Оглавление
Группа авторов. Clinical Obesity in Adults and Children
Table of Contents
List of Tables
List of Illustrations
Guide
Pages
Clinical Obesity in Adults and Children
List of Contributors
Preface
Dedication
List of Abbreviations
1 Obesity – Introduction: History and the Scale of the Problem Worldwide
Obesity as a public health problem
Lower limits of BMIs in non‐Caucasians?
Morbidity burden starts at much lower BMIs
Obesity epidemic starts in the early 1980s
The global epidemic gets underway
Abdominal obesity
Different regional societal burdens of obesity with abdominal obesity
Historical analyses of contributors to obesity
Marked declines in society’s physical activity
A revolution in food industrial strategies which increase food intakes
The burden of obesity
The economic impact of excess weight gain
Conclusions
References
2 The Epidemiology and Social Determinants of Obesity
Introduction
Defining excess body fat
Adult obesity
Childhood obesity
Global obesity
Social determinants of obesity
National economic development
Individual socioeconomic status
Urbanization
Technology
Crime
Culture
Conclusions
References
3 Fetal and Infant Origins of Obesity
Background
Assessing obesity in children
Conceptual frameworks
Study designs
Developmental risk factors
Maternal overnutrition
Maternal diet quality
Environmental chemicals
Infant growth patterns and timing
Infant diet quality and eating behaviors
Other behaviors in infancy
Biology and mechanisms
Epigenetics
Mediating metabolic factors
Gut microbiota
Estimating population attributable risks
Implications for policy and practice
Acknowledgments
References
4 Genes and Obesity
Introduction
Historical perspective
Gene–environment interactions
Evidence for the heritability of fat mass
Adoption studies
Twin studies
Pleiotropic obesity syndromes
Prader–Willi syndrome
Albright hereditary osteodystrophy
Bardet–Biedl syndrome
Molecular mechanisms involved in energy homeostasis
Rodent models of obesity
Leptin–melanocortin pathway
Monogenic obesity syndromes affecting the leptin‐melanocortin pathway. Congenital leptin deficiency
Response to leptin therapy
Leptin receptor deficiency
POMC deficiency
Prohormone convertase 1 deficiency
MC4R deficiency
Genes that affect the development and function of POMC neurons
Obesity syndromes associated with neurobehavioral phenotypes
Conclusions
References
5 Bias, Stigma, and Social Consequences of Obesity
Social consequences for adults
Employment and wages
Health care
Social consequences for youth
Education
Peer victimization
Impact of weight stigma on health
Discrimination
Teasing and bullying
Internalization
Interventions to prevent and reduce weight stigma
Laws
Policies and training
Clinical intervention
Conclusion
References
6 Ecology, Protein Leverage, and Public Health
Introduction
An ecological view of nutrition. The simple and the complex
Laboratory studies of animals
Animals in natural food environments
Human macronutrient regulation
Do humans select an intake target?
Response to variation in dietary macronutrient balance: protein leverage
Human nutritional ecology
Some relevant frameworks from public health nutrition
Protein leverage and nutrition transitions
Why do humans select low‐protein foods that cause energy over‐consumption?
Bringing it all together: complex systems
Conclusions
References
7 The Living Environment and Physical Activity
From the environment to behaviors to obesity
Physical activity and health
Physical activity and weight gain
Spatial variation in obesity
Measuring attributes of the built environment
Relations between the built environment, physical activity, and obesity
Research trends
Changes in the urban environment
Conclusion
References
8 Psychobiology of Obesity: Eating Behavior and Appetite Control
Setting the scene
Can obesity be managed through behavior change?
