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listlengths 384
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adipocytes\t(\nBray\tand\tBouchard,\t2014\n).\nOther\tHormones\nCharacteristics\tand\tFunction\nThyroid\thormones\nModulate\tthe\ttissue\tresponsiveness\tto\tthe\tcatecholamines\tsecreted\tby\tthe\tSNS.\tA\ndecrease\tin\ttriiodothyronine\tlowers\tthe\tresponse\tto\tSNS\tactivity\tand\tdiminishes\nadaptive\tthermogenesis.\n\tWomen\tshould\tbe\ttested\tfor\thypothyroidism,\tparticularly
|
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] |
Women\tshould\tbe\ttested\tfor\thypothyroidism,\tparticularly\nafter\tmenopause.\tWeight\tregain\tafter\tweight\tloss\tmay\tbe\ta\tfunction\tof\ta\nhypometabolic\tstate;\tenergy\trestriction\tproduces\ta\ttransient,\thypothyroid,\nhypometabolic\tstate.\nVisfatin\nAn\tadipocytokine\tprotein\tsecreted\tby\tvisceral\tadipose\ttissue\tthat\thas\tan\tinsulin-like
|
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0.0679193064570427,
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0.10487566888332367,
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0.06114180013537407,
0.07334904372692108,
0.107051782310009,
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] |
effect;\tplasma\tlevels\tincrease\twith\tincreasing\tadiposity\tand\tinsulin\tresistance.\nAdrenomedullin\nA\tnew\tregulatory\tpeptide\tsecreted\tby\tadipocytes\tas\ta\tresult\tof\tinflammatory\nprocesses.\nBMI\n,\tBody\tmass\tindex;\t\nCCK\n,\tcholecystokinin;\t\nCNS\n,\tcentral\tnervous\tsystem;\t\nCRF\n,\tcorticotropin-releasing\tfactor;\t\nGIP\n,\tglucose-dependent\ninsulinotropic\tpeptide;
|
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0.04363614693284035,
0.10124991089105606,
0.00006930517702130601
] |
GIP\n,\tglucose-dependent\ninsulinotropic\tpeptide;\t\nGLP-1,\n\tglucagon-like\tpeptide\t1;\t\nIL-6\n,\tinterleukin-6;\t\nPYY\n3-36\n,\tpeptide\tYY3-36;\t\nSNS\n,\tsympathetic\tnervous\tsystem;\t\nTNF\n-α,\ttumor\nnecrosis.\nThomas\tS,\tSchauer\tP:\tBariatric\tsurgery\tand\tthe\tgut\thormone\tresponse,\t\nNutr\tClin\tPract\n\t25:175,\t2010;\tBray\tGA,\tBouchard\tC:\t\nHandbook\tof\tobesity,
|
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] |
25:175,\t2010;\tBray\tGA,\tBouchard\tC:\t\nHandbook\tof\tobesity,\ned\t3,\tBoca\tRaton,\tFla,\t2014,\tCRC\tPress.\nMetabolic\trate\tand\tvoluntary\tactivity\nThe\tRMR\t(see\t\nChapter\t2\n)\texplains\t60%\tto\t70%\tof\ttotal\tenergy\texpenditure.\tRMR\tdeclines\twith\tage.\nWhen\tthe\tbody\tis\tdeprived\tof\tadequate\tenergy\tfrom\tstarvation\tor\tvoluntary\tenergy\n\trestriction,\tRMR
|
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restriction,\tRMR\ndrops,\ttherefore\tconserving\tenergy.\tThe\tmore\tsevere\tthe\tenergy\trestriction,\tthe\tgreater\tthe\tpotential\nreduction\tin\tRMR;\tup\tto\t15%\twith\tvery-low-calorie\tdiets\t(VLCDs).\tThis\tsuppression\tof\tRMR\tis\nbeyond\twhat\tis\tattributable\tto\tweight\tloss\t(which\tconsists\tof\tboth\tLBM\tand\tfat\tmass)\tand\tis\ta\tform\tof
|
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] |
adaptation\tto\tenergy\tscarcity.\tMost\tbut\tnot\tall\treviews\tof\tthe\tsubject\tfind\tRMR\tnormalizes\n\tpost-\nweight\tloss\twith\tmaintenance\tlevel\tenergy\tintakes\t(\nOstendorf\tet\tal,\t2018\n).\tOngoing\tsuppression\tof\nRMR\tmay\tresult\tfrom\textreme\tapproaches\tto\tweight\tloss.\nActivity\tthermogenesis\t(AT)\n\tis\tthe\tenergy\texpended\tin\tvoluntary\tactivity,\tthe\tmost\tvariable
|
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] |
Nonexercise\tactivity\tthermogenesis\t(NEAT)\n\tis\tthe\tenergy\nexpended\tfor\tall\tactivity\tthat\tis\tnot\tsleeping,\teating,\tor\tsports-like\texercise.\tIt\tincludes\tgoing\tto\nwork,\ttyping,\tdoing\tyard\twork,\ttoe-tapping,\teven\tfidgeting\t(see\t\nChapter\t2\n).\tNEAT\tvaries\tas\tmuch\tas
|
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] |
Chapter\t2\n).\tNEAT\tvaries\tas\tmuch\tas\n2000\tkcal/day\tbetween\tindividuals,\tand\tit\thas\tbeen\ttheorized\tto\thave\tuntapped\tpotential\tvalue\tin\nweight\tmanagement.\tProponents\tof\tNEAT\tsuggest\tstanding\tand\tambulating\tfor\t2.5\thours\n\tper\tday,\nand\treengineering\twork,\tschool,\tand\thome\tenvironments\tto\tsupport\ta\tmore\tactive\tlifestyle\t(\nGarland\net\tal,\t2011
|
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] |
Garland\net\tal,\t2011\n).\tHowever,\tpassive\tcompensation,\tby\treducing\tother\tforms\tof\tphysical\tactivity,\tmay\tprove\nto\tbalance\toff\tincreases\tin\tNEAT\t(\nO’Neal\tet\tal,\t2017\n)\tand\tthere\tis\tpresently\tno\tevidence\tshowing\nthat\tstrategies\tpromoting\tNEAT\tare\teffective\tfor\tweight\tloss\tor\tobesity\ttreatment\t(\nChung\tet\tal,\n2018\n).\n\t\nFocus\tOn
|
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] |
Chung\tet\tal,\n2018\n).\n\t\nFocus\tOn\nSignals\tfrom\ta\tHost\tof\tHormones\nA\thost\tof\thormones—insulin,\tleptin,\tadiponectin,\tand\tghrelin,\tamong\tothers—communicate\twith\nthe\thypothalamus\tto\tregulate\ta\tperson’s\tfood\tintake.\tThese\tregulatory\thormones\tgovern\tfeeding\nin\tresponse\tto\tsignals\toriginated\tin\taffected\tbody\ttissues.\nInsulin\n\tcontrols\tthe\tamount
|
