Obesity (to be) ______ a condition in which the natural energy reserve, stored in the fatty tissue of humans and other mammals, (to increase) _______________________ to a point where it (to associate) ______________________ with certain health conditions or increased mortality.
Obesity (to be) _____ both an individual clinical condition and (to view) ____increasingly _______________ as a serious public health problem. Excessive body weight (to show) _____________________________ to predispose to various diseases, particularly cardiovascular diseases, diabetes mellitus type 2, sleep apnea, and osteoarthritis.
Many negative stereotypes (to associate) _______ commonly _________________ with obese people, such as the belief that they (to be) _________ lazy, stupid, or even evil. Obesity in adulthood can (to lead) ______________ to a slower rate of career advancement. Most obese people have experienced negative thoughts about their body image, and many take drastic steps to try to change their shape.
Obesity, especially central obesity (male-type or waist-predominant obesity), (to be) ______an important risk factor for the "metabolic syndrome", the clustering of a number of diseases and risk factors that heavily (to predispose) ___________________ for cardiovascular disease. These (to be) ______ diabetes mellitus type 2, high blood pressure, high blood cholesterol, and triglyceride levels (combined hyperlipidemia). An inflammatory state (to be) _____ present, which — together with the above — (to implicate) ___________________________________ in the high prevalence of atherosclerosis (fatty lumps in the arterial wall), and a prothrombotic state may further worsen cardiovascular risk.
Apart from the metabolic syndrome, obesity (to correlate) _____ also ______________ (in population studies) with a variety of other complications.
• Cardiovascular: congestive heart failure, enlarged heart and its associated arrhythmias and dizziness, cor pulmonale, varicose veins, and pulmonary embolism
• Endocrine: polycystic ovarian syndrome, menstrual disorders, and infertility
• Gastrointestinal: gastroesophageal reflux disease (GERD), fatty liver disease, cholelithiasis (gallstones), hernia, and colorectal cancer
• Renal and genitourinary: urinary incontinence, glomerulopathy, breast cancer (female), uterine cancer (female), stillbirth
• Musculoskeletal: hyperuricemia (which predisposes to gout), immobility, osteoarthritis, low back pain
• Neurologic: stroke, headache
• Respiratory: dyspnea, obstructive sleep apnea, hypoventilation syndrome, asthma
• Psychological: Depression, low self esteem
In the clinical setting, obesity (to evaluate) ____ typically ________________ by measuring BMI (body mass index), waist circumference, and evaluating the presence of risk factors. In epidemiological studies, BMI alone (to use) ____________ to define obesity.
BMI, or Body Mass Index, (to develop) ___________________ by the Belgian statistician and anthropometrist Adolphe Quetelet.
The current definitions commonly in use (to establish) ________________________ the following values, agreed in 1997 and published in 2000:
• A BMI less than 18.5 (to be) ____ underweight
• A BMI of 18.5 - 24.9 (to be) ____ normal weight
• A BMI of 25.0 - 29.9 (to be) ____ overweight
• A BMI of 30.0 - 39.9 (to be) ____ obese
• A BMI of 40.0 or higher (to be) ____ severely (or morbidly) obese
BMI is a simple and widely used method for estimating body fat.[9] In epidemiology BMI alone is used as an indicator of prevalence and incidence.
The absolute waist circumference (>102 cm in men and >88 cm in women) or waist-hip ratio (>0.9 for men and >0.85 for women) (to use) _____both ____________ as measures of central obesity.
An alternative way to determine obesity (to be) _____ to assess percent body fat. Doctors and scientists generally (to agree) _____________ that men with more than 25% body fat and women with more than 30% body fat (to be) _______ obese. However, it (to be) ____ difficult to measure body fat precisely.
In its simplest conception, obesity (to make) ____only ____________ possible when the lifetime energy intake exceeds lifetime energy expenditure by more than it does for individuals of "normal weight".
When food energy intake (to exceed) ______________ energy expenditure, fat cells (and to a lesser extent muscle and liver cells) throughout the body (to take) ______________ in the energy and (to store) ________________ it as fat.
Factors that (to suggest) _____________________________________to contribute to the development of obesity (to include) ______________________:
• Genetic factors and some genetic disorders
• Underlying illness (e.g., hypothyroidism)
• Eating disorders
• Certain medications
• Sedentary lifestyle
• A high glycemic diet
• Weight cycling, caused by repeated attempts to lose weight by dieting
• Stressful mentality
• Insufficient sleep
• Smoking cessation
Certain populations and individuals may (to be) ______ more prone to obesity than others
The mainstay of treatment for obesity (to be) ____ an energy-limited diet and increased exercise.
