The Only Constant is Change

Obesity… “You did this to yourself.” “Look at that person; he’s big as a house.” “Can you spell exercise?” “With a little self control you could take off a few pounds.” “Why don’t you put down the potato and get off the couch!” Look at your own views and preconceptions about obesity and I’m sure you can add a few sentences to this list. It can easily be said that there are more misunderstandings about obesity than about any other major health epidemic. Faulty or incomplete weight loss information is introduced on a daily basis by a variety of “experts”, with offerings of yet another fad diet, each with a new array of marketable diet products. And yet more then one-half of American adults are overweight and about half of those could be considered obese.
Up until the early 1980s, Americans’ body sizes had remained relatively stable, growing by just a third of a pound between 1962 and 1980. The average adult male weighed 174 pounds, and the typical woman was 145 pounds. But as society sped up, eating habits changed. Larger portions of “cheaper, fattier food; more dual-income households that scarfed more restaurant grub and cooked less at home; and suburban sprawl that turned formerly active urban dwellers into sedentary drivers and couch potatoes” (Crawford). Obesity was on the rise.
Obesity has become a national epidemic during the past twenty years, with nearly one-third of all adults being classified as obese, according to the American Medical Association. The Center for Disease Control shows a 30% increase in obesity adults 20 years of age and older (a body mass index (BMI) of 30 or greater), and a 16% increase among children and teens (defined as BMI-for-age at or above the 95th percentile of the CDC Growth Charts). Over 60 million American adults and over 9 million American young people are considered overweight. The CDC has made this issue a priority and pledged to reduce the prevalence of obesity among adults to less than 15% by the year 2010, however “current data indicate that the situation is worsening rather than improving” (CDC).
The obesity problem seems to affect women (33 percent) more than men (28 percent); non-Hispanic black women (49 percent) more then Mexican-American women (38 percent) and non-Hispanic white women a little less (31 percent). Men are affected at the same numbers regardless of race or ethnicity. Teens ages 12-19 fare a bit better, with non-Hispanic blacks (21 percent), Mexican-American adolescents (23 percent), and non-Hispanic white adolescents (14 percent). The trend for ever increasing numbers in children is the most disturbing. Children ages 6-11 show obesity rates of 22% for Mexican-American children, 20% for non-Hispanic black children, and 14% for non-Hispanic white children, with an additional 15% of children and teens ages 6 to 19 considered at risk for becoming overweight, showing a BMI-for-age between the 85th and 95th percentiles (NCHS). California’s numbers are even bleaker, “with numbers rivaling the tobacco problem. The prevalence of overweight in Californians has increased from 38 percent in 1984 to 57 percent in 2003. All gender, age, and race/ethnic groups have shown an increase during the past decade.  Californians below the poverty level are disproportionately affected” (COPI).
Why should obesity be such a concern? Besides being considered “unattractive” in our society which could result in stigmatism, discrimination and isolation, obesity brings with it an increase in other health conditions and diseases. Some of these concerns include hypertension, dyslipidemia, type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea and respiratory problems, and some cancers such as endometrial, breast, and colon cancer. (CDC). “Poor diet and physical inactivity are the second leading causes of death and disability, resulting in nearly 30,000 deaths each year in California” (COPI). And then there is the issue of eating disorders which can be life threatening.
Obesity is a complicated issue and we are looking for a simple solution. Many diet professionals’ simple answer to the growing epidemic of obesity has been to recommend more exercise and a balanced diet. This fails to take into account other factors that can affect weight loss, and fosters an incomplete understanding of the biological and hormonal changes that underlie obesity among aging adults. The fact is that as we age, we undergo physiological changes that encourage weight gain. These include hormonal changes and alterations in the way our bodies process nutrients.