Complex bio‐cultural system of appetite control
The bio‐behavioral appetite system: tonic and episodic processes
The satiety cascade: homeostatic and hedonic processes
Individual variation in susceptibility to overconsumption: phenotypes for appetite control
Satiety responsiveness and the low satiety phenotype
Sensitivity to food reward
Compensation in response to exercise
Implications for the treatment and prevention of obesity and future directions
Closing comments
References
9 Energy Balance and Body Weight Homeostasis
Introduction
Basic concepts and principles in human energetics. Energy balance and laws of thermodynamics
Pattern of food intake and energy expenditure
Components of energy expenditure
Basal metabolic rate (BMR)
Energy expenditure due to physical activity
Energy expenditure in response to various thermogenic stimuli
Spontaneous physical activity and nonexercise activity thermogenesis
Timescale of energy balance
Control of food intake. Hunger and satiety
Hunger‐satiety control centers in the brain
Hunger‐satiety signals from the periphery
Signals from the gastro‐intestinal tract
Aminostatic or protein‐static signals
Glucostatic and glycogenostatic signals
Lipostatic and adiposity signals
Hepatic nutrient metabolism signals
Impact of peripheral signals on brain higher centers
Integrated models of food intake control
The nutrient balance model
Sensitivity of appetite control to habitual physical activity
Autoregulatory adjustments in energy expenditure
Beyond adaptation through mass action
Inter‐individual variability in adaptive thermogenesis
Adaptive thermogenesis at rest and during movements
Spontaneous physical activity
Efficiency of muscle work
Mechanisms of thermogenesis
Peripheral effectors of thermogenesis
Models for body composition regulation via adaptive thermogenesis
Integrating intake and expenditure
References
10 Obesity, Ectopic Fat and Type 2 Diabetes
Introduction
Epidemiology
Not all fat is the same
Metabolically healthy obese and metabolically unhealthy lean
Pathogenesis of visceral and ectopic fat accumulation
The role of adipocytokines in ectopic fat accumulation, insulin resistance, and beta‐cell failure
Adiponectin
Leptin
Other adipokines
Adipokines involved in fat mass proliferation
The role of adipokines in chronic inflammation
The role of free fatty acids
Factors affecting body fat distribution
Genetic and epigenetic
Hormonal
Linking ectopic fat accumulation to diabetes
Ectopic fat accumulation in muscle
Nonalcoholic fatty liver disease
Mechanisms explaining the interrelationship of NAFLD and impaired glucose metabolism
Pancreatic steatosis
Myocardial steatosis and epicardial fat accumulation
How can we measure VAT and ectopic fat
Clinical measures
Imaging techniques
Diagnostic procedures to diagnose NAFLD
Indices
Imaging techniques
Therapy. Weight loss. Prevention of diabetes
Treatment of diabetes
Drugs acting on the peroxisome proliferator‐activated receptors
Fibrates
Thiazolidinediones
Glucagon like peptide‐1 receptor agonists
SGLT‐2 inhibitors
Bariatric/Metabolic surgery
Conclusion
References
11 Obesity and Dyslipidemia, Importance of Body Fat Distribution
Introduction
Limitations to fat storage
Hyperlipidemia in relation to adiposity
The dynamics and difference of adipose tissue depot functions in the body in relation to hyperlipidemia. Subcutaneous abdominal adipose tissue
Gluteofemoral adipose tissue
Visceral adipose tissue
Associations between plasma lipids and lipoproteins and discrete fat depots. Abdominal adiposity
References
12 Obesity and Fertility
Introduction
Female fertility
Male fertility
Obesity and assisted reproductive technology
Obesity and pregnancy outcomes
Conclusions and future directions
References
13 Metabolic Syndrome and Metabolic Dysfunction‐Associated Fatty Liver Disease
Introduction
Pathogenesis of MS
Pathogenesis and clinical implications of MAFLD
Association between MS and MAFLD
Pathological link between MAFLD and MS
Insulin resistance is a key factor in the development of MS and MAFLD
Inflammation, linked with MS, is the main determinant in progression from NAFLD to NASH
Increased inflow of FFAs and de novo hepatic lipogenesis are the main determinants of MAFLD
Oxidative and ER stresses are involved in the association between MS and MAFLD
Adiponectin, a critical link between MS and MAFLD
Role of gut microbiota in the crosstalk between MAFLD and MS
Association of sarcopenia with MS and MAFLD
Medications for the treatment of MAFLD/NASH
Role of SGLT2 inhibitors
Role of GLP1 receptor agonists
Conclusions
References
14 Cardiovascular Consequences
Introduction
Epidemiology. Atherosclerotic cardiovascular disease
Risk of dying from CVD, CHD, or stroke
Incident heart failure
Adiposity and incident atrial fibrillation
Adiposity and peripheral arterial disease
Risk associations in people with the prevalent disease – obesity paradox or confounding?