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Insulin\n\tcontrols\tthe\tamount\n\tof\tglucose\tin\tthe\tblood\tby\tmoving\tit\tinto\tthe\tcells\tfor\tenergy.\nLeptin\n,\twhich\tis\tproduced\tmainly\tby\tfat\tcells,\tcontributes\tto\tlong-term\tfullness\tby\tsensing\tthe\nbody’s\toverall\tenergy\tstores.\tAdiponectin\tis\talso\tmade\tby\tfat\tcells\tand\thelps\tthe\tbody\trespond\nbetter\tto\tinsulin\tby\tboosting\tmetabolism.\t\nGhrelin
|
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] |
better\tto\tinsulin\tby\tboosting\tmetabolism.\t\nGhrelin\n,\tthe\thunger\thormone,\ttells\tthe\tbrain\twhen\tthe\nstomach\tis\tempty,\tprompting\thunger\tpangs.\nThe\n\tstomach\tcommunicates\twith\tthe\tbrain\tvia\tthe\t\nvagus\tnerve\n,\tpart\tof\tthe\tautonomic\tnervous\nsystem\tthat\ttravels\tfrom\tthe\tbrain\tto\tthe\tstomach.\tWhen\tfilled\twith\tfood\tor\tliquid,\tthe\tstomach’s
|
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] |
stretch\treceptors\tsend\ta\tmessage\tto\tthe\tbrain\tindicating\tsatiety\t(\nGuo\tet\tal,\t2018\n).\tGastric\tbypass\nsurgery\treduces\tthe\tstomach\tto\tthe\tsize\tof\tan\tegg,\tand\ttriggers\ta\tsharp\tdrop\tin\tghrelin\tlevels,\nwhich\tlessens\thunger\n\tand\toral\tintake.\tTraditional\tdieting,\thowever,\ttends\tto\tboost\tghrelin\tlevels.\nOverweight\tand\tobesity
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Overweight\tand\tobesity\nOverweight\tand\tobesity\toccur\tas\ta\tresult\tof\tan\timbalance\tbetween\ttotal\tenergy\tintake\t(food\tand\nbeverages\tconsumed)\tand\ttotal\tenergy\texpenditure.\tDespite\tthis\tseemingly\tstraightforward\tmodel,\nthe\tfactors\twhich\tact\tto\tdysregulate\tenergy\tbalance\tare\tcomplex.\tLifestyle,\tenvironmental,\tand
|
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] |
genetic\tfactors\thave\ta\tmultifaceted\tinteraction\twith\tpsychological,\tcultural,\tand\tphysiologic\ninfluences.\tOver\tthe\tyears,\tmany\thypotheses\thave\tevolved\thowever\tno\tsingle\ttheory\tcan\tcompletely
|
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] |
FIG.\t20.4\nCDC\tObesity\tPrevalence\tMap\tPrevalence\tof\tobesity\tamong\tU.S.\tadults\tin\t2017.\n\t\nSource:\n\t(Centers\tfor\nDisease\tControl\tand\tPrevention\t[CDC]\tBehavioral\tRisk\tFactor\tSurveillance\tSystem\tSurvey,\t2017.)\n\t\nNew\tDirections\nPartnership\tfor\ta\tHealthier\tAmerica\tAddressing\tChildhood\tObesity\nBecause\tthe\tnumber\tof\tobese\tchildren
|
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] |
Because\tthe\tnumber\tof\tobese\tchildren\n\tin\tthe\tUnited\tStates\thas\ttripled\tsince\t1980,\tand\tobesity\nnow\trivals\tsmoking\tas\tthe\tlargest\tcause\tof\tpreventable\tdeath\tand\tdisease,\ta\tfoundation\twas\nlaunched\tin\tthe\tspring\tof\t2010\tto\taddress\tthis\tserious\tepidemic\tof\tchildhood\tobesity.\tThis\nfoundation,\tPartnership\tfor\ta\tHealthier\tAmerica\n,
|
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] |
foundation,\tPartnership\tfor\ta\tHealthier\tAmerica\n,\n\thas\tas\tits\tmission\tthe\tsimple\tconcept\tthat\nchildren\tshould\thave\tgood,\tnutritious\tfood\tto\teat\tand\tthe\tchance\n\tto\tbe\tphysically\tactive\tevery\tday\nto\tbecome\thealthy\tadults.\nThe\tobjectives\tof\tthe\tpartnership\tare\tto\tsupport\tthe\tnational\tgoal\tof\tsolving\tthe\tchildhood
|
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obesity\tchallenge\t“within\ta\tgeneration”\tset\tby\tformer\tFirst\tLady\tMichelle\tObama,\twho\thistorically\nhas\tserved\tas\tHonorary\tChairperson\tof\tthe\torganization.\tThe\tPartnership\tbrings\ttogether\tthe\npublic\tand\tprivate\tsectors,\torganizations,\tbusiness\tand\n\tthought\tleaders,\tthe\tmedia,\tand\tstates\tand
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thought\tleaders,\tthe\tmedia,\tand\tstates\tand\nlocal\tcommunities\tto\tmake\tmeaningful\tand\tmeasurable\tcommitments\tfor\tfighting\tchildhood\nobesity.\tThe\tplan\thas\tfour\tpillars:\n•\t\nOffering\tparents\tthe\ttools\tand\tinformation\tthey\tneed\tto\tmake\thealthy\tchoices\tfor\ttheir\nchildren\n•\t\nIntroducing\thealthier\tfood\tinto\tthe\tnation’s\tschools\n•
|
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] |
children\n•\t\nIntroducing\thealthier\tfood\tinto\tthe\tnation’s\tschools\n•\t\nEnsuring\tthat\tall\tfamilies\thave\taccess\tto\thealthy,\taffordable\tfood\tin\n\ttheir\tcommunities\n•\t\nIncreasing\topportunities\tfor\tchildren\tto\tbe\tphysically\tactive,\tboth\tin\tand\tout\tof\tschool\nThe\tpartnership\taims\tto\tsupport,\tunite,\tand\tinspire\tfamilies\tfrom\tevery\tcorner\tof\tthe\tUnited
|
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] |
complex\tinteraction\twith\tnumerous\tgenetic\tvariants\tand\tenvironmental\tfactors\trelated\tto\tenergy\nintake\tand\texpenditure\t(\nGoodarzi,\t2018\n).\tHormonal\tand\tneural\tfactors\tinvolved\tin\tweight\tregulation\ninclude\tshort-term\tand\tlong-term\t“signals”\tthat\tdetermine\tsatiety\tand\tfeeding\tactivity.\tSmall\n\tdefects
|
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] |
defects\nin\ttheir\texpression\tor\tinteraction\tmay\tcontribute\tsignificantly\tto\tweight\tgain.\t\nNutritional\tgenomics\nis\tthe\tstudy\tof\tthe\tinteractions\tbetween\tdietary\tcomponents\tand\tthe\tinstructions\tin\ta\tcell\tor\tgenome,\nand\tthe\tresulting\tchanges\tin\tmetabolites\tthat\taffect\tgene\texpression\t(\nCamp\tand\tTrujillo,\t2014\n)\t(see\nChapter\t6\n).
