieyer, P. A., Cowan, P. A., Arheart, K. L., Buffington, C. K., Spencer, K. A.,
Connelly, B. E., Cowan, G. W., and Lustig, R. H. (2003). Suppression of insulin secretion is
associated with weight loss and altered macronutrient intake and preference in a subset of obese
adults. International Journal of Obesity, 27(2), 219-226.

Hyperinsulinemia is a common feature of many obesity syndromes. We investigated

whether suppression of insulin secretion, without dietary or exercise intervention, could
promote weight loss and alter food intake and preference in obese adults.

Vessey, J. A., Yim Chiplis, P. K., and MacKenzie, N. R. (1998). Primary care approaches.
Effects of television viewing on children's development. Pediatric Nursing, 24(5), 483-486.

Because television and its explicit and implicit messages are ubiquitous in our society,
pediatric nurses need to be aware of the effects of inappropriate television viewing. This
article reviews physical, cognitive, and psychological effects associated with
inappropriate television viewing and suggests assessment procedures and interventions
that can be used with families who want to change their pattern of television viewing.

Veugelers, P. J., and Fitzgerald, A. L. (2005). Effectiveness of school programs in preventing

childhood obesity: a multilevel comparison. Am J Public Health, 95(3), 432-5.

In light of the alarming increase in childhood obesity and lack of evidence for the
effectiveness of school programs, we studied the effects of school programs in regard to
preventing excess body weight.

Veugelers, P. J., Fitzgerald, A. L., and Johnston, E. (2005). Dietary intake and risk factors for
poor diet quality among children in Nova Scotia. Canadian Journal of Public Health, 96(3), 212-
6.

Public health policies promote healthy nutrition but evaluations of children's adherence to
dietary recommendations and studies of risk factors of poor nutrition are scarce, despite
the importance of diet for the temporal increase in the prevalence of childhood obesity.
Here we examine dietary intake and risk factors for poor diet quality among children in
Nova Scotia to provide direction for health policies and prevention initiatives.
 223

Vickers, F. (2002). Obesity bodes ill for the future. World of Irish Nursing, 10(11), 34-35.

The health risks associated with being overweight are poorly understood by the public.
Frances Vickers reports.

Vincent, J. B. (2003). The potential value and toxicity of chromium picolinate as a nutritional
supplement, weight loss agent and muscle development agent. Sports Medicine, 33(3), 213-230.

The element chromium apparently has a role in maintaining proper carbohydrate and
lipid metabolism in mammals. As this role probably involves potentiation of insulin
signalling, chromium dietary supplementation has been postulated to potentially have
effects on body composition, including reducing fat mass and increasing lean body mass.
Because the supplement is absorbed better than dietary chromium, most studies have
focused on the use of chromium picolinate [Cr(pic)(3)]. Cr(pic)(3) has been amazingly
popular with the general public, especially with athletes who may have exercise-induced
increased urinary chromium loss; however, its effectiveness in manifesting body
composition changes has been an area of intense debate in the last decade.

Volek, J. S., Vanheest, J. L., and Forsythe, C. E. (2005). Diet and exercise for weight loss: a
review of current issues. Sports Medicine, 35(1), 1-9.

Obesity is a fast growing epidemic that is primarily due to environmental influences.

Nutrition and exercise represent modifiable factors with a major impact on energy
balance. Despite considerable research, there remains continued debate regarding the
energy content and the optimal macronutrient distribution for promoting healthy and
effective weight loss. Low-fat diets have been advised for many years to reduce obesity.

Volume, C. I., and Farris, K. B. (2000). Hoping to maintain a balance: the concept of hope and
the discontinuation of anorexiant medications. Qualitative Health Research, 10(2), 174-187.

The secondary analysis of transcripts from a study of 9 women who used prescription
anorexiant medications described in this article was conducted to discover the role that
hope played in the women's weight-loss initiatives. It was found that hope grew
throughout the women's weight-loss initiative but peaked once the medications were
discontinued. Seven components of the concept of hope were described in the context of
the women's weight-loss experiences. Characteristics of hope in women who have
discontinued anorexiant medications are different than those associated with hope in
other contexts. A unique pattern of hope, hoping to maintain a balance, describes the
women's experiences as they strove to maintain the weight they had lost.

Von Goeler, D. S., Rosal, M. C., Ockene, J. K., Scavron, J., and De Torrijos, F. (2003). Self-
management of type 2 diabetes: a survey of low-income urban Puerto Ricans. Diabetes Educator,
29(4), 663-672.
 224

This study explored self-reported barriers to diabetes self-management in a population of

urban, low-income Puerto Rican individuals.

Vuori, I. (1998). Does physical activity enhance health? Patient Education and Counseling, 33,
S95-S103.

This paper provides the justification of physical activity promotion for health by critically
reviewing the recent US Surgeon General's Report. Evidence is summarized of the effects
of physical activity on physiological responses, overall mortality, a number of diseases
and disabilities, overall functional capacity, and mental health and quality of life.
Cumulating evidence suggests that the effects be applicable to both genders and to a wide
age range. The adverse effects of physical activity on health are shown to be small and
mostly preventable. It is emphasized that substantial health effects can be gained by
moderate daily physical activity which does not require high skill level nor specialized
equipment or facilities. It is concluded that the health potential of physical activity is
substantial due to the high prevalence of inactive lifestyle in the populations, the great
number of health conditions being affected by physical activity, and the feasibility arid
safety of physical activity as a health measure.

Wadden, T. A., Butryn, M. L., and Byrne, K. J. (2004). Efficacy of lifestyle modification for
long-term weight control. Obesity Research, 12 Suppl, 151S-62S.

A comprehensive program of lifestyle modification induces loss of approximately 10% of

initial weight in 16 to 26 weeks, as revealed by a review of recent randomized controlled
trials, including the Diabetes Prevention Program. Long-term weight control is facilitated
by continued patient-therapist contact, whether provided in person or by telephone, mail,
or e-mail. High levels of physical activity and the consumption of low-calorie, portion-
controlled meals, including liquid meal replacements, can also help maintain weight loss.

Wadden, T. A., Foster, G. D., and Brownell, K. D. (2002). Obesity: responding to the global
epidemic. Journal of Consulting and Clinical Psychology, 70(3), 510-526.

Obesity has reached epidemic proportions in the United States and other developed
nations. In the United States, 27% of adults are obese and an additional 34% are
overweight. Research in the past decade has shown that genetic influences clearly
predispose some individuals to obesity. The marked increase in prevalence, however,
appears to be attributable to a toxic environment that implicitly discourages physical
activity while explicitly encouraging the consumption of supersized portions of high-fat,
high-sugar foods. Management of the obesity epidemic will require a two-pronged
approach.

Wadden, T. A., Foster, G. D., Sarwer, D. B., Anderson, D. A., Gladis, M., Sanderson, R. S.,
Letchak, R. V., Berkowitz, R. I., and Phelan, S. (2004). Dieting and the development of eating
disorders in obese women: results of a randomized controlled trial. American Journal of Clinical
Nutrition, 80(3), 560-568.
 225

Some investigators fear that dieting may precipitate binge eating and other adverse
behavioral consequences. The objective of the study was to examine whether dieting
would elicit binge eating and mood disturbance in individuals free of these complications
before treatment.

Wadden, T. A., Sarwer, D. B., and Berkowitz, R. I. (1999). treatment of the overweight patient.
Clinical Endocrinology and Metabolism, 13(1), 93-107.

The goal of obesity treatment has changed significantly in the past decade. Where once
the goal was a reduction to ideal weight, the current objective is the achievement of a
healthier weight. For many obese individuals, this means losing as little as 5-15% of their
initial weight. This article briefly describes behavioural methods to help obese
individuals modify their eating and activity habits in order to achieve these new goals. A
review of recent studies shows that patients treated by a comprehensive group
behavioural programme lose approximately 9% of their initial weight in 20 weeks and,
without further treatment, maintain a loss of 5% one year later. Methods of improving the
maintenance of weight loss include increasing physical activity, extending the length of
behavioural treatment and, with appropriately selected individuals, combining
behavioural and pharmacological interventions. The importance of helping obese
individuals adopt realistic treatment expectations is also discussed.

Walters, P. H., Holloman, A., Blomquist, L., and Bollier, M. (2003). Childhood obesity: causes
and treatment. ACSM's Health and Fitness Journal, 7(1), 17-22.

Discusses how genetic predisposition, decreased physical activity, poor dietary choices
and the environment play a role in childhood obesity. Describes treatment suggestions
such as early intervention, physical activity and helping children to eat in response to
hunger. Includes the role parents have in the prevention and treatment of obesity in
children. Reports on studies and statistics on childhood obesity are also included.

Wardle, J. (2005). Understanding the aetiology of childhood obesity: implications for treatment.
Proceedings of the Nutrition Society, 64(1), 73-9.

Childhood obesity poses one of the greatest challenges to paediatric health in the 21st
century. Developing effective strategies for treatment and prevention is therefore a
priority for clinical medicine and public health. This process is taking place at a time of
unprecedented change in the understanding of the role of genetic factors in human health
and disease, and genetic research into obesity has challenged assumptions about causal
processes.

Wardle, J., and Griffith, J. (2001). Socioeconomic status and weight control practices in British
adults. Journal of Epidemiology and Community Health, 55(3), 185-190.

Attitudes and practices concerning weight control in British adults were examined to test
the hypothesis that variation in concern about weight and deliberate weight control might
 226

partly explain the socioeconomic status (SES) gradient in obesity. Higher SES groups
were hypothesised to show more weight concern and higher levels of dieting.

Wardle, J., Rapoport, L., Miles, A., Afuape, T., and Duman, M. (2001). Mass education for
obesity prevention: the penetration of the BBC's 'Fighting Fat, Fighting Fit' campaign. Health
Education Research, 16(3), 343-355.

The study aimed to evaluate the BBC's "Fighting Fat, Fighting Fit" Campaign's success
in achieving public awareness of the need for obesity prevention, healthy eating habits
and increased physical activity. Demographic factors associated with awareness of the
campaign were analysed. Data collected were part of the monthly Omnibus Survey of the
Office of the National Statistics in March 1999. Questions included weight and height,
recognition of the campaign name, and participation in the campaign registration scheme.
More than half of the respondents had heard of the campaign and 30% recalled the
healthy lifestyle messages. Fewer than 1% registered to participate in the scheme.
Awareness of the campaign was high in all socio-economic groups, but memory for the
healthy lifestyle message was significantly poorer in those with lower levels of education
an from ethnic minority groups. Awareness was also not higher in overweight than
normal weight respondents. The results strongly support the effectiveness of the
campaign in publicizing the issue of increasing prevalence of obesity and the need for
lifestyle change, but suggest that different approaches might be needed to maximize
participation from groups most in need of lifestyle change.

Wardle, J., Waller, J., and Jarvis, M. J. (2002). Sex differences in the association of
socioeconomic status with obesity. American Journal of Public Health, 92(8), 1299-1304.

Investigated socioeconomic predictors of obesity in 15,061 men and women (aged 16-
75+ yrs). Data from the 1996 Health Survey for England were used to compare odds
ratios for obesity by education, occupation, and 2 economic markers after controlling for
age, marital status, and ethnicity. Obesity risk was greater among men and women with
fewer years of education and poorer economic circumstances and among women, but not
men, of lower occupational status. Higher educational attainment and higher
socioeconomic status were associated with a lower risk of obesity in both men and
women, whereas higher occupational status was associated with a lower risk only for
women. Implications of these findings for understanding causes and prevention of obesity
are discussed.

Warren, J. M., Henry, C. J. K., Lightowler, H. J., Bradshaw, S. M., and Perwaiz, S. (2003).
Evaluation of a pilot school programme aimed at the prevention of obesity in children. Health
Promotion International, 18(4), 287-296.

This paper describes the development, implementation and evaluation of a school- and
family-based intervention to prevent obesity in children aged 5-7 years. Children aged 5-
7 years (n = 213) were recruited from three primary schools in Oxford and randomly
allocated to a control group or one of three intervention groups: nutrition group, physical
activity group, and combined nutrition and physical activity group. The setting for the
 227

interventions was lunchtime clubs, where an interactive and age-appropriate nutrition

and/or physical activity curriculum was delivered. Children's growth, nutrition
knowledge, diet and physical activity were assessed at baseline and at the end of the
intervention.

Waterhouse, D. (1995). Outsmarting the female fat cell. Women's Health Digest, 1(4), 276-277.

Have you ever wondered why men lose weight quickly and keep it off, while women lose
weight slowly and gain it back? Or why a woman's hip and thigh fat seems resistant to
dieting and even exercising? The answer lies in the mystery of the female fat cell.

Watkins, M. L., Rasmussen, S. A., Honein, M. A., Botto, L. D., and Moore, C. A. (2003).
Maternal obesity and risk for birth defects. Pediatrics, 111(5), 1152-1158.

Several studies have shown an increased risk for neural tube defects associated with
prepregnancy maternal obesity. Because few recent studies have examined the relation
between maternal prepregnancy obesity and overweight and other birth defects, we
explored the relation for several birth defects and compared our findings with those of
previous studies.

Watts, K., Jones, T. W., Davis, E. A., and Green, D. (2005). Exercise training in obese children
and adolescents: current concepts. Sports Medicine, 35(5), 375-92.

Childhood obesity has reached epidemic proportions worldwide and is associated with
increased cardiovascular mortality and morbidity in adult life. The increase in fat mass in
children and adolescents has occurred concomitantly with a decline in reported time for
exercise. Evidence suggests that non-physically active children are more likely to become
non-physically active adults and that encouraging the development of physical activity
habits in children helps establish patterns that continue into adulthood. Dietary treatment
of obesity is relatively ineffective in adults and it has been suggested that prevention of
obesity in childhood and adolescence should emphasise increased physical activity rather
than diet because of fears relating to the adverse effects of inappropriate eating patterns.

Watts, K., Siafarikas, A., Davis, E., Jones, T., O'Driscoll, G., and Green, D. (2003). Exercise
training normalises vascular function and improves body composition in obese adolescents.
Journal of Science and Medicine in Sport, 6(4).

Obesity is epidemic in western societies but treatment of established obesity in adults is

relatively ineffective and primary prevention should be emphasised, particularly as
obesity and inactivity in adolescents are increasing. Atherosclerosis begins in childhood
and vascular endothelial dysfunction its earliest detectable manifestation. Few studies
have examined the effect of exercise training in obese adolescents and none have
specifically determined its effect on vascular function.
 228

Weaver, C. M. (2000). Dietary guidelines take obesity to task. Food Technology, 54(7), 130.

The 2000 version of the Dietary Guidelines for Americans emphasizes daily physical
activity. Up to now, with emphasis on dietary guidelines to prevent or correct obesity, the
other side of the equation for energy balance has been neglected. That part of the
equation deals with energy expended in daily physical activity. More than half of US
adults are overweight and a quarter are obese. Nutritionists outnumber exercise
physiologists 10 to 1, so it is important that those involved in the food world be involved.
Those in the foodservice industry could work on controlling portion sizes and cutting out
unlimited free refills.

Webb, R., Brammah, T., Lunt, M., Urwin, M., Allison, T., and Symmons, D. (2004).
Opportunities for prevention of 'clinically significant' knee pain: results from a population-based
cross sectional survey. Journal of Public Health Management and Practice, 26(3), 277-284.

There is little UK-based evidence on the prevalence and predictors of knee pain
associated with disability across all adult ages. We aimed to estimate the prevalence of
'clinically significant' knee pain, identify and assess the population impact of independent
risk factors, and estimate levels of healthcare need.

Wechsler, J. G., and Leopold, K. (2003). Medical management of obesity. Langenbeck's

Archives of Surgery, 388(6), 369-374.

Obesity is associated with elevated morbidity and death rates. The World Health
Organization defines obesity as a chronic disease. The percentage of obese persons is
increasing worldwide. Many different treatment modalities are available. Long-term
success rates are not convincing. Research focus: Overweight and obesity should be
treated in an interdisciplinary and multimodal approach. The best results in loosing body
weight, especially body fat use very low calorie diets followed by a fat-reduced,
carbohydrate-rich diets.

Weepie, A. K. W., and McCarthy, A. M. (2002). A healthy lifestyle program: promoting child
health in schools. Journal of School Nursing, 18(6), 322-328.

The problem of overweight children is an increasing public health concern in the United
States. Many children today consume diets that are high in fat, lack regular physical
activity, and receive minimal amounts of nutrition education at school. School-based
education about nutrition and healthy lifestyles provides an opportunity for intervention
with all children. A program for 4th- and 5th-grade students was designed to increase the
student's knowledge about nutrition and healthy lifestyles. After implementation of the
program, there was a significant increase in student knowledge of nutrition and healthy
lifestyles as determined by a pretest and posttest evaluation. The results have implications
for school nurses because childhood behaviors have such a profound impact on future
adult lifestyle choices.
 229

Weight Realities Division of the Society for Nutrition Education. (2003). Guidelines for
childhood obesity prevention programs: promoting healthy weight in children. Journal of
Nutrition Education and Behavior, 35(1), 1-4.