Genetics of obesity and cardiovascular outcomes
BMI genes and HF risk
Genetics to directly test the obesity paradox in people with CHD
Mechanisms
Type 2 diabetes
Hypertension
Dyslipidemia
Hemostatic abnormalities
Renal effects
Decreased physical activity
Other pathways
Systemic inflammation
Other pathways
Interventions: weight loss benefits in CV medicine
CV outcome benefits lacking in trials with only modest weight loss
Need for more pronounced weight loss to show CV benefits?
Evidence from bariatric surgery studies
Examples of ongoing randomized weight‐loss trials that could shift clinical paradigms
Timing of weight loss benefits on metabolic versus ASCVD outcomes
Summary
References
15 Obstructive Sleep Apnea
Sleep‐disordered breathing
The physiology of sleep
Definitions in sleep‐disordered breathing
Pathogenesis of OSA: general
Pathogenesis of OSA: the role of obesity
Obesity‐hypoventilation syndrome
Sleep‐disordered breathing: epidemiology. Epidemiology in the general community
Epidemiology in the population with obesity
Sleep‐disordered breathing: clinical aspects. Symptoms and signs of sleep‐disordered breathing
Diagnosis of sleep‐disordered breathing
Consequences of sleep‐disordered breathing. Psycho‐social effects
Cardiovascular effects. Acute effects
Chronic effects: hypertension
Chronic effects: cardiovascular disease
Chronic effects: pulmonary hypertension and lung disease
Chronic effects: endocrine abnormalities
Sleep disordered breathing: treatment
Weight loss
Weight loss interventions
Other general measures
Devices. Continuous positive airway pressure (CPAP)
Mandibular advancement devices
Surgery. Tracheostomy
Uvulopalatopharyngoplasty (UPPP) and other upper airway surgery
Pharmacological treatment
Management of OSA with daytime respiratory failure (including OHS)
Conclusion
References
16 Obesity and Cancer
General mechanisms linking obesity and cancer
Colorectal cancer
Breast cancer
Stomach cancer
Liver cancer
Esophageal cancer
Pancreatic cancer
Ovarian cancer
Intentional weight loss
Early life risk factors for cancer
Dietary characteristics
Wholegrains and Fiber
Comprehensive integration of the evidence‐base
Disclosure
References
17 A Practical Approach to Contemporary Obesity Management
Introduction
Obesity
Weight loss
Weight control in the age of SARs‐CoV‐2 coronavirus (COVID‐19)
Aims of obesity treatment
Current obesity treatment options
Where should these interventions be available/delivered?
Advice, eating, and activity
Very low energy diets
Pharmacotherapy
Bariatric surgery
The multidisciplinary clinic
What of the future?