|
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] |
Camp\tand\tTrujillo,\t2014\n)\t(see\nChapter\t6\n).\nThe\tnumber\tand\tsize\tof\tfat\tcells,\tregional\tdistribution\tof\tbody\tfat,\tand\n\tRMR\talso\tare\tinfluenced\tby\ngenes.\tStudies\tof\ttwins\tconfirm\tthat\tgenes\tdetermine\t50%\tto\t70%\tof\tthe\tpredisposition\tto\tobesity.\nAlthough\tnumerous\tgenes\tare\tinvolved,\tseveral\thave\treceived\tmuch\tattention—the\t\nOb\n\tgene,\tthe
|
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] |
Ob\n\tgene,\tthe\nadiponectin\t(ADIPOQ)\n\tgene,\tthe\t“fat\tmass\tand\tobesity\tassociated”\tgene\tor\t\nFTO\n\tgene,\tand\tthe\t\nbeta\n3\n-\nadrenoreceptor\n\tgene.\tThe\t\nOb\n\tgene\tproduces\tleptin\t(\nFerguson,\t2010\n).\tThe\t\nbeta3-adrenoreceptor\ngene,\tlocated\tprimarily\tin\tthe\tadipose\ttissue,\tis\tthought\tto\tregulate\tRMR\tand\tfat\toxidation\tin\nhumans.
|
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humans.\nNutritional\tand/or\tlifestyle\tchoices\tcan\teither\tactivate\tor\tinhibit\tthese\tobesity-triggering\tgenes.\nThus\tthe\tformula\tfor\tsuccessful\tlong-term\tweight\tmanagement\tcould\tnecessitate\tthe\tbehavioral
|
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application\tof\tindividual\tgenetics.\tGenetic\tresearch\tis\tcurrently\tdrawing\tsignificant\tattention\tfrom\nprivate\tinterests\tinvested\tin\tcapitalizing\ton\tgenetic-based\t“individualized\tmedicine\tand\tnutrition”\n(\nLoos,\t2018\n).\tDespite\thundreds\tof\t“obesity\tgenes”\thaving\tbeen\tidentified,\thowever,\twe\tare\tonly\tat
|
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the\tpoint\tof\tbeing\table\tto\tapply\tgenetic\tinformation\tto\ta\tfew\tindividual\ttreatments.\tOne\tsuch\ntreatment\tis\tcongenital\tleptin\tdeficiency,\twhich\tcan\tbe\ttreated\twith\tdaily\tinjections\tof\trecombinant\nhuman\n\tleptin\t(\nChoquet,\t2011\n).\tWell\tknown\tobesity\tresearcher\tClaude\tBouchard,\tPhD,\trecently
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surrounding\tthis\t[obesity\tgene]\tissue,\tit\tstill\tcomes\tdown\tto\tchanging\tyour\tbehavior.\tIt’s\tdiet\tand\nexercise”\t(\nEndocrine\tToday,\t2018\n)\t(see\t\nClinical\tInsight:\n\tRandomized\tControlled\tTrial\tMatching\tDiet\nto\tGenetic\tPredisposition\tFails\tto\tImprove\tWeight\tLoss\n).\nCLINICAL\tINSIGHT
|
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).\nCLINICAL\tINSIGHT\nRandomized\tControlled\tTrial\tMatching\tDiet\tto\tGenetic\tPredisposition\tFails\tto\nImprove\tWeight\tLoss\nThe\tfirst\trandomized\tcontrolled\ttrial\t(RCT)\tto\ttest\tif\tgenetic\tpredisposition\timproved\tweight\tloss\nin\tresponse\tto\ta\thealthy\tlow-fat\tvs.\thealthy\thigh-fat\n\tdiet\tshowed\tno\tdifference\tin\tweight\tloss\n(\nGardner\tet\tal,\t2018
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diet\tshowed\tno\tdifference\tin\tweight\tloss\n(\nGardner\tet\tal,\t2018\n).\tWill\tpersonalized\tmedicine\tand\tnutrition\teventually\tbecome\tthe\tprevailing\napproach\tto\ttreatment\tof\tdisease—including\toverweight\tand\tobesity?\tThis\talmost\tcertainly\twill\tbe\nthe\tcase.\tHowever,\taccording\tto\ta\tnumber\tof\tscientific\tpapers,\tthe\thype\tsurrounding\tpersonalized
|
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medicine\tusing\tnutritional\tgenomics\tremains\tahead\tof\tthe\tscience\t(\nCaulfield,\t2015\n;\t\nEndocrine\nToday,\t2018\n;\t\nMozaffarian,\t2016\n).\nInadequate\tphysical\tactivity\nThe\tview\tthat\tinactivity\tis\ta\tmajor\tfactor\tin\tthe\tdevelopment\tof\toverweight\tand\tobesity\tis\tdebated.\tIt
|
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is\ttrue\tthat\tlack\tof\tregular\tphysical\tactivity\tis\ta\tfact\tfor\tAmericans\tof\tall\tages.\tOnly\t21%\tof\tadults\nmeet\tthe\trecommended\tlevels\tof\tweekly\tphysical\tactivity\t(150\tminutes\tper\tweek\tof\tmoderate-\nintensity\taerobic\tactivity\n\tand\ttwo\tsessions\tof\tmuscle\tstrengthening)\tfor\tgeneral\thealth.\tMeanwhile
|
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250\tto\t300\tminutes\tof\tmoderate-intensity\taerobic\tactivity\tper\tweek\tis\trecommended\tfor\tweight\tloss\nand\tweight\tloss\tmaintenance\t(\nChin\tet\tal,\t2016\n).\tHowever,\tresearchers\tpushing\tback\ton\tthe\tphysical\nactivity\temphasis\tpoint\tout\tthat\t“you\tcan’t\toutrun\ta\tbad\tdiet,”\tand\targue\tthat\tavoiding\tsugary\tdrinks,\nfast\tfood,\tand\tovereating
|
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fast\tfood,\tand\tovereating\n\tin\tgeneral\twill\tsave\tfar\tmore\tcalories\tthan\tpeople\twill\texpend\thitting\nweekly\tphysical\tactivity\ttargets\t(\nFulton,\t2016\n;\t\nMalhotra\tet\tal,\t2015\n).\nMedication\tusage\tand\tweight\tgain\nAlthough\tweight\tgain\tcan\tbe\tdue\tto\tdisease,\tclinicians\talso\tshould\tconsider\tthe\tpossibility\tthat\tthe
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] |
patient’s\tmedication\tmay\tbe\tcontributing.\tDiabetes\tmedications,\tthyroid\thormone\treplacement,\npsychotropics,\tantidepressants,\n\tsteroids,\tand\tantihypertensive\tmedications\tcan\tbe\tproblematic.\tThe\nuse\tof\tsuch\tmedications\tmust\tbe\tconsidered\tcarefully,\tand\talternatives\twith\tless\tdeleterious\teffects\nselected\twhen\tpossible\t(\nAppendix\t13\n).
