The people on the discussion board offer caring support and beneficial advice for free. For little expense there are the McDougall books. Now all you have to do is decide how much longer you are willing to suffer before you make the decision. Home Contact Us Customer Support. Cures Morbid Obesity Lost pounds and more Soldotna, Alaska — I was always heavy as a child — and I come from parents who were very overweight as well. Suffered from Type-2 Diabetes Benjamin Eksouzian: Cures Type-2 Diabetes Bill Zahlar: Suffered Massive Heart Attack Brett: Lost weight and regained health Caroline Duke: Loses a Hundred Pounds Dan: No longer needs blood pressure meds Daniel: Has taken back control of his health Dr.
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Thus, obesity is no longer a problem only in industrialized countries. It has now reached urban and rural areas in the poorest countries of sub-Saharan Africa and South Asia [ Popkin et al. Local traditions of foods with high fiber content have been exchanged for processed foods and sugar sweetened soft drinks as a sign of wealth.
In fact, not only do many countries suffer from the double burden of both nutrient malnutrition and its related diseases, they also face the comorbidities associated with obesity and being overweight in parallel [ Swinburn et al. Although obesity is not an infectious disease, and consequently cannot correctly be entitled a pandemic, it is rapidly spreading across regions and continents, making it a worldwide concern.
Perhaps it is time to question the definition of a pandemic, and upgrade the commonly called obesity epidemic to the new pandemic? By definition, a pandemic disease threatens the whole of society and, therefore, powerful measures have been taken on when a pandemic warning has been issued. Possibly, this upgrade could make politicians react and take command as promptly as they did with the outbreak of swine flu, H1N1.
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The goal was to nip it in the bud before the situation got worse. Awareness about the obesity situation has improved, at least in terms of the number of policy programs, guidelines and strategic plans. However, translation into action has not followed. In , the US Surgeon General pointed out that there is a need for dedicated and compassionate citizens involved in grass root efforts [ U. Department of Health and Human Services, ]. These grass roots are thought to find their own creative ways to implement changes for healthier behaviors in their families and communities.
Understanding Extreme Obesity
Parents, child care professionals and teachers are encouraged to prevent and intervene even before a child enters the path to obesity. To resolve the obesity epidemic we also need concerted action involving not only the civil society, but also the private sector, professional networks, media and international organizations and last, but not least, the governments [ Deitel, ]. Obesity is one of the most difficult conditions to overcome. The forces that make us enjoy energy-dense food and a sedentary lifestyle are strong.
There is a general agreement that prevention of obesity, already from childhood, would be an optimal strategy. When prevention fails, there are in principle three tools to counter obesity: This nonsystematic, brief review addresses prevention, as well as current approaches to manage the rising tide of obesity, from patient-centered individual therapies to community-based interventions. There is a growing demand that governments and international bodies such as the United Nations UN and World Health organization WHO take action to reduce the burden of obesity.
Charters may be signed, but too often the resources needed to make a change are not set aside. Political commitment hopefully increases when interventions prove to give value for money. Interestingly, environmental interventions are rated as the most cost-effective. While the cost is fairly low, such activities have a moderate effect on the individual, but since they affect the entire population the overall impact makes a difference.
For example, ACE recommends the following interventions: Below are examples of how these interventions have successfully been implemented in some countries around the world. Next in line are soft drinks, tobacco and alcohol [ Wilkins, ]. The Danes have a good track record. In they passed a law to ban the use of transfatty acids.
Transfatty acids, known to increase the risk of coronary heart disease [ Willett et al. Instead, food producers have developed new production methods. Hence, the products in focus are still around, but with better fat quality [ Leth et al. Neighboring countries have emphasized voluntary agreements, but have not succeeded in completely ridding their populations of transfatty acid consumption. Front-of-pack signposting for informed and healthy shopping decisions has received increasing interest.
Even if the consumers are under time constraints, traffic light labels and logos have been proven to enhance the likelihood of healthy choices [ Hebden et al. Not surprisingly, unlabeled food is more difficult to classify as healthy or unhealthy [ Borgmeier and Westenhoefer, ].
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Consumers are constantly exposed to many information sources such as the media, advertisements and promotions. Interestingly, Canadians claim product labels as their most important source for nutritional information. This source is then followed by printed media, friends and family, electronic media channels and lastly family physicians or other professionals [ Wills et al.