Summary
Appendix A. Overview of obesity care. Weight history
Physical examination and investigations
Assessment of risk
Assessment of motivation to lose weight
Judging the success of weight control/obesity treatment programs
References
18 Dietary Management of Obesity: Eating Plans
Dietary treatment of obesity
Energy deficit
Energy density
Low‐fat diets
Plant‐based diets
Mediterranean diets
Low energy diets
Partial meal replacement therapy
Low carbohydrate or higher protein diets
Ketogenic diets
Very low energy (calorie) diets (VLEDs)
Box 18.1 Potential complications associated with the use of very low energy diets
Box 18.2 Quick guide to patient exclusion for very low energy diets
Intermittent energy restriction
The less restrictive dieting approach
Ultra‐processed food
Sugar sweetened beverages
Basic principles. Assessment of dietary intake
Smartphone applications
How the information collected in food diaries may be used in the dietary treatment of obesity
Assessing food intake in patients with obesity
Nutrition in practice
Portion sizes and eating frequency
Maintenance and/or success
Clinical guidelines
Conclusion
References
19 The Behavioral Treatment of Obesity
Behavioral treatment
Components of behavioral treatment
Self‐monitoring
Functional analysis
Stimulus control
Cognitive restructuring
Problem solving
Relapse prevention
Dietary options for weight loss
Portion‐controlled foods and meal replacements
Physical activity
Structure of behavioral treatment
Individual treatment
Group‐based treatment
Remote treatment
Short‐ and long‐term weight losses
Strategies to improve long‐term weight losses
Extended care
Physical activity and other weight‐related behaviors
Anti‐obesity medications (AOMs)
New behavioral approaches
Motivational interviewing
Acceptance and commitment therapy
Implementation and dissemination of behavioral treatment
Primary care management of obesity
Community‐based treatment
Commercial weight loss programs
Technology‐based interventions
Technology for self‐monitoring
Real‐time telephone and videoconferencing
Text messaging
Apps
Conclusion
References
20 Role of Exercise and Physical Activity in Promoting Weight Loss and Weight Loss Maintenance
Introduction
Operational definitions
Relationships between PA levels and body mass
Relationships between sedentary behavior and body mass
Energy balance considerations
Exercise and weight reduction
Efficacy of exercise compared to other interventions
Effectiveness of diet‐plus‐exercise interventions
Resistance training
Exercise factors that may influence magnitude of weight loss
Exercise duration
Exercise intensity
Energy expenditure
Can walking interventions aid weight loss?
Walking intensity
Using other measures of excess weight to determine the metabolic benefit of exercise
Biological response to weight loss from any type of intervention
Compensatory changes in EI
Compensatory changes in EE
Evidence for metabolic adaptations to exercise
Evidence for adjustments in EE with exercise
Evidence for adjustments in EI
Heterogeneity in exercise response and the concept of responders vs. nonresponders
Use of exercise/PA as a tool to achieve weight loss maintenance (WLM)
Conclusions
References
21 Adjunctive Therapy, Including Pharmacotherapy
Introduction and general principles
Classification of obesity medication
Currently approved drugs. Drugs which inhibit drugs that inhibit intestinal fat absorption. Orlistat
Drugs suppressing food intake. Phentermine and other sympathomimetic agents
Phentermine
Diethylpropion
Recommended doses and side effects
Liraglutide
Combination therapy. Phentermine and topiramate
Naltrexone and bupropion
Potential future targets including medications not licensed for use in obesity
GLP‐1 RA
Exenatide
Lixisenatide
Dulaglutide
Semaglutide
GLP‐1 multi‐agonists
GLP‐1/glucagon dual receptor agonists: oxyntomodulin
GLP‐1/GIP receptor dual agonists
GLP‐1/GIP/glucagon tri‐agonists
SGLT2 inhibitors
Dapagliflozin
Canagliflozin
Anti‐epileptic drugs. Topiramate
Zonisamide
Zonisamide and bupropion
Amylin mimetics and leptin analogs
Tesofensine
Setmelanotide
Cannabinoid type‐1 receptor antagonist
Ghrelin antagonism
The use of anti‐obesity drug therapy post‐bariatric surgery
Conclusion
References
22 The Management of Obesity: Surgery
Introduction
The evolution of surgical technique. The initial phase (1950–1970): small bowel bypass
The middle phase (1970–1990): stomach stapling
The current phase (1990–present): minimally invasive and adjustable procedures
Overview of outcomes from bariatric procedures
Weight loss outcomes from bariatric surgery
Changes in health after bariatric surgery
Type 2 diabetes mellitus
Dyslipidemia of obesity
Hypertension
Ovarian dysfunction, infertility, and pregnancy
Obstructive sleep apnea
Nonalcoholic steatohepatitis
Changes in quality of life after bariatric surgery
Survival after bariatric surgery
The Swedish Obese Subjects (SOS) study
Safety of bariatric surgery
Conclusion
References
23 Weight Loss Maintenance and Weight Cycling
What is weight loss maintenance and how is it defined?
