Database: Ovid MEDLINE(R) <1966 to January Week 4 2004>Search Strategy:--------------------------------------------------------------------------------1 exp Obesity/ (54206)2 exp EXERCISE/ or exp EXERCISE THERAPY/ (40066)3 1 and 2 (2764)4 limit 3 to (human and english language) (2379)5 exp *Obesity/ and 4 (1713)6 (exp *EXERCISE/ or exp *EXERCISE THERAPY/) and 5 (823)7 limit 6 to yr=1996-2004 (569)8 limit 7 to yr=2000-2004 (358)9 limit 8 to review (59)10 limit 7 to review (98)11 limit 10 to ovid full text available (8)12 9 (59)13 limit 12 to local holdings (14)14 11 or 13 (22)15 12 not 14 (42)16 from 15 keep 3,6,13-16,19,21,27-28,30-31,33-34,36,40 (16)17 15 not 16 (26)18 14 or 17 (48)19 from 18 keep 1-48 (48)20 from 19 keep 1-48 (48)

***************************<1>Unique Identifier 10929704Authors Berke EM. Morden NE.Institution University of Massachusetts Medical School, Worcester 01610, USA.Title Medical management of obesity.[erratum appears in Am Fam Physician 2001 Aug 15;64(4):570]. [Review] [26 refs]Source American Family Physician. 62(2):419-26, 2000 Jul 15.Abstract 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. Obesity is defined as a body mass index greater than 30. Many patients accomplish weight loss with diet, exercise and lifestyle modification. Others require more aggressive therapy. Weight loss medications may be appropriate for use in selected patients who meet the definition of obesity or who are overweight with comorbid conditions. Medications are formulated to reduce energy intake, increase energy output or decrease the absorption of nutrients. Drugs cannot replace diet, exercise and lifestyle modification, which remain the cornerstones of obesity treatment. Two new agents, sibutramine and orlistat, exhibit novel mechanisms of action and avoid some of the side effects that occurred with earlier drugs. Sibutramine acts to block uptake of serotonin, norepinephrine and dopamine, while orlistat decreases fat absorption in the intestines. [References: 26]

<2>Unique Identifier 12674453Authors McInnis KJ. Franklin BA. Rippe JM.Institution

Dept of Exercise Science and Physical Education, University of Massachusetts, Boston, Massachusetts 02125, USA. kyle.mcinnis@umb.eduTitle Counseling for physical activity in overweight and obese patients.[see comment]. [Review] [33 refs]Comments Comment in: Am Fam Physician. 2003 Mar 15;67(6):1199-200, 1202; PMID: 12674450, Comment in: Am Fam Physician. 2003 Mar 15;67(6):1266-8; PMID: 12674454Source American Family Physician. 67(6):1249-56, 2003 Mar 15.Abstract 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 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. Results of research studies have shown that physician intervention to discuss physical activity (including the wide array of health benefits and the potential barriers to being active) need not take more than three to five minutes during an office visit but can play a critical role in patient implementation. This article describes elements of effective counseling for physical activity and presents guidelines for developing physical activity programs for overweight and obese patients. [References: 33]

<3>Unique Identifier 12240709Authors Dubbert PM. Carithers T. Sumner AE. Barbour KA. Clark BL. Hall JE. Crook ED.Institution University of Mississippi School of Medicine, Jackson, USA. patricia.dubbert@med.va.govTitle Obesity, physical inactivity, and risk for cardiovascular disease. [Review] [99 refs]Source American Journal of the Medical Sciences. 324(3):116-26, 2002 Sep.Abstract Despite considerable progress in understanding disease mechanisms and risk factors, improved treatments, and public education efforts, cardiovascular disease (CVD) remains the leading cause of death in the United States. Obesity and physical inactivity, 2 important lifestyle-related risk factors for CVD, are prevalent in the southeastern United States and are becoming more prevalent in all racial groups and areas of the country. In reviewing these risk factors, we explored topics including prevalence and trends in population data; associated psychosocial and environmental factors; and some of the mechanisms through which these risk factors are thought to contribute to CVD. We identified significant, but as yet poorly understood, racial disparities in prevalence of obesity, low levels of physical activity, and correlates of these risk factors and examined important differences in the complex relationship between obesity, diabetes, and cardiovascular disease risk between African American and European American women. The Jackson Heart Study will provide important and unique information relevant to many unanswered questions about obesity, physical inactivity, and obesity in African Americans. [References: 99]

<4>Unique Identifier 12626686Authors Costacou T. Mayer-Davis EJ.Institution Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA. t_costacou@hotmail.comTitle Nutrition and prevention of type 2 diabetes. [Review] [121 refs]Source Annual Review of Nutrition. 23:147-70, 2003.Abstract 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. [References: 121]

<5>Unique Identifier 11274524Authors French SA. Story M. Jeffery RW.Institution Division of Epidemiology, University of Minnesota, 1300 South Second Street, Minneapolis, Minnesota 55454, USA. french@epi.umn.eduTitle Environmental influences on eating and physical activity. [Review] [100 refs]Source Annual Review of Public Health. 22:309-35, 2001.Abstract Obesity has increased dramatically over the past two decades and currently about 50% of US adults and 25% of US children are overweight. The current epidemic of obesity is caused largely by an environment that promotes excessive food intake and discourages physical activity. This chapter reviews what is known about environmental influences on physical activity and eating behaviors. Recent trends in food supply, eating out, physical activity, and inactivity are reviewed, as are the effects of advertising, promotion, and pricing on eating and physical activity. Public health interventions, opportunities, and potential strategies to combat the obesity epidemic by promoting an environment that supports healthy eating and physical activity are discussed. [References: 100]

<6>Unique Identifier 12468414Authors Blaak EE. Saris WH.Institution Department of Human Biology, Nutrition Research Centre, Maastricht University, The Netherlands.

Title Substrate oxidation, obesity and exercise training. [Review] [74 refs]Source Best Practice & Research Clinical Endocrinology & Metabolism. 16(4):667-78, 2002 Dec.Abstract Regular physical exercise is of the utmost importance in the treatment of obesity because exercise is one of the factors determining long-term weight maintenance in weight reduction programmes and because exercise has been associated with a reduced risk for developing type 2 diabetes mellitus and cardiovascular disease. Obesity is associated with an impaired utilization of fat as a fuel during post-absorptive conditions, during beta-adrenergic stimulation and possibly during exercise, although the latter data are controversial.One of the underlying mechanisms for the positive effect of exercise training in obesity may be related to its effects on fat utilization because exercise training has been shown to increase basal fat oxidation and exercise fat oxidation in lean volunteers. Data on the effect of aerobic exercise training on exercise fat oxidation are controversial, whereas the available data indicate that exercise training may not be able to increase resting fat oxidation or 24-hour fat oxidation in obese subjects. Because disturbed muscle fat oxidation may be a primary event in the aetiology of obesity it is of the utmost importance to obtain more information on how and whether exercise training may be able to compensate for these impairments. [References: 74]