This article presents recommendations for childhood obesity prevention programmes.

The recommendations focus on living actively, eating in normal and healthful ways and
creating a nurturing environment that helps children recognize their own worth and
respects cultural foodways and family traditions.

Weng, H. H., Bastian, L. A., Taylor, D. H., Jr., Moser, B. K., and Ostbye, T. (2004). Number of
children associated with obesity in middle-aged women and men: results from the Health and
Retirement Study. Journal of Women's Health, 13(1), 85-91.

To study associations between number of children and obesity in middle-aged women

and men. METHODS: In the Health and Retirement Study, a national survey of
households, we tested the association between increasing number of children and obesity
(body mass index [BMI] >or= 30) in 9046 middle-aged women and men (4523 couples).

Wenos, J., Konin, J., and Wenos, D. (2002). Treatment and prevention of childhood obesity:
seeking quality interventions in the public schools. Virginia journal, 24(1), 14-15.

Discusses the prevention and treatment of childhood obesity in the United States
including the use of physical therapists and physical educators in public schools.

Westenhoefer, J. (2001). Establishing good dietary habits -- capturing the minds of children.
Public Health Nutrition, 4(1A), 125-9.

To review the psycho-social research with respect to relevance for the development of
nutritional education strategies.

Westenhoefer, J. (2002). Establishing dietary habits during childhood for long-term weight
control. Ann Nutr Metab, 46 Suppl 1, 18-23.

To review psychosocial research with respect to relevance for the development of

nutritional education strategies for optimal weight control during childhood and the
longer term.

Westererp Plantenga, M. S., and Kovacs, E. M. R. (2002). The effect of (--)-hydroxycitrate on

energy intake and satiety in overweight humans. International Journal of Obesity and Related
Metabolism Disorders, 26(6), 870-872.

Assessed the effects of 2 wks of daily administration of (--)-hydroxycitrate (HCA) on

energy intake and satiety in overweight men and women in a 6-wk randomized placebo-
controlled single-blinded cross-over trial. The 24 Ss (mean age 37 yrs) consumed 3 times
 230

daily for 2 wks 100 ml tomato juice (placebo) and, separated by a 2 wk wash-out period,
100 ml tomato juice with 300 mg HCA.

Whitaker, R. C. (2004). Predicting preschooler obesity at birth: The role of maternal obesity in
early pregnancy. Pediatrics, 114(1), E29-E36.

Knowing risk factors at birth for the development of childhood obesity could help to
identify children who are in need of early obesity prevention efforts. The objective of this
study was to determine whether children whose mothers were obese in early pregnancy
were more likely to be obese at 2 to 4 years of age.

White, A. A., Nitzke, S., and Peterson, K. E. (2004). Viewpoint. Are soft drinks getting a bum
rap? We don't think so. Journal of Nutrition Education and Behavior, 36(5), 266-271.

The viewpoint presented in this article is that soft drink consumption is a contributing
factor in the rising incidence of overweight among school-aged children. Misinformation
must be dispelled so that resources can be directed to real, evidence-based concerns.
Child nutrition advocates have called for reducing access to soft drinks in schools as an
important step in optimizing healthful environments for children. School nutrition
policies are being revised at national, state, and local levels. Along with other
stakeholders, soft drink manufacturers must acknowledge the problem of rising rates of
overweight in children and work within their spheres of influence to limit access to soft
drinks in schools.

White, F., Mayer, C., Hullatt, I., and Drake, L. (2002). Today's lesson: a healthy diet. Nursing
Standard, 17(12), 24-25.

We asked our readers panel what they would do about the increasing incidence of
overweight school children developing diabetes.

White, S. (2002). Verb: it's about action. IDEA Personal Trainer, 13(9), 1.

Briefly describes a program recently launched called "VERB: It's What You Do" to
promote physical and social activity in children between the ages of 9 and 13 to
encourage them to adopt a health lifestyle and prevent overweight and obesity.

Whittemore, R., D'Eramo Melkus, G., and Grey, M. (2004). Applying the social ecological
theory to type 2 diabetes prevention and management. Journal of Community Health Nursing,
21(2), 87-99.

Obesity and Type 2 diabetes have become major public health problems in the United
States. Community health nurses, with expertise in preventive health care, have the
potential to play a vital role in addressing these significant health issues. The purposes of
this article are to identify current challenges related to obesity and Type 2 diabetes and to
present the social ecological theory as a framework for the expansion of the reach of
diabetes prevention and management that is relevant to community health nurses.
 231

Wiecha, J. L., Ayadi, A. M. E., Fuemmeler, B. F., Carter, J. E., Handler, S., Johnson, S., Strunk,
N., Korzec-Ramirez, D., and Gortmaker, S. L. (2004). Diffusion of an integrated health
education program in an urban school system: Planet Health. Journal of Pediatric Psychology,
29(6), 467-475.

Assessed the feasibility, acceptability, and sustainability of Planet Health, an

interdisciplinary, integrated health education curriculum implemented in six public
middle schools. Methods Workshops on Planet Health implementation were attended by
129 teachers (language arts, math, science, and social studies) over three school years
(1999-2000, 2000-2001, and 2001-2002).

Wiederman, M. W., Sansone, R. A., and Sansone, L. A. (1999). Obesity among sexually abused
women: an adaptive function for some? Women and Health, 29(1), 89-100.

In an attempt to explore the possibly adaptive function obesity may serve for some
women with histories of sexual trauma, we examined relationships among sexual abuse
history, body dissatisfaction, and maximum weight fluctuation among obese (n = 38;
Body Mass Index >/= 27.3) and nonobese (n = 112; Body Mass Index < 27.3) women
sampled from a primary care medical setting. History of sexual abuse was unrelated to
current body weight within the entire sample, as well as the nonobese and the obese
subsamples.

Wierenga, M. E., and Oldham, K. K. (2002). Weight control: a lifestyle-modification model for
improving health. Nursing Clinics of North America, 37(2), 303-313.

The alarming increase in the prevalence of obesity in the United States is associated with
many chronic health problems. Individuals need to learn how to modify their eating
behaviors to control their weight and improve their health. Programs that include a
combination of diet, exercise, and cognitive-behavioral strategies are effective in helping
mild to moderately obese individuals modify their eating patterns. We review current
findings in obesity and weight loss lifestyle modification research. The Lifestyle
Modification Model, its practical implications, and implementation ideas for practitioners
are presented along with suggestions for considering cultural differences.

Wiese, W., Sanders, S. L., and Wortmann, R. L. (2004). Gout: effective strategies for acute and
long-term control. Journal of Musculoskeletal Medicine, 21(10), 510-512, 514-516, 518-519.

The incidence of gout increases with advancing age and elevations in serum urate levels.
Although still much more common in men than in women, gout is increasingly being
observed in post-menopausal women. The initial attack begins suddenly and, typically, is
monarticular; exquisite pain and inflammation are characteristic. Response to colchicine
supports the presumptive clinical diagnosis, but confirmation of the diagnosis depends on
identification of urate crystals in synovial fluid or tophaceous material. Prompt therapy
with colchicine, NSAIDs, or corticotropin is the cornerstone of acute care.
 232

Wilding, J. (1997). Obesity treatment. British Medical Journal (Clinical Research edition),
315(7114), 997-1000.

This article reviews the mechanisms that control body weight and then discusses how an
understanding of these mechanisms may lead to the development of new, effective and
safe treatments for obese people.

Wilkinson, D. L., and McCargar, L. (2004). Is there an optimal macronutrient mix for weight
loss and weight maintenance? Best Pract Res Clin Gastroenterol, 18(6), 1031-47.

Low carbohydrate diets are gaining popularity, however there is no clear consensus
regarding their safety and efficacy for weight loss. Proponents of these diet plans
advocate dramatic reductions in carbohydrate intake to combat insulin resistance and
hyperinsulinaemia, which they claim are responsible for obesity. There are no long-term
studies that directly compare the weight loss potential of low versus higher carbohydrate
diets. Evidence from randomized controlled trials suggests that low carbohydrate diets
may enable short-term weight loss by facilitating reduced energy intakes, however poor
dietary compliance may prevent long-term success. Unbalanced nutrient profiles may
increase the risk of adverse health consequences in adherents. Low carbohydrate diets
should not be recommended at this time due to a lack of adequate long-term follow up
data. Successful weight loss occurs through the creation of a sustained energy deficit, and
should be achieved through a combination of exercise and a nutritionally balanced and
varied diet.

Willaing, I., Ladelund, S., Jorgensen, T., Simonsen, T., and Nielsen, L. M. (2004). Nutritional
counselling in primary health care: a randomized comparison of an intervention by general
practitioner or dietician. Eur J Cardiovasc Prev Rehabil, 11(6), 513-20.

AIMS: To compare health effects and risk reduction in two different strategies of
nutritional counselling in primary health care for patients at high risk of ischaemic heart
disease.

Williams, J. H., Belle, G. A., Houston, C., Haire Joshu, D., and Auslander, W. F. (2001). Process
evaluation methods of a peer-delivered health promotion program for African American women.
Health Promotion Practice, 2(2), 135-142.

The Eat Well, Live Well (EWLW) Nutrition Pro-gram was a community-based, dietary
change program delivered by peer educators to low income African American women.
To ensure that the program was delivered as intended, a process evaluation was
conducted to determine the extent to which the content was accurate and comprehensive.
The methodology included developing checklists for each of the intervention sessions,
audiotaping randomly selected sessions, and independently rating the audiotapes.

Williamson, D. F. (1999). The prevention of obesity. New England Journal of Medicine,

341(15), 1140-1142.
 233

Doctors need to do more to encourage their obese patients to lose weight. A 1999 study
of over 1 million American adults showed that obese people were twice as likely to die
from any cause as people of normal weight. As the mortality rate from heart disease
drops, more effort should be placed on preventing other diseases related to obesity.
Diabetes is one such complication of obesity.

Williamson, L. (1998). Eating disorders and the cultural forces behind the drive for thinness: are
African American women really protected? Social Work in Health Care, 28(1), 61-73.

Responding to mainstream ideals of female beauty, many women and girls view thinness
as a requirement for feeling acceptable to themselves and to others. The drive to be thin
can lead to problematic eating patterns, such as self-starvation, binge-eating, and purging,
symptoms of the eating disorders, anorexia and bulimia nervosa. Most current literature
on eating disorders and the drive for thinness focuses only on White middle-class women
and girls. African American females have been largely excluded from studies, due to the
assumption that the Black community's acceptance of women with fuller shapes protects
its women from eating problems.

Wilmore, J. H. (1996). Increasing physical activity: alterations in body mass and composition.
(American Health Foundation Roundtable on Healthy Weight). American Journal of Clinical
Nutrition, 63(3), 456S-461S.

I provide an overview of the role of physical activity in the prevention of overweight and
obesity and in the treatment of overweight and obese individuals. A secondary focus of
this paper is on the potential mechanisms responsible for changes in body composition
consequent to physical activity. The use of the term "physical activity" is preferred to the
term "exercise" to better reflect a broader scope of movement, not limited to formal
exercise regimes.

Wilson, P. (2003). Tackling childhood obesity. Professional Nurse, 18(6), 310.

The number of overweight or obese children has increased markedly over the past 20
years in the UK. How can health-care staff best tackle sedentary lifestyles and poor
eating habits?

Winett, R. A., Tate, D. F., Anderson, E. S., Wojcik, J. R., and Winett, S. G. (2005). Long-term
weight gain prevention: A theoretically based Internet approach. Preventive Medicine, 41(2),
629-41.

A major focus of Healthy People 2010 is promoting weight management and physical
activity because overweight, obesity, and a sedentary lifestyle are strongly associated
with risk for heart disease and stroke, diabetes, cancers, and premature death.

Wing, R. R. (1999). Physical activity in the treatment of the adulthood overweight and obesity:
current evidence and research issues. Medicine and Science in Sports and Exercise, 31(11
Suppl), S547-S552.
 234

The purpose of this paper is to review the evidence on the role of physical activity in the
treatment of adult overweight and obesity. Three specific questions are addressed: (1)
Does exercise alone produce weight loss? (2) Does exercise in combination with diet
produce greater weight loss than diet only? And (3) Does exercise in combination with
diet produce better maintenance of weight loss than diet alone?

Wolfe, B. L., and Smith, J. E. (2002). Different strokes for different folks: Why overweight men
do not seek weight loss treatment. Eating Disorders: The Journal of Treatment and Prevention,
10(2), 115-124.

Despite health risks associated with male-pattern obesity, few men utilize weight
management programs. Strikingly missing from the literature are studies that ask,
"Why?" Seventy-two overweight males were surveyed regarding what might motivate
them to seek treatment, and which treatment characteristics might appeal to them.
Respondents indicated that health problems and the desire to improve appearance are
primary motivators. In contrast to the programs most widely available, respondents
preferred individualized, athletics-based programs that allow autonomy in food selection.
It was concluded that both a modified program and marketing approach are needed if the
clinical community is to help overweight men.

Wood, T. (1997). Prevalence of overweight in Shropshire infant school children. Health Visitor,
70(4), 151-152.

Obesity is an increasing problem in the UK, both for adults and children. Obesity in
childhood tends to track into adulthood. TINA WOOD describes the findings of a study
of infant school children which found increasing levels of obesity over the past decade,
and underlines the importance of targeting preventive strategies at this age group.

Wray, S., and Levy Milne, R. (2002). Weight management in childhood: Canadian dietitians'
practices. Canadian Journal of Dietetic Practice and Research, 63(3), 130-133.

Canadian dietitians specializing in pediatric practice were surveyed to provide a

preliminary profile of the strategies they use to manage overweight youth. The survey
was mailed to 298 dietitians belonging to the Dietitians of Canada's (DC) Pediatric
Nutrition and Consulting Dietitians' Networks and to the head dietitians in Canadian
pediatric hospitals across the country. It was also posted on the DC website and sent by
electronic mail. Of the 164 respondents, 65 reported that they provide an intervention
program to overweight youth.
 235

Wrotniak, B. H., Epstein, L. H., Paluch, R. A., and Roemmich, J. N. (2004). Parent weight
change as a predictor of child weight change in family-based behavioral obesity treatment.
Archives of Pediatrics and Adolescent Medicine, 158(4), 342-347.

Family-based behavioral weight control treatment involves the parent in the modification
of child and parent eating and activity change. To assess if parent standardized body mass
index (z-BMI) change predicts child z-BMI change.

Wu, F., Yu, S., Wei, I., and Yin, T. J. C. (2003). Weight-control behavior among obese children:
association with family-related factors. Journal of Nursing Research, 11(1), 19-30.

The purpose of this study was to investigate the weight-control behavior of obese
children, to understand parents' supervision and to explore related factors that influenced
the weight-control behavior.

Wyatt, H. R., Peters, J. C., Reed, G. W., Barry, M., and Hill, J. O. (2005). A Colorado statewide
survey of walking and its relation to excessive weight. Med Sci Sports Exerc, 37(5), 724-30.

There is an urgent need to increase the physical activity in the population. Small-scale
success has been achieved in programs like Colorado on the Move (COM), an obesity
prevention program using electronic pedometers.

Yackel, E. E. (2003). An activity calendar program for children who are overweight. Pediatric
Nursing, 29(1), 17-24.

Sedentary lifestyle activities, such as computer use and television viewing, are modifiable
causes of overweight among children. There are many recommendations in the literature
that suggest the number of children who are overweight must be decreased; however,
none of the research describes an instrument to achieve this goal. This article describes
the use of a home-based physical activity calendar and its successes and failures.

Yadrick, K. (2005). Supporting healthy lifestyle choices. Journal of Family and Consumer
Sciences, 97(2), 8-13.

An analysis is presented on the obesity related problems in the United States. Obesity is
considered as the major public health crisis in the country. The importance of leading a
healthy lifestyle for preventing obesity is also discussed.

Yaissle, J. E., Holloway, C., and Buffington, C. A. T. (2004). Evaluation of owner education as a
component of obesity treatment programs for dogs. Journal of the American Veterinary Medical
Association, 224(12), 1932-1935.

To compare results of a conventional obesity treatment program with those of an obesity

treatment program that included education of owners of obese dogs.
 236

Yamada, Y., Ishizaki, M., and Tsuritani, I. (2002). Prevention of weight gain and obesity in
occupational populations: A new target of health promotion services at worksites. Journal of
Occupational Health, 44(6), 373-384.