|
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] |
selected\twhen\tpossible\t(\nAppendix\t13\n).\nSleep,\tstress,\tand\tcircadian\trhythms\nLack\tof\tadequate\tsleep\talters\tthe\tendocrine\tregulation\tof\thunger\tand\tappetite.\tHormones\tthat\taffect\nappetite\tare\tactivated\tand\tmay\tpromote\texcessive\n\tenergy\tintake.\tRecurrent\tsleep\tdeprivation\tcan
|
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] |
energy\tintake.\tRecurrent\tsleep\tdeprivation\tcan\nmodify\tthe\tamount,\tcomposition,\tand\tdistribution\tof\tfood\tintake\tand\tmay\tbe\tcontributing\tto\tthe\nobesity\tepidemic.\tIt\tis\testimated\tthat\tmore\tthan\t50\tmillion\tAmericans\tsuffer\tfrom\tsleep\tdeprivation.\nOthers\tmay\thave\tshift\twork\tor\texposure\tto\tbright\tlight\tat\tnight,\tincreasing\tthe\tdisruption\tof
|
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circadian\trhythms\tand\tenhancing\tthe\tprevalence\tof\tobesity\t(\nGaraulet\tet\tal,\t2013\n).\nThere\tis\talso\ta\trelationship\tbetween\tinadequate\tsleep,\tdisrupted\tcircadian\trhythm,\tgenes,\tand\tthe\ndevelopment\tof\tmetabolic\tsyndrome.\tStress\tis\tanother\tfactor.\tThe\tadrenal\thormone\tcortisol\tis
|
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] |
released\twhen\tan\tindividual\tis\tunder\tstress.\tCortisol\tstimulates\tinsulin\trelease\tto\tmaintain\tblood\nglucose\tlevels\tin\tthe\t“fight-or-flight”\tresponse;\tincreased\tappetite\teventually\tfollows.\tChronic\tstress\nwith\tconstantly\televated\tcortisol\tlevels\tcan\talso\tlead\tto\tappetite\tchanges.
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] |
Cortisol\tlevels\tare\ttypically\thigh\tin\tthe\tearly\tmorning\tand\tlow\taround\tmidnight.\tIndividuals\twith\nnight-eating\tsyndrome\t(NES)\n\tmay\thave\ta\tdelayed\tcircadian\trhythm\tof\tmeal\tintake\tdue\tto\ngenetically\tprogrammed\tneuroendocrine\tfactors,\tincluding\taltered\tcortisol\tlevels\t(\nStunkard\tand\tLu,\n2010\n).\nTaste,\tsatiety,\tand\tportion\n\tsizes
|
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] |
Stunkard\tand\tLu,\n2010\n).\nTaste,\tsatiety,\tand\tportion\n\tsizes\nFood\tand\tits\ttaste\telements\tevoke\tpleasure\tresponses.\tThe\tendless\tvariety\tand\treasonable\tcost\tof\nfood\t(especially\thighly\tprocessed\tfood)\tin\tthe\tUnited\tStates\tcontributes\tto\thigher\tcalorie\tintake;
|
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] |
people\teat\tmore\twhen\toffered\ta\tvariety\tof\tchoices\tthan\twhen\ta\tsingle\tfood\tis\tavailable.\tNormally,\tas\nfoods\tare\tconsumed,\tthey\tbecome\tless\tdesirable;\tthis\tphenomenon\tis\tknown\tas\t\nsensory-specific\nsatiety\n.\tThe\topposite\tsituation\tis\tthe\t“all-you-can-eat\tbuffet,”\tin\twhich\tthe\tdiner\treaches\tsatiety\tfor
|
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one\tfood\tbut\thas\tmany\tchoices\tremaining\tfor\tthe\tnext\tcourse.\tFrom\tan\tevolutionary\tperspective\nsensory-specific\tsatiety\tpromoted\tthe\tintake\tof\ta\tvaried\tand\tnutritionally\tbalanced\tdiet;\tthe\tmodern\nfood\tenvironment\thowever\tprovides\ttoo\tmany\t(energy-dense,\tlow-nutrient)\tchoices.\nLeptin\n\tis\ta\thormone,\tmade\n\tby\tfat\tcells,\tthat\tdecreases\tappetite.