In a clinical practice guideline by the American College of Physicians, the following five recommendations (to make) _______________:
1. People with a BMI of over 30 should (to counsel)_________________ on diet, exercise and other relevant behavioral interventions, and (to set) _______ a realistic goal for weight loss.
2. If these goals (not to achieved) _________________, pharmacotherapy can (to offer) __________________. The patient (to need)__________ to be informed of the possibility of side-effects and the unavailability of long-term safety.
3. Drug therapy may (to consist) ______________ of sibutramine, orlistat, phentermine, diethylpropion, fluoxetine, and bupropion. For more severe cases of obesity, stronger drugs such as amphetamine and methamphetamine may (to use) ______________on a selective basis.
4. In patients with BMI > 40 who (to fail) ____________ to achieve their weight loss goals (with or without medication) and who (to develop) _____________ obesity-related complications, referral for bariatric surgery may (to indicate) __________________. The patient (to need) ______________ to be aware of the potential complications.
5. Those requiring bariatric surgery should (to refer) ________________ to high-volume referral centers, as the evidence (to suggest) ___________ that surgeons who frequently (to perform) ______________ these procedures (to have) ______________ fewer complications.
The Health Survey for England (to predict) ____________ that more than 12 million adults and 1 million children (to be) _____________obese by 2010 if no action (to take) _____________.
The prevalence of overweight and obesity in the United States (to make) ________ obesity a leading public health problem. The United States (to have) ______the highest rates of obesity in the developed world. From 1980 to 2002, obesity (to double) ____________ in adults and overweight prevalence (to triple) __________________ in children and adolescents. From 2003-2004, "children and adolescents aged 2 to 19 years, 17.1% (to be) ________ overweight...and 32.2% of adults aged 20 years or older (to be) ______ obese." The prevalence in the United States (to continue) ____________ to rise. The prevalence of obesity (to rise) _____________________continually ____________ for two decades. This sudden rise in obesity prevalence (to attribute) _____________ to environmental and population factors rather than individual behavior and biology because of the rapid and continual rise in the number of overweight and obese individuals. The current environment (to produce) ________________ risk factors for decreased physical activity and for increased calorie consumption.
• Lack of activity: obese people (to appear) ___________ to be less active in general than lean people, and not just because of their obesity. A controlled increase in calorie intake of lean people (not to make) ____________ them less active; correspondingly when obese people (to lose) _______ weight they (not to become) _____________ more active. Weight change (not to affect) _______________ activity levels, but the converse (to seem) ________________to be the case.
• One of the most important (to be) ______is the much lower relative cost of foodstuffs: massive changes in agricultural policy in the United States and Europe (to lead) ___________________ to food prices for consumers being lower than at any point in history. Sugar and corn syrup, two huge sources of food energy, (to be) ______ some of the most subsidized products by the United States government.
• Increased marketing (to play) _____ also _________ a role. The number of advertisements seen by the average child (to increase) ____________ greatly, and a large proportion of these (to be) ________ for fast food and sweets.
• Changes in the price of petrol (i.e. gasoline) (to believe) _____ also _________ to have had an effect, as unlike during the 1970s it (to be) _____ now affordable in the United States to drive everywhere. At the same time more areas (to build) ___________________________ without sidewalks and parks.
• The changing workforce as each year a greater percent of the population (to spend) _______ their entire workday behind a desk or computer, seeing virtually no exercise. In the kitchen the microwave oven (to see) _____________________ sales of calorie-dense frozen convenience foods skyrocket.
• A social cause that (to believe) ______________ by many to play a role (to be) _____ the increasing number of two income households in which one parent no longer (to remain) _________ home to look after the house. This (to increase) ______________ the number of restaurant and take-out meals.
• Low food costs, and intense competition for market share, (to lead) ___ to increased portion sizes — for example, McDonalds french fries portions (to rise) ________ from 200 calories (840 kilojoules) in 1960 to over 600 calories (2,500 kJ) today.
• Increased food production (to be) ____ a probable factor. The U.S. (to produce) _____ three times more food than U.S. residents (to eat) ________.
An aging population may also (to be) _____ a major factor, as the likelihood of becoming obese (to increase) ___ with age.