Obesity has been recognized as a global epidemic threatening health and life. Today in
Japan, obesity defined as a body mass index (BMI) greater than 30 kg/m2 is found in 2-
3% of adults, but one in five men and women is defined as overweight with a BMI
greater than 25, and thus the prevention of obesity should be targeted in health promotion
services at worksites. Vigorous research is required in workplaces because a few work-
related factors, such as socioeconomic status including job and position, job stress,
extended work including overtime, shift or night work and sedentary work, have been
suggested in the literature to promote weight gain and abdominal fat accumulation.

Yancey, A. K., Jordan, A., Bradford, J., Voas, J., Eller, T. J., Buzzard, M., Welch, M., and
McCarthy, W. J. (2003). Engaging high-risk populations in community-level fitness promotion:
ROCK! Richmond. Health Promotion Practice, 4(2), 180-188.

The purpose of this study was to determine whether ROCK! Richmond, a healthy
nutrition and physical activity promotion initiative of the Richmond (Virginia) City
Department of Public Health was effectively recruiting the high-risk individuals for
whom this lifestyle change intervention was intended. The effectiveness of recruitment,
participant demographic and health status characteristics were compared with those of
respondents to a random sample survey conducted 18 months earlier. Relatively high-risk
residents were recruited. ROCK! Richmond participants were disproportionately African
American and female, had significantly higher body mass indices (BMIs), and were more
likely to report a family history of chronic disease. However, their employment,
education, and income levels were higher than those of the citywide sample. Certain
high-risk segments of the population were successfully reached and involved in
community fitness activities. Different recruitment methods may need to be used to
recruit more from among the lowest socioeconomic strata.

Yancey, A. K., Lewis, L. B., Sloane, D. C., Guinyard, J. J., Diamant, A. L., Nascimento, L. M.,
and McCarthy, W. J. (2004). Leading by example: a local health department-community
collaboration to incorporate physical activity into organizational practice. Journal of Public
Health Management and Practice, 10(5), 116-123.

A multisectoral model promoting sociocultural environmental change to increase

physical activity levels among African Americans in Los Angeles County, California,
was developed and implemented. This model represents a true collaboration between a
local health department and a community lead agency. Community organizations serving
targeted areas of the county participated in one or more interventions incorporating
physical activity into routine organizational practice, which centered around modeling the
behaviors promoted ("walking the talk"). In the current study, level of organizational
support for physical activity integration was assessed, as reflected in the extent of
organizational commitment associated with each intervention.
 237

Yanovski, S. Z. (2003). Binge eating disorder and obesity in 2003: Could treating an eating
disorder have a positive effect on the obesity epidemic? International Journal of Eating
Disorders, 34(Supplement), S117-S120.

The purpose of this paper is to explore the relationship between binge eating disorder
(BED) and obesity.

Yanovski, S. Z., Bain, R. P., and Williamson, D. F. (1999). Report of a National Institutes of
Health--Centers for Disease Control and Prevention workshop on the feasibility of conducting a
randomized clinical trial to estimate the long-term health effects of intentional weight loss in
obese persons. American Journal of Clinical Nutrition, 69(3), 366-372.

A workshop was convened in 1997 by the National Institutes of Health and the Centers
for Disease Control and Prevention to consider the need for and feasibility of conducting
a randomized clinical trial to estimate the long-term health effects of intentional weight
loss in obese persons. Although the benefits of weight loss in obese individuals may seem
obvious, little information is available showing that intentional weight loss improves
long-term health outcomes.

Yanovski, S. Z., and Devlin, M. J. (1995). Role of behavioral therapy in the management of
obesity. Endocrine Practice, 1(5), 340-5.

Behavioral therapy for obesity that is, the application of learning theory to obesity
treatment is now a standard component of weight-loss programs. The hallmark of
behavioral therapy for obesity is self-monitoring of eating behavior, but techniques of
stimulus control, self-reward, cognitive restructuring, nutrition education, and physical
activity are also emphasized. Although behavioral treatment programs that incorporate
lengthier and more intensive regimens are often successful in producing short-term
weight loss, most patients have regained much or all of their lost weight at long-term
follow-up. One approach to this problem has been to supplement behavioral treatment
with other modalities such as very-low-calorie diets, surgical procedures, and medication.

Yao, M., Lichtenstein, A. H., Roberts, S. B., Ma, G., Gao, S., Tucker, K. L., and McCrory, M. A.
(2003). Relative influence of diet and physical activity on cardiovascular risk factors in urban
Chinese adults. International Journal of Obesity and Related Metabolism Disorders, 27(8), 920-
932.

The relative influence of dietary factors vs physical activity on cardiovascular risk factors
are poorly understood. We investigated these factors in a population whose traditional
diet may have both positive and negative aspects, and whose physical activity levels
(PALs) vary widely. A total of 1 30 weight stable adults aged 35-49 y living in urban
Beijing, China. Dietary intake, percent body fat, and central adiposity were assessed.
Biochemical parameters, blood pressure and presence of the metabolic syndrome were
also examined.
 238

Yin, Z., Davis, C. L., Moore, J. B., and Treiber, F. A. (2005). Physical Activity Buffers the
Effects of Chronic Stress on Adiposity in Youth. Annals of Behavioral Medicine, 29(1), 29-36.

The moderating effect of physical activity (PA) on relations between chronic stress and
adiposity is unknown in youth. Purpose: The objective is to assess the mediating effect of
PA on relations between stress and adiposity in youth.

Yin, Z., Hanes, J., Jr., Moore, J. B., Humbles, P., Barbeau, P., and Gutin, B. (2005). An after-
school physical activity program for obesity prevention in children: the Medical College of
Georgia FitKid Project. Eval Health Prof, 28(1), 67-89.

This article describes the process of setting up a 3-year, school-based after-school

physical activity intervention in elementary schools. The primary aim of the study is to
determine whether adiposity and fitness will improve in children who are exposed to a
fitogenic versus an obesogenic environment. Eighteen schools were randomized to the
control (obesogenic) or intervention (fitogenic) group. The study design, program
components, and evaluation of the intervention are described in detail. The intervention
consists of (a) academic enrichment, (b) a healthy snack, and (c) physical activity in a
mastery-oriented environment. Successful implementation would show the feasibility of
schools' being able to provide a fitogenic environment. Significant differences between
the groups would provide evidence that a fitogenic environment after school has positive
health benefits.

Yoshinaga, M., Sameshima, K., Miyata, K., Hashiguchi, J., and Imamura, M. (2004). Prevention
of mildly overweight children from development of more overweight condition. Preventive
Medicine, 38(2), 172-174.

A follow-up study has reported that not only highly obese but also mildly obese children
are becoming heavier during the elementary school children. Then we determined the
effect of programs for the screening and treatment of overweight elementary school
children whether the programs prevented mildly overweight children from development
of more overweight condition.

Young, L. R., and Nestle, M. (2002). The contribution of expanding portion sizes to the US
obesity epidemic. American Journal of Public Health, 92(2), 246-249.

Because larger food portions could be contributing to the increasing prevalence of

overweight and obesity, this study was designed to weigh samples of marketplace foods,
identify historical changes in the sizes of those foods, and compare current portions with
federal standards.

Zago, S., Saber, B., Labate, M., Ferrari, D., Maffeis, P., Agagliati, D., Bauducco, E., Martignone,
L., Spanu, M., and Rovera, G. M. (2002). Severe obesity: Multidimensional treatment.
International Journal of Obesity, 26(1).
 239

Aim of the study is to develop multidimensional approach for severe obesity (BMI>40)
and to assess the use of obesity surgery. We evaluated from January 1999 to January
2002 363 patients (104 male, 259 female) through our Clinical Nutrition Department.

Zhi, J., Moore, R., Kanitra, L., and Mulligan, T. E. (2003). Effects of orlistat, a lipase inhibitor,
on the pharmacokinetics of three highly lipophilic drugs (amiodarone, fluoxetine, and
simvastatin) in healthy volunteers. Journal of Clinical Pharmacology, 43(4), 428-435.

To investigate the effect of orlistat on the pharmacokinetics of three highly lipophilic

drugs (amiodarone, fluoxetine, and simvastatin), the authors performed double-blind,
placebo-controlled, randomized two-period crossover (for fluoxetine and simvastatin) or
parallel (for amiodarone) studies in healthy volunteers ages 18 to 65 years of a body mass
index between 18 and 30 kg/m2.

Zhou, J., Takebe, W. P. M., and Blackburn, G. L. (2002). Effects of isoflavone aglycone on the
prevention of obesity in a diet-induced-obesity mouse model. Journal of Nutrition, 132(3), 601S-
603S.

Obesity, which now affects up to 35% of the U.S. adult population, is the most common
nutritional disorder in affluent societies and is becoming an increasingly important health
problem in developing countries. It has been shown to be a risk factor for cardiovascular
disease, type 2 diabetes mellitus, hypertension, stroke, and certain types of cancer.
Contain soybean components, such as soy protein and soy isoflavones, have been shown
to have hypocholesterolemic effects that reduce the risk of cardiovascular disease.

Ziviani, J., Scott, J., and Wadley, D. (2004). Walking to school: incidental physical activity in
the daily occupations of Australian children. Occupational Therapy International, 11(1), 1-11.

Children's participation in physical activity is declining, and nowhere is this more

apparent than in the incidental activity of walking to school. The aim of this pilot study
was to examine the extent to which Australian children walked to and from primary
school, and to survey parents to identify factors influencing this behaviour.

Zuppa, J. A., Morton, H., and Mehta, K. P. (2003). Television food advertising:
counterproductive to children's health? A content analysis using the Australian Guide to Healthy
Eating. Nutrition and Dietetics: Journal of the Dietitians Association of Australia, 60(2), 78-84.

To undertake a content analysis of the types of foods advertised during programs, which
have particular appeal to children and in timeslots where children are likely to be
watching television and to assess conformity with the recommendations of the Australian
Guide to Healthy Eating (AGHE).

INDEX
A BODY MASS INDEX, 25, 28, 32, 36, 39, 45, 46, 53, 74,
ACCELEROMETERS, 134
ACTIVITIES, 39, 41, 49, 51, 59, 62, 63, 72, 75, 76, 84,
104, 126, 128, 130, 177, 183, 219, 228, 230, 253, 254
ADOLESCENCE, 78, 90, 97, 117, 145, 166, 203, 229, 234,
244
ADOLESCENT HEALTH, 119
ADOLESCENTS, 23, 32, 33, 35, 36, 37, 38, 46, 57, 62, 70,
72, 85, 89, 90, 91, 94, 97, 104, 111, 126, 127, 138, 145,
148, 150, 153, 159, 164, 165, 166, 167, 169, 171, 177,
178, 183, 185, 192, 193, 195, 196, 200, 201, 208, 214,
224, 235, 244, 245
ADULTS, 20, 24, 29, 30, 32, 33, 35, 36, 49, 51, 52, 57, 63,
69, 72, 74, 79, 82, 88, 91, 92, 93, 100, 110, 111, 113,
127, 131, 137, 140, 142, 144, 145, 147, 151, 157, 162,
163, 164, 165, 169, 171, 176, 177, 178, 179, 180, 185,
186, 189, 191, 210, 212, 214, 215, 220, 221, 231, 238,
240, 242, 244, 245, 250, 252, 254, 256
AFTER SCHOOL, 256
ALCOHOL, 27, 40, 63, 64, 71, 73, 109, 170, 183
CONSUMPTION, 71, 73, 109
ALCOHOL CONSUMPTION, 71, 73, 109
AMERICAN, 32
ANIMAL, 44, 46, 167, 218, 236
ASSESSMENT, 25, 26, 36, 61, 75, 93, 102, 105, 108, 109,
120, 130, 138, 155, 157, 164, 179, 186, 190, 197, 199,
226, 228, 234, 238
ATHLETICS, 167, 252
ATTITUDES, 46, 53, 93, 96, 101, 128, 132, 164, 178, 180,
184, 189, 207, 213, 214, 223, 224, 225, 230
ATTITUDES AND PRACTICE, 132, 214
B CARDIOVASCULAR RISK FACTORS, 17, 57, 105, 130,
BEHAVIOR, 18, 24, 26, 28, 29, 30, 37, 43, 49, 54, 61, 62,
65, 68, 72, 83, 86, 88, 92, 95, 98, 100, 102, 103, 125,
128, 137, 138, 139, 141, 152, 156, 157, 188, 197, 200,
201, 204, 216, 217, 221, 223, 236, 253, 255
BEHAVIOR CHANGE, 30, 37, 43, 68, 72, 95, 125, 138
BEHAVIOR MODIFICATION, 29, 83, 92, 98, 103, 128,
200, 204
BEHAVIORS, 33, 52, 56, 113, 144, 152, 169, 193, 201,
206, 226, 231
BEVERAGE, 55, 190
BINGE EATING, 39, 64, 71, 78, 91, 127, 161, 162, 176,
231, 234, 241, 255
BLOOD PRESSURE, 40, 44, 52, 60, 61, 65, 71, 88, 105,
109, 110, 117, 134, 169, 170, 174, 183, 203, 204, 208,
256
BODY FAT, 33, 53, 55, 68, 78, 82, 90, 107, 108, 112, 117,
122, 126, 130, 136, 150, 157, 163, 169, 175, 184, 186,
209, 210, 219, 221, 231, 232, 245, 256
BODY IMAGE, 101, 128, 135, 136, 141, 213, 238
BODY MASS, 25, 28, 32, 36, 39, 45, 46, 53, 74, 76, 78,
82, 86, 88, 91, 98, 108, 111, 121, 122, 123, 124, 127,
138, 147, 149, 152, 157, 158, 160, 161, 169, 175, 185,
240
186, 203, 204, 205, 208, 214, 224, 225, 226, 229, 232,
239, 246, 250, 253, 254, 257
76, 78, 82, 86, 88, 91, 98, 108, 111, 121, 122, 123, 124,
127, 138, 147, 149, 152, 157, 158, 160, 161, 169, 175,
186, 203, 204, 205, 208, 214, 224, 225, 226, 229, 232,
246, 253, 254, 257
BOYS, 78, 90, 91, 177
BREAKFAST, 30, 68, 71, 72, 135, 139
BREASTFEEDING, 78, 79, 108, 109, 160
C
CANCER, 38, 45, 85, 89, 101, 109, 123, 149, 153, 160,
164, 167, 173, 186, 190, 192, 215, 217, 233, 257
PREVENTION, 45, 109
CARDIOVASCULAR, 17, 23, 25, 28, 30, 33, 37, 38, 45,
49, 53, 56, 57, 60, 64, 68, 73, 75, 82, 84, 85, 89, 90, 93,
105, 108, 109, 110, 111, 115, 117, 121, 123, 124, 125,
128, 130, 137, 140, 149, 151, 159, 162, 164, 166, 167,
170, 171, 173, 174, 179, 181, 194, 196, 197, 204, 205,
206, 207, 208, 210, 211, 217, 219, 220, 235, 236, 244,
256, 257
DISEASE, 23, 25, 28, 30, 33, 37, 45, 56, 57, 60, 64, 68,
73, 75, 82, 84, 85, 89, 90, 93, 105, 108, 109, 111,
117, 121, 123, 124, 125, 128, 140, 149, 151, 162,
164, 167, 170, 173, 174, 179, 181, 194, 196, 204,
205, 206, 210, 211, 217, 257
RISK FACTORS, 17, 57, 105, 130, 197, 219, 220, 235,
236, 256
CARDIOVASCULAR DISEASE, 23, 25, 28, 30, 33, 37,
45, 56, 57, 60, 64, 68, 73, 75, 82, 84, 85, 89, 90, 93,
105, 108, 109, 111, 117, 121, 123, 124, 125, 128, 140,
149, 151, 162, 164, 167, 170, 173, 174, 179, 181, 194,
196, 204, 205, 206, 210, 211, 217, 257
197, 219, 220, 235, 236, 256
CHARACTERISTICS, 23, 37, 49, 52, 55, 60, 86, 88, 119,
144, 152, 154, 159, 195, 213, 214, 221, 230, 234, 252,
254
CHILD, 21, 36, 42, 52, 55, 56, 66, 67, 76, 78, 79, 81, 86,
89, 93, 103, 106, 111, 114, 120, 126, 160, 162, 166,
175, 183, 199, 200, 209, 216, 223, 246, 253
CHILDHOOD, 17, 23, 35, 36, 39, 40, 42, 43, 49, 55, 56,
57, 59, 60, 62, 64, 68, 70, 75, 78, 83, 85, 94, 97, 98,
100, 103, 110, 112, 114, 115, 119, 126, 130, 138, 139,
142, 143, 145, 146, 152, 154, 155, 158, 159, 161, 164,
166, 169, 172, 176, 181, 183, 194, 195, 199, 200, 203,
204, 205, 209, 213, 215, 218, 219, 220, 222, 223, 224,
228, 229, 234, 238, 239, 241, 244, 245, 246, 247, 252,
253
CHILDHOOD OBESITY, 17, 23, 36, 39, 40, 42, 43, 49,
55, 57, 59, 60, 64, 75, 78, 83, 85, 94, 98, 103, 110, 114,
119, 139, 142, 146, 154, 155, 158, 159, 172, 176, 183,
194, 195, 199, 200, 203, 204, 205, 209, 213, 218, 219,
220, 222, 223, 224, 228, 229, 238, 239, 241, 246, 247,
252
CHILDREN, 21, 22, 23, 30, 32, 33, 35, 36, 37, 38, 39, 40,
42, 43, 46, 49, 51, 52, 53, 55, 56, 57, 59, 62, 64, 66, 68,