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Leptin\n\tis\ta\thormone,\tmade\n\tby\tfat\tcells,\tthat\tdecreases\tappetite.\t\nGhrelin\n\tis\ta\thormone\tthat\nincreases\tappetite\tin\tresponse\tto\tthe\ttime\telapsed\tsince\tthe\tlast\tmeal.\tLevels\tof\tleptin,\tthe\tappetite\nsuppressor,\tare\tlower\tin\tindividuals\twith\ta\tlower\tbody\tweight\tand\thigher\tin\tthe\tobese\tbecause\tthey
|
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] |
correlate\tto\tone’s\ttotal\tadipose\ttissue.\tHowever,\tfor\treasons\tyet\tto\tbe\telucidated,\tpeople\twith\tobesity
|
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are\tseemingly\tresistant\tto\n\tthe\tappetite-suppressing\teffects\tof\tleptin\tand\tare\tsometimes\treferred\tto\tas\nleptin\tresistant.\nPassive\tovereating\tis\tpartly\tthe\tresult\tof\texcessive\tportion\tsizes\tthat\tare\tnow\taccepted\tas\tnormal.\nThe\tportions\tand\tcalories\tthat\trestaurants\tand\tfast-food\toutlets\tcommonly\tserve\tin\tone\tmeal\tcan
|
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often\texceed\ta\tperson’s\tenergy\tneeds\tfor\tthe\tentire\tday.\nObesogens\nEndocrine\tdisrupting\tchemicals\t(EDCs)\n\tare\texogenous\tchemicals\tthat\tcan\tinterfere\twith\tany\taspect\nof\thormone\taction.\tMost\tEDCs\tare\tpersistent\torganic\tpollutants\t(POPs),\twhich\tare\tmanufactured
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chemicals\tin\tthe\tenvironment\t(water,\tfood,\tand\tfood\tpackaging),\tthat\tare\tbecoming\tincreasingly\nimplicated\tin\tbodyweight\tdysregulation.\tThe\toriginal\t“obesogen\thypothesis”\t(\nGrün\tand\tBlumberg,\n2006\n)\tpertained\tto\tfetal\tEDC\texposure\tleading\tto\tobesity\n\tin\tlater\tlife.\tMost\tEDCs\tare\tlipophilic\tand
|
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] |
in\tlater\tlife.\tMost\tEDCs\tare\tlipophilic\tand\nstored\tin\tadipose\ttissue.\tSome\tEDCs\thave\t3-\tto\t8-year\thalf-lives\tin\tthe\thuman\tbody.\tHigher\texposure\nlevels\tmay\tbe\tassociated\twith\tinsulin\tresistance,\texpansion\tof\tfat\tstorage,\talterations\tin\tsatiety\tand\nappetite\tregulation,\tgreater\treductions\tin\tRMR\twith\tweight\tloss,\tand\ta\tlesser\tincrease\tin\tRMR\twith
|
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] |
weight\tgain\t(\nLiu,\t2018\n).\tExamples\tof\tsuspected\t\nobesogens\n\tare\tbisphenol-A\t(BPA)\tand\tphthalates\t(in\nfood\tcontainers\tand\tpackaging),\torganochlorine\tand\torganophosphate\t(banned\tpesticides),\tand\nperfluoroalkyl\tsubstances\t(industrial\tmarine\tapplications)\t(\nNappi,\t2016\n).\t(See\t\nClinical\tInsight:\nWhat’s\tin\tthat\tFat\tWhen\tYou\tLose\tIt?\n)
|
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] |
).\t(See\t\nClinical\tInsight:\nWhat’s\tin\tthat\tFat\tWhen\tYou\tLose\tIt?\n)\nViruses\tand\tpathogens\nIn\tthe\tlast\ttwo\tdecades,\tat\tleast\t10\tadipogenic\tpathogens\thave\tbeen\tidentified,\tincluding\tviruses,\nscrapie\n\tagents\t(spongiform\tencephalopathies\tfrom\tsheep\tor\tgoats),\tbacteria,\tand\tgut\tmicroflora.
|
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Whether\t“infectobesity”\tis\ta\trelevant\tcontributor\tto\tthe\tobesity\tepidemic\tremains\tto\tbe\tdetermined.\nA\thuman\tadenovirus,\tadenovirus-36\t(Ad-36),\tis\tcapable\tof\tinducing\tadiposity\tin\texperimentally\ninfected\tanimals\tby\tincreasing\tthe\treplication,\tdifferentiation,\tlipid\taccumulation,\tand\tinsulin\nsensitivity\tin\tfat
|
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] |
sensitivity\tin\tfat\n\tcells\tand\treducing\tleptin\tsecretion\tand\texpression.\tA\tgrowing\tnumber\tof\tstudies\nhave\tfound\thigher\tlevels\tof\tAd-36\tantibodies\tin\tsubjects\twith\tobesity\t(\nPonterio\tand\tGnessi,\t2015\n).\tTo\ndate,\tthree\tmeta-analyses\thave\tshown\tan\tassociation\tbetween\tAd-36\tinfection\tand\tobesity\tin\tboth\nadults\tand\tchildren\t(\nTambo\tand\tPace,\t2016\n).
|
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0.003647680627182126,
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] |
adults\tand\tchildren\t(\nTambo\tand\tPace,\t2016\n).\nGut\tmicroflora\tand\tdiet\nResearchers\tstudying\tthe\tmicrobiome\thave\tproposed\n\tthat\tthe\tgut\tmay\thave\ta\tbigger\trole\tin\tenergy\nbalance\tthan\tpreviously\tthought.\tA\tnumber\tof\ttheories\tattempt\tto\texplain\thow\tthis\tcomplicated\nprocess\tmight\twork\t(\nKrajmalnik-Brown\tet\tal,\t2012\n).\tEssentially,\tindigestible\tcomplex
|
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] |
Krajmalnik-Brown\tet\tal,\t2012\n).\tEssentially,\tindigestible\tcomplex\npolysaccharides\tpromote\tand\tmaintain\ta\thealthy\tmicrobiome.\tA\thighly\tprocessed-food\tdiet\n(essentially\tdevoid\tof\tindigestible\tpolysaccharides)\tbegins\tand\treinforces\ta\tdownward\n\tspiral\tof\ninflammation,\tincreased\ttendency\tto\tstore\tfat,\tas\twell\tas\tappetite\tand\tsatiety\tdysregulation.
|
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] |
Assessment\nOverweight\n\tand\t\nobesity\n\tare\tdefined\tas\tabnormal\tor\texcessive\tfat\taccumulation\tthat\tmay\timpair\nhealth\t(\nWHO,\t2018\n).\t\nBody\tmass\tindex\t(BMI)\n\tis\tcalculated\tby\tthe\tformula:\tweight\t(in\nkilograms)/height\t(in\tmeters)\n2\n.\tIt\tis\tpossible\tto\tbe\toverweight\tbased\ton\tBMI\tbut\tnot\tbe\t“overfat”\tor
|
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] |
obese.\tIt\tis\talso\tpossible\tto\thave\ta\thealthy\tBMI\tbut\tstill\thave\texcessive\tbody\tfat.\tIn\tfact,\tnormal\nweight\tobesity\t(NWO)\tallows\tpatients\tat\tgreater\trisk\tfor\tcardiovascular\tdisease\t(CVD)\tand\tcoronary\nartery\tdisease\t(CAD)\tto\tgo\tunnoticed\tby\ttheir\tphysicians\t(\nAshraf\tand\tBaweja,\t2013\n).\tThese\tsituations
|
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] |
Ashraf\tand\tBaweja,\t2013\n).\tThese\tsituations\noccur\tbecause\tBMI\tis\tonly\ta\tproxy\tfor\tadiposity\trather\tthan\ta\tdirect\tmeasurement.\tHowever,\tbecause\nBMI\tis\tderived\tfrom\treadily\tavailable\tmeasurements\tof\theight\tand\tweight\tit\tis\tthe\tmost\tconvenient\nclinical\tapproach\tto\testimate\tbody\tfat.\tThe\tNational\tInstitutes\tof\tHealth\t(NIH)\tguidelines\tclassify
|
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] |
individuals\twith\ta\tBMI\tof\t≥25\tas\toverweight\tand\tthose\twith\ta\tBMI\tof\t≥30\tas\tobese\t(\nTable\t20.3\n).\nBased\ton\tpercent\tbody\tfat\tcontent\tobesity\tis\t≥25%\tin\tmen\tand\t≥30%\tin\twoman.\tSee\t\nChapter\t5\n\tfor\ta\ndetailed\n\tdiscussion\tof\tbody\tfat\tassessment.