With the best information available is seems that there is no single cause of obesity. Some of the most popular theories indicate that genetic predisposition, environmental factors, and behavior are the most common causes. It is clear that overeating and lack of exercise are critical causes of weight gain and obesity, but many other factors can affect body weight and composition. Hormonal changes including a deficiency of testosterone or an overproduction of estrogen can contribute to abdominal obesity. As women age progesterone and estrogen levels decrease causing imbalances that can lead to central body fat accumulation. DHEA hormones decrease as we age, which affect metabolism rates. All of these factors can lead to insulin resistance, also known as metabolic syndrome or Syndrome X, which can occur as we age, and are associated with obesity. And of course there is the issue of emotional hunger which may be responsible for 75 percent of overeating.
While it is true that Americans are consuming more calories than ever before, it is also true that we are performing less physical activity. Dr. Marion Nestle, Professor and Chair of the Department of Nutrition and Food Studies at New York University (NYU) states that, “The ubiquity of fast food outlets and soda vending machines, the huge increase in portion sizes at restaurants, the decline in school physical education programs, and the many hours spent on the Internet and watching television are all contributing to the obesity epidemic.” Dr. Michael F. Jacobson, Executive Director of the Center for Science in the Public Interest states that “Public health officials need to recognize that obesity is a natural consequence of an auto-oriented, TV-watching lifestyle. To prevent obesity, we need to change our lifestyle, not just admonish people to eat less. We need national leadership to get us out of the drive-thru and off the couch if we want to stop the epidemic of obesity.” (CSPI).
California Obesity Prevention Initiative states that “The worldwide spread of obesity has been attributed to complex, powerful societal forces that encourage eating too many high calorie foods, getting too little physical activity, and acquiring too much body weight over time.” This makes for happy marketing companies who push “large portions of high calorie foods with little nutritional value” which are made ever present choices for our fast moving society, making it inconvenient for people to maintain a healthy diet.
Technology has decreased the extent of physical activity in most workplaces, in daily living, for transportation, and during leisure. Renewed emphasis on academic achievement, nationwide budget cuts in the educational system and newly imposed safety concerns have reduced the time and space available for active play as well as for structured physical education. Long workdays and single parent households limit time for physical activity, and safety concerns, poor community design, and urban sprawl discourage walking, bicycling, and recreation in many neighborhoods. Time spent watching television plays an important role in adult, adolescent and childhood obesity.
Some childhood factors occurring very early or for brief periods in life contribute to obesity later in life. These include high birth weight from uncontrolled diabetes, low birth weight, and lack of breastfeeding.  Children breastfed at any time are 15% to 25% less likely to become overweight, while children breastfed 6 months or longer are 20% to 40% less likely” (COPI).
Long term dieting is a newly recognized factor in the growing obesity rates. Michael Sponagle sites a University of Toronto study that found that “long-term dieters have less ability to recognize subtle physical hunger cues and tend to respond to hunger only when it has reached ravenous proportions. Additionally, when diet devotees did eat, they couldn’t tell when they were experiencing subtle feelings of fullness”. Sponagle cites a Herman and Polivy study that suggests a zone of “biological indifference,” when eating-or not eating-becomes controlled by outside factors such as time of day, thoughts and feelings, rather than the body”. (Sponagle)
What is in your genes plays a major role in the propensity toward obesity, according to a study from an international team of researchers that included scientists from the Boston University School of Medicine and the Harvard School of Public Health in the Framingham Heart Study. A new technique was used that studied thousands of genetic fragments to determine whether there were any common genetic links that occurred in people with obesity. The study found that there are common genetic traits, but as yet haven’t determined how they relate to obesity. Michael Christman, an author of the study and chairman of BU’s department of genetics and genomics, said that, “What it says is that obesity is better viewed as a medical condition like heart disease, and if someone has heart disease or cancer it’s not generally considered their fault. But if they’re obese, it generally is.” Further research looks hopeful and could eventually lead to the development of drugs that could fight the condition. (Smith) Other studies published in the New England Journal of Medicine that look promising have suggested that “obesity is a medical condition that can’t be solved by willpower alone”. Studies on severely obese adults have discovered that some have a mutated gene called melanocortin 4, and “of that group, 100 percent were binge eaters” (Sponagle). Another report finds that “Researchers at Boston University (found) a genetic link to obesity that seems to run in families, which could lead to a genetic treatment…” (Taylor). All these discoveries look promising for future treatments in the battle against obesity.