What lifestyle characteristics are associated with weight maintenance success?
Interventions – what works for weight loss maintenance, and when. Studies using a multicomponent intervention to maximize weight loss maintenance
Impact of self‐weighing and physical activity on weight loss maintenance
Advice to eat greater amounts of low energy density foods and alter macronutrient content
Relationship between quantity of intentional weight loss and weight maintenance success
Strategies to challenge weight cycling/weight regain
Weight maintenance in those postbariatric surgery
Weight loss maintenance post pharmacologically assisted weight loss
Weight maintenance using Intermittent weight loss LELD approaches
Clinical and commercial approaches for weight loss maintenance
Conclusion
References
24 Training and Medical Systems for Obesity Care
The current state of obesity knowledge and care
Medical education
Provider training and competencies
Obesity medicine education collaborative competencies
Medical licensure
Obesity medicine as a specialty
Systems of care for obesity. The cultural context of obesity
Stigma and bias
Language and accommodation
The need for changes in care delivery
An alternative care delivery system
Standard of care for pediatric obesity treatment
Standard of care for adult obesity treatment
Summary
References
25 The Prevention of Childhood Obesity
Introduction
The socio‐ecological framework for childhood obesity
World Health Organization recommendations for childhood obesity
Panel 25.1: The six key areas of action from the 2016 Report of the World Health Organization Commission on Ending Childhood Obesity
Cochrane review on interventions for preventing obesity in children
Obesity prevention in clinical settings
Panel 25.2 Target behaviors/healthy habits for obesity prevention. (Adapted from Barlow [14].)
Early childhood
Family focus in early childhood
Schools
School policy changes
Behavior change interventions in communities
Policy interventions in communities. Somerville, Massachusetts
Be Active Eat Well
Childhood Obesity Declines Project (COBD)
The Healthy Communities Study
EPODE
Recommendations for physical activity from the Guide for Community Preventive Services
Country‐level Initiatives. United States
Chile
Sugary drink taxes
Novel approaches to obesity prevention. The two‐generation approach
Approaches to obesity as a complex system
Criteria for the selection of prevention strategies
Summary
References
26 Consequences of Childhood and Adolescent Obesity: The Need for a Broad Approach
Seeing the child and youth in context
Comparing the consequences of obesity, and obesity as a causal factor of chronic health conditions
Consequences of childhood and adolescent obesity
Medical consequences of childhood and adolescent obesity. Cardiovascular
Hypertension
Dyslipidemia
Box 26.1 Medical and psychological complications of child and adolescent obesity
Endocrine. Type 2 diabetes mellitus
Insulin resistance
Puberty, fertility, menses, and polycystic ovarian syndrome
Gynecomastia and pseudogynecomastia
Metabolic syndrome
Box 26.2 IDF definition of at‐risk group and of metabolic syndrome in children and adolescents
Respiratory impairment. Obstructive sleep apnea
Asthma and decreased exercise tolerance
Obesity hypoventilation syndrome
Orthopedic, musculoskeletal discomfort and mobility issues
Gastrointestinal. Functional gastrointestinal disorders including constipation
Gastroesophageal reflux disease
Cholelithiasis
Liver dysfunction
Renal
Neurologic. Idiopathic intracranial hypertension
Headache
Malignancy
Dermatologic. Acanthosis nigricans
Intertrigo
Heat rash/intolerance
Skin infections/panniculus
Striae
Oral. Dental caries
Psychological and psychosocial consequences of childhood and adolescent obesity
Self‐esteem and health‐related quality of life
Stigmatization, stereotypes, and bullying behavior
Depression and psychological distress
Disordered eating behavior
Impairment of cognitive functioning
Physical examination of the child and adolescent with obesity
Investigations for a child or adolescent with obesity
Box 26.3 Updated definitions for blood pressure categories and stages
Conclusion
References