|
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0.07558106631040573,
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0.16558533906936646,
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0.09116064757108688,
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0.0480288565158844,
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0.03129635378718376,
0.028522655367851257,
0.018114399164915085
] |
TABLE\t20.3\nClassification\tof\tOverweight\tand\tObesity\nClassification\tof\tOverweight\tand\tObesity\tby\tBMI,\tWaist\tCircumference,\tand\tAssociated\tDisease\nRisk\n*\nDisease\tRisk\n*\n\t\nRelative\tto\tNormal\tWeight\tand\tWaist\tCircumference\nBMI\n(kg/m\n2\n)\nObesity\nClass\nMen\t≤102\tcm\t(≤40\tin)\tWomen\t≤\n88\tcm\t(≤\t35\tin)\n>\t102\tcm\t(>40\tin)\t>\t88\ncm\t(>35\tin)\nUnderweight\n<18.5\n___
|
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0.014513184316456318
] |
>\t102\tcm\t(>40\tin)\t>\t88\ncm\t(>35\tin)\nUnderweight\n<18.5\n___\n___\nNormal\n+\n18.5-24.9\n___\n___\nOverweight\n25.0-29.9\nIncreased\nHigh\nObesity\n30.0-34.9\nI\nHigh\nVery\tHigh\n35.0-39.9\nII\nVery\tHigh\nVery\tHigh\nExtreme\nObesity\n≥40\nIII\nExtremely\tHigh\nExtremely\tHigh
|
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] |
Very\tHigh\nExtreme\nObesity\n≥40\nIII\nExtremely\tHigh\nExtremely\tHigh\nFrom\tNational\tInstitutes\tof\tHealth,\tNational\tHeart,\tLung,\tand\tBlood\tInstitute:\tClinical\tGuidelines\ton\tthe\tIdentification,\tEvaluation,\tand\tTreatment\tof\nOverweight\tand\tObesity\tin\tAdults:\tEvidence\tReport,\tNIH\tPublication\tNo.\t98-4083,\t1998.\n*
|
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] |
*\nDisease\trisk\tfor\ttype\t2\tdiabetes,\thypertension,\n\tand\tCVD.\n+\nIncreased\twaist\tcircumference\tcan\talso\tbe\ta\tmarker\tfor\tincreased\trisk\teven\tin\tpersons\tof\tnormal\tweight.\nBecause\tBMI\tis\ta\tcrude\tproxy\tfor\tbody\tfat,\tand\talso\tfails\tto\taccount\tfor\tbody\tfat\tdistribution,
|
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morbidity\tand\tmortality\tstudies\tusing\tBMI\tconsistently\tproduce\t“J”\tshaped\tcurves,\twhich\tat\tfirst\nseem\tto\tsuggest\tthat\tlower\tBMIs\tare\tas\tunhealthy\tas\tthe\thigher\tBMIs\t(class\tII\tobesity\n\tor\tabove).\nWhen\twaist-to-hip\tratio\t(WHR)\tor\tweight-to-height\tratio\t(WHtR)\tare\tsubstituted\tfor\tBMI\thowever,
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] |
both\tdemonstrate\tpositive\t(linear)\trelationships\twith\tmortality\t(\nCarmienke\tet\tal,\t2013\n).\tSimilarly,\tA\nBody\tShape\tIndex\t(ABSI),\twhich\tincorporates\twaist\tcircumference\t(WC)\twith\theight\tand\tweight\tinto\none\tformula,\thas\talso\tbeen\tshown\tto\tbe\ta\tbetter\tmortality\tpredictor\tthan\tBMI\talone\t(\nKrakauer\tand\nKrakauer,\t2014\n).
|
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] |
Krakauer\tand\nKrakauer,\t2014\n).\nWhen\tWC\tand\tpercentage\tof\tfat\tare\tboth\thigh,\tthey\tare\tsignificant\tpredictors\tof\theart\tfailure\tand\nother\trisks\tassociated\twith\tobesity.\tWC\tis\ta\tstrong\tcorrelate\tof\tinsulin\tsensitivity\tindex\tin\tolder\nadults\t(\nHuth\tet\tal,\t2016\n).\tA\tWHR\tof\tmore\tthan\t0.8\tfor\twomen\tand\t1\tfor\tmen\tis\tassociated\twith\thigh
|
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risk\tfor\tcardiovascular\tevents.\tSimilarly,\tWC\t≥\t40\tinches\tin\tmen\tand\t≥35\tinches\tin\twomen\tsignifies\nincreased\trisk,\tequivalent\tto\ta\tBMI\tof\t25\tto\t34.\nHealth\trisks\tand\tlongevity\nIn\tmost\tpeople,\tobesity\tcan\tbe\tviewed\tas\tmetabolically\tunhealthy.\tChronic\tdiseases\tsuch\tas\theart
|
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0.004292492289096117
] |
disease,\ttype\t2\tdiabetes,\thypertension,\tstroke,\tgallbladder\tdisease,\tinfertility,\tsleep\tapnea,\thormonal\ncancers,\tand\tosteoarthritis\ttend\tto\tworsen\tas\tthe\tdegree\tof\tobesity\tincreases\t(\nFig.\t20.5\n;\tsee\t\nTable\n20.3\n).
|
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] |
FIG.\t20.5\nThe\tmedical\tcomplications\tof\tobesity\tare\textensive.\n\t\nSource:\n\t(Reprinted\twith\tpermission\tfrom\tDelichatsios\tHK:\nObesity\tassessment\tin\tthe\tprimary\tcare\toffice,\tHarvard\tMedical\tSchool.\t23rd\tAnnual\tInternational\tConference-Practical\tapproaches\nto\tthe\ttreatment\tof\tobesity,\tBoston,\tJune\t18-20\t2009).