Emotional eating is a cause of over consumption of calories, which can lead to obesity, and is encouraged in our culture. Food can be used to comfort, to celebrate, to show love, to compensate for tiredness or pain, to calm and to provide pleasure. Emotional eating can be a substitute for dealing with underlying issues which could be causing emotional distress such as loneliness, boredom, sadness, anxiety, anger or just generally feeling lost. This cultural food nurturing is passed along to our children as we use food to comfort children, leading to a sort of “self-medication through food” in later teen and adult years. Add to this the possible addictive qualities that are being found in certain foods such as chocolate and it is easy to see how food becomes a panacea for what ails you. Also being investigated is the possibility that “sweet and foods might actually alleviate feelings of anxiety” which suggest that certain foods can lead to “nonphysical hunger” (Sponagle). Making normal eating tougher still is the typical North American lifestyle, which exists in a constant state of stress and chaos. No longer is the typical evening spent sitting down to dinner, but rather eating on the run, eating at our desks, eating while we multi-task, or watch TV, disconnecting us from our natural hunger cues.
Dr. Oliver-Pyatt also blames chronic dieting itself for pushing us to eat when we’re not physically hungry. “Restricting food choices while dieting leads to compulsivity, due to deprivation. Telling yourself you can’t have something sets you up for failure and creates a stronger psychological pull to those so-called bad foods. If you want to lose weight, you have to stop dieting. My patients look at me in horror when I say this, but it’s true.” (Sponagle) Nutritionists suggest that cutting calories, meals, food groups or “eating only when hungry” sets the body up to enter a sort of “starvation mode” where any calories taken in will be stored as fat, rather then used to build and maintain healthy cells and energy.
Some of the medical issues that can result in weight gain include hypothyroidism, insulin resistance, which can lead to metabolic syndrome (aka Syndrome X), and hormonal changes in men and women.

Hypothyroidism is caused by a lack of thyroid hormone and is connected to weight gain, as well as dry hair and skin, fatigue, and sluggishness. Thyroid hormone is produced in the thyroid gland and is the master metabolic control mechanism. One of the first tests that should be performed on an overweight person is a simple blood test that can check thyroid levels to make sure they aren’t lacking thyroid hormone. A simple prescription can supplement the body and promote healing.

Insulin resistance is an impaired metabolic response to our body’s own insulin. This can cause the individual muscles cells to fail to recognize that they need to take in the available glucose, which in turn causes the pancreas to release more insulin, making the blood insulin levels chronically high. This can cause the fat cells to hoard their energy, making it difficult to lose weight. This disorder is associated with obesity, hypertension, abnormal triglycerides, glucose intolerance (syndrome ‘X”) and Type 2 diabetes mellitus. This condition can go unrecognized and undiagnosed causing metabolic damage which can lead to Type 2 diabetes. “Insulin resistant diabetics are 2-5 times more likely to die from heart attack or stroke than are non diabetics” (Jelovsek).

Risk factors for insulin resistance are similar to those for developing diabetes and include a family history of type 2 diabetes, high blood pressure, central obesity, body mass index over 27, a low HDL level or elevated triglycerides, atherosclerotic or coronary heart disease, polycystic ovarian syndrome, a history of gestational diabetes in pregnancy, and darkened skin changes in the neck, auxiliary and/or breast folds consistent with acanthosis nigracans. Additionally, insulin resistance may be worsened by reduced physical activity, aging, tobacco smoking, or drugs such as diuretics, certain anti-hypertensives, or steroids. Insulin resistance is diagnosed through a test called the hyperinsulinemic euglycemic clamp study in which insulin and glucose is infused intravenously at several different doses to see what levels of insulin control different levels of glucose. The main reason to diagnose insulin resistance is to go further on to look for Type 2 diabetes. (Jelovsek)

Metabolic syndrome is characterized by a group of metabolic risk factors including “abdominal obesity, atherogenic dyslipidemia (high triglycerides, low HDL cholesterol and high LDL cholesterol — that foster plaque buildups in artery walls), elevated blood pressure, insulin resistance or glucose intolerance, prothrombotic state, and proinflammatory state (e.g., elevated C-reactive protein in the blood). Other conditions associated with the syndrome include physical inactivity, aging, hormonal imbalance and genetic predisposition” (AHA). Metabolic syndrome increases the risk of coronary heart disease and other diseases related to plaque buildups in artery walls such as stroke and peripheral vascular disease, and type 2 diabetes. It is estimated that over 50 million Americans as metabolic syndrome has become increasingly common in the United States.