<7>Unique Identifier 11103212Authors Schrauwen P. Westerterp KR.Institution Department of Human Biology, Maastricht University, The Netherlands. p.schrauwen@hb.unimaas.nlTitle The role of high-fat diets and physical activity in the regulation of body weight. [Review] [92 refs]Source British Journal of Nutrition. 84(4):417-27, 2000 Oct.Abstract The prevalence of obesity is increasing in westernized societies. In the USA the age-adjusted prevalence of BMI > 30 kg/m2 increased between 1960 and 1994 from 13% to 23% for people over 20 years of age. This increase in the prevalence of obesity has been attributed to an increased fat intake and a decreased physical activity. However, the role of the impact of the level of dietary fat intake on human obesity has been challenged. High-fat diets, due to their high energy density, stimulate voluntary energy intake. An increased fat intake does not stimulate its own oxidation but the fat is stored in the human body. When diet composition is isoenergetically switched from low to high fat, fat oxidation only slowly increases, resulting in positive fat balances on the short term. Together with a diminished fat oxidation capacity in pre-obese subjects, high-fat diets can therefore be considered to be fattening. Another environmental factor which could explain the increasing prevalence of obesity is a decrease in physical activity. The percentage of body fat is negatively associated with physical activity and exercise has pronounced effects on energy expenditure and substrate oxidation. High-intensity exercise, due to a lowering of glycogen stores, can lead to a rapid increase in fat oxidation, which could compensate for the consumption of high-fat diets in westernized societies. Although the consumption of high-fat diets and low physical activity will easily lead to the development of obesity, there is still considerable inter-individual variability in body composition in individuals on similar diets. This can be

attributed to the genetic background, and some candidate genes have been discovered recently. Both leptin and uncoupling protein have been suggested to play a role in the prevention of diet-induced obesity. Indeed, leptin levels are increased on a high-fat diet but this effect can be attributed to the increased fat mass observed on the high-fat diet. No effect of a high-fat diet per se on leptin levels is observed. Uncoupling proteins are increased by high-fat diets in rats but no data are available in human subjects yet. In conclusion, the increased intake of dietary fat and a decreasing physical activity level are the most important environmental factors explaining the increased prevalence of obesity in westernized societies. [References: 92]

<8>Unique Identifier 10786862Authors Pescatello LS. VanHeest JL.Institution University of Connecticut, School of Allied Health Professions, Storrs 06269-2102, USA.Title Physical activity mediates a healthier body weight in the presence of obesity. [Review] [39 refs]Source British Journal of Sports Medicine. 34(2):86-93, 2000 Apr.

<9>Unique Identifier 10683597Authors Ross R. Janssen I. Tremblay A.Institution School of Physical and Health Education, Queen's University, Kingston, Ontario K7L 3N6.Title Obesity reduction through lifestyle modification. [Review] [72 refs]Source Canadian Journal of Applied Physiology. 25(1):1-18, 2000 Feb.Abstract Obesity is a worldwide public health problem. One in three Canadians is overweight, a prevalence that is already high and increasing. Moreover, 54% of men and 37% of Canadian women are characterized as abdominally obese, the phenotype that is strongly associated with cardiovascular disease and type II diabetes. These observations underscore the importance of considering the efficacy of methods commonly used to reduce total and abdominal obesity. These strategies include a decrease in energy intake (diet), an increase in energy expenditure (exercise), or pharmacological intervention. The combination of diet and exercise is more commonly prescribed, with pharmacological intervention suggested only when lifestyle changes fail to achieve weight loss.The aim of this report is to review current knowledge regarding the influence of diet and exercise as treatment strategies for obesity reduction and provide recommendations for attaining and maintaining a healthy weight. The importance of diet composition in the treatment of obesity is also considered. [References: 72]

<10>Unique Identifier 11570117Authors

Poirier P. Despres JP.Institution Department of Pharmacy, Laval University School of Pharmacy, Sainte-Foy, Quebec, Canada.Title Exercise in weight management of obesity. [Review] [115 refs]Source Cardiology Clinics. 19(3):459-70, 2001 Aug.Abstract Obesity is a chronic metabolic disorder associated with CVD and increased morbidity and mortality. When the BMI is > or = 30 kg/m2, mortality rates from all causes, and especially CVD, are increased by 50% to 100%. There is strong evidence that weight loss in overweight and obese individuals improves risk factors for diabetes and CVD. Additional evidence indicates that weight loss and the associated diuresis reduce blood pressure in both overweight hypertensive and nonhypertensive individuals, reduce serum TG levels, increase high-density lipoprotein cholesterol levels, and may produce some reduction in low-density lipoprotein cholesterol concentrations. Of interest, even if weight loss is minimal, obese individuals showing a good level of cardiorespiratory fitness are at reduced risk for cardiovascular mortality than lean but poorly fit subjects. Insulin and catecholamines have pronounced metabolic effects on human adipose tissue metabolism. Insulin stimulates LPL and inhibits HSL; the opposite is true for catecholamines. There is regional variation in adipocyte TG turnover favoring lipid mobilization in the visceral fat depots and lipid storage in the peripheral subcutaneous sites. The hormonal regulation of adipocyte TG turnover is altered in obesity and is most marked in central obesity. There is resistance to insulin stimulation of LPL; however, LPL activity in fasted obese subjects is increased and remains so following weight reduction. Catecholamine-induced lipolysis is enhanced in visceral fat but decreased in subcutaneous fat. Numerous adaptive responses take place with physical training. These adaptations result in a more efficient system for oxygen transfer to muscle, which is now able to better utilize the unlimited lipid stores instead of the limited carbohydrate reserves available. In addition, the reduced adipose tissue mass represents an important mechanical advantage, allowing better long-term work. Gender differences have been reported in the adaptation of adipose tissue metabolism to aerobic exercise training. Physical training helps counteract the permissive and affluent environment that predisposes reduced-obese subjects to regain weight. An exercise program using weight resistance modalities may also be included safely, and it improved program retention in a multidisciplinary weight management program that was designed for obese children. Thirty to 45 minutes of physical activity of moderate intensity, performed 3 to 5 days a week, should be encouraged. All adults should set a long-term goal to accumulate at least 30 minutes or more of moderate-intensity physical activity on most, and preferably all days. Public health interventions promoting walking are likely to be the most successful. Indeed, walking is unique because of its safety, accessibility, and popularity. It is noteworthy that there is a clear dissociation between the adaptation of cardiorespiratory fitness and the improvements in the metabolic risk profile that can be induced by endurance training programs. It appears that as long as the increase in energy expenditure is sufficient, low-intensity endurance exercise is likely to generate beneficial metabolic effects that would be essentially similar to those produced by high-intensity exercise. The clinician should therefore focus on the improvement of the metabolic profile rather than on weight loss alone. Realistic goals should be set between the clinician and the patient, with a weight loss of approximately of 0.5 to 1 pound per week. It should be kept in mind that since it generally takes years to become overweight or obese, a weight loss pattern of 0.5 or 1 pound per week will require time and perseverance to reach the proposed target. However, the use of physical activity as a method to lose weight seems inversely related to patients' age and BMI and directly related to the level of education. Thus, public health interventions helping these groups to become physically active remain a challenge and further emphasize the importance of the

one-on-one interaction between the clinician/health care professional with the obese individual "at risk" of CVD. This notion is critical, as it has been shown that less than half of obese adults have reported being advised to lose weight under the guidance of health care professionals. [References: 115]