It is noteworthy that the medical profession seems to play such a minor role in national information. Potentially, with the right organization and presentation, signposts could be of high value and result in improved food choice patterns. To achieve implementation of successful nutrition labeling, engagement and regulation from the authorities are needed.https://niwasbaufronom.gq/map15.php
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Regulation has also been suggested for food and beverages advertised to children. In Sweden, Norway and Quebec the government has regulated television advertising to children. More specifically, the Swedish Radio and Television Act does not allow commercial television advertising intended to attract the attention of children below the age of However, most countries do not regulate advertisements to children. A comparison of food advertising in 13 countries across 5 continents, found that a child who was watching television 2 hours per day would be exposed to between 28 and 84 food advertisements a week for food with high energy content and undesirable nutrients.
Only television channel promotions were more frequently advertised than food. Fast food restaurant meals constituted every third advertisement in the US and every seventh advertisement in Australia [ Kelly et al. The Australian fast-food industry has agreed on a self-regulation to decrease fast-food advertisement to children.
Despite this, exposure is unchanged according to Australian researchers requesting policy framework for regulation of advertising to children [ Hebden et al. Commonly, but not unexpectedly, recommended food policies and regulations are opposed by the powerful food industry. Other types of interventions, such as physical activity interventions, and different types of school and community actions may be easier to implement, but may also be less beneficial ways to fight obesity. There is general agreement that weight loss will follow a negative energy balance, independently of how that is achieved.
It is important to distinguish between weight loss reasonably easy to achieve and weight-loss maintenance considerably more difficult to achieve. Weight loss can be accomplished in numerous ways. Bariatric surgery has proven to be more effective than conventional weight-loss management for morbid obesity, in a Cochrane database systematic review [ Colquitt et al. Still, lifestyle interventions will be the most realistic treatment option for the vast majority of obese children, adolescents and adults.
Leblanc and colleagues [ Leblanc et al. The authors concluded that behavior-based treatment programs are safe and effective. As long as 20 years ago the Diabetes Prevention Study DPS randomized Finish middle-aged, overweight men and women with impaired glucose tolerance into either intensive lifestyle intervention or to a control group receiving usual care. After 3 years, weight reductions were 3. In addition, favorable changes were seen in terms of measures of lipemia [ Lindstrom et al.
Patients were randomized to one of three arms: The average follow-up time was 2. Lifestyle intervention turned out to be the most successful method. Presented as numbers needed to treat NNT , 6. The DPP study was soon followed by another large, still ongoing intervention study: It aimed to investigate the long-term effects of lifestyle intervention diet modification and increased physical activity with a gradual progression; the goal was set as minutes of moderate intensity a week in overweight and obese subjects with type 2 diabetes.
Participants randomized to the intervention arm lost on average 8. HbA1c, urine albumin-to-creatinine ratio and risk factors for cardiovascular disease such as high systolic and diastolic blood pressure, triglycerides and high-density lipoprotein HDL cholesterol all improved significantly more in the intervention group compared with the control group [ Pi-Sunyer et al. A minor weight loss seems to be sufficient to provide a clinically significant health benefit in terms of risk factors for cardiovascular disease and diabetes. These, and similar findings [ Van Gaal et al. This was illustrated in a study by Foster and colleagues, where 60 obese women mean BMI After almost a year of treatment, the average weight loss was an impressive In a severely obese group with an average BMI of It is conceivable that poor compliance could be due to unrealistic expectations from the start.
A concern in lifestyle interventions is participant attrition. The typical story of success with initial weight loss and the sad story of attrition and subsequent weight gain is shown in Figure 1. Despite this initiative, their weight had returned to baseline weight at the end of the program.
Among other barriers to successful weight loss is family eating habits eating out, unhealthy cooking and lack of healthy food in the home [ Porter et al. Family and social pressure to consume large amounts of food, including high-fat foods, have been described in focus groups as a barrier to weight loss [ Blixen et al.
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Culture and ethnicity are other aspects of importance. Likewise, in a focus group study among Latinos in South Carolina, USA, both males and females expressed a preference for a heavier body type. Their perception of fat being healthy was in direct conflict with medical advice [ Diaz et al. Attributes of the neighborhood have also been reported to be associated with BMI. In a study of almost 11, participants in four US states, the presence of supermarkets in the neighborhood was associated with a lower prevalence of obesity and overweight, while the presence of convenience stores was associated with a higher prevalence of obesity and being overweight [ Morland et al.