69, 70, 72, 73, 75, 77, 78, 79, 80, 81, 84, 85, 86, 89, 90,
91, 92, 94, 96, 97, 100, 102, 103, 105, 106, 110, 111,
112, 113, 114, 117, 120, 121, 122, 124, 126, 127, 128,
130, 131, 134, 135, 136, 138, 140, 142, 143, 145, 146,
148, 149, 150, 151, 152, 153, 155, 157, 158, 159, 160,
162, 163, 165, 166, 169, 171, 172, 174, 175, 176, 179,
182, 183, 184, 185, 186, 189, 190, 192, 193, 194, 195,
196, 199, 200, 203, 204, 206, 209, 215, 216, 219, 221,
222, 223, 226, 228, 229, 230, 234, 238, 239, 241, 244,
246, 247, 248, 252, 253, 256, 257, 258
CHOLESTEROL, 25, 60, 61, 70, 93, 117, 122, 123, 128,
139, 185, 205, 208, 219, 221
COMMUNITY, 17, 22, 33, 39, 41, 43, 47, 73, 74, 83, 92,
93, 96, 99, 102, 103, 106, 107, 114, 126, 149, 158, 174,
179, 185, 187, 204, 229, 230, 234, 236, 248, 250, 252,
254, 255
COMMUNITY-BASED, 92, 106, 149, 158, 185, 250
CORONARY HEART DISEASE, 20, 29, 41, 46, 70, 88,
92, 110, 137, 138, 151, 159, 174, 220, 232
CULTURAL, 24, 40, 42, 46, 75, 94, 100, 102, 106, 128,
158, 169, 207, 226, 229, 246, 249, 250
CULTURALLY APPROPRIATE, 33, 75, 102, 103, 191
CULTURE, 69, 101, 116, 135, 171, 200
D ETHNIC, 34, 57, 75, 78, 105, 116, 121, 179, 181, 187, 196,
DEPRESSION, 65, 88, 89, 105, 142, 218, 224
DEPRIVATION, 231
DIABETES, 23, 25, 27, 28, 29, 30, 32, 33, 34, 37, 38, 41,
42, 43, 44, 45, 46, 52, 53, 54, 56, 57, 60, 63, 64, 65, 68,
72, 73, 80, 82, 84, 85, 88, 89, 90, 93, 95, 96, 99, 105,
107, 108, 110, 111, 116, 122, 123, 126, 127, 136, 138,
140, 145, 148, 149, 151, 152, 153, 154, 155, 158, 160,
164, 166, 167, 169, 171, 172, 174, 184, 185, 186, 189,
190, 193, 194, 196, 199, 204, 205, 209, 214, 216, 218,
220, 222, 230, 235, 236, 240, 247, 248, 252, 257
DIET, 20, 23, 27, 28, 29, 30, 31, 37, 39, 42, 44, 46, 52, 54,
63, 66, 69, 71, 72, 73, 74, 77, 79, 81, 83, 88, 93, 95, 98,
99, 100, 105, 108, 111, 112, 113, 125, 126, 131, 132,
139, 144, 146, 148, 151, 152, 153, 156, 158, 159, 160,
161, 163, 167, 169, 170, 173, 174, 175, 178, 180, 181,
183, 184, 185, 188, 189, 190, 191, 192, 195, 196, 197,
199, 202, 203, 204, 205, 206, 207, 208, 211, 219, 221,
223, 229, 231, 235, 236, 238, 239, 244, 247, 248, 249,
252, 256, 257
DIETARY, 18, 24, 27, 30, 32, 34, 35, 36, 40, 41, 44, 52,
63, 67, 70, 71, 72, 74, 76, 78, 80, 82, 83, 86, 91, 97, 98,
101, 102, 103, 105, 107, 108, 111, 112, 113, 119, 120,
121, 124, 125, 130, 131, 132, 135, 136, 139, 140, 141,
146, 148, 152, 153, 155, 156, 157, 158, 160, 161, 162,
165, 166, 170, 174, 176, 177, 179, 184, 185, 188, 192,
193, 195, 196, 198, 199, 200, 201, 202, 203, 206, 207,
210, 216, 225, 233, 235, 236, 238, 239, 241, 245, 246,
247, 249, 250, 256
DIETARY GUIDELINES, 67, 74, 113, 148, 170, 206, 245
DIETING, 52, 54, 66, 70, 91, 100, 120, 144, 147, 156, 176,
180, 188, 190, 192, 202, 213, 231, 232, 241, 242, 244
DISEASES, 28, 29, 38, 40, 41, 45, 46, 54, 64, 65, 81, 85,
107, 109, 111, 125, 126, 149, 159, 162, 163, 165, 166,
170, 172, 178, 181, 184, 190, 200, 204, 208, 220, 234,
236, 240, 250
241
DOSE, 175, 215
E
EATING DISORDERS, 38, 39, 42, 54, 64, 76, 96, 111,
126, 141, 176, 190, 200, 205, 210, 225, 241, 250
EATING PATTERN, 28, 47, 75, 93, 105, 148, 152, 169,
170, 179, 208, 225, 244, 249, 250
EDUCATION, 21, 39, 43, 62, 74, 77, 83, 91, 105, 107,
110, 116, 119, 122, 126, 132, 134, 146, 153, 171, 200,
228, 230, 242, 246, 247, 254
EDUCATORS, 102, 116, 159, 172, 223, 234, 246, 250
ELEMENTARY SCHOOL, 66, 68, 74, 122, 126, 135, 158,
171, 230, 256
ENERGY BALANCE, 41, 44, 57, 61, 79, 82, 111, 136,
185, 197, 201, 210, 219, 224, 239, 245
ENERGY EXPENDITURE, 26, 27, 29, 32, 40, 41, 44, 49,
56, 79, 81, 82, 96, 97, 111, 115, 127, 131, 134, 147,
151, 167, 172, 185, 188, 209, 210, 218, 220, 223, 228
ENERGY INTAKE, 32, 41, 44, 47, 68, 70, 79, 86, 89, 101,
110, 111, 127, 131, 135, 137, 148, 150, 188, 206, 209,
211, 219, 223, 224, 247, 249
EPIDEMIOLOGIC, 68, 79, 101, 150, 151
EPIDEMIOLOGY, 32, 74, 222
242
ETHNICITY, 97, 98, 145, 194, 242
EVALUATION, 20, 23, 26, 35, 36, 37, 39, 57, 62, 68, 75,
91, 104, 115, 119, 122, 126, 128, 134, 138, 141, 148,
150, 158, 174, 180, 206, 219, 244, 246, 250, 256
EXERCISE, 26, 27, 28, 29, 30, 32, 34, 35, 37, 38, 39, 40,
43, 44, 46, 52, 53, 57, 60, 61, 63, 64, 66, 68, 70, 77, 81,
82, 84, 85, 88, 93, 96, 99, 100, 103, 104, 105, 108, 111,
112, 113, 116, 117, 119, 122, 123, 125, 126, 127, 128,
130, 131, 136, 137, 138, 139, 143, 144, 145, 146, 148,
150, 151, 153, 160, 161, 162, 163, 165, 167, 169, 171,
177, 178, 179, 180, 183, 184, 186, 188, 189, 197, 199,
202, 203, 204, 205, 207, 208, 210, 211, 214, 218, 219,
223, 233, 234, 235, 236, 238, 239, 244, 245, 248, 249,
250, 252
F
FAMILY, 18, 21, 33, 38, 39, 40, 42, 43, 49, 56, 57, 65, 69,
72, 75, 76, 86, 103, 115, 128, 142, 145, 146, 149, 163,
167, 169, 183, 195, 209, 214, 216, 219, 226, 230, 236,
244, 246, 253, 254
FATS, 41, 83, 98, 101, 173, 217
FISH, 83
FITNESS, 22, 28, 49, 57, 60, 88, 90, 95, 99, 110, 112, 122,
125, 145, 148, 163, 174, 176, 180, 181, 183, 184, 188,
204, 214, 218, 228, 235, 254, 256
FOCUS GROUPS, 80, 103, 106, 177, 229
FOOD AVAILABILITY, 120, 191
FOOD BEHAVIOR CHECKLIST (FBC), 202
FOOD CHOICE, 27, 44, 69, 72, 74, 98, 103, 112, 139, 164,
217, 226
FOOD FREQUENCY, 90
FOOD GROUPS, 195
FOOD INSECURITY, 160

FOOD INSUFFICIENCY, 160
FOOD PATTERNS, 74
FORMULA, 208, 220
FRUIT, 67, 76, 83, 91, 98, 111, 146, 153
FRUITS, 65, 71, 86, 91, 103, 173, 204
G 110, 113, 130, 131, 135, 140, 142, 152, 164, 165, 190,
GENDER, 30, 57, 89, 98, 177, 179, 187, 213, 224, 231
GENETIC, 24, 25, 28, 30, 33, 34, 35, 41, 43, 44, 52, 59,
80, 94, 108, 112, 115, 116, 139, 159, 161, 167, 172,
173, 189, 201, 241, 242
GIRLS, 19, 20, 24, 27, 40, 65, 78, 90, 91, 94, 126, 136,
177, 178, 181, 183, 203, 213, 214, 221, 222, 225, 229,
250
H 137, 139, 141, 149, 151, 152, 153, 157, 159, 160, 162,
HEALTH, 17, 18, 22, 23, 24, 28, 29, 30, 32, 33, 34, 36, 37,
38, 40, 41, 42, 43, 46, 49, 51, 52, 53, 56, 57, 59, 60, 61,
62, 63, 64, 65, 66, 67, 68, 70, 72, 73, 74, 75, 76, 77, 78,
81, 82, 83, 84, 85, 87, 88, 89, 90, 91, 92, 93, 94, 95, 98,
99, 100, 101, 103, 104, 105, 106, 108, 109, 110, 111,
114, 115, 117, 119, 120, 121, 122, 123, 124, 125, 126,
128, 130, 135, 136, 140, 141, 145, 146, 148, 149, 151,
152, 154, 157, 158, 160, 161, 162, 163, 164, 165, 166,
167, 169, 171, 173, 174, 175, 176, 178, 179, 180, 181,
183, 184, 185, 186, 187, 189, 190, 192, 193, 195, 196,
197, 198, 199, 200, 202, 204, 205, 206, 208, 209, 210,
212, 213, 214, 215, 216, 217, 218, 220, 222, 223, 224,
225, 226, 228, 229, 230, 234, 239, 240, 242, 246, 248,
249, 250, 252, 254, 255, 256, 257, 258
HEALTH EDUCATION, 119, 126, 169, 185, 215, 219,
248
HEALTH PROMOTION, 23, 34, 37, 51, 62, 63, 98, 124,
126, 130, 146, 152, 181, 185, 186, 216, 230, 234, 250,
254
HEALTH STATUS, 41, 49, 65, 83, 85, 88, 130, 185, 229,
234, 254
HEART RATE, 44, 147, 204, 235
HEIGHT, 36, 105, 143, 242
HOST, 28, 29, 52, 162, 163
HOSTILITY, 105
HUNGER, 47, 241
HYPERTENSION, 25, 29, 32, 40, 41, 42, 43, 45, 53, 54,
64, 71, 72, 73, 82, 84, 88, 89, 93, 99, 110, 111, 116,
128, 140, 148, 151, 153, 170, 174, 183, 185, 215, 222,
236, 257
I MINORITIES, 34, 75, 105
INFANTS, 150
INNER CITY, 84, 85, 177
INTERVENTION, 17, 18, 20, 21, 23, 24, 25, 27, 29, 30, 33,
34, 35, 36, 38, 39, 40, 44, 49, 55, 56, 57, 60, 65, 66, 67,
68, 70, 71, 72, 74, 75, 77, 78, 82, 84, 88, 91, 92, 95, 96,
98, 102, 103, 104, 105, 107, 109, 113, 114, 121, 122,
125, 126, 127, 128, 132, 134, 135, 136, 137, 138, 140,
143, 144, 146, 149, 153, 155, 156, 159, 162, 165, 166,
174, 176, 181, 182, 183, 184, 191, 192, 193, 195, 197,
242
199, 200, 206, 210, 211, 214, 215, 216, 219, 221, 226,
235, 238, 241, 244, 246, 249, 250, 253, 254, 255, 256
K
KNOWLEDGE, 41, 44, 46, 71, 75, 85, 92, 98, 103, 107,
193, 196, 199, 204, 210, 215, 229, 244, 246
L
LEISURE, 88, 92, 128, 176, 219
LIFE CYCLE, 129, 161
LIFESTYLE, 17, 23, 26, 28, 30, 33, 35, 40, 41, 43, 46, 52,
56, 57, 68, 71, 72, 76, 77, 87, 90, 93, 99, 100, 105, 107,
113, 114, 115, 119, 120, 121, 122, 125, 128, 131, 136,
166, 169, 170, 173, 184, 185, 191, 192, 195, 197, 199,
201, 205, 206, 215, 216, 220, 223, 224, 228, 234, 235,
236, 240, 242, 246, 248, 249, 252, 253, 254
LIPIDS, 46, 52, 105, 117, 123, 208
LONGITUDINAL, 27, 49, 79, 90, 108, 139, 229
LONGITUDINAL STUDY, 27, 49, 79, 90, 108, 139, 229
LOW INCOME, 160, 250
LOW-ENERGY, 131
LOW-FAT, 67, 77, 92, 107, 157, 221
LOW-INCOME, 46, 66, 70, 83, 85, 92, 108, 122, 160, 180,
213, 221, 240
LUNCH, 68, 71, 72, 113
M
MANAGEMENT, 24, 28, 29, 34, 35, 42, 43, 55, 64, 65, 67,
72, 78, 82, 84, 85, 89, 95, 98, 100, 104, 105, 110, 111,
115, 119, 120, 128, 132, 140, 142, 145, 148, 149, 150,
157, 164, 170, 176, 180, 181, 183, 187, 188, 189, 191,
197, 199, 209, 210, 211, 216, 219, 220, 223, 231, 240,
245, 248, 253, 255
MEASUREMENT, 33, 36, 46, 89, 138, 143
MEDIA, 56, 59, 73, 109, 115, 183, 190, 191, 199, 201, 209
MEDITERRANEAN, 208
MEN, 27, 28, 39, 41, 44, 45, 60, 69, 81, 88, 92, 95, 99, 101,
121, 123, 124, 131, 147, 151, 172, 173, 175, 186, 187,
211, 214, 219, 231, 232, 233, 242, 244, 246, 247, 249,
252, 254
MENTAL ILLNESS, 189, 205
METABOLIC SYNDROME, 24, 25, 60, 64, 72, 80, 90, 93,
123, 166, 186, 196, 256
MIDDLE AGE, 79
MINORITY, 34, 75, 92, 104, 107, 122, 159, 177, 221, 242
MINORITY GROUPS, 177, 242
MORBIDITY, 28, 32, 33, 38, 41, 42, 46, 63, 66, 85, 93, 98,
105, 115, 153, 176, 179, 181, 193, 209, 230, 232, 233,
244, 245
MORTALITY, 25, 28, 32, 33, 37, 38, 41, 42, 46, 57, 60,
63, 66, 83, 85, 93, 98, 99, 105, 111, 112, 115, 121, 123,
150, 176, 178, 179, 181, 189, 193, 209, 230, 232, 233,
240, 244, 250
MOTIVATION, 113, 183
 243