Since there are no well-accepted criteria for diagnosing metabolic syndrome, the American Heart Association and the National Heart, Lung, and Blood Institute recommend that the metabolic syndrome be identified as the presence of three or more of these components: elevated waist circumference, elevated triglycerides, reduced HDL (“good” cholesterol), elevated blood pressure, or elevated fasting glucose.
AHA Recommendations for Managing the Metabolic Syndrome include weight loss to achieve a desirable weight (BMI less than 25 kg/m2), increased physical activity, with a goal of at least 30 minutes of moderate-intensity activity on most days of the week, and healthy eating habits that include reduced intake of saturated fat, trans fat and cholesterol” (AHA) with the primary goal of reducing the risk for cardiovascular disease and type 2 diabetes.
Hormonal changes in men can lead to gaining weight around the middle, a medical condition called “abdominal obesity.” This happens because as men age, their levels of free testosterone decline, and levels of estrogen and insulin increase which in turn converts their testosterone into estradiol, a form of estrogen. The remaining testosterone is not biologically active and can lead to central obesity. This sort of fat accumulation greatly increases the risk of cardiovascular and other diseases.
Testosterone replacement therapy can restore the level of free testosterone levels of a much younger man, which can reverse the conversion of the testosterone into estradiol. Clinical studies have shown that testosterone replacement therapy can provide a variety of benefits including decreased middle abdomen, decreased blood pressure, a decrease in plasma insulin and an increase in glucose disposal (suggesting improved insulin sensitivity) improved sexual function after testosterone therapy (Obesity Online reference, Boyanov et al 2003).
Hormonal changes in women appear to lead to excess body fat, although the relationship between testosterone, estrogens, and progesterone is somewhat more complicated. As women age, levels of progesterone and all estrogens (including estriol, estradiol, and estrone) decline. Progesterone declines much more rapidly than do the estrogens, leading to “estrogen dominance” which “may play a pivotal role in the dynamics of metabolic obesity and visceral fat accumulation in aging women” (Obesity Online reference).
Testosterone and estrogen are not the only hormones implicated in weight gain. Low levels of DHEA (dehydroepiandrosterone), a steroid hormone, have also been linked to increased weight gain. Virtually everyone over age 35 experiences a significant reduction in DHEA. Studies suggest that supplementing with DHEA produces beneficial body composition changes including decreased abdominal obesity and improved insulin action. (Obesity Online reference, Villareal et al 2000; Villareal et al 2004).
What can be done to combat the Obesity Epidemic? Let’s begin with diet and exercise. Studies show that the best eating recommendations includes no dieting! A balanced diet including complete proteins, whole grains, fresh fruits and vegetables and healthy fats are the only solution to a stable weight. Feeding the body to maintain, renew and build the cellular structure is necessary and should be taken in regular 3-4 hour increments in order to maintain stable insulin and blood glucose levels, which in turn will make the nutrients available to the cells to maintain a healthy cellular mechanism. Exercise is equally important, however should be done to maintain health. Studies have shown that “over exercise” can be as damaging as “under exercise”, as it subjects the body to a constant break down of cellular structure that can be difficult to maintain healthy maintenance of cell, muscles tissue and glucose levels. Exercise should include cardio exercise as well as weight baring exercise to encourage muscle maintenance.