|
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] |
to\tthe\ttreatment\tof\tobesity,\tBoston,\tJune\t18-20\t2009).\nThere\tis\ta\tsubset\tof\tobese\tpersons\twho\tpresent\tas\tmetabolically\thealthy.\tThis\tsubgroup,\n\tthe\nmetabolically\thealthy\tobese\t(MHO),\thas\tappropriate\tinsulin\tsensitivity\tand\tabsence\tof\tdiabetes,\ndyslipidemia,\tand\thypertension\t(\nBoonchaya-anant\tand\tApovian,\t2014\n).\tThere\tis\tcurrently\tno
|
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] |
Boonchaya-anant\tand\tApovian,\t2014\n).\tThere\tis\tcurrently\tno\nuniversal\tdefinition\tof\tMHO.\tHowever,\tthe\tidea\tthat\tMHO\tmight\tbe\tbenign\tand\tnot\trequire\ttreatment\nis\tdebatable.\tIn\tlong-term\tfollow-up\tMHO\tadults\twere\tat\tincreased\trisk\tfor\tall-cause\tmortality\tand\nCVD\t(\nKramer\tet\tal,\t2013\n).\tResearchers\tare\turging\tthat\ttreatment\tof\tMHO\tnot\tbe\tignored\tuntil
|
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).\tResearchers\tare\turging\tthat\ttreatment\tof\tMHO\tnot\tbe\tignored\tuntil\nmetabolic\tsymptoms\toccur\t(\nAtkinson\tand\tMacdonald,\t2018\n).\nInflammation\nObesity\tis\tnow\trecognized\tas\ta\tchronic\tand\tsystemic\tinflammatory\tdisease\twhereas\tit\twas\tonce\nbelieved\tthat\texcess\tadipose\tstores\twere\tinert.\tAdipose\ttissue\tis\tinvolved\tin\tthe\tsecretion\tof\ta\twide
|
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] |
range\tof\tactive\tsubstances\t(tumor\tnecrosis\tfactor,\tinterleukin-6,\n\tC-reactive\tprotein\t[CRP],\tetc.),\tmost\nbut\tnot\tall\t(adiponectin)\tinvolved\tin\tinflammatory\tactions.\tThe\toverall\tresult\tunderlies\tdevelopment\nof\thyperlipidemia,\tmetabolic\tsyndrome,\tdiabetes\tmellitus,\tmuscle\tprotein\tloss,\tCVD,\tstroke,\tand\nsome\tcancers\t(\nBueno\tet\tal,\t2014\n;
|
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] |
some\tcancers\t(\nBueno\tet\tal,\t2014\n;\t\nGrimble,\t2010\n;\t\nRocha\tand\tFolco,\t2011\n).\nIrrespective\tof\tthe\tgrowing\tbody\tof\tdata\ton\tthe\tsystemic\tinflammatory\tsystems\tset\toff\tby\n\tobesity,\nthe\tprecise\ttrigger\tis\tyet\tto\tbe\tdetermined.\tOne\ttheory\tis\tthat\tnutrient\toverload\tin\tadipocytes
|
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induces\tintracellular\tstress,\twhich\tresults\tin\tactivation\tof\tinflammatory\tcascades\t(\nEllulu\tet\tal,\t2017\n).\nAs\tdiscussed\tearlier,\tother\tfactors\timplicated\tin\tthe\tdevelopment\tof\tinflammation\tinclude\nmicrobiome-derived\tendotoxins,\tenvironmental\tchemicals,\tviruses,\tsaturated\tfats,\tand\tchronic\novereating.
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] |
overeating.\n\tA\tdietary\tchange\tto\tan\tantiinflammatory\tdiet\tand\tregular\tphysical\tactivity\tcan\treduce\nobesity-related\tinflammation.\t(For\tdiscussion\tof\tinflammation,\tsee\t\nChapter\t7\n.)\nNonalcoholic\tfatty\tliver\tdisease\t(NAFLD)\n\tis\tassociated\twith\toverweight\tand\tobesity\tand\tmay\nprogress\tto\tend-stage\tliver\tdisease\t(see\t\nChapter\t28
|
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] |
progress\tto\tend-stage\tliver\tdisease\t(see\t\nChapter\t28\n).\tObesity\tis\talso\ta\trisk\tfactor\tfor\tvarious\tcancers,\ninfertility,\tpoor\twound\thealing,\tand\n\tpoor\tantibody\tresponse\tto\thepatitis\tB\tvaccine.\tThus\tthe\tcosts\tof\nobesity\tare\tstaggering.\tThe\tCDC\testimates\tthe\tdirect\tcost\tof\tcare\tfor\tobesity\tat\t$147\tbillion\t(\nCDC,\n2008
|
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CDC,\n2008\n).\tThe\tInternal\tRevenue\tService\tissued\ta\trule\tin\t2002\tqualifying\tobesity\tas\ta\tdisease,\tallowing\ntaxpayers\tto\tclaim\tweight\tloss\texpenses\tas\ta\tmedical\tdeduction\tif\tundertaken\tto\ttreat\tan\texisting\ndisease.\nThe\tU.S.\tgovernment\trecognizes\n\tthe\timmense\teffect\tof\tobesity\ton\tthe\thealth\tand\tfinancial\twell-
|
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the\timmense\teffect\tof\tobesity\ton\tthe\thealth\tand\tfinancial\twell-\nbeing\tof\tits\tcitizens.\tHealthy\tPeople\t2020\tobjectives\talso\tidentify\tthe\timplications\tof\toverweight\tand\nobesity\t(see\t\nChapter\t8\n).\tThe\tobjectives\tinclude\ttargets\tto\tincrease\tthe\tproportion\tof\tadults\twho\tare
|
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] |
at\ta\thealthy\tweight\tand\tto\treduce\tthe\tproportion\tof\tadults,\tchildren,\tand\tadolescents\twho\tare\tobese.\nOverweight\tadolescents\toften\n\tbecome\tobese\tadults;\tobese\tindividuals\tare\tat\tincreased\trisk\tfor\ncomorbidities\n\tof\ttype\t2\tdiabetes,\thypertension,\tstroke,\tcertain\tcancers,\tinfertility,\tand\tother\nconditions.\nFat\tdeposition\tand\tthe\tmetabolic\tsyndrome
|
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conditions.\nFat\tdeposition\tand\tthe\tmetabolic\tsyndrome\nRegional\tpatterns\tof\tfat\tdeposit\tare\tcontrolled\tgenetically\tand\tdiffer\tbetween\tand\tamong\tmen\tand\nwomen.\tTwo\tmajor\ttypes\tof\tfat\tdeposition\tare\texcess\tsubcutaneous\ttruncal-abdominal\n\tfat\t(the\tapple-
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] |
lactation.\tWomen\twith\tthe\tgynoid\ttype\tof\tobesity\tdo\tnot\tdevelop\tthe\timpairments\tof\tglucose\nmetabolism\n\tin\tthose\twith\tan\tandroid\tdeposition\t(\nWajchenberg,\t2013\n).\tPostmenopausal\twomen\tmore\nclosely\tfollow\tthe\tmale\tpattern\tof\tabdominal\tfat\tstores,\tsometimes\treferred\tto\tas\t“belly\tfat.”\nAbdominal\tfat
|
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Abdominal\tfat\n\tis\tan\tindicator\tof\tfat\tsurrounding\tinternal\torgans\tor\tvisceral\tfat.\tAccording\tto\ta\nmajor\tstudy\tdone\tthrough\tthe\tBrigham\tand\tWomen’s\tHospital\tin\tBoston\tover\t7\tyears\tand\tincluding\nmore\tthan\t3000\tpeople\t(Framingham\n\tStudy\tpatients\twere\tused),\tthose\twith\thigher\tamounts\tof
|
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] |
Study\tpatients\twere\tused),\tthose\twith\thigher\tamounts\tof\nabdominal\tfat,\tversus\tfat\tin\tother\tparts\tof\tthe\tbody,\twere\tfound\tto\thave\thigher\trisks\tof\tcancer\tand\nheart\tdisease\t(\nBritton\tet\tal,\t2013\n).\tMany\tother\treputable\tscientific\tstudies\thave\tbeen\tperformed,\nvalidating\tthe\tfindings\trepeatedly.