65, 67, 68, 69, 70, 72, 73, 75, 76, 77, 78, 79, 81, 84, 85,
N 86, 88, 89, 91, 93, 95, 98, 99, 100, 101, 102, 103, 104,
105, 106, 108, 110, 111, 117, 120, 122, 124, 125, 127,
NUTRIENT INTAKE, 59, 196 128, 130, 131, 132, 134, 136, 137, 138, 139, 141, 144,
NUTRITION, 19, 26, 32, 33, 37, 43, 45, 46, 47, 51, 53, 56, 145, 146, 147, 148, 151, 152, 153, 156, 158, 159, 161,
59, 62, 63, 68, 69, 80, 81, 93, 98, 100, 105, 107, 111, 162, 163, 164, 165, 166, 169, 170, 171, 172, 174, 176,
112, 113, 117, 125, 128, 131, 134, 137, 139, 143, 145, 177, 178, 180, 181, 184, 185, 186, 191, 192, 193, 194,
146, 149, 153, 155, 159, 165, 167, 171, 173, 181, 188, 195, 196, 197, 198, 199, 200, 201, 202, 203, 204, 206,
190, 191, 193, 197, 204, 206, 207, 208, 215, 216, 217, 215, 216, 217, 218, 219, 220, 221, 223, 224, 225, 226,
218, 229, 230, 234, 235, 239, 244, 246, 247, 254, 255 228, 229, 233, 234, 235, 236, 238, 240, 241, 242, 244,
NUTRITION EDUCATION, 43, 63, 68, 111, 113, 117, 245, 246, 250, 252, 253, 254, 255, 256, 257
125, 134, 204, 229, 234, 246, 255 PHYSICAL ACTIVITY INTERVENTIONS, 169
PHYSICAL EDUCATION, 74, 75, 103, 121, 126, 127,
142, 170, 178, 189, 190, 234
O PHYSICAL FITNESS, 18, 27, 30, 64, 99, 134, 143, 145,
154, 185, 214, 238
OBESITY, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29,
POVERTY, 115, 160
30, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45,
PREADOLESCENT, 92, 229
46, 47, 49, 51, 52, 53, 54, 55, 56, 57, 59, 60, 61, 62, 64,
PREDICTORS, 65, 97, 134, 226, 242, 245
65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 78, 79, 80,
PREGNANCY, 66, 99, 150, 166, 172, 202, 247
81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95,
PRENATAL, 149, 185
96, 97, 98, 99, 100, 101, 102, 103, 104, 105, 106, 107,
PRESCHOOL, 39, 56, 83, 105, 114, 149, 162, 171, 175,
108, 109, 110, 111, 112, 113, 114, 115, 116, 117, 119,
221, 229
120, 121, 122, 123, 124, 125, 126, 127, 128, 130, 131,
PREVENTION, 17, 20, 23, 24, 25, 26, 27, 28, 29, 32, 35,
132, 133, 134, 135, 136, 137, 138, 139, 140, 141, 142,
36, 37, 38, 39, 40, 41, 42, 46, 49, 51, 52, 55, 56, 57, 59,
143, 144, 145, 146, 147, 148, 149, 150, 151, 152, 153,
63, 64, 66, 67, 68, 69, 71, 72, 73, 75, 79, 82, 84, 85, 88,
154, 155, 156, 157, 158, 159, 160, 161, 162, 163, 164,
92, 93, 94, 95, 96, 97, 98, 99, 100, 102, 105, 108, 109,
165, 166, 167, 169, 170, 171, 172, 173, 174, 175, 176,
110, 111, 112, 113, 114, 116, 117, 124, 126, 127, 128,
177, 178, 179, 180, 181, 182, 183, 184, 185, 186, 187,
130, 136, 139, 140, 143, 144, 145, 148, 149, 151, 155,
188, 189, 190, 191, 192, 193, 194, 195, 196, 197, 199,
156, 158, 164, 165, 166, 167, 170, 171, 172, 174, 176,
200, 201, 202, 203, 204, 205, 206, 207, 208, 209, 210,
179, 181, 183, 184, 185, 188, 191, 194, 195, 197, 199,
211, 212, 213, 214, 215, 216, 217, 218, 219, 220, 221,
201, 202, 203, 206, 209, 210, 211, 213, 214, 215, 216,
222, 223, 224, 225, 226, 228, 229, 230, 231, 232, 233,
217, 218, 219, 220, 221, 222, 224, 226, 228, 230, 232,
234, 235, 236, 238, 239, 241, 242, 244, 245, 246, 247,
234, 235, 236, 239, 241, 242, 243, 244, 245, 246, 248,
248, 249, 250, 252, 253, 254, 255, 256, 257
250, 252, 254, 257
OBESITY PREVENTION, 20, 21, 22, 26, 27, 28, 35, 36,
PROGRAMS, 19, 28, 35, 42, 44, 57, 61, 63, 70, 75, 77, 84,
42, 53, 56, 57, 59, 66, 70, 71, 72, 74, 75, 80, 84, 85, 92,
85, 86, 92, 96, 97, 100, 112, 127, 129, 134, 144, 149,
94, 98, 100, 101, 102, 104, 112, 113, 114, 115, 120,
150, 151, 155, 161, 162, 171, 176, 177, 179, 181, 184,
121, 134, 136, 139, 140, 142, 145, 155, 174, 176, 177,
188, 193, 196, 200, 202, 213, 216, 217, 219, 222, 230,
178, 181, 182, 185, 189, 190, 201, 208, 213, 221, 222,
238, 239, 246, 252, 253, 254, 255, 256, 258
224, 226, 228, 235, 242, 247, 253, 256
PSYCHOLOGICAL, 38, 49, 53, 65, 88, 94, 97, 104, 107,
ODDS RATIO, 242
127, 162, 166, 169, 184, 200, 211, 231, 238
OSTEOARTHRITIS, 38, 56, 187, 199
PUBLIC HEALTH, 17, 19, 23, 26, 28, 32, 34, 35, 38, 39,
OVERWEIGHT, 18, 23, 25, 26, 30, 32, 33, 36, 37, 39, 42,
42, 47, 51, 57, 60, 61, 71, 73, 74, 76, 78, 81, 83, 87, 91,
45, 46, 52, 53, 55, 56, 57, 59, 62, 63, 64, 66, 67, 69, 70,
95, 96, 97, 99, 100, 108, 114, 116, 119, 127, 139, 142,
71, 72, 73, 76, 77, 79, 80, 81, 84, 85, 88, 89, 92, 95, 97,
145, 149, 156, 163, 165, 166, 171, 175, 179, 184, 190,
99, 100, 101, 103, 106, 108, 110, 111, 112, 113, 114,
192, 193, 194, 211, 214, 215, 221, 224, 226, 228, 242,
119, 120, 122, 124, 125, 126, 127, 128, 131, 135, 136,
246, 248, 254
138, 139, 141, 142, 146, 153, 155, 156, 159, 162, 163,
166, 169, 171, 173, 175, 176, 177, 178, 179, 180, 181,
183, 184, 185, 187, 189, 191, 193, 194, 196, 199, 202, Q
203, 205, 206, 207, 209, 210, 212, 214, 216, 218, 219,
220, 221, 224, 225, 228, 229, 232, 234, 236, 239, 241, QUALITATIVE, 23, 62, 84, 102, 103, 111, 113, 120, 151,
242, 244, 245, 246, 247, 248, 250, 252, 253, 254, 256, 155, 195, 226, 229
257 QUESTIONNAIRE, 27, 28, 77, 90, 173, 175, 238

P R
PATHWAYS, 36, 44, 57, 96, 97, 102, 104, 160 RACISM, 41
PATHWAYS STUDY, 102 RECALL, 26, 179
PHYSICAL ACTIVITY, 16, 18, 19, 20, 22, 23, 24, 26, 27,
33, 34, 35, 37, 38, 39, 40, 43, 44, 46, 47, 49, 60, 61, 64,

RECOMMENDATIONS, 18, 35, 37, 38, 39, 66, 71, 82, 99,
101, 105, 108, 110, 125, 132, 138, 140, 142, 148, 150,
151, 153, 160, 167, 176, 177, 196, 217, 228, 232, 239,
246, 253, 258
RECREATION, 61
REFERENCE, 30, 33, 44, 115, 133, 149, 182, 195, 222,
232
REGRESSION, 92, 125, 134, 210
RESTRAINED EATING, 202
RISK, 20, 22, 25, 28, 29, 30, 32, 33, 34, 37, 38, 42, 45, 46,
49, 53, 54, 57, 60, 64, 66, 68, 70, 71, 72, 73, 74, 75, 79,
82, 84, 85, 87, 88, 89, 90, 92, 93, 97, 98, 100, 101, 102,
103, 104, 105, 107, 108, 109, 110, 111, 114, 115, 117,
119, 121, 123, 124, 125, 126, 128, 130, 131, 136, 137,
140, 143, 145, 149, 150, 151, 153, 154, 155, 157, 158,
159, 160, 162, 164, 165, 170, 171, 174, 178, 179, 181,
184, 186, 189, 190, 192, 193, 194, 196, 197, 199, 200,
202, 203, 204, 205, 207, 208, 210, 211, 214, 215, 218,
219, 220, 221, 223, 229, 230, 233, 235, 236, 239, 242,
244, 245, 247, 249, 250, 252, 254, 257
RISK BEHAVIOR, 102, 103
RISK FACTORS, 25, 29, 30, 33, 37, 54, 57, 60, 64, 71, 72,
73, 79, 84, 85, 87, 89, 102, 105, 110, 114, 115, 117,
121, 125, 128, 137, 151, 155, 158, 159, 164, 165, 170,
179, 181, 184, 186, 190, 194, 196, 200, 215, 218, 221,
239, 245, 247
RURAL, 47, 152, 230
S UNDERNUTRITION, 80, 115, 208, 222
SCHOOL, 17, 19, 20, 22, 33, 35, 39, 43, 53, 55, 59, 60, 62,
63, 64, 65, 66, 68, 71, 72, 75, 80, 84, 85, 95, 96, 97,
100, 101, 102, 103, 107, 111, 112, 113, 117, 119, 125,
126, 127, 128, 134, 142, 145, 155, 160, 166, 171, 174,
176, 177, 178, 179, 189, 199, 205, 206, 215, 218, 219,
221, 222, 224, 226, 228, 230, 234, 238, 239, 244, 246,
247, 248, 252, 256, 257
SCHOOL CHILDREN, 100, 101, 102, 112, 113, 134, 247,
252, 256
SCHOOL FOOD SERVICE, 75
SCHOOL-BASED, 17, 20, 35, 55, 75, 80, 97, 101, 102,
107, 113, 155, 171, 177, 178, 179, 199, 215, 219, 221,
224, 226, 228, 230, 234, 256
SCHOOL-BASED PROGRAMS, 17, 20, 35, 55, 75, 80,
97, 101, 102, 107, 113, 155, 171, 177, 178, 179, 199,
215, 219, 221, 224, 226, 228, 230, 234, 256
SEDENTARY, 18, 26, 28, 30, 35, 39, 40, 43, 46, 56, 57,
65, 70, 72, 86, 92, 120, 121, 122, 126, 131, 137, 149,
169, 170, 171, 177, 178, 180, 195, 206, 214, 215, 222,
252, 254
SELF-ESTEEM, 78, 169, 204
SELF-REPORT, 98, 161, 240
SMOKING, 20, 30, 57, 63, 65, 69, 76, 84, 105, 110, 128,
136, 137, 149, 181, 183, 186, 203, 211, 220, 230
SNACK, 55, 90, 139, 164, 256
SOCIAL, 27, 41, 42, 54, 59, 62, 69, 74, 75, 89, 94, 95, 97,
102, 105, 109, 120, 128, 130, 137, 141, 146, 149, 162,
166, 169, 178, 185, 187, 189, 200, 207, 209, 224, 246,
248
SOCIAL CLASS, 69
SOCIAL COGNITIVE THEORY, 137
244
SOCIOECONOMIC, 73, 83, 100, 121, 132, 146, 153, 160,
171, 177, 179, 224, 242, 254
SODIUM, 40, 71
STRATEGIES, 24, 28, 30, 32, 33, 34, 37, 39, 44, 47, 49,
51, 54, 55, 56, 62, 63, 64, 66, 67, 70, 72, 74, 78, 91, 92,
95, 98, 100, 102, 104, 105, 110, 113, 116, 117, 120,
126, 127, 128, 132, 143, 144, 152, 153, 158, 165, 169,
174, 180, 183, 185, 188, 189, 193, 195, 201, 203, 205,
206, 210, 215, 216, 217, 222, 230, 233, 235, 242, 246,
247, 248, 249, 250, 252, 253
SURVEY, 24, 27, 36, 53, 55, 67, 71, 98, 110, 132, 145,
173, 178, 180, 196, 213, 231, 240, 245, 246, 253, 254,
257
T
TEACHERS, 35, 75, 102, 122, 170, 178, 223, 224, 228,
229, 248
TECHNIQUES, 29, 42, 125, 128, 137, 149, 156, 193, 255
TEENAGE, 73, 203
TELEPHONE, 116, 145, 180, 240
TELEVISION, 35, 59, 76, 91, 127, 128, 146, 159, 195,
199, 219, 230, 238, 253, 258
THEORIES, 76
U
URBAN, 17, 46, 61, 70, 73, 80, 88, 92, 178, 179, 180, 213,
229, 240, 248, 256
US, 69, 179
V
VEGETABLE, 91, 139, 153, 167
VEGETABLES, 65, 71, 83, 86, 91, 98, 103, 111, 146, 173,
204
VENDING, 55
VIDEO, 128, 199
VIDEO GAMES, 128
W
WAIST CIRCUMFERENCE, 28, 46, 124, 161, 204, 208
WEIGHT, 18, 21, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 35,
36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 51, 52, 53,
54, 55, 56, 57, 61, 62, 64, 65, 66, 67, 68, 69, 70, 71, 72,
73, 74, 76, 77, 79, 81, 82, 83, 84, 86, 87, 88, 89, 90, 91,
93, 94, 95, 96, 97, 99, 100, 101, 103, 104, 105, 107,
108, 110, 111, 112, 113, 114, 115, 117, 120, 122, 123,
124, 125, 127, 128, 131, 132, 134, 135, 136, 137, 138,
139, 140, 141, 142, 143, 144, 145, 146, 147, 148, 150,
151, 152, 153, 154, 155, 156, 157, 158, 159, 161, 162,
163, 164, 167, 169, 171, 172, 174, 175, 176, 177, 178,
180, 181, 184, 186, 187, 188, 189, 190, 191, 192, 193,
194, 195, 196, 197, 199, 200, 201, 202, 203, 204, 205,
206, 207, 209, 210, 211, 213, 214, 216, 217, 218, 220,
221, 222, 223, 224, 225, 226, 228, 229, 230, 231, 232,

233, 234, 235, 236, 238, 239, 240, 241, 242, 244, 245,
246, 247, 248, 249, 250, 252, 253, 254, 255, 256
WEIGHT MANAGEMENT, 26, 30, 35, 37, 61, 65, 70, 83,
94, 96, 113, 120, 131, 138, 139, 140, 141, 143, 161,
164, 176, 180, 187, 188, 197, 211, 216, 223, 231, 252
WEIGHT-LOSS, 27, 43, 103, 122, 128, 131, 134, 135, 151,
163, 176, 192, 203, 206, 207, 211, 240, 255
WELL-BEING, 37, 46, 53, 100, 126, 165, 185, 226
WHITE, 70, 96, 97, 117, 122, 128, 150, 213, 214
WOMEN, 16, 17, 24, 27, 28, 33, 34, 39, 43, 44, 45, 46, 54,
57, 60, 62, 63, 64, 66, 69, 70, 72, 76, 77, 81, 88, 90, 92,
95, 96, 97, 99, 101, 103, 105, 108, 121, 122, 123, 124,
126, 131, 132, 134, 136, 141, 147, 148, 150, 151, 153,
245
161, 172, 173, 180, 181, 183, 191, 192, 193, 208, 210,
211, 214, 218, 219, 221, 223, 226, 230, 231, 232, 235,
238, 239, 241, 242, 244, 246, 247, 248, 249, 250, 254
WORKSITE, 126
Y
YOUNG ADULTS, 70, 90, 111, 214
YOUTH, 18, 19, 24, 33, 35, 43, 45, 81, 84, 86, 91, 99, 101,
107, 110, 119, 126, 127, 139, 145, 154, 165, 171, 177,
178, 193, 216, 225, 253, 256
 246

Web-Based Resources

ASSOCIATIONS AND ORGANIZATIONS

ABOUT-FACE

Promotes positive self-esteem in women and girls of all ages.

http://www.about-face.org/

10 Ways to Empower Yourself

http://www.about-face.org/mc/empower/

Facts about body image.

http://www.about-face.org/r/facts/bi.shtml

ACTION FOR HEALTHY KIDS

The only nonprofit organization formed specifically to address the epidemic of overweight, undernourished and
sedentary youth by focusing on changes at school.

http://www.actionforhealthykids.org/

AMERICA ON THE MOVE

America On the Move is a national initiative dedicated to helping individuals and communities across our nation
make positive changes to improve health and quality of life. By focusing on individuals and communities AOM
strives to support healthy eating and active living habits in our society.

http://www.americaonthemove.org/

Tips for active living.

http://www.americaonthemove.org/WActiveLiving.asp?PageID=8

AMERICAN ACADEMY OF FAMILY PHYSICIANS

Information on overall health.