27 The Treatment of Childhood and Adolescent Obesity
Introduction
Approach to the child with obesity
Treatment overview
Treating obesity as a chronic disease
Behavioral interventions
Motivational interviewing and primary care counseling to modify lifestyle behaviors
Comprehensive multidisciplinary obesity treatment
Specific dietary modifications
Pharmacotherapy
Bariatric surgery
Information systems
Conclusions
References
28 Policy Approaches to Obesity Prevention
Early interest in obesity policy: the 1970s and 1980s
Ecological determinants of obesity: the 1990s and early 2000s
Life‐course approach
Nutrition security
Nutrient profiling and ultra‐processing
Global development and systems approach: the early 2000s
Systems and evidence‐based interventions
Cross‐cutting issue: inequalities
Targets and “best buys” in the early 2010s
Voluntary measures
From best buys to regulating commerce: the later 2010s
Box 28.1 Extract from an address by Dr Margaret Chan, Director General of the WHO, June 2013
Box 28.2 Reasons given by WHO NCD Commission for slow progress in meeting targets
Explicit recognition of “commercial determinants” of obesity
A sustainable political economy of health: the 2020s
Box 28.3 Comment from the International Food and Beverage Association on the draft NCD Roadmap. IFBA, 2017 [106]
The political economy of obesity: building a sustainable response
Identifying the political objectives
Changing the narrative
Demonstrate societal causes of obesity
Declare no shame in obesity
Change public health language
Using the power of rights
The Right to Health
The Right to Food
The Rights of the Child
Conclusion
Notes
References
29 The Double Burden of Malnutrition
Introduction
Scope of the problem and prevalence. Country level
Household level
Individual level
Dynamics of the double burden. Social determinants
Economic and technology revolution and the changing food environment
Equity considerations
Double‐duty actions
Early childhood development amidst double burden malnutrition. Breastfeeding
Nutrient and food‐based dietary recommendations
Conclusion
Acknowledgments
References
30 Taxes, Subsidies, and Policies
Introduction
Food environments and dietary determinants
Importance of policies with an environmental lens
Impact on dietary patterns and health
Taxes and subsidies
Taxes on other products
Health benefits of introducing taxes or subsidies to food
Subsidies and their effects on consumption
Cost‐effectiveness of fiscal measures and other interventions to combat obesity and NCDs
Production subsidies
Subsidizing healthy foods
Complementary policies to accompany fiscal policies
Breastfeeding practices
Interventions in healthcare settings
Marketing restrictions for unhealthy products
Front of pack labeling
Policies supporting nutrition education
Built environment
Schools and the workplace
Conclusion
References
31 The Global Syndemic of Obesity, Undernutrition, and Climate Change
Background
Trends in obesity, undernutrition, and climate change
Operating in silos
Malnutrition in all its forms
The highest global burden of disease is from malnutrition
The Global Syndemic
The Systems Outcomes Framework
Interactions and common drivers of the Global Syndemic
Common driver examples
Five critical sets of feedback loops
The roles for individuals
Policy inertia
Systems thinking approach to the Global Syndemic
Syndemic and obesity systems thinking
Different ways to understand a system
Interventions and policy challenges
Leverage points
Double‐ and triple‐duty actions
Reducing red meat consumption
Transport mode shifts
Healthy, sustainable dietary guidelines
Restrict commercial influences on policy‐making
Right to wellbeing legislation
Framework Convention on Food Systems
Applying systems approaches – cities
A whole‐of‐systems city‐approaches
WHO Healthy Cities Initiative
C40 Network
Other examples of city initiatives: Food Policy Councils
Amsterdam case study of whole‐of‐systems city‐approach to obesity
Integrated approach
Systemic action
Evaluation
Applying systems approaches – communities
Illustrative examples of communities using systems approaches
Key challenges for community‐based systems approaches
References
Index
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