Education on a national level can help encourage new major governmental and societal changes to reduce the prevalence of obesity. In a Public Health Reports, nutrition professor Marion Nestle and nutrition activist Michael F. Jacobson suggest specific recommendations including “mounting large scale mass-media campaigns to promote healthier diets and physical activity; requiring chain restaurants to provide information about calorie content on menus or menu boards; designating more downtown areas as pedestrian malls and automobile-free zones; and having health insurance companies pay for effective weight-loss programs. (CSPI). Organizations are coming together to encourage the U.S. Department of Health and Human Services and the U.S. Department of Agriculture to emphasize, at their upcoming (May 30 – 31) National Nutrition Summit, “changes in government policies and corporate practices, including a ban in schools on the sale of soft drinks, candy bars, and other foods high in calories, fat, or sugar” (CSPI).
They go on to explain that these actions are necessary if the country is to reverse the increasing weight trends.
Bariatric surgery can be a solution for people who are morbidly obese, as diet and exercise alone don’t work in the long term. Morbid obesity is a very specific kind of obesity, and it’s determined by a body mass index (BMI) of 40 or greater, or a BMI that is higher than 35m, in addition to other serious health problems such as diabetes and high blood pressure. Bariatric surgery includes several surgical procedures, including gastric bypass that is expected to lose a person’s excess body weight to about 60-70%. (Raftopoulos). In addition to losing weight, many people who undergo gastric bypass see a significant improvement in other serious health problems, including hypertension, sleep apnea, heart problems, osteoarthritis, and high cholesterol levels, and diabetes (both type 1 and type 2).
Emotional eating requires a different approach which usually includes some type of therapy. Psychiatric counseling can help a person with emotional hunger, which has been estimated to account for 75 percent of overeating. “When emotional hunger overshadows physical hunger, our ability to hear what the body is saying erodes. And that’s when we can find ourselves in the middle of a complicated love/hate relationship with food” (Sponagle). Studies concerning the chemical processes which occur between appetite and satiety have shown that the “complex system controls the signals that start and stop the urge to eat and how food is processed in the body. The system works just fine most of the time, but some conditions (bulimia, anorexia nervosa and obesity) cause it to behave abnormally. Ironically, habitual dieting can throw a wrench into our well-oiled eating machinery”. (Sponagle) Therapy can help address issues behind emotional eating habits and address any medical concerns which may be necessary to treat in order for long term changes to be implemented.
Physical Education Programs need to be encouraged and/or expanded. Data from the 2003 California Department of Education FITNESSGRAM reveals that “out of children in grades five, seven, and nine only 23 percent of the students tested in grade five, 27.1 percent in grade seven, and 24.1 percent in grade nine met the minimum fitness standards” (COPI) which measured major fitness areas including aerobic capacity, body composition, abdominal strength and endurance, trunk strength and flexibility, upper body strength and endurance, and overall flexibility. “National and state surveys indicate that rates of overweight and obesity began to rise in the late 1980’s, accelerated in the 1990’s, and as yet in this decade show no signs of slowing. Of the nation’s ten Leading Health Indicators for Healthy People 2010, only overweight and obesity are moving strongly in the wrong direction” (COPI).
Some of the issues that prevent America from addressing the obesity problem include time management, social stigmas, and new marketing trends.
Time management is a difficult issue to address in our society today. With most households needing duel incomes or jobs in order to maintain our perceived or real standard of living needs, there seems little time to devote to enhancing the quality of life issues, like health. When single parents, dual income parents, or the single career bound upwardly mobile individuals come home after a ten hour day, the last thing on their minds is exercise, good eating and some soothing relaxation before going to bed at a descent hour (in order to assure a good night’s sleep). No, it’s more like rushing home and picking up some pre-made meal on the way to shove in front of the kids in order to rush off to homework, housework, continuing education work, PTA meetings, work brought home from the office work, or the second job. Exercise? Taking time for a quality meal? Bubble bath, reading, soothing music, or a nice leisurely chat with a friend? In your dreams.