http://www.aafp.org/

Successful Management of the Obese Patient.

http://www.aafp.org/afp/20000615/3615.html
 247

AMERICAN ALLIANCE FOR HEALTH, PHYSICAL EDUCATION, RECREATION, AND DANCE

AAHPERD is an alliance of six national associations and six district associations and is designed to provide
members with a comprehensive and coordinated array of resources, support, and programs to help practitioners
improve their skills and so further the health and well-being of the American public.

http://www.aahperd.org/

Issues and legislation regarding improving physical activity.

http://member.aahperd.org/advocacy/

Information on the No Child Left Behind Legislation.

http://www.aahperd.org/aahperd/template.cfm?template=nclb.html

Information on how to eat better.

http://aahperd.healthology.com/focus_index.asp?b=aahperd&f=nutrition

AMERICAN COLLEGE OF SPORTS MEDICINE

MISSION STATEMENT: ACSM advances and integrates scientific research to provide educational and practical
applications of exercise science and sports medicine. Information on health and fitness, research, and certifications
are available from this website.

http://acsm.org/

General health and fitness information and tips for beginning an exercise program are available.

http://acsm.org/health%2Bfitness/index.htm

Links to current comments on various exercise related factors.

http://acsm.org/health%2Bfitness/comments.htm

Links to topics in exercise.

http://acsm.org/health%2Bfitness/fit_society.htm

How to purchase proper exercise equipment.

http://acsm.org/health%2Bfitness/productpurchase.htm
 248

AMERICAN COUNCIL FOR FITNESS AND NUTRITION

The American Council for Fitness and Nutrition works with partners to raise awareness of the nutrition education
and physical activity programs designed to improve community health and to demonstrate the commitment of
public, private and non-profit sectors to finding effective obesity solutions.

http://www.acfn.org/

Quick tips for nutrition and physical activity.

http://www.acfn.org/resources-quick/

One on one questions with a nutrition expert. You can submit your own questions as well.

http://www.acfn.org/resources-ask/

How to improve the eating habits of your family.

http://www.acfn.org/news/030105/

Links to helpful articles on increasing physical activity and eating better.

http://www.acfn.org/media-news/

AMERICAN COUNCIL ON EXERCISE

The American Council on Exercise (ACE), Americas Authority on Fitness, is a nonprofit organization dedicated to
promoting the benefits of physical activity and protecting consumers against unsafe and ineffective fitness products
and instruction. As the nations workout watchdog, ACE sponsors university-based exercise science research and
testing that targets fitness products and trends. ACE sets standards for fitness professionals and is the worlds largest
nonprofit fitness certifying organization.

http://www.acefitness.org/default.aspx

Links to specific exercise tips.

http://www.acefitness.org/fitfacts/fitbits_list.aspx

Six fitness myths.

http://www.acefitness.org/fitfacts/fitbits_display.aspx?itemid=241

Ten tips to stay healthy during the holidays.

http://www.acefitness.org/fitfacts/fitbits_display.aspx?itemid=192

Top seven healthiest foods.

 249

http://www.acefitness.org/fitfacts/fitbits_display.aspx?itemid=123

How to choose the type of fats that you eat wisely.

http://www.acefitness.org/fitfacts/fitbits_display.aspx?itemid=227

AMERICAN DIETETIC ASSOCIATION

With nearly 65,000 members, the American Dietetic Association is the nations largest organization of food and
nutrition professionals. ADA serves the public by promoting optimal nutrition, health and well-being. Information
about eating healthy is available at this website.

http://www.eatright.org/Public/

Information about food fortification and dietary supplements, functional foods, dietary fiber, total diet
approach, and vegetarian diets is available here.

http://www.eatright.org/Member/PolicyInitiatives/index_21009.cfm

Information on weight management.

http://www.eatright.org/Member/PolicyInitiatives/index_21054.cfm

Information on food misinformation.

http://www.eatright.org/Member/PolicyInitiatives/index_21044.cfm

AMERICAN HEART ASSOCIATION

Information on heart health and conditions.

http://americanheart.org/presenter.jhtml?identifier=1200000

Information on childhood obesity.

http://americanheart.org/presenter.jhtml?identifier=3030527
Top ten ways to help children develop healthy habits.

http://americanheart.org/presenter.jhtml?identifier=3030485

Information on exercise for children.

http://americanheart.org/presenter.jhtml?identifier=3007589

Information on diet for children.

http://americanheart.org/presenter.jhtml?identifier=3007590
 250

AMERICAN MEDICAL ASSOCIATION

Information on most if not all aspects of health, links to specific information, news reports, and updates.

http://www.ama-assn.org/

Nutrition and physical fitness information for youth.

http://www.ama-assn.org/ama/pub/category/2282.html

Links to ten chapters of the Obesity Primer. Links are separated by the chapter titles.

http://www.ama-assn.org/ama/pub/category/10931.html

AMERICAN OBESITY ASSOCIATION

Here you will find what we think is the most comprehensive site on obesity and overweight on the Internet. Obesity
is not a simple condition of eating too much. It is now recognized that obesity is a serious, chronic disease. No
human condition not race, religion, gender, ethnicity or disease state compares to obesity in prevalence and
prejudice, mortality and morbidity, sickness and stigma. Links to information on education, research, prevention,
treatment, consumer protection and discrimination are on this site.

http://obesity.org/

Information on how to prevent weight gain.

http://obesity.org/prevention/preventing.shtml

Information on maintaining weight loss.

http://obesity.org/prevention/maintaining.shtml

Information on preventative and wellness programs.

http://obesity.org/prevention/programs.shtml

Information on weight loss strategies, treatment options, and a goal weight calculator.

http://obesity.org/treatment/weight.shtml

Weight and wellness profile assessment.

http://obesity.org/education/profile.shtml

Links to information on treatment programs.

http://obesity.org/treatment/guidelines.shtml
 251

Cost of obesity.

http://obesity.org/treatment/cost.shtml

AMERICAN SOCIETY OF BARIATRIC PATIENTS

The American Society of Bariatric Physicians (ASBP) is a professional medical society of licensed physicians who
specialize in the medical treatment of obesity (Bariatrics) and its associated conditions. Formed in 1950, ASBP has
been instrumental in offering practical information that doctors can use in their bariatric practices, and supporting
public policies to prevent overweight and obesity.

http://www.asbp.org/

Frequently asked questions about obesity.

http://www.asbp.org/faq.htm

Links to stories on obesity in the news.

http://www.asbp.org/news.htm

CALIFORNIA ADOLESCENT NUTRITION AND FITNESS PROGRAM

The California Adolescent Nutrition and Fitness (CANFit) Program is a statewide, non-profit organization whose
mission is to engage communities and build their capacity to improve the nutrition and physical activity status of
Californias low-income African American, American Indian, Latino, Asian American, and Pacific Islander youth
10-14 years old.

http://www.canfit.org/

10 Nutrition Tips

http://www.canfit.org/nutrition_tips.html

Nutrition Activities

http://www.canfit.org/nutrition_activities.html

3-week healthy snack plan

http://www.canfit.org/nutrition_snackplan.html

Obesity Prevention and the Role of Schools

http://www.canfit.org/nutrition_obesity.html

Links to fitness information

http://www.canfit.org/fitness.html
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CANADIAN TASK FORCE ON PREVENTIVE HEALTH CARE

This website is designed to serve as a practical guide to health care providers, planners and consumers for
determining the inclusion or exclusion, content and frequency of a wide variety of preventive health interventions,
using the evidence-based recommendations of the Canadian Task Force on Preventive Health Care (CTFPHC).

http://www.ctfphc.org/

Summary Table of Recommendations about obesity.

http://www.ctfphc.org/Tables/Obesity_tab.htm

Screening for Childhood Obesity

http://ctfphc.org/Full_Text/Ch30full.htm

Detection, prevention, and treatment of obesity

http://www.ctfphc.org/to_cmaj_obesity.htm

Prevention of Obesity in Adults

http://www.ctfphc.org/Full_Text/Ch4full.htm

DAIRY COUNCIL OF CALIFORNIA

Information on dairy products and health.

http://www.dairycouncilofca.org/

The Importance of Breakfast

http://www.dairycouncilofca.org/edu/edu_prog_bhm_brea.htm

Information on milk and dairy products.

http://www.dairycouncilofca.org/dairy/index.html

DRUGDIGEST

DrugDigest is a non-commercial, evidence-based, consumer health and drug information site dedicated to
empowering consumers to make informed choices about drugs and treatment options.

http://www.drugdigest.org/DD/Home
 253

Introduction on Obesity

http://www.drugdigest.org/DD/HC/HCIntro/0,4043,550266,00.html

Obesity defined

http://www.drugdigest.org/DD/HC/WhatIs/0,4044,550266,00.html

Causes of obesity

http://www.drugdigest.org/DD/HC/Causes/0,4045,550266,00.html

Who is obese?

http://www.drugdigest.org/DD/HC/WhoHas/0,4046,550266,00.html

RISK FACTORS OF OBESITY.

http://www.drugdigest.org/DD/HC/RiskFactors/0,4049,550266,00.html

Symptoms of Obesity

http://www.drugdigest.org/DD/HC/Symptoms/0,4048,550266,00.html
Treatment options for obesity.

http://www.drugdigest.org/DD/HC/Treatment/0,4047,550266,00.html

Current research underway on obesity.

http://www.drugdigest.org/DD/HC/Horizon/0,4050,550266,00.html

GATORADE SPORTS SCIENCE INSTITUTE

Information on nutrition, athletic performance, hydration, and weight loss are available at this site. The sports
science library contains information on obesity and weight loss.

http://gssiweb.org/

A compilation of articles dealing with athletic performance and weight loss. Information on obesity is
available in this list.

http://gssiweb.org/sportssciencecenter/topic.cfm?id=96&type=research

GET FIT FRESNO

Access to quality fitness programs for every Fresno Citizen in every neighborhood
 254

http://www.getfitfresno.org/

Locations for free aerobics classes in Fresno.

http://www.getfitfresno.org/pages/CurrentEvents.asp

HEALTH POLICY GUIDE

Health Policy Guide provides evidence-based, peer-reviewed policy guidance and resources to support advocacy
and decision-making at the state and local levels.

http://www.healthpolicycoach.org/

Childhood Obesity: Using School Programs to Encourage Increased Physical Activity among Youth.

http://www.healthpolicycoach.org/doc.asp?id=6457

Links to information on obesity prevention.

http://www.healthpolicycoach.org/doc.asp?id=6651

KIDSHEALTH

KidsHealth is the largest and most visited site on the Web providing doctor-approved health information about
children from before birth through adolescence.

http://www.kidshealth.org/

Popular types of exercise.

http://www.kidshealth.org/parent/nutrition_fit/fitness/exercise.html

Nutrition and fitness articles for parents.

http://www.kidshealth.org/parent/nutrition_fit/index.html

Staying healthy links for kids.

http://www.kidshealth.org/kid/stay_healthy/

Food and fitness info for teens.

http://www.kidshealth.org/teen/food_fitness/
 255

MELPOMENE

Melpomene Institute, founded in 1982, helps girls & women of all ages link physical activity and health through
research, publication and education.

http://www.melpomene.org/

Information about physical activity

http://www.melpomene.org/research/about_physical_activity.asp

Tips and suggestions to get in shape.

http://www.melpomene.org/outreach/get_in_shape_tips_suggestions.asp

NATIONAL ASSOCIATION FOR HEALTH AND FITNESS

The National Association for Health and Fitness (NAHF) is a non-profit organization that exists to improve the
quality of life for individuals in the United States through the promotion of physical fitness, sports and healthy
lifestyles and by the fostering and supporting of Governors and State Councils and coalitions that promote and
encourages regular physical activity.

http://www.physicalfitness.org/

Benefits of fitness for worksites and employees.

http://www.physicalfitness.org/nehf.html

NATIONAL ASSOCIATION FOR SPORT AND PHYSICAL EDUCATION

The National Association for Sport and Physical Education seeks to enhance knowledge and professional practice in
sport and physical activity through scientific study and dissemination of research-based and experiential knowledge
to members and the public.

http://www.aahperd.org/naspe/template.cfm

NATIONAL CENTER ON PHYSICAL ACTIVITY AND DISABILITY

Information on physical activity for disabled people.

http://www.ncpad.org/

Information on exercise and fitness activities.

http://www.ncpad.org/exercise/
 256

Combating fatigue via diet, exercise, and sleep.

http://www.ncpad.org/nutrition/fact_sheet.php?sheet=92

Eating Breakfast as a Weight Management Tool

http://www.ncpad.org/nutrition/fact_sheet.php?sheet=276

Information on serving sizes.

http://www.ncpad.org/nutrition/fact_sheet.php?sheet=91

Food Guide Pyramid

http://www.ncpad.org/nutrition/fact_sheet.php?sheet=93

Information on food labels.

http://www.ncpad.org/nutrition/fact_sheet.php?sheet=94

Information on low carbohydrate fad diets.

http://www.ncpad.org/nutrition/fact_sheet.php?sheet=263

Information on low fat dairy meals.

http://www.ncpad.org/nutrition/fact_sheet.php?sheet=292

NATIONAL COALITION FOR PROMOTING PHYSICAL ACTIVITY

The National Coalition for Promoting Physical Activity's mission is to unite the strengths of public, private, and
industry efforts into collaborative partnerships that inspire and empower all Americans to lead more physically
active lifestyles.

http://www.ncppa.org/

FAQs about physical activity.

http://www.ncppa.org/faqs.asp

Landmark reports on physical activity.

http://www.ncppa.org/landmarkreports.asp
 257

NATIONAL STRENGTH AND CONDITIONING ASSOCIATION

The National Strength and Conditioning Association (NSCA) is the world's leading authority on strength and
conditioning. We provide reliable, research-based, strength and conditioning information to our members and the
general public.

http://www.nsca-lift.org/

Strength Training for Female Athletes

http://www.nsca-lift.org/Publications/posstatements.shtml#StrengthFemale

Health Aspects of Resistance Exercise and Training

http://www.nsca-lift.org/Publications/posstatements.shtml#HealthAspects

NORTH AMERICAN ASSOCIATION FOR THE STUDY OF OBESITY

Information on obesity.

http://www.naaso.org/

Obesity Newsletter

http://www.naaso.org/newsletter/nl200403.html

NORTH CAROLINA DIETETIC ASSOCIATION

The North Carolina Dietetic Association (NCDA) is one of 50 state associations affiliated with the American
Dietetic Association. NCDA has over 1500 members, all of whom are Registered Dietitians. The North Carolina
Dietetic Association is the advocate of the dietetic profession serving the public through the promotion of optimal
nutrition, health and well being.

http://www.eatrightnc.org/

NCs Obesity Prevention Initiative Unveils New Campaign

http://www.eatrightnc.org/newsandpress.htm

OBESITY RESEARCH

Research on obesity.

http://www.obesityresearch.org/
 258

PALO ALTO MEDICAL FOUNDATION

We commit to excellence, innovation and caring in health care, education and research. We are community based
and not for profit.

http://www.pamf.org/

Childhood Obesity: A New Epidemic

http://www.pamf.org/health/toyourhealth/child_obesity.html

PE 4 LIFE

PE4Life inspires active, healthy living by advancing the development of quality, daily physical education programs
for children.

http://www.pe4life.org/

99 Tips for Family Fitness Fun.

http://www.aahperd.org/naspe/template.cfm?template=tips-spanish.html

Links to articles on physical activity.

http://www.pe4life.org/news_links.php

Message boards where you can post information and ask questions about improving health through
physical activity and nutrition.

http://www.pe4life.org/forum/index.php

PE CENTRAL

Our goal is to provide the latest information about developmentally appropriate physical education programs for
children and youth. Database with information on various level of physical education.

http://www.pecentral.org/

SCHOOL NUTRITION ASSOCIATION

Information on nutrition in schools.

http://www.schoolnutrition.org/

Comprehensive Childhood Obesity Bill Introduced in Senate

http://www.schoolnutrition.org/Index.aspx?id=1219
 259

Frequently asked questions about school nutrition programs.

http://www.schoolnutrition.org/Index.aspx?id=1078

Nutrition tips and education.

http://www.schoolnutrition.org/Index.aspx?id=1138

Information available on programs, nutrition, and fitness. Reviews on nutrition and exercise books are also
available.

http://wellness.schoolnutrition.org/content/home.aspx

SOCIETY FOR NUTRITION EDUCATION

The Society for Nutrition Education (SNE) represents the unique professional interests of nutrition educators in the
United States and worldwide. SNE is dedicated to promoting healthy, sustainable food choices and has a vision of
healthy people in healthy communities. SNE provides forums for sharing innovative strategies for nutrition
education, expressing a range of views on important issues, and disseminating research findings. Members of SNE
educate individuals, families, fellow professionals, and students, and influence policy makers about nutrition, food,
and health.