|
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] |
validating\tthe\tfindings\trepeatedly.\nVisceral\tobesity,\tor\texcessive\tVAT\tunder\tthe\tperitoneum\tand\tin\tthe\tintraabdominal\tcavity,\tis\ncorrelated\thighly\n\twith\tinsulin\tresistance\tand\tdiabetes.\t\nMetabolic\tsyndrome\t(MetS)\n\tconsists\tof\nthree\tor\tmore\tof\tthe\tfollowing\tabnormalities:\twaist\tcircumference\t≥102\tcm\t(40\tin)\tin\tmen\tand\t≥88
|
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0.04804665967822075,
0.07268931716680527,
0.0010019675828516483
] |
cm\t(35\tin)\tin\twomen,\tserum\tTGs\t≥150\tmg/dL,\thigh-density\tlipoprotein\t(HDL)\tlevel\tless\tthan\t40\nmg/dL\tin\tmen\tand\tless\tthan\t50\tmg/dL\tin\twomen,\tblood\tpressure\t135/85\tmm\tHg\tor\thigher,\tor\tfasting\nglucose\t100\tmg/dL\tor\thigher.\tIncreased\n\tvisceral\tfat\tis\ta\trisk\tfactor\tfor\tCAD,\tdyslipidemia,\nhypertension,\tstroke,\ttype\t2\tdiabetes,\tand\tMetS\t(\nWajchenberg,\t2013
|
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] |
hypertension,\tstroke,\ttype\t2\tdiabetes,\tand\tMetS\t(\nWajchenberg,\t2013\n).\tBy\tthe\tsame\ttoken,\tVAT\tand\nlow\tcardiorespiratory\tfitness\t(CRF)\tlevels\tare\tassociated\twith\ta\tdeteriorated\tcardiometabolic\trisk\nprofile.\tAchieving\ta\tlow\tlevel\tof\tVAT\tand\ta\thigh\tlevel\tof\tCRF\tis\tan\timportant\ttarget\tfor\ncardiometabolic\thealth.\nWeight\tdiscrimination\nWidespread
|
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] |
cardiometabolic\thealth.\nWeight\tdiscrimination\nWidespread\n\tbias\tand\tdiscrimination\tbased\ton\tweight\thave\tbeen\tdocumented\tin\teducation,\nemployment,\tand\thealth\tcare.\tLike\tother\tforms\tof\tprejudice,\tthis\tstems\tfrom\ta\tlack\tof\tunderstanding\nof\tthe\tchronic,\tcomplex,\tand\tsometimes\tintractable\tnature\tof\tobesity\tand\tits\tmedical\tconsequences.
|
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] |
The\tUnited\tStates\tis\tthe\tfirst\t(and\tonly)\tcountry\tthat\tcurrently\tclassifies\tobesity\tas\ta\tdisease;\tthe\ndisease\tclassification\n\twas\tnecessary\tin\torder\tfor\tinsurance\tto\tcover\tobesity\ttreatment\twithin\tthe\tU.S.\nhealth\tcare\tsystem\t(\nMüller\tand\tGeisler,\t2017\n).\tThe\tvast\tmajority\tof\tthe\tUnited\tStates\tdoes\tnot
|
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] |
).\tThe\tvast\tmajority\tof\tthe\tUnited\tStates\tdoes\tnot\nconsider\tobesity\ta\tprotected\tclass\tand\ttherefore\tweight-based\temployment\tdiscrimination\tdoes\tnot\nhave\ta\tbasis\tfor\ta\tlegal\tclaim\t(\nPomeranz\tand\tPuhl,\t2013\n).\tBoth\tadults\tand\tchildren\twith\ta\tlarger\nbody\tsize\texperience\tadverse\n\tsocial,\teducational,\tand\tpsychological\tconsequences\tas\ta\tresult\tof
|
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social,\teducational,\tand\tpsychological\tconsequences\tas\ta\tresult\tof\nweight\tbias.\tThey\talso\tface\tdiscrimination\tfrom\thealthcare\tproviders\tand\tthis\tcan\taffect\ttheir\nwillingness\tto\tseek\tmedical\tcare.\tIt\tis\tessential\tto\tbreak\tdown\tthe\tbarriers\tcaused\tby\tignorance\tand
|
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indifference.\tPatient\tsupport\tgroups\thelp\tto\tcorrect\tthe\tnegative\teffect\tof\tthis\ttype\tof\tdiscrimination.\nManagement\tof\tobesity\tin\n\tadults\nIn\t1998\tthe\tNational\tHeart,\tLung,\tand\tBlood\tInstitute\t(NHLBI)\tin\tcollaboration\twith\tNational\nInstitute\tof\tDiabetes\tand\tDigestive\tand\tKidney\tDiseases\t(NIDDK)\tissued\tthe\t\nClinical\tGuidelines\ton
|
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Clinical\tGuidelines\ton\nthe\tIdentification,\tEvaluation,\tand\tTreatment\tof\tOverweight\tand\tObesity\tin\tAdults:\tEvidence\tReport\n.\nIt\twas\tthe\tfirst\tfederal\tclinical\tpractice\tguidelines\tto\tdeal\twith\toverweight\tand\tobesity\tissues\ndeveloped\n\tusing\tevidence-based\tmedicine\tmethodology.\tThe\tguidelines\tprovided\tthe\tscientific
|
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] |
evidence\tbehind\tthe\trecommendations\tfor\tweight\tloss\tand\tweight\tloss\tmaintenance\tas\twell\tas\npractical\tstrategies\tfor\timplementing\tthe\trecommendations.\tThe\t1998\tclinical\tguidelines\twere\npartially\tupdated\tin\t2013\taddressing\tfive\tspecific\tquestions\tand\tpublished\tin\tthree\tmajor\tmedical\njournals\t(\nNHLBI,\t2014\n).\tThe\tfive
|
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] |
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