The pace of everyday life has become a frantic dance and the best of us play catch up on a good day. We have put our priorities firmly in place and at the top of the list is all the stuff we “need”. We “need” cars, plasma screen TV’s, DVD players, designer labels (sometimes bought at reduced prices at Ross), gym memberships (even if you don’t use them), SUV’s (4 wheel drive for our dangerous city streets), stuff, stuff and more stuff! Somewhere in there we list health, family, and the pursuit of happiness. And that is life if we are fortunate enough to have the jobs. For those of us that don’t? Well, the dance is a bit different, but no less stressful. America has become unbalanced, and it is no surprise that it is reflected in our health and in our weight. A major change in lifestyle is needed in order to re-prioritize life’s “necessities”. Perhaps it’s time to slow down and smell the roses, or at least the coffee.
Social stigmas are another reason that obesity issues are difficult to address as they can be quite powerful and lead to an imposed social identity. Harlan Lane illustrates this beautifully when he describes the “unblushing male in America” as “a young married, white, urban northern heterosexual protestant father of college education, fully employed, of good complexion, weight, and height, and a recent record in sports.” He goes on to suggest that “any deviation is likely to entail a stigma”. Obesity certainly lies outside of that unrealistic and confining definition and the stigma is strong in our American society.
In my personal experience I have had the opportunity of being on both sides of this issue. I “perceived” a weight problem in my life at age 10 and have been dieting ever since; although my weight was not outside of “normal” weight range until I got pregnant at age 37. From that time on I experienced a true weight problem. I watched as I went from a 5’8” tall woman weighing 140 lbs. to a 5’8” woman weighing 220 lbs. over a period of three years. I frantically went from one fad diet to another, but nothing worked. I found people responding to me with a new air of condescending superiority, patronizing acceptance, or looking right through me as if I were invisible. I was in a different body, with the same brain. I felt like a transplant. I remembered a time when I was young and I had looked at a severely obese woman and said to myself “if I ever get that fat take a gun and shoot me”. Now I was one of those people, and there were times I wanted to take the gun and shoot me.
Harlan Lane says that “Stigma is relational.” Although obesity rates are ever rising, the stigma of obesity does not seem to be diminishing. People who are “normal” find it easy to judge, diminish and discount people with weight issues. I know because I was one of them. And now I know what it feels like to be stigmatized as “obese”, because now I am one of them. From where I stand stigmatizing people is a waste of time, and has nothing constructive to add to the world.
That being said, I’ve found a certain power in walking in these “obese” shoes. I have become sure of who I am and what I want out of life. And I have come to accept that health is more important then looks, and made a commitment to live a healthy lifestyle regardless of what weight that will leave me at. The side effect seems to be a slow, steady weight loss that (if I were I betting woman) I bet eventually will lead me to a rebalanced life and weight. Time will tell.
The last issue that seems to be affecting our ability to address the obesity issue is the new trend in marketing to the Plus Sized population; not a good thing or a bad thing, but it certainly is an American thing. As Americans are getting fatter, businesses have responded with the weight-loss industry–huge and profitable, the gym industry, and now it is expanding into the rest of the economy. “Just as baby boomers have driven business and shaped the economy during the past half century, the “plus-size” population is likely to dictate marketing trends through much of the 21st” (Crawford). Some of the exciting new trends include “everything from sofas and toilets to clothes and nights on the town
Toyota has designed a Rav4 that comes with seats up to 3 inches wider. Select Comfort mattresses have a “grand king size that’s 30 percent bigger than a traditional king”. Designer labels like Tommy Hilfiger and Ralph Lauren make clothes in new larger sizes. New businesses are springing up all over to accommodate the plus-sized money spending population. Perhaps this is a good thing. If the population of obese people is a growing minority and it is true that obesity is a medical issue, then discrimination would be unacceptable. Perhaps marketing trends indicate an acceptance of this issue is going to be in our future.
The bottom line is that obesity is a complex disease. Medical factors, psychological factors, nutritional factors, physical exercise factors and even hereditary factors can make for a complex understanding of this ever growing health issue. We will undoubtedly require complex