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Obesity: Science to Practice

Gareth Williams (Editor), Gema Fruhbeck (Editor)
ISBN: 978-0-470-01911-5
604 pages
April 2009
Obesity: Science to Practice (0470019115) cover image
This comprehensive textbook addresses one of the major public health concerns of our era – obesity. Clearly and simply, Obesity: science to practice provides a balanced, coherent account of obesity: how to define and measure it, its epidemiology, the physiological basis, associated diseases, how to assess, manage and treat it, and also strategies for prevention. The book is generously illustrated, including graphs and flow charts for easy reference. The chapters cite key references so that interested readers may pursue a given topic in more detail. Well presented and thoroughly edited by one of the leading experts in the field, this is the textbook of choice for anyone working in obesity.
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Preface xiii

List of Contributors xv

1 History of Obesity 3
George A. Bray

Early human history 3

History of the biology of obesity 6

Descriptions and measurements of obesity 7

Metabolism and energy balance 8

Health hazards of obesity 10

Causes of obesity 12

Treatment of obesity 15

Growth of the scientifi c community 16

References 17

2 Epidemiology and Social Impact of Obesity 21
Neville Rigby, Rachel Leach, Tim Lobstein, Rachel Huxley, and Shiriki Kumanyika

Definitions of obesity 21

Current and recent prevalences of obesity 25

Childhood obesity 31

Predicted increases in obesity in adults 34

Comorbidities of obesity 35

Costs of obesity to society 37

Conclusions 39

References 39

3 Key Methodologies in Obesity Research and Practice 45
Susan A. Jebb, Alexandra M. Johnstone, Janet Warren, Gail R. Goldberg, and Les Bluck

Anthropometric indices 45

Measurements of body composition 49

Measurements of fat distribution 53

Measuring energy balance 55

Assessing insulin sensitivity 66

References 72

4 Adipose Tissue: Development, Anatomy and Functions 79
Dominique Langin, Gema Frühbeck, Keith N. Frayn, and Max Lafontan