http://www.sne.org/

THE COMMUNITY NUTRITION INSTITUTE

The Community Nutrition Institute (CNI) is a national non-profit organization, founded in 1970, which provides
information, education, and training on domestic and international food and nutrition concerns.

http://www.communitynutrition.org/

Obesity Resource Section of the Community Nutrition Institute

http://www.communitynutrition.org/obesity_resources.htm

THE FINANCE PROJECT

Resources for policy makers, program administrators, service providers, researchers, academics and students, and
others. A comprehensive clearinghouse of information and resources to support decision-making that produces and
sustains good results for children, families, and communities.

http://www.financeprojectinfo.org/

THE HORMONE FOUNDATION

The Hormone Foundation is dedicated to serving as a resource for the public by promoting the prevention, treatment
and cure of hormone-related conditions.

http://www.hormone.org/
 260

Homepage for obesity information with useful links and information.

http://www.hormone.org/learn/obesity.html

Overview of obesity including causes.

http://www.hormone.org/learn/obesity_1.html

Symptoms of obesity.

http://www.hormone.org/learn/obesity_2.html

Treatment options for obesity.

http://www.hormone.org/learn/obesity_3.html

Lifestyle issues of obesity and prevention.

http://www.hormone.org/learn/obesity_4.html

THE PRESIDENTS CHALLENGE

The President's Challenge is a program that encourages all Americans to make being active part of their everyday
lives. No matter what your activity and fitness level, the President's Challenge can help motivate you to improve.
Information on activities to improve health is included on this website.

http://www.presidentschallenge.org/

A list of lifestyle activities for improving health.

http://www.presidentschallenge.org/the_challenge/active_lifestyle.aspx#

Ten ideas to get active.

http://www.presidentschallenge.org/tools_to_help/ten_ideas.aspx

BMI calculator.

http://www.presidentschallenge.org/tools_to_help/bmi.aspx

TEENSHEALTH

Information on teen health

http://www.teenshealth.org/
 261

Links to information on food and fitness

http://www.teenshealth.org/teen/food_fitness/

TV TURNOFF NETWORK

TV-Turnoff Network encourages children and adults to watch much less television in order to promote healthier
lives and communities.

http://www.tvturnoff.org/

Tips for turning off the TV.

http://www.tvturnoff.org/brock10.htm
Tips to TV-Proof Your Home

http://www.tvturnoff.org/proof.htm
 262

COMMERCIAL

ABC-OF-FITNESS

Welcome to ABC-of-Fitness.com - the Exercise, Fitness Routine, and Fitness Information Portal. On this
informative website we provide you with all imaginable information about Fitness, Fitness Exercises and Fitness
Health.

http://www.abc-of-fitness.com/

The five basic components of a fitness workout.

http://www.abc-of-fitness.com/start-fitness-program/components-of-fitness.asp

Five tips for setting fitness goals.

http://www.abc-of-fitness.com/start-fitness-program/set-fitness-goals.asp

Nutrition information: calories.

http://www.abc-of-fitness.com/fitness-nutrition-diet/calorie-check.asp

Ideas for limiting fat intake.

http://www.abc-of-fitness.com/fitness-nutrition-diet/attack-your-fats.asp

Information on hydration.

http://www.abc-of-fitness.com/fitness-nutrition-diet/water-intake.asp

Five reasons to begin or continue exercising.

http://www.abc-of-fitness.com/fitness-focus/why-do-fitness.asp

How to choose a fitness method.

http://www.abc-of-fitness.com/fitness-basics/fitness-method.asp

ABOUT.COM HEALTH AND FITNESS CENTER

Information on health and fitness covering a wide range of topics.

http://about.com/health/

How to choose the right diet for you.

http://weightloss.about.com/c/ht/00/07/Choose_Diet__Right0962933779.htm
 263

Easy weight loss tips.

http://weightloss.about.com/od/easyweightlosstips/

Articles on eating smart.

http://weightloss.about.com/od/eatsmart/

Tips for improving your walking workout.

http://weightloss.about.com/od/exercise/ss/aa0320a.htm

Five Tips for People Who Don't Want to Exercise

http://weightloss.about.com/od/exercise/a/bl_5tips.htm

Six Great Benefits of Exercising

http://weightloss.about.com/od/exercise/a/bl_exerben.htm

How Much Exercise is enough?

http://weightloss.about.com/cs/justthefaqs/a/aa120603a.htm

The Top 50 Foods for Fat Fighters

http://weightloss.about.com/od/eatsmart/a/bltopfoods.htm

Top 10 Ways to Control Portions

http://weightloss.about.com/od/eatsmart/tp/aa030405a.htm

How few calories can you take in and still lose weight?

http://weightloss.about.com/od/eatsmart/a/blcalorieslow2.htm

How Many Calories Should I Eat?

http://weightloss.about.com/od/eatsmart/a/blhowmany.htm

Vegetarian diet for weight loss.

http://weightloss.about.com/cs/nutrition/a/aa092903a.htm
 264

DRMIRKIN.COM

Information on fitness, nutrition, men's health, women's health, heart health, etc.

http://www.drmirkin.com/

Links to reports on nutrition topics written by Dr. Mirkin

http://www.drmirkin.com/nutrition/index.html

Links to reports on fitness written by Dr. Mirkin

http://www.drmirkin.com/fitness/index.html

E-MEDICINE CONSUMER HEALTH

Online site for health.

http://www.emedicinehealth.com/

Obesity Overview

http://www.emedicinehealth.com/articles/11506-1.asp

Obesity Causes

http://www.emedicinehealth.com/articles/11506-2.asp

Methods to treat obesity.

http://www.emedicinehealth.com/articles/11506-5.asp

Prevention and outlook about obesity.

http://www.emedicinehealth.com/articles/11506-6.asp

HEALTH AND FITNESS TIPS

Information on health and wellness in the 'Features' section.

http://healthfitnesstips.healthology.com/nip_v2.asp?f=nip_default&c=general

Daily Exercise Suggestions.

http://www.health-fitness-tips.com/features/daily-excercise-suggestions.htm
 265

Motivational Quote of the Day

http://www.health-fitness-tips.com/motivational-quote/

Health and fitness tips archive.

http://www.health-fitness-tips.com/newsletters/

HEALTHFITNESS

Articles and tools for nutrition and fitness.

http://healthfitness.com.au/

Articles in health and fitness.

http://healthfitness.com.au/articles/index.html

Information on the link between exercise and mental health.

http://healthfitness.com.au/mind/index.html

Health and fitness directory.

http://healthfitness.com.au/directory/index.html

LLC PARTNERS IN NUTRITION

We are a group of highly skilled Registered Dietitians who provide a wide variety of services on eating and health-
related issues. With over 80 combined years of experience in the field of nutrition and health, we provide state-of-
the art nutrition counseling and consultation services.

http://www.partnersinnutrition.com/sportsnutrition.html

Health at Every Size

http://www.partnersinnutrition.com/page/page/1095249.htm

Resource List

http://www.partnersinnutrition.com/page/page/933229.htm

Articles on fitness and nutrition

http://www.partnersinnutrition.com/page/page/399922.htm
 266

MAYOCLINIC.COM

Tools and information for happier lives.

http://www.mayoclinic.com/

Information on making healthy diet decisions.

http://www.mayoclinic.com/invoke.cfm?objectid=03653D0C-535A-4173-B87C8C3E1C28133B

Slide show on serving sizes.

http://www.mayoclinic.com/invoke.cfm?objectid=1F7E8CF3-0B32-4AF2-878A4F3AEF496B58

How to build a better diet.

http://www.mayoclinic.com/invoke.cfm?objectid=357FAABB-312F-414A-A8D6401C15EE66B4

Information on specific vitamins and minerals.

http://www.mayoclinic.com/findinformation/conditioncenters/subcenters.cfm?objectid=AA5DF4BD-
EDE3-4D13-85EAC2FEAE12650C

Information on healthy weight basics and strategies for weight loss.

http://www.mayoclinic.com/findinformation/conditioncenters/subcenters.cfm?objectid=12BBDBC0-4553-
4CED-8BB40C7D23899D49

Self assessments and calculators.

http://www.mayoclinic.com/programsandtools/index.cfm

MENS FITNESS

Information on fitness, nutrition, sex, and life for men is available.

http://www.mensfitness.com/

Fitness 101

http://www.mensfitness.com/fitness/48

Fast Fitness: How to make your workouts more time efficient.

http://www.mensfitness.com/fitness/47
 267

Best and Worst Foods a Man Can Eat

http://www.mensfitness.com/nutrition/26

MENS HEALTH

Information on the health of men including fitness, sex, lifestyle, weight loss, and nutrition.

http://www.menshealth.com/cda/home/0,s1-0-0-0-0,00.html

Information on how food manufacturers confuse the public.

http://www.menshealth.com/cda/article/0,2823,s1-6-0-0-2482,00.html

Healthy Eating Guide. "Five a day the color way" is one way to go about it, but we're here to keep you
from sliding off that food pyramid. We've got the power foods, protection from the restaurant saboteurs,
how to cook for yourself, the special brew that can keep you disease free (no, not beer), the safe way to get
an extra boost, and even though this is about food, you still need to work out.

http://www.menshealth.com/cda/article/0,2823,s1-6-0-0-2474,00.html

Weight loss message board where you can post comments, ask questions, and read about motivating
success stories.

http://forums.menshealth.com/forum.jspa?forumID=5

Eat Right Every Time

http://www.menshealth.com/cda/article/0,2823,s1-6-0-0-2087,00.html

21 Ways to Stick to a Workout

http://www.menshealth.com/cda/article/0,2823,s1-1-0-0-2121,00.html

MUSCLE AND FITNESS ONLINE

Information on fitness and nutrition that is easy to understand.

http://www.muscleandfitness.com/

17 Common Training and Nutrition Questions

http://www.muscleandfitness.com/training/32

Information on the amount of protein, carbohydrates, and fat you should ingest.

http://www.muscleandfitness.com/nutrition/25
 268

Message Board where you can post information and ask questions about fitness and nutrition.

http://boards.muscleandfitness.com/ib/ikonboard.ci

OBESITYHELP

A support site for obese people with information on treatment issues.

http://www.obesityhelp.com/

Tips for eating out.

http://www.obesityhelp.com/main-info-eatingout.php

Low-fat food alternatives.

http://www.obesityhelp.com/main-info-alternatives.php

Tips for losing weight.

http://www.obesityhelp.com/main-info-losingweight.php

How to know if you child is overweight or obese.

http://www.obesityhelp.com/ChildhoodObesityHow.php

Risks involved in childhood obesity.

http://www.obesityhelp.com/ChildhoodObesityRisks.php

Main causes for childhood obesity.

http://www.obesityhelp.com/ChildhoodObesityCauses.php

Treatment options for childhood obesity.

http://www.obesityhelp.com/ChildhoodObesityTreatment.php
Prevention options for childhood obesity.

http://www.obesityhelp.com/ChildhoodObesityPrevention.php

PREVENTION MAGAZINE

Information on smart ways to live well.

http://www.prevention.com/home/0,s1-21-0-0-0-0,00.html
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Information on fitness programs including: aerobics, Pilates, spinning, and yoga.

http://www.prevention.com/category/0,5775,s1-2-67-0-0-0,00.html

Information on getting started in your workout program.

http://www.prevention.com/category/0,5775,s1-2-69-0-0-0,00.html

Information on cardiovascular exercise including: aerobics, cycling, running, spinning, swimming, and
walking.

http://www.prevention.com/category/0,5775,s1-2-56-0-0-0,00.html

Information on walking basics and how to take advantage of this very popular type of cardio.

http://www.prevention.com/category/0,5775,s1-2-92-0-0-0,00.html

RICHARD D. NORTH

Information on a wide variety of topics including obesity.

http://www.richarddnorth.com/

10 Propositions on obesity and rationing treatment for it. Remarks prepared for a National Obesity Forum
debate, London, 14 October, 2004

http://www.richarddnorth.com/10_propositions/obesity.htm

SIMPLANT - THE EASY WEIGHT LOSS

Information on understanding adult obesity.

http://www.virilplant.com/obesity-tratment.htm

What is obesity and how is it measured?

http://www.virilplant.com/obesity.htm
Obesity and body mass index.

http://www.virilplant.com/body-mass-index.htm

Understanding Your Body Fat Percentage

http://www.virilplant.com/body-fat-understanding.htm
 270

Genetic, environmental, psychological, and other causes of obesity.

http://www.virilplant.com/obesity-causes.htm

Consequences, health risks, psychological, and social effects of obesity.

http://www.virilplant.com/obesity-consequences.htm

How obesity is treated and who should lose weight.

http://www.virilplant.com/obesity-tratment.htm

SIZE WISE

We are here to provide you with information and resources designed to make your life healthier, more comfortable,
and more complete.

http://www.sizewise.com/

Information on health and fitness

http://www.sizewise.com/articles/health.html

STANFORD HOSPITAL AND CLINICS

http://www.stanfordhospital.com/index.html

Obesity Treatment Overview

http://www.stanfordhospital.com/healthLib/greystone/heartCenter/heartDiseasePrevention/obesityTreatmen
tOverview.html

Overview of Obesity

http://www.stanfordhospital.com/healthLib/greystone/heartCenter/heartDiseasePrevention/overviewofObes
ity.html

Maintaining Weight Loss

http://www.stanfordhospital.com/healthLib/greystone/heartCenter/heartDiseasePrevention/maintainingWei
ghtLoss.html

Preventing Obesity

http://www.stanfordhospital.com/healthLib/greystone/heartCenter/heartDiseasePrevention/preventingObesi
ty.html
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Exercise: Before Starting an Exercise Program

http://www.stanfordhospital.com/healthLib/greystone/heartCenter/heartDiseasePrevention/exerciseBeforeS
tartinganExerciseProgram.html

Designing an Exercise Program

http://www.stanfordhospital.com/healthLib/greystone/heartCenter/heartDiseasePrevention/designinganExer
ciseProgram.html

Risks of Physical Inactivity

http://www.stanfordhospital.com/healthLib/greystone/heartCenter/heartDiseasePrevention/risksofPhysicalI
nactivity.html

TESTOSTERONE NATION

Mostly information for bodybuilders. Information on fitness and nutrition can be found here as well. You can
search for information on weight loss, obesity, etc. via the search label at the top of the webpage.

http://www.t-nation.com/

WEBMD WEIGHT LOSS CLINIC

Information on food and recipes and how to stay fit and stay motivated.

https://diet.webmd.com/webmddiet/default_home.aspx?referrer=1111_013_0000_0005&secure=1

Information on how to get fit including how to overcome five common excuses, how to find the right
activity and workouts that work.

https://diet.webmd.com/WebMDDiet/default_getfit.aspx?secure=1
Information on how to stay motivated to lose weight including how to set proper goals, tips for success, and
mental strategies for success. A calorie counter, target heart rate calculator, and dessert wizard are included
at the lower right portion of the webpage.

https://diet.webmd.com/WebMDDiet/default_staymotivated.aspx?secure=1
WEIGHT.COM

Information on obesity including causes, trends, frequently asked questions, and treatment options are available on
this website.

http://www.weight.com/index.asp

Definition of obesity.

http://www.weight.com/definition.asp
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Causes of obesity.

http://www.weight.com/causes.asp

Years of life loss due to obesity.

http://www.weight.com/whyworry.asp

Psycho-social factors of obesity.

http://www.weight.com/psychosocial.asp

Complications of Obesity.

http://www.weight.com/complications.asp

Information on weight loss gimmicks.

http://www.weight.com/gimmick.asp

WEIGHT LOSS INFORMATION

Information on how to lose weight and eat a healthy diet. Various types of weight management strategies are
discussed.

http://www.weight-loss-i.com/

Types of weight loss programs.

http://www.weight-loss-i.com/weight-loss-programs.htm
Calorie needs to lose weight.

http://www.weight-loss-i.com/calorie-needs-to-lose-weight.htm

Dietary guidelines for Americans.

http://www.weight-loss-i.com/dietary-guidelines.htm
Balanced Healthy Diet

http://www.weight-loss-i.com/balanced-healthy-diet.htm

Information about weight loss.

http://www.weight-loss-i.com/weight-loss.htm
 273

Practical guidelines to lose weight.

http://www.weight-loss-i.com/lose-weight.htm

Weight reduction tips.

http://www.weight-loss-i.com/weight-reduction.htm

Weight Loss for Adolescents Teenagers & Children

http://www.weight-loss-i.com/weight-loss-for-adolescents.htm

Perspectives on How to Lose Weight

http://www.weight-loss-i.com/how-to-lose-weight.htm

Exercise and weight management.

http://www.weight-loss-i.com/weight-management.htm

WEIGHT WATCHERS

Information on eating right and living an active lifestyle to lose weight.