Similarly, a high concentration of local restaurants was associated with a higher BMI in a study by Inagami and colleagues [ Inagami et al. Perceived neighborhood safety is another mechanism through which the neighborhood may have an impact on obesity. Those that perceive their neighborhoods as less than extremely safe were more than twice as likely to have no leisure-time physical activity in a Texas study [ Centers of Disease Control and Prevention, ].
Individuals who perceived their neighborhoods as unsafe had a BMI that was 2. Adjustment for depressive symptoms did not alter this finding.
Similar findings have been reported among children growing up in neighborhoods perceived as less safe; the parental perception of the neighborhood as less safe was independently associated with an increased risk of overweight at the age of seven [ Lumeng et al. Neighborhood walkability has also been examined in some studies. Hardly surprisingly, lower neighborhood walkability was associated with more driving time, but also with more self-reported TV viewing [ Kozo et al. The latter has been shown in an Australian study as well; walkability was negatively associated with TV viewing in women, but not in men [ Sugiyama et al.
While this can be done with pamphlets, books and other paper-based material, the rapid increase in availability and access to modern technology enables innovative ways of delivering, for example, weight-loss programs. Today, the Internet has more than 2. Almost a third, The potential reach of health information through the Internet is enormous. Health information found is also in general trusted: Internet has increasingly been used for delivery of health interventions.
At least theoretically, the Internet has the potential to overcome many of the limitations traditional weight-loss interventions are facing.
Extreme Obesity, And What You Can Do
Internet health applications, accessible at any time and independent of geography, could be a way to minimize the high attrition rates in obesity weight-loss programs. The programs can be reached with convenient tools, which are in place when the patient has the time and motivation to access them, 24 hours a day. A high number of participants may be targeted at a low cost when face-to-face programs are remodeled and become more accessible via new technology. Furthermore, healthcare professionals have the opportunity to maintain long-term contact with a large number of obese and overweight patients in a cost-effective way using the Internet.
New motivation and action support systems facilitate the process of tailoring programs to the precise needs of the participants. New technology may serve as a facilitator to acquire behavioral change. Even age groups, not growing up with new advanced technology such as computers, do well in Internet-based behavioral weight-loss programs.
A study examining the effectiveness of an Internet-based program among those above the age of 65 concluded that they performed equally well or even better than younger participants. Older participants were more likely to be active, to log in and record their diet and current weight more frequently. Among women, those older than 65 had on average the highest percentage of weight loss, 6.
Weight Watchers is another example of a weight-loss program using the Internet [ Weight Watchers, ]. It is an enterprise offering regular group meetings. With new technology, such as a smartphone application, the participants can choose whether they would like to attend the meetings online or in person, making the program available also for those who cannot, or are not interested in, attending meetings.
Despite more and more intervention studies using the Internet and the increasing number of commercial Web-based weight-loss programs, further evidence is required to assess the effectiveness. Systematic reviews on Internet-based behavioral interventions for obesity have identified the lack of well-designed efficacy trials. The heterogeneity of designs and low generalization of findings make effectiveness difficult to assess [ Tsai and Wadden, ; Manzoni et al. It is also still unclear which intervention components, for example support forums, coaching messages and BMI calculators, produce weight loss, either in isolation or collectively [ Bennett and Glasgow, ].
Bennett and Glasgow [ Bennett and Glasgow, ] point out the need to attract, retain and engage intervention participants to prevent attrition.
The trend on the Internet is a progression away from Web sites towards Web services, allowing users to have a high degree of control over their own data. They can store, view and share personal data in sophisticated ways.
This set of design principles, called Web 2. A creative Internet service implementation of research sites for weight loss may be an attractive way to self-monitor weight and other health behaviors. Today, the only limiting factor to health professionals and researchers is creativity. With an expanding field of new possibilities it is time to ask questions such as the following. How can behavioral weight-loss strategies effectively be taught online? Which features self-monitoring, chat rooms, food diaries etc.
How can motivation be maintained throughout a long treatment program using new technology? How can new technology overcome the boredom and fatigue associated with previous failures? How can different types of technology interact to offer enhanced support for individuals trying to lose weight? How can we integrate Web service principles into research Web sites? How can healthcare facilities utilize modern technology to target new groups of patients?
Appetite regulation has been a matter of survival for thousands of years. The neurobiology of hunger, appetite and eating is intricate, with many pathways not yet fully disentangled. Its complexity is a challenge, particularly in the development of a drug aimed at targeting one or several of these specific pathways.
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