Introduction 79

Development of white adipose tissue 79

Structure of white adipose tissue 82

Fat storage and mobilization 88

Adipokines 93

Receptors expressed by adipose tissue 98

Brown adipose tissue 98

Adipose tissue development and dynamics 102

References 103

5 The Regulation of Energy Balance: An Overview 111
Gareth Williams

Regulation of body fat and composition 111

Regulation of energy intake and expenditure 118

Lessons from other species: informative or misleading? 120

Causes of obesity 121

References 124

6 Control of Eating 127
Wolfgang Langhans, Joanne Harrold, Gareth Williams, and Nori Geary

Flavour and orosensory signals 127

Gut signals 129

Metabolic signals 133

Adiposity signals 136

The neuroanatomy of eating regulation 140

The neuropharmacology of eating control 147

Modulating factors 151

References 152

7 Energy Balance in Humans 167
Ellen E. Blaak

Energy balance 167

Energy intake 167

Energy expenditure 171

Altered sympathetic activity in obesity 178

Substrate oxidation and predisposition to obesity 179

References 181

8 Aetiology of Human Obesity 187
John R. Speakman and David Levitsky

Lifestyle-related obesity 187

Changes in the prevalence of obesity over time 196

Drug-induced obesity 202

Endocrine causes of obesity 204

Specifi c genetic disorders 205

References 208

9 Health Hazards of Obesity: An Overview 215
Ronald C.W. Ma, Gary T.C. Ko, and Juliana C.N. Chan

Measures of obesity as predictors of morbidity and mortality 215

Obesity and premature mortality 217

Cardiovascular disease 221

Type 2 diabetes 225

Malignancy 228

Gall-bladder disease 229

Osteoarthritis 229

Chronic renal failure 230

Ethnic differences in obesity-related predictors of disease 230

Conclusions 231

References 232

10 Metabolic Complications of Obesity 237
Ronald Ma and Juliana Chan

Type 2 diabetes 237

The metabolic syndrome 241

Obesity and insulin resistance 244

Obesity and the development of type 2 diabetes 254

Dyslipidaemia in obesity and the metabolic syndrome 258

References 261

11 Liver Disease in Obesity 273
Nimantha de Alwis and Chris Day

Epidemiology 273

Pathogenesis of NAFLD in obesity 273

Pathology of NAFLD 275

Natural history of NAFLD 275

Clinical presentation 276

Investigation of suspected NAFLD 277

Management of patients with NAFLD 279

References 282

12 Cardiovascular Disease and Obesity 287
Gianluca Iacobellis and Arya M. Sharma

General links between obesity and cardiovascular disease 287

Impact of obesity on the heart 290

Obesity and hypertension 296

Obesity and congestive heart failure 299

Obesity and coronary artery disease 300

Obesity and arrhythmias 300

Cardiac-associated adipose tissue 301

Peripheral vascular disease 304

Cardiovascular disease in ‘metabolically healthy obesity’ 306

Investigation of cardiovascular disease in obesity 307

Management of cardiovascular disease in obese subjects 308

References 311

13 Obesity and Other Diseases 323
Mimi Chen and Robert Andrews

Musculoskeletal disorders 323

Respiratory system 324

Endocrine system 328

Gastrointestinal tract 336

Obesity and cancer 336

Psychological and psychiatric disorders 339

References 339

14 Social and Psychological Factors in Obesity 347
Andrew J. Hill

Stereotyping of obesity 347

Adult attitudes 349

Social disadvantage 349

Psychological well-being 354

The way forward 359

References 360

15 Assessment and Investigation of Obesity 367
Luc Van Gaal and Ilse Mertens

Causes of obesity 367

Comorbidities and health risks of obesity 370

Practical assessment of obesity 375

Personal history 375

Review of systems 380

Clinical examination 380

Screening investigations 384

Assessment of the overweight patient 385

References 385

16 Managing Obesity: General Approach and Lifestyle Intervention 393
Susanne Wiesner and Jens Jordan

Selection of patients for obesity management 393

Treatment targets 394

Lifestyle modifi cation 398

Physical activity 407

References 411

17 Pharmacological Approaches for Treating Obesity 421
John Wilding

Historical context 421

Defining the effi cacy of anti-obesity drugs 424

Potential targets for intervention 425

Indications for pharmacotherapy in obesity 432

Currently available treatments 433

Use of anti-obesity drugs in children and adolescents 441

Drugs causing weight gain 441

Future directions 441

References 442

18 Surgical Approaches to the Management of Obesity 449
Mervyn Deitel

Rationale of bariatric surgical procedures 449

History of bariatric surgery 449

Bariatric operations in current use 454

General aspects of bariatric surgery 460

Conclusions 464

References 464

19 Special Considerations in Managing Obesity 471
Mimi Chen and Robert Andrews

Managing causes of secondary obesity 471

Management of intercurrent conditions in obesity 474

Managing type 2 diabetes in obese patients 479

Management of IFG and IGT 488

Management of dyslipidaemia 489

Complementary therapies and obesity 490

References 492

20 Eating Disorders in Obesity 499
Susan M. Byrne and Emma R. Dove

Binge eating and binge eating disorder 499

Night eating syndrome 502

Psychopathology associated with BED and NES in obese individuals 502

Body dissatisfaction and preoccupation with weight and shape 503

Assessment and treatment of eating disorders in obese individuals 503

References 505

21 Obesity in Childhood 509
Julian Shield and Carolyn Summerbell

Defining obesity in children 509

Aetiology of childhood obesity 512

Consequences of childhood obesity 520

Investigation and assessment 522

Treatment of childhood obesity 525

Prevention of childhood obesity 531

References 533

22 Prevention of Obesity 543
Tim Lobstein

Primary and secondary obesity prevention 543

Extending the evidence base through future studies 554

Tertiary prevention 554

Cost-effectiveness of obesity prevention strategies 556

Investing in health 557

Inequalities and health promotion 557

Conclusions 558

References 558

23 A Look to the Future 565
Gareth Williams and Gema Frühbeck

Obesity and its fellow-travellers: here to stay 565

More secrets from fat? 566

Energy balance and obesity: signals and noise 567

Managing obesity: must do better 567

Prevention: better than cure, but ... 569

Whose problem is it anyway? 569

Index 571

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Gareth Williams, MD, ScD FRCP Edin, Professor of Medicine, University of Bristol, Southmead Hospital, Bristol, UK.

Gema Fruhbeck, Department of Endocrinology, Clinica Universitaria and Metabolic Research Laboratory, University of Navarra, Spain.

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