<11>Unique Identifier 12613089Authors MacKnight JM.Institution University Physicians Clinic, University of Virginia Health System, Box 800671, Charlottesville, VA 22908, USA. jm9m@virginia.eduTitle Exercise considerations in hypertension, obesity, and dyslipidemia. [Review] [150 refs]Source Clinics in Sports Medicine. 22(1):101-21, vii, 2003 Jan.Abstract Sports medicine practitioners who care for a wide array of athletes and active individuals will consistently face issues regarding chronic cardiovascular diseases and their associated risk factors. Among these, hypertension, obesity, and dyslipidemia are common clinical conditions that may be encountered even amongst elite caliber athletes. Consequently, those entrusted with the care of this active population must recognize the presence of these disorders and feel comfortable with their management in the face of continued sports or exercise participation. This article reviews the pathophysiology of these conditions as they relate to athletes and outlines the value of continued exercise in the management of each of these entities while addressing the specific and unique treatment needs of active individuals. [References: 150]

<12>Unique Identifier 11507324Authors Liu S. Manson JE.Institution Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02215, USA. sliu@rics.bwh.harvard.eduTitle Dietary carbohydrates, physical inactivity, obesity, and the 'metabolic syndrome' as predictors of coronary heart disease. [Review] [115 refs]Source Current Opinion in Lipidology. 12(4):395-404, 2001 Aug.Abstract Several decades of epidemiological and clinical research have identified physical inactivity, excessive calorie consumption, and excess weight as common risk factors for both type 2 diabetes mellitus and coronary heart disease. This trio forms the environmental substrate for a now well-recognized metabolic phenotype called the insulin resistance syndrome. Recent data suggest that a high intake of rapidly absorbed carbohydrates, which is characterized by a high glycemic load (a measure of carbohydrate quality and quantity), may increase the risk of coronary heart disease by aggravating glucose intolerance and dyslipidemia. These data also suggest that individuals who are obese and insulin resistant are particularly prone to the adverse effects of a high dietary glycemic load. In addition, data continue to accumulate suggesting the important beneficial effects of physical activity, even at moderate levels, and weight reduction on improving insulin sensitivity and reducing the risk of coronary

heart disease. Future metabolic studies should continue to quantify the physiological impact of different foods on serum glucose and insulin, and such information should routinely be incorporated into large-scale and long-term prospective studies, in which the possible interaction effects between diet and other metabolic determinants such as physical activity and obesity can be examined. Until more definitive data are available, replacing refined grain products and potatoes with minimally processed plant-based foods such as whole grains, fruits, and vegetables, and reducing the intake of high glycemic load beverages may offer a simple strategy for reducing the incidence of coronary heart disease. [References: 115]

<13>Unique Identifier 12716822Authors Willey KA. Singh MA.Institution School of Exercise and Sport Science, the University of Sydney, Lidcombe, Australia.Title Battling insulin resistance in elderly obese people with type 2 diabetes: bring on the heavy weights. [Review] [68 refs]Source Diabetes Care. 26(5):1580-8, 2003 May.Abstract Exercise improves insulin resistance and has beneficial effects in preventing and treating type 2 diabetes. However, aerobic exercise is hindered in many type 2 diabetic patients because of advancing age, obesity, and other comorbid conditions. Weight lifting or progressive resistance training (PRT) offers a safe and effective exercise alternative for these people. PRT promotes favorable energy balance and reduced visceral fat deposition through enhanced basal metabolism and activity levels while counteracting age- and disease-related muscle wasting. PRT improves insulin sensitivity and glycemic control; increases muscle mass, strength, and endurance; and has positive effects on bone density, osteoarthritic symptoms, mobility impairment, self-efficacy, hypertension, and lipid profiles. PRT also alleviates symptoms of anxiety, depression, and insomnia in individuals with clinical depression and improves exercise tolerance in individuals with cardiac ischemic disease and congestive heart failure; all of these aspects are relevant to the care of diabetic elders. Moreover, PRT is safe and well accepted in many complex patient populations, including very frail elderly individuals and those with cardiovascular disease. The greater feasibility of using PRT over aerobic exercise in elderly obese type 2 diabetic individuals because of concomitant cardiovascular, arthritic, and other disease provides a solid rationale for investigating the global benefits of PRT in the management of diabetes. [References: 68]

<14>Unique Identifier 12494312Authors Minehira K. Tappy L.Institution Institut de physiologie, Universite de Lausanne, Lausanne, Switzerland.Title Dietary and lifestyle interventions in the management of the metabolic syndrome: present status and future perspective. [Review] [44 refs]Source European Journal of Clinical Nutrition. 56(12):7 p following 1262, 2002 Dec.Abstract

OBJECTIVE: To review the mechanisms underlying the metabolic syndrome, or syndrome X, in humans, and to delineate dietary and environmental strategies for its prevention. DESIGN: Review of selected papers of the literature. RESULTS: Hyperinsulinemia and insulin resistance play a key role in the development of the metabolic syndrome. Strategies aimed at reducing insulin resistance may be effective in improving the metabolic syndrome. They include low saturated fat intake, consumption of low-glycemic-index foods, physical exercise and prevention of obesity. CONCLUSIONS: Future research, in particular the genetic basis of the metabolic syndrome and the interorgan interactions responsible for insulin resistance, is needed to improve therapeutic strategies for the metabolic syndrome. [References: 44]

<15>Unique Identifier 11011955Authors Molnar D. Livingstone B.Institution Department of Paediatrics, University of Pecs, Hungary. dmolnar@apacs.pote.huTitle Physical activity in relation to overweight and obesity in children and adolescents. [Review] [109 refs]Source European Journal of Pediatrics. 159 Suppl 1:S45-55, 2000 Sep.Abstract Fitness and physical activity levels of children and adolescents are commonly addressed but data on scientific investigations are both equivocal and methodologically diverse. The intensity and type of physical activity that benefit health and development during childhood are not known. Measurement of activity in children is problematic since there is no valid method of assessing activity levels that is feasible for use in large field studies. Most studies using self-report methods, heart rate studies using low heart rate threshold and doubly labelled water studies indicate relatively high levels of activity in children. The three national surveys on large representative samples reported that 60% to 70% of all children were involved in sufficient physical activity according to various definitions. Heart rate studies demonstrate that children generally perform short bouts of moderate to vigorous activities and seldom participate in long-sustained vigorous activities. They also proved that children perform large volumes of activity in the lower heart rate zones. It is generally accepted that boys are more active than girls and physical activity declines by age (peak around 13 to 14 years of age). The difference between the physical activity of European and North American children or between children living in different European countries is difficult to judge due to the diversity of methodology and definitions. CONCLUSION: There is a need to identify more clearly the quantity and type of activity which improves the health and promotes the normal development of children and to improve the methods assessing physical activity. [References: 109]

<16>Unique Identifier 11210447Authors Horowitz JF.Institution Division of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA. jeffhoro@umich.eduTitle Regulation of lipid mobilization and oxidation during exercise in obesity. [Review] [15 refs]

Source Exercise & Sport Sciences Reviews. 29(1):42-6, 2001.Abstract Regulation of lipid mobilization and oxidation during exercise in obesity. Exerc. Sport Sci. Rev. Vol. 29, No. 1, pp 42-46, 2001. Obesity is associated with metabolic disorders that may be related to alterations in lipid mobilization and oxidation. Although exercise is essential for successful weight management, the regulation of fatty acid metabolism during exercise in obesity is unclear. This review discusses factors that regulate fat metabolism during exercise and the effects of endurance training on these responses. [References: 15]