http://www.weightwatchers.com/index.aspx

Fitness questions and answers.

http://www.weightwatchers.com/util/art/archive.aspx?tabnum=4&sc=128

Topics to help you stay motivated.

http://www.weightwatchers.com/util/art/archive.aspx?tabnum=4&sc=119

Fitness ideas

http://www.weightwatchers.com/util/art/archive.aspx?tabnum=4&sc=113

Workout tips for women.

http://www.weightwatchers.com/health/wko/women_workouts.aspx?newcategory=introduction

Workout tips for men.

http://www.weightwatchers.com/health/wko/men_workouts.aspx?newcategory=introduction
 274

Topics in living a healthier lifestyle.

http://www.weightwatchers.com/util/art/archive.aspx?tabnum=4&sc=3

Health assessments.

http://www.weightwatchers.com/health/asm/index.aspx

Health quizzes.

http://www.weightwatchers.com/util/qzs/index.aspx?tabnum=4

YAHOO! HEALTH

Yahoo! Fitness Center with information on getting started with exercise, the benefits of exercise, and a guide to
getting fit.

http://health.yahoo.com/health/centers/fitness/

Archive of daily fitness tips.

http://health.yahoo.com/nutrition_fitness/miavita/fitnesstip=all

Body fat percentage calculator.

http://health.yahoo.com/centers/fitness/10002

Calorie burning calculator

http://health.yahoo.com/centers/fitness/10003

A tool to help you pick the best type of activity for you to get more active.

http://health.yahoo.com/centers/fitness/10001

Tips for achieving weight loss.

http://health.yahoo.com/centers/fitness/2

The key role of exercise in achieving weight loss.

http://health.yahoo.com/centers/fitness/20031158

Yahoo! Weight Loss Center with information on overweight, obesity, and weight loss.
http://health.yahoo.com/centers/weight_loss/
 275

Getting started in weight loss.

http://health.yahoo.com/centers/weight_loss/102

Achieving weight loss for life.

http://health.yahoo.com/centers/weight_loss/103

Weight loss strategies.

http://health.yahoo.com/centers/weight_loss/30003

Choosing the right weight loss program.

http://health.yahoo.com/centers/weight_loss/101
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CORPORATIONS

DOLE

A site dedicated to helping people teach children how to eat better.

http://www.dole5aday.com/

GENERAL MILLS

Corporate and health and wellness information.

http://www.generalmills.com/corporate/index.aspx

Health and wellness main page with links to information on health, nutrition, and fitness.

http://www.generalmills.com/corporate/health_wellness/index.aspx

Health information including BMI calculator and nutrition.

http://www.generalmills.com/corporate/health_wellness/your_health.aspx?section=yourhealth

10 Simple Strategies to Increase Activity.

http://www.generalmills.com/corporate/health_wellness/your_health_detail.aspx?CatID=7846&SelectCatI
D=7846&section=yourhealth

Five steps to help you eat better.

http://www.generalmills.com/corporate/health_wellness/your_health_detail.aspx?CatID=7584&SelectCatI
D=7584&section=yourhealth
GENERAL MILLS

Information on Energy ways to lose weight including diet and activity modification.

http://www.generalmills.com/corporate/health_wellness/your_health_detail.aspx?CatID=7782&SelectCatI
D=7782&section=yourhealth

Recommendations for adolescence to get more active.

http://www.generalmills.com/corporate/health_wellness/exercise_fitness.aspx?section=fitnut&sub=fit
 277

KELLOGG'S

Product and nutrition information.

http://www.kelloggs.com/us/

Nutritional benefits of whole grain and fiber.

http://www.kelloggwholegrain.com/nutrition/wholegrain/benefits.shtml

A calisthenics calculator game.

http://www.kelloggs.com/nutrition/nutritioncamp/learning/index.html

Information about calories and four myths about nutrition and calories.

http://www.kelloggs.com/nutrition/nutritioncamp/learning/index.html

Information about food labels and how to read them.

http://www.kelloggs.com/nutrition/nutritioncamp/learning/index.html

KRAFT FOODS

Information on products, recipes, food and family, and healthy living are available.

http://www.kraftfoods.com/kf/

Meal and fitness planner.

http://www.kraftfoods.com/kf/HealthyLiving/MealPlanner/MealPlanner.htm

Healthy weight range calculator.

http://www.kraftfoods.com/main.aspx?s=health&m=plans/tools/weight/control

Overview of the Institute of Medicines new recommendations for preventing childhood obesity.

http://www.kraftfoods.com/kf/HealthyLiving/NutritionUpdate/PracticalPractice/knuSepr04PP.htm
Healthy eating tips for Hispanic Americans.

http://www.kraftfoods.com/kf/HealthyLiving/NutritionUpdate/ConsumerEducation/consumerEdMay.htm

Healthy eating tips for African Americans.

http://www.kraftfoods.com/kf/HealthyLiving/NutritionUpdate/ConsumerEducation/consumerEd2.htm
 278

Information on how to count calories in foods.

http://www.kraftfoods.com/kf/HealthyLiving/WeightManagement/countingcalories.htm

Portion size tips.

http://www.kraftfoods.com/kf/HealthyLiving/articles/rulesofthumb.htm

Ten snacks less than 150 calories.

http://www.kraftfoods.com/kf/FoodandFamily/Spring_2004/healthyliving/10SnacksUnder150Calories.htm

Eight tips for beginning an exercise program.

http://www.kraftfoods.com/kf/HealthyLiving/articles/beginanexercise.htm

NABISCO

Product information available with a link to sensible snacking.

http://www.nabisco.com/

Criteria for a snack to be considered a sensible snack. Other dietary information is available as well.

http://www.nabisco.com/sensiblesnacking/

Sensible snacking quiz.

http://www.nabisco.com/sensiblesnacking/ss_trivia.aspx

100 ways to burn 100 calories.

http://www.nabisco.com/100caloriepacks/100cp_burn.aspx

Sensible snack recipes.

http://www.nabisco.com/sensiblesnacking/recipes/ss_recipemain.aspx
 279

Government Websites

CALIFORNIA DEPARTMENT OF HEALTH SERVICES

Protecting and Improving the Health of All Californians"

http://www.dhs.ca.gov/

California Obesity Prevention Initiative

http://www.dhs.ca.gov/ps/cdic/copi/html/Taking%20Action.htm

Information on the Obesity Problem

http://www.dhs.ca.gov/ps/cdic/copi/html/problem.htm

The mission of the California Obesity Prevention Initiative (COPI) is to reduce the prevalence of obesity
and its associated health risks in Californians through promotion of physical activity and healthy eating as
well as address the societal, technological, and environmental influences on obesity.

http://www.dhs.ca.gov/ps/cdic/copi/default.htm

CENTER FOR DISEASE CONTROL AND PREVENTION

Information on health, safety, and products. Includes publications, data, and statistics on health related topics.

http://www.cdc.gov/

Information on obesity and treatment.

http://www.cdc.gov/nccdphp/dnpa/obesity/

Overweight and obesity defined.

http://www.cdc.gov/nccdphp/dnpa/obesity/defining.htm

Current obesity trends.

http://www.cdc.gov/nccdphp/dnpa/obesity/defining.htm

Factors that contribute to obesity.

http://www.cdc.gov/nccdphp/dnpa/obesity/contributing_factors.htm

Health consequences of obesity.

http://www.cdc.gov/nccdphp/dnpa/obesity/consequences.htm
 280

Economic consequences of obesity.

http://www.cdc.gov/nccdphp/dnpa/obesity/economic_consequences.htm

State-based programs to prevent obesity and other chronic diseases.

http://www.cdc.gov/nccdphp/dnpa/obesity/state_programs/index.htm

Recommendations for obesity treatment.

http://www.cdc.gov/nccdphp/dnpa/obesity/recommendations.htm

FAQs about overweight and obesity.

http://www.cdc.gov/nccdphp/dnpa/obesity/faq.htm

General resources for overweight and obesity.

http://www.cdc.gov/nccdphp/dnpa/obesity/resources.htm

COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT

The Colorado Department of Public Health and Environment is committed to protecting and preserving the health
and environment of the people of Colorado.

http://www.cdphe.state.co.us/cdphehom.asp

Best Practices: Obesity Prevention for Children and Youth

http://www.cdphe.state.co.us/ps/bestpractices/topicsubpages/obesity.html

CONSUMER.GOV

Resource for consumer information from the federal government.

http://www.consumer.gov/

Setting Goals for Weight Loss

http://www.consumer.gov/weightloss/setgoals.htm

Voluntary Guidelines for Providers of Weight Loss Products or Services

http://www.consumer.gov/weightloss/guidelines.htm
BMI Chart

http://www.consumer.gov/weightloss/bmi.htm
 281

FEDERAL TRADE COMMISSION

Information for consumers.

http://www.ftc.gov/

Weighing the Evidence in Diet Ads

http://www.ftc.gov/bcp/conline/pubs/health/evidence.htm

Project Waistline Campaign

http://www.ftc.gov/bcp/conline/edcams/waistline/index.html

FOOD AND NUTRITION INFORMATION CENTER

Information on food and nutrition

http://www.nal.usda.gov/fnic/pubs_and_db.html

Food guide pyramid information

http://www.nal.usda.gov/fnic/Fpyr/pyramid.html

Information on food composition

http://www.nal.usda.gov/fnic/etext/000020.html

Information on dietary guidelines

http://www.nal.usda.gov/fnic/dga/index.html

Consumer Corner contains information about the food and nutrition topics the public most frequently asks
about. Much of the information is presented in full-text documents for your convenience.

http://www.nal.usda.gov/fnic/consumersite/index.html
 282

HEALTHY PEOPLE 2010

Healthy People 2010 challenges individuals, communities, and professionalsindeed, all of us to take specific
steps to ensure that good health, as well as long life, is enjoyed by all. Information on the relationship between
health, fitness, nutrition, and disease are available at this website. The primary goal is to increase the quality of your
life.

http://www.healthypeople.gov/

Healthfinder provides information on many topics related to the 28 focus areas of Healthy People 2010.

http://www.healthypeople.gov/healthfinder/

The Leading Health Indicators (LHIs) established by Healthy People 2010 will be used to measure the
health of the Nation over the next 10 years.

http://www.healthypeople.gov/LHI/

Health objectives that enable groups to work together as a team.

http://www.healthypeople.gov/Implementation/

The publications that set out the goals and objectives of Healthy People 2010, document the statistical basis
for the initiative, and provide guidance for its implementation are available online and in print.

http://www.healthypeople.gov/Publications/

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

The Institute of Medicine serves as adviser to the nation to improve health. As an independent, scientific adviser,
the Institute of Medicine strives to provide advice that is unbiased, based on evidence, and grounded in science. The
mission of the Institute of Medicine embraces the health of people everywhere.

http://www.iom.edu/

Information on obesity and steps that can be taken to prevent and treat obesity.

http://www.iom.edu/focuson.asp?id=22593

NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES

Causes for childhood obesity.

http://www-apps.niehs.nih.gov/conferences/drcpt/oe2005/index.cfm
 283

NATIONAL INSTITUTES OF HEALTH

U.S. Department of Health and Human Services Website on health.

http://www.nih.gov/

Links to information on nutrition.

http://health.nih.gov/result.asp/474/29

Links to information on weight loss and dieting.

http://health.nih.gov/result.asp/725/29

Links to information on obesity.

http://health.nih.gov/result.asp/476/29

Links to information on vitamins, minerals, and diet supplementation.

http://health.nih.gov/result.asp/719/29

NSW HEALTH

Health Information

http://www.health.nsw.gov.au/

TEAM NUTRITION

Team Nutrition is an initiative of the USDA Food and Nutrition Service to support the Child Nutrition Programs
through training and technical assistance for foodservice, nutrition education for children and their caregivers, and
school and community support for healthy eating and physical activity.

http://www.fns.usda.gov/tn/

THE PRESIDENTS COUNCIL ON PHYSICAL FITNESS AND SPORTS

The Presidents Council on Physical Fitness and Sports is the health, physical activity, fitness and sports information
website of the President's Council on Physical Fitness and Sports. You can find out about the Council and its work,
view our publications, and link to the resources of other government agencies as well as to health and fitness
organizations.

http://www.fitness.gov/

Physical activity fact sheet.

http://www.fitness.gov/resources_factsheet.htm
 284

Fitness topics.

http://www.fitness.gov/council_pubs.htm

U.S. FOOD AND DRUG ADMINISTRATION

Information on the regulated products of the FDA, as well as information on hot topics and the food industry.

http://www.fda.gov/

Losing Weight: Start By Counting Calories

http://www.fda.gov/fdac/features/2002/102_fat.html

Choose a heart healthy lifestyle

http://www.fda.gov/hearthealth/lifestyles/lifestyles.html

U.S. SURGEON GENERAL

America's chief health educator, giving Americans the best scientific information available on how to improve their
health and reduce the risk of illness and injury.

http://www.surgeongeneral.gov/

Links to overweight and obesity information.

http://www.surgeongeneral.gov/publichealthpriorities.html#overweight

Information on methods to increase physical activity.

http://www.surgeongeneral.gov/publichealthpriorities.html#increasing

Database containing useful information on diet, nutrition, and eating right.

http://www.hhs.gov/safety/index.shtml

WEIGHT-CONTROL INFORMATION NETWORK

Information on helping your overweight child.

http://win.niddk.nih.gov/publications/over_child.htm
 285

Statistics Related to Overweight and Obesity

http://win.niddk.nih.gov/statistics/index.htm

Resources for information on overweight and obesity.

http://win.niddk.nih.gov/resources/index.htm#obesity
 286

UNIVERSITIES

KANASAS STATE UNIVERSITY

The purpose of this page is to provide links to various sites that focus on nutrition and nutrition-related areas.
Although it is not all-inclusive by any means, the hope is that you will be able to find something of use. Always
remember to exercise good judgment as you surf from site to site.

http://www.oznet.ksu.edu/humannutrition/nutLink/n2.htm

Links to information on lifespan nutrition.

http://www.oznet.ksu.edu/humannutrition/nutLink/life.htm

Links to information on exercise and fitness.

http://www.oznet.ksu.edu/humannutrition/nutLink/pages/EXERCISE.HTM

Information on food nutrients.

http://www.oznet.ksu.edu/humannutrition/nutLink/pages/FOOD.HTM

Nutrition Profiles

http://www.oznet.ksu.edu/humannutrition/nutLink/pages/PROFILE.HTM

Vegetarianism

http://www.oznet.ksu.edu/humannutrition/nutLink/pages/VEG.HTM

Links to information on nutrition, health, exercise, and fitness.

http://www.oznet.ksu.edu/humannutrition/nutLink/pages/ORG.HTM

Links to government health sites.

http://www.oznet.ksu.edu/humannutrition/nutLink/pages/GOV.HTM

Newsgroups for health related information.

http://www.oznet.ksu.edu/humannutrition/nutLink/pages/NEWS.HTM

Nutrition related resources.

http://www.oznet.ksu.edu/humannutrition/nutLink/pages/RES.HTM
 287

NORTH CAROLINA STATE UNIVERSITY

Guidelines for Childhood Obesity Prevention Programs: Promoting Healthy Weight in Children

http://www.ces.ncsu.edu/pitt/fcs/childObesity.html

This program provides you with research-based information that you can use to help you make healthful
changes in your eating and exercise habits designed to help prevent cardiovascular disease.

http://www.ces.ncsu.edu/depts/fcs/food/hhb/index.htm

Links to information on food and nutrition.

http://www.ces.ncsu.edu/depts/fcs/food/index.html

Publications on nutrition.

http://www.ces.ncsu.edu/depts/fcs/food/pubs/index.html

UNIVERSITY OF CALIFORNIA, BERKLEY

Berkeley Center for Weight and Health

http://www.cnr.berkeley.edu/cwh/

Project on Reversing Childhood Obesity Trends

http://www.cnr.berkeley.edu/cwh/activities/trends.shtml

Children and Weight: What Can Communities Do?

http://www.cnr.berkeley.edu/cwh/activities/child_weight2.shtml

Fit WIC

http://www.cnr.berkeley.edu/cwh/activities/fitwic.shtml

Programs for Overweight Children

http://nature.berkeley.edu/cwh/resources/progs_overwt.shtml

Nutrition and Food Security Programs

http://nature.berkeley.edu/cwh/resources/progs_projs_nutrfs.shtml
 288

Physical Activity Programs

http://nature.berkeley.edu/cwh/resources/progs_projs_pa.shtml

Physical Activity and Nutrition Program Guidelines

http://nature.berkeley.edu/cwh/resources/progs_projs_paguide.shtml

Links to articles on obesity.

http://nature.berkeley.edu/pipermail/prc-obesity-network-cwh/2005-May/