<17>Unique Identifier 11064850Authors Ross R. Freeman JA. Janssen I.Institution School of Physical and Health Education, Queen's University, Kingston, Ontario, Canada. rossr@post.queensu.caTitle Exercise alone is an effective strategy for reducing obesity and related comorbidities. [Review] [17 refs]Source Exercise & Sport Sciences Reviews. 28(4):165-70, 2000 Oct.Abstract The commonly held view that exercise alone is not a useful strategy for obesity reduction is drawn from studies with limitations that confound interpretation. Recent evidence counters the dogma that daily exercise produces only modest weight loss and suggests that exercise without diet restriction is an effective strategy for reducing obesity and related co-morbidities. [References: 17]

<18>Unique Identifier 12680567Authors McInnis KJ.Institution Department of Exercise Science and Physical Education, University of Massachusetts-Boston, Mass 02125, USA. kyle.mcinnis@umb.eduTitle Diet, exercise, and the challenge of combating obesity in primary care. [Review] [25 refs]Source Journal of Cardiovascular Nursing. 18(2):93-100; quiz 101-2, 2003 Apr-Jun.Abstract 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. [References: 25]

<19>Unique Identifier 12508957Authors Womble LG. Clark VL. Wadden TA.Institution University of Pennsylvania School of Medicine, Department of Psychiatry, Philadelphia, USA. Womble@mail.med.upenn.eduTitle Diet and physical activity for obesity: how effective are they?. [Review] [23 refs]Source Journal of Endocrinological Investigation. 25(10):922-4, 2002 Nov.

<20>Unique Identifier 12540311Authors Shepherd TM.Institution Department of Family Medicine, Medical University of South Carolina, Charleston, SC 29425, USA. toddmshepherd@hotmail.comTitle Effective management of obesity.[see comment]. [Review] [46 refs]Comments Comment in: J Fam Pract. 2003 Aug;52(8):635; PMID: 12899819Source Journal of Family Practice. 52(1):34-42, 2003 Jan.Abstract Successful treatment of obesity usually requires multiple interventions. The choice of therapies should be guided by the initial assessment of a patient's degree of obesity and comorbid conditions, if present. A variety of interventions can achieve short-term weight loss, but rebound weight gain is common when therapy is stopped. Thus, programs for weight maintenance are critical to ultimate success. [References: 46]

<21>Unique Identifier 12830652Authors Keller C. Fleury J. Mujezinovic-Womack M.Institution University of Texas Health Science Center, San Antonio School of Nursing, 7703 Floyd Curl Drive, San Antonio, TX 78284, USA.Title Managing cardiovascular risk reduction in elderly adults. By promoting and monitoring healthy lifestyle changes, health care providers can help older adults improve their cardiovascular health. [Review] [35 refs]Source Journal of Gerontological Nursing. 29(6):18-23, 2003 Jun.Abstract 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 homocysteinemia, and sedentary behavior. These factors are presented as equally important modifiable coronary heart disease risks. [References: 35]

<22>Unique Identifier 12092690Authors Nemet D. Cooper DM.Institution Center for the Study of Health Effects of Exercise in Children, University of California, Irvine, College of Medicine, Orange 92868, USA. dcooper@uci.eduTitle Exercise, diet, and childhood obesity: the GH-IGF-I connection. [Review] [36 refs]Source Journal of Pediatric Endocrinology & Metabolism. 15 Suppl 2:751-7, 2002 May.Abstract The recent "obesity epidemic" among children and adolescents is a major public health concern. The mechanisms responsible for the increased incidence of childhood obesity are not yet well understood. The absence of a clear mechanism makes treating the obese child or adolescent a difficult task, and standardized therapeutic approaches simply do not yet exist. Metabolic derangements associated with obesity may contribute to the difficulty in treatment. Observed abnormalities in the growth hormone (GH)-insulin-like growth factor-I (IGF-I) axis in obese adults and the impact of exercise on the GH-IGF-I system are of particular relevance to the growing obese child. In this review, we focus on the interacting mechanisms of diet and exercise through specific hormonal mediators and their contribution to the current obesity epidemic. An improved understanding of these mechanisms may be helpful in creating effective treatment programs for children with obesity. [References: 36]

<23>Unique Identifier 11905462Authors Sothern MS. Schumacher H. von Almen TK. Carlisle LK. Udall JN.Institution Prevention of Childhood Obesity Laboratory, Louisiana State University, Pennington Biomedical Research Center, Baton Rouge 70808, USA.Title Committed to kids: an integrated, 4-level team approach to weight management in adolescents. [Review] [18 refs]Source Journal of the American Dietetic Association. 102(3 Suppl):S81-5, 2002 Mar.Abstract The integrated, 4-level approach of Committed to Kids is successful because of several factors: The sessions are designed to entertain the adolescents and promote initial success; The program features parent-training methods in short, interactive, educational sessions; In severely obese adolescents, the diet intervention results in noticeable weight loss that motivates the patient to continue; also, the improved exercise tolerance resulting from the weight loss promotes increased physical activity; and The program team provides consistent feedback-patients and their families receive results and updates every 3 months. Most importantly, the program is conducted in groups of families. The adolescent group dynamics and peer modeling are primary components of the successful management of obesity in youth. [References: 18]

<24>Unique Identifier 11730237Authors Chernoff R.Institution Geriatric Research Education and Clinical Center, Central Arkansas Veterans Healthcare System, Little Rock 72205, USA. chernoffronni@uams.eduTitle Nutrition and health promotion in older adults. [Review] [100 refs]Source Journals of Gerontology Series A-Biological Sciences & Medical Sciences. 56 Spec No 2:47-53, 2001 Oct.Abstract During recent decades, the concept of health promotion has become a legitimate part of health care because of the aging of the postwar baby boom generation. As this population ages, the potential strain on health care systems will increase because the greatest use of health care services occurs during the last years of life. In older adults there are many correctable health factors that can be assessed through screening protocols. Hypertension, cholesterol, hearing, vision, diabetes, and cancer screening are well integrated into health promotion programs; nutrition promotion programs are not as well integrated. Reluctance to develop health promotion programs for older adults exists because of a perception that they would not follow such plans or change their lifestyles. However, longitudinal studies have shown that health promotion activities extend the number of years of health in older people although the relationship weakens in older age. Changes in diet and exercise patterns are most effective in the prevention of nutrition-related conditions when they are instituted early in life, but positive effects can occur at any age. If nutritional interventions are instituted early, a substantial reduction in health care expenditures may result from a decrease in the incidence or the delayed onset of these conditions. Changes in behaviors (reducing salt and fat intake) were positively associated with a belief that consuming a healthful diet would contribute to better health. The use of a variety of adult education theories and models will enhance behavior changes that lead to more healthful habits and enable a health educator to be successful in effecting change. [References: 100]

<25>Unique Identifier 10793650Authors Leermakers EA. Dunn AL. Blair SN.Institution Division of Epidemiology and Clinical Applications, Cooper Institute, Dallas, Texas, USA. bleermakers@cooperinst.orgTitle Exercise management of obesity. [Review] [40 refs]Source Medical Clinics of North America. 84(2):419-40, 2000 Mar.Abstract When dealing with overweight patients, it is important to treat obesity as a chronic condition requiring long-term management. Physicians do not send a patient with hypertension home with just one bottle of pills and expect blood pressure to be managed forever. Similarly, it is naive to think that sending an overweight patient home with only a single word of advice to "lose weight" will solve the problem. Medical staff would be wise to adopt the attitude that obesity requires long-term intervention and management, just as hypertension requires ongoing monitoring and management. Continued attention to patients' physical activity is required. It is important for physicians to spend a few minutes discussing physical activity with their patients. The patient's current

and past levels of physical activity should be assessed as well as the barriers to and benefits of activity. Normal-weight patients should accumulate at least 30 minutes of moderate-intensity activity on most days of the week, and overweight patients should accumulate 60 to 80 minutes per day, every day. The physician can provide some simple tools, such as a step counter and self-monitoring forms, to promote increases in activity and can follow up with the patient after the office visit. This information may sound like a lot to cover, especially given the limited time available for each patient. By spending 3 to 5 minutes intervening, however, physicians can play a critical role in promoting health. Physicians should set a goal to address one specific topic (e.g., a brief discussion of exercise benefits and barriers) and try one strategy (e.g., introduce self-monitoring) during the next counseling session with patients. It is also important for physicians to remember that their success in changing behavior may be in small increments. These small changes can and do eventually lead to success for many patients and physicians. [References: 40]

<26>Unique Identifier 10449014Authors Miller WC.Institution Exercise Science Programs, The George Washington University Medical Center, Washington DC 20052, USA. wmiller@gwu.eduTitle How effective are traditional dietary and exercise interventions for weight loss?. [Review] [68 refs]Source Medicine & Science in Sports & Exercise. 31(8):1129-34, 1999 Aug.Abstract Health care professionals have used restrictive dieting and exercise intervention strategies in an effort to combat the rising prevalence of obesity in affluent countries. In spite of these efforts, the prevalence of obesity continues to rise. This apparent ineffectiveness of diet and exercise programming to reduce obesity has caused many health care providers, obesity researchers, and lay persons to challenge the further use of diet and exercise for the sole purpose of reducing body weight in the obese. The purposes of this paper were to examine the history and effectiveness of diet and exercise in obesity therapy and to determine the best future approach for health promotion in the obese population. A brief survey of the most popular dieting techniques used over the past 40 yr shows that most techniques cycle in and out of popularity and that many of these techniques may be hazardous to health. Data from the scientific community indicate that a 15-wk diet or diet plus exercise program produces a weight loss of about 11 kg with a 60-80% maintenance after 1 yr. Although long-term follow-up data are meager, the data that do exist suggest almost complete relapse after 3-5 yr. The paucity of data provided by the weight-loss industry has been inadequate or inconclusive. Those who challenge the use of diet and exercise solely for weight control purposes base their position on the absence of weight-loss effectiveness data and on the presence of harmful effects of restrictive dieting. Any intervention strategy for the obese should be one that would promote the development of a healthy lifestyle. The outcome parameters used to evaluate the success of such an intervention should be specific to chronic disease risk and symptomatologies and not limited to medically ambiguous variables like body weight or body composition. [References: 68]

<27>Unique Identifier 9924725

Authors Babb TG.Institution Institute for Exercise and Environmental Medicine, Presbyterian Hospital of Dallas, TX 75231. babbt@wpmail.phscare.orgTitle Mechanical ventilatory constraints in aging, lung disease, and obesity: perspectives and brief review. [Review] [44 refs]Source Medicine & Science in Sports & Exercise. 31(1 Suppl):S12-22, 1999 Jan.Abstract Mechanical ventilatory constraints in aging, lung disease, and obesity; perspectives and brief review. Med. Sci. Sports Exerc., Vol. 31, No. 1 (Suppl.), pp. S12-S22, 1999. One of the most difficult tasks of cardiopulmonary exercise testing is to determine the influence of ventilatory limitations on the ventilatory response to exercise. Currently there is no generally accepted method in which to quantify the magnitude of mechanical ventilatory constraints during exercise. Nor is there agreement on how to quantify maximal ventilatory capacity. To address these issues, this article focuses on the evaluation of mechanical ventilatory constraints during exercise and provides an overview of the mechanical ventilatory constraints that are encountered with aging, lung disease, and obesity. [References: 44]

<28>Unique Identifier 10593539Authors Rauramaa R. Vaisanen SB.Institution Kuopio Research Institute of Exercise Medicine, Kuopio, Finland. rainer.rauramaa@messi.uku.fiTitle Physical activity in the prevention and treatment of a thrombogenic profile in the obese: current evidence and research issues. [Review] [46 refs]Source Medicine & Science in Sports & Exercise. 31(11 Suppl):S631-4, 1999 Nov.Abstract PURPOSE: To evaluate the impact of regular physical activity on thrombogenic profile in obese individuals. DESIGN: 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. RESULTS: Physical activity increases acutely 1) platelet number and activity, 2) activation of coagulation leading to a thrombin generation, and 3) simultaneous activation of fibrinolysis. On the other hand, hemostatic changes resulting from regular exercise training are limited to few data on platelets and blood coagulation and to some indications of increased fibrinolysis. Obesity is a risk factor for atherosclerotic cardiovascular diseases, and it is associated with hypertriglyceridemia, hyperinsulinemia, and non-insulin-dependent diabetes (NIDDM). These states interfere with a balance between blood coagulation and fibrinolysis leading to an increased thrombogenesis. Regular physical activity reduces platelet aggregability, while the effects on plasma fibrinogen and fibrinolytic activity remain unclear. CONCLUSIONS: Although obesity associates with several unfavorable derangements in the hemostatic system, data on the interactions of regular physical activity with blood coagulation in overweight or obese subjects are scarce. Therefore, controlled randomized clinical trials with adequate statistical power are needed for the evaluation of physical activity in the prevention and treatment of obesity-related atherothrombotic disorders. [References: 46]

<29>Unique Identifier 8776222Authors Blair SN. Horton E. Leon AS. Lee IM. Drinkwater BL. Dishman RK. Mackey M. Kienholz ML.Institution Cooper Institute for Aerobics Research, Dallas, TX, USA.Title Physical activity, nutrition, and chronic disease. [Review] [202 refs]Source Medicine & Science in Sports & Exercise. 28(3):335-49, 1996 Mar.Abstract 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. A discussion of how to increase physical activity levels and how to improve dietary intake also is included. Finally, current exercise and dietary recommendations are summarized, as are directions for future research. [References: 202]

<30>Unique Identifier 8778547Authors Epstein LH. Coleman KJ. Myers MD.Institution Department of Psychology, University at Buffalo, NY 14260, USA.Title Exercise in treating obesity in children and adolescents. [Review] [52 refs]Source Medicine & Science in Sports & Exercise. 28(4):428-35, 1996 Apr.Abstract 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. Factors that should be considered in research testing exercise interventions are discussed, including adherence, diet, age, gender, and type of exercise. In addition, the potential for exercise programs in the prevention of obesity in childhood and adolescence is discussed. The results support the continued use of exercise in combination with diet for child and adolescent obesity treatment, but the limited number of controlled studies indicates the need for more research in the area. The potential for exercise programs in the prevention of obesity in childhood and adolescence is discussed. [References: 52]

<31>Unique Identifier 11427779Authors

Ross R. Janssen I.Institution School of Physical and Health Education, Queen's University, Ontario, Canada. rossr@post.queensu.caTitle Physical activity, total and regional obesity: dose-response considerations. [Review] [48 refs]Source Medicine & Science in Sports & Exercise. 33(6 Suppl):S521-7; discussion S528-9, 2001 Jun.Abstract PURPOSE: This review was undertaken to determine whether exercise-induced weight loss was associated with corresponding reductions in total, abdominal, and visceral fat in a dose-response manner. METHODS: A literature search (MEDLINE, 1966--2000) was performed using appropriate keywords to identify studies that consider the influence of exercise-induced weight loss on total and/or abdominal fat. The reference lists of those studies identified were cross-referenced for additional studies. RESULTS: Total fat. Review of available evidence suggested that studies evaluating the utility of physical activity as a means of obesity reduction could be subdivided into two categories based on study duration. Short-term studies (< or = 16 wk, N = 20) were characterized by exercise programs that increased energy expenditure by values double (2200 vs 1100 kcal.wk-1) that of long-term studies (> or = 26 wk, N = 11). Accordingly, short-term studies report reductions in body weight (-0.18 vs -0.06 kg x wk(-1)) and total fat (-0.21 vs -0.06 kg x wk(-1)) that are threefold higher than those reported in long-term studies. Moreover, with respect to dose-response issues, the evidence from short-term studies suggest that exercise-induced weight loss is positively related to reductions in total fat in a dose-response manner. No such relationship was observed when the results from long-term studies were examined. Abdominal fat. Limited evidence suggests that exercise-induced weight loss is associated with reductions in abdominal obesity as measured by waist circumference or imaging methods; however, at present there is insufficient evidence to determine a dose-response relationship between physical activity, and abdominal or visceral fat. CONCLUSION: In response to well-controlled, short-term trials, increasing physical activity expressed as energy expended per week is positively related to reductions in total adiposity in a dose-response manner. Although physical activity is associated with reduction in abdominal and visceral fat, there is insufficient evidence to determine a dose-response relationship. [References: 48]

<32>Unique Identifier 10705072Authors Votruba SB. Horvitz MA. Schoeller DA.Institution From the Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI 53706, USA.Title The role of exercise in the treatment of obesity. [Review] [68 refs]Source Nutrition. 16(3):179-88, 2000 Mar.Abstract The prevalence of obesity in the USA has increased dramatically in the past decade. This foreshadows an increase in the rates of morbidity and mortality from obesity-related diseases and increases in the number of individuals undergoing weight-loss therapy. Although exercise has long been recommended for inclusion in such therapy, the present review has found that it has had little or no effect on weight loss per se when the exercise is limited to the typically prescribed 3-5 h/wk of moderate or vigorous activity. However, further review

has shown that exercise helps to preserve and at times even increase fat-free mass during weight loss. At the same time, fat loss is generally increased. Neither type nor amount of exercise appears to have much effect during treatment, with the possible exception of resistance training, which is associated with the best outcome for fat-free mass. The most important role of exercise, however, is in the maintenance of the weight loss. In this respect, the volume of exercise seems to be important because several lines of evidence have indicated that exercise must expend roughly 2500 kcal/wk to maintain weight loss. Studies of weight maintenance, however, have generally not included randomized controls; thus, further research is required to solidify these conclusions. [References: 68]

<33>Unique Identifier 12446862Authors Ainsworth BE. Youmans CP.Institution Prevention Research Center, Department of Epidemiology & Biostatistics, Norman J. Arnold School of Public Health, 730 Devine Street, University of South Carolina, Columbia, SC 29208, USA.Title Tools for physical activity counseling in medical practice. [Review] [27 refs]Source Obesity Research. 10 Suppl 1:69S-75S, 2002 Nov.

<34>Unique Identifier 12226146Authors Fenster CP. Weinsier RL. Darley-Usmar VM. Patel RP.Institution Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL 35294, USA.Title Obesity, aerobic exercise, and vascular disease: the role of oxidant stress. [Review] [49 refs]Source Obesity Research. 10(9):964-8, 2002 Sep.Abstract Oxidant formation in the vasculature contributes to vascular disease and dysfunction associated with obesity. In contrast, exercise-dependent production of oxidants may stimulate adaptive responses that protect against the development of such diseases. In this review, we discuss current concepts in the biology of reactive oxygen and nitrogen species and how their function is modulated in the context of vascular disease, obesity, and aerobic exercise. [References: 49]

<35>Unique Identifier 12119990Authors Thorburn AW. Proietto J.Institution Department of Medicine, University of Melbourne, Royal Melbourne Hospital, Victoria, 3050 Australia. a.thorburn@medicine.unimelb.edu.auTitle Biological determinants of spontaneous physical activity. [Review] [90 refs]

Source Obesity Reviews. 1(2):87-94, 2000 Oct.Abstract A decline in daily physical activity levels is clearly a major factor contributing to the current obesity epidemic affecting both developed and developing countries in the world. This escalating problem is associated with increased morbidity and mortality and reduced psychosocial health. Thus, increasing physical activity has become the strategy of choice in public health strategies to prevent obesity. Efforts to improve levels of physical activity in the population rely upon an accurate understanding of the determinants of physical activity. Most research has focused on environmental and social influences, while the potential for physical activity to be controlled by intrinsic biological processes has been largely overlooked. This review presents some of the compelling and diverse evidence that has emerged recently showing that physical activity energy expenditure is a critical factor in both the successful regulation of energy balance in normal individuals, as well as the abnormal regulation of energy balance that characterizes obesity. Although the metabolic and genetic factors involved in these regulatory processes remain mostly unidentified, some novel discoveries have been made in this area recently and these are described within this review. [References: 90]

<36>Unique Identifier 12119637Authors Perez-Martin A. Raynaud E. Mercier J.Institution Service Central de Physiologie Clinique, Unite CERAMM (Centre d'Exploration et de Readaptation des Anomalies Metaboliques et Musculaires), CHU Lapeyronie 34295 Montpellier, France. a-perez_martin@chu-montpellier.frTitle Insulin resistance and associated metabolic abnormalities in muscle: effects of exercise. [Review] [132 refs]Source Obesity Reviews. 2(1):47-59, 2001 Feb.Abstract Skeletal muscle is a major site of insulin resistance. In addition to glucose transport, oxidative disposal and storage defects, insulin resistant muscle exhibit many other metabolic abnormalities. After a brief review of insulin resistance determinants, we will focus on muscular abnormalities in obesity and type 2 diabetes. Glucose and lipid metabolism defects will be analysed and their interactions discussed. Exercise can improve many of these muscular abnormalities and the mechanisms underlying exercise-induced benefits have been clarified during the past decades. Therefore, exercise training has proved to be useful in the management of insulin resistant states, i.e. mainly obesity, especially in its truncal distribution, and type 2 diabetes. However, exercise prescription remains poorly codified, and results on glycaemic control are sometimes conflicting. In the last part of this review, we will emphasize the pathophysiological basis for an individualized exercise prescription in insulin resistant subjects. [References: 132]

<37>Unique Identifier 12119660Authors Bianchini F. Kaaks R. Vainio H.Institution International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon, France. Bianchini@iarc.fr

Title Weight control and physical activity in cancer prevention. [Review] [5 refs]Source Obesity Reviews. 3(1):5-8, 2002 Feb.Abstract Overweight and obesity have reached epidemic dimensions worldwide, mainly due to consumption of high energy diets and increased sedentary behaviour. Overweight and insufficient physical activity are clearly associated with cardiovascular diseases and type 2 diabetes. Evidence is also accumulating that they may also increase cancer risk, particularly in the colon, breast and endometrium. This effect seems to be mediated by alterations in the metabolism of endogenous hormones, including sex steroids and insulin, and levels of insulin-like growth factor(IGF)-I and IGF-binding proteins. In light of the beneficial effects of weight control and physical activity for cancer prevention, a healthy lifestyle, keeping a low body weight and exercising most days of the week, is recommended. [References: 5]

<38>Unique Identifier 12119663Authors Steinbeck KS.Institution Metabolism & Obesity Services, Royal Prince Alfred Hospital, Missenden Road, Camperdown, Sydney, NSW 2050, Australia. kss@diab.rpa.cs.nsw.gov.auTitle The importance of physical activity in the prevention of overweight and obesity in childhood: a review and an opinion. [Review] [147 refs]Source Obesity Reviews. 2(2):117-30, 2001 May.Abstract 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 component of energy expenditure and there is evidence that falling levels of physical activity are contributing to the obesity epidemic. Physical activity in children is related to developmental stage, is reduced with increasing age and is influenced by parental physical activity. While there is debate about the immediate health benefits of physical activity to children, there are data to support that lower physical activity levels and sedentary behaviours are associated with a higher prevalence of obesity in children. Physical activity is an accepted strategy in the treatment of established obesity (tertiary prevention). The role of physical activity in the prevention of obesity (primary and secondary prevention) is less clear. However a number of recent school-based interventions directed at either increasing physical activity and/or decreasing sedentary behaviours, have shown encouraging results. On balance, increasing physical activity in children is an attractive and non-restrictive approach to obesity prevention. To adopt this approach requires the support and involvement of many community sectors other than health. [References: 147]

<39>Unique Identifier 11494644Authors Goran MI. Treuth MS.Institution

Institute for Prevention Research, Departments of Preventive Medicine and Physiology and Biophysics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA. goran@usc.eduTitle Energy expenditure, physical activity, and obesity in children. [Review] [101 refs]Source Pediatric Clinics of North America. 48(4):931-53, 2001 Aug.Abstract Although there are physiologic and genetic influences on the various components of energy metabolism and body weight regulation, and a major portion of individual differences in body weight can be explained by genetic differences, it seems unlikely that the increased global prevalence of obesity has been driven by a dramatic change in the gene pool. It is more likely and more reasonable that acute changes in behavior and environment have contributed to the rapid increase in obesity and that genetic factors may be important in the deferring individual susceptibilities to these changes. The most striking behavioral changes that have occurred have been an increased reliance on high-fat and energy-dense "fast foods," with larger portion sizes, coupled with an ever-increasing sedentary lifestyle. The more sedentary lifestyle is caused by an increased reliance on technology and labor-saving devices, which has reduced the need for physical exertion for everyday activities. Examples of energy-saving devices that have resulted in a secular decline in physical activity include: Increased use of automated transport rather than walking or biking Central heating and use of automated equipment, such as washing machines, in the household. Reduction in physical activity in the workplace because of computers, automated equipment, and electronic mail. Increased use of television and computers for entertainment and leisure activities. Use of elevators and escalators rather than stairs. Increased concern for crime, which has reduced the likelihood of outdoor playing. Poor urban planning that does not provide adequate biking paths or even sidewalks in some communities. Thus, the increasing prevalence, numerous health risks, and astounding economic costs of obesity clearly justify widespread efforts toward prevention efforts. These prevention efforts should begin in childhood because the behaviors are learned and continue through the lifetime. [References: 101]

<40>Unique Identifier 11494648Authors Sothern MS.Institution Prevention of Childhood Obesity Laboratory, Division of Health and Performance Enhancement, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA. sotherms@pbrc.eduTitle Exercise as a modality in the treatment of childhood obesity. [Review] [79 refs]Source Pediatric Clinics of North America. 48(4):995-1015, 2001 Aug.Abstract In a review of the literature, Glenny et al determined that family therapy and lifestyle modification seem to be effective in the prevention and treatment of childhood but not necessarily adult obesity. Furthermore, research indicates that obese children are better able to maintain weight loss over a long-term period than are adults. Based on the limited research in the treatment of obesity in children, approaches should include family interventions with nutrition and physical activity education, structured exercise, and behavior modification. These interventions should be delivered by a team of health care experts in a nurturing, nonintimidating environment; however, obese children

respond differently physiologically and emotionally to exercise than do normal-weight children. Therefore, obese children may experience negative consequences to participation in activities considered appropriate for normal-weight children. In clinical settings, specialized exercise programs based on appropriate theories that include specific recommendations for children with varied obese conditions have been shown to enhance safety, efficacy, and compliance during pediatric obesity treatment. Optimal results may be achieved by combining programs to reduce sedentary behaviors based on similar theories with specialized, structured exercise prescriptions. When used in conjunction with appropriate dietary prescriptions and consistent behavior modification, exercise serves as a promising modality that may reverse obese conditions during childhood and, perhaps, prevent the onset of adult obesity. [References: 79]

<41>Unique Identifier 12630501Authors Yackel EE.Institution Joel Health and Dental Clinic, Fort Bragg, NC, USA.Title An activity calendar program for children who are overweight. [Review] [19 refs]Source Pediatric Nursing. 29(1):17-22, 2003 Jan-Feb.Abstract 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. [References: 19]

<42>Unique Identifier 14567155Authors Jakicic JM.Institution Physical Activity and Weight Management Research Center, Department of Health, Physical, and Recreation Education, University of Pittsburgh, 140 Trees Hall, Pittsburgh, PA 15261, USA. jjakicic@pitt.eduTitle Exercise strategies for the obese patient. [Review] [32 refs]Source Primary Care; Clinics in Office Practice. 30(2):393-403, 2003 Jun.Abstract Exercise is an important component of weight-control programs, yet the impact of exercise for weight control is based on the ability of patients to engage in adequate levels of activity. The minimal level that should be recommended is at least 30 minutes of moderate-intensity physical activity on most days of the week. Although this level of physical activity may improve health-related factors, there is some evidence to support the recommendation of higher levels of exercise for weight-control purposes. The role of the clinician is to provide adequate guidance to patients regarding issues related to the intensity, duration, and mode of exercise that may be most appropriate. When addressing these issues, it is also important to consider the barriers that individual patients may encounter that will have an effect on adoption and maintenance of exercise behaviors. [References: 32]

<43>Unique Identifier 10946798Authors Johnson RK.Institution Department of Nutrition and Food Sciences, The University of Vermont, Burlington 05405, USA. rachel.johnson@uvm.eduTitle Changing eating and physical activity patterns of US children. [Review] [55 refs]Source Proceedings of the Nutrition Society. 59(2):295-301, 2000 May.Abstract The number of US children who are overweight has more than doubled over the last decade. This change has broadened the focus of dietary guidance for children to address nutrient overconsumption and physical activity patterns. Total fat consumption expressed as a percentage of energy intake has decreased among US children. However, this decrease is largely the result of increased total energy intake in the form of carbohydrates and not necessarily due to decreased fat consumption. The majority of children aged 5-17 years are not meeting recommendations for Ca intakes. Much of this deficit is attributed to changing beverage consumption patterns, characterized by declining milk intakes and substantial increases in soft-drink consumption. On average, US children are not eating the recommended amounts of fruits and vegetables. US adolescents become less active as they get older, and one-quarter of all US children watch > or = 4 h television each day, which is positively associated with increased BMI and skinfold thickness. There is an urgent need in the USA for effective prevention strategies aimed at helping children grow up with healthful eating and physical activity habits to achieve optimal health. [References: 55]

<44>Unique Identifier 10997649Authors Martinez JA.Institution Department of Physiology and Nutrition, University of Navarra, Pamplona, Spain. jalfmtz@unav.esTitle Body-weight regulation: causes of obesity. [Review] [130 refs]Source Proceedings of the Nutrition Society. 59(3):337-45, 2000 Aug.Abstract The aetiology and treatment of obesity have been fraught with disappointment for researchers, because the mechanisms that control fuel homeostasis and adiposity are incompletely understood. It is assumed that regulatory processes match the dietary fuel supply with energy requirements in order to maintain a stable body mass and adiposity. In this context several theories have been proposed to explain the laws of thermodynamics describing the conservation and transformation of energy in living organisms. In the light of new evidence it can now be hypothesized that the control of body weight and composition depends on an axis with three interrelated and self-controlled components: (1) food intake; (2) nutrient turnover and thermogenesis; (3) body fat stores. Complex feedback mechanisms underlie all these components. The major factors involved in obesity seem to be dietary and physical activity habits. These factors are affected by susceptibility genes that in turn may influence energy expenditure, fuel metabolism, muscle fibre function and appetite or food preferences.

However, the increasing rates of obesity cannot be explained exclusively by changes in the gene pool, although genetic variants that were previously 'silent' are now being triggered by the high availability of energy- and fat-dense foods, and by the increasingly sedentary lifestyle of modern societies. The study of factors such as genetics and lifestyle implicated in weight gain and obesity is crucial for predictions about the future impact of the global epidemic of obesity, and provides a unique opportunity for the implementation of preventive action. [References: 130]

<45>Unique Identifier 11683546Authors Vuori IM.Institution UKK Institute for Health Promotion Research, Tampere, Finland. llkka.vuori@uta.fiTitle Health benefits of physical activity with special reference to interaction with diet. [Review] [79 refs]Source Public Health Nutrition. 4(2B):517-28, 2001 Apr.Abstract Regular physical activity causes numerous and substantial performance-improving and health-enhancing effects. Most of them are highly predictable, dose-dependent and generalizable to a wide range of population groups. Many of the biological effects of regular, moderate physical activity translate into substantially reduced risk of coronary heart disease, cerebrovascular disease, hypertension, maturity onset diabetes, overweight and obesity, and osteoporosis. These effects also substantially reduce the risk of deterioration of functional capacity. In the genesis of these conditions, a lack of physical activity and inadequate nutrition act synergistically and in part additively, and they operate largely through the same pathways. It is conceivable to suggest that the prevalence of, e.g, the above mentioned metabolic diseases is so high in Europe largely because of the high prevalence of sedentariness and inadequate nutrition. Thus, both physical activity and nutrition have to be given strong emphasis in policies, strategies and programmes that will be developed and implemented for improving the health of Europeans. [References: 79]

<46>Unique Identifier 11683565Authors Dowler E.Institution School of Health and Social Studies, University of Warwick, Coventry, UK. elizabeth.dowler@warwick.ac.ukTitle Inequalities in diet and physical activity in Europe. [Review] [86 refs]Source Public Health Nutrition. 4(2B):701-9, 2001 Apr.Abstract The contribution of food, nutrition and physical activity to inequalities in health across Europe is largely unexplored. This paper summarizes cross sectional survey data on food patterns and nutrient intakes, and briefer data on physical activity, by various indicators of socio-economic status for countries across Europe. Factors are examined which underlie the outcome data seen. These include structural and material conditions and circumstances which contribute to excluding socio-demographic groups from participating in mainstream patterns of

living. Trends in social and economic conditions, and their implications for nutritional and physical wellbeing are briefly outlined. [References: 86]

<47>Unique Identifier 11683545Authors Astrup A.Institution Research Department of Human Nutrition, The Royal Veterinary and Agricultural University, Denmark. ast@kvl.dkTitle Healthy lifestyles in Europe: prevention of obesity and type II diabetes by diet and physical activity. [Review] [56 refs]Source Public Health Nutrition. 4(2B):499-515, 2001 Apr.Abstract The prevalence of obesity is increasing rapidly in all age groups in most EU-countries and is one of the fastest growing epidemics, now affecting 10-40% of the adult population. Obesity increases the risk of serious co-morbidities such as type 2 diabetes, cardiovascular disease, certain cancers and reduced life expectancy, and these complications may account for 5-10% of all health costs in EU countries. The risk of diabetes is particularly increased by obesity, and 80-95% of the increase in diabetes can be attributed to obesity and overweight with abdominal fat distribution. There is robust evidence from cross-sectional and longitudinal studies to support that an energy-dense, high fat diet and physical inactivity are independent risk factors for weight gain and obesity. Furthermore, interaction 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. Ad libitum consumption of diets low in fat and high in protein and complex carbohydrates, with a low glycaemic index, contributes to the prevention of weight gain in normal weight subjects. It also causes a spontaneous weight loss of 3-4 kg in overweight subjects, and has beneficial effects on risk factors for diabetes and CVD. To prevent obesity and diabetes there are grounds for recommending the combination of increasing daily physical activity level to a PAL-value of at least 1.8 and reducing dietary fat content to 20-25 energy-% in sedentary subjects, and to 25-35% in more physically active individuals. [References: 56]

<48>Unique Identifier 11547893Authors Miller WC.Institution Exercise Science Programs, The George Washington University Medical Center, Washington, DC 20052, USA. wmiller@gwu.eduTitle Effective diet and exercise treatments for overweight and recommendations for intervention. [Review] [61 refs]Source Sports Medicine. 31(10):717-24, 2001.Abstract 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). Regardless of the specific outcome measures used to define successful treatment, the desired outcome must be maintained for several years to be considered effective. Energy restrictive diets cause significant initial bodyweight loss, but are plagued with high dropout- and relapse-rate. Low-fat diets have met with minimal success for bodyweight control, but nonetheless can significantly lower blood lipid levels. High-protein/low-carbohydrate diets are claimed to be the most effective in reducing bodyweight, but there are no scientific data to support these claims. Persons on these types of diets are also at the greatest risk for metabolic adverse effects. Nondieting approaches and programmes that stress 'health at any size' have not been researched rigorously, but preliminary data show minimal bodyweight loss with significant improvements in psychological state, eating pathology and well-being. Exercise is the only variable that consistently shows effectiveness in physiological, medical, psychological and behavioural outcomes. A treatment programme that has the greatest potential for success, regardless of outcome measure, is a programme that consists of 4 key components. These components are: (i) pre-evaluation, where historical information is gathered and used to set programme goals, objectives and outcome measures; (ii) exercise, wherein enjoyable exercise is encouraged for health, bodyweight control and well being; (iii) a behavioural plan, which is based on patterns of eating and activity that will lead to the desired outcome measures; and (iv) a maintenance plan, that helps the individual develop skills for maintaining newly developed behaviours. [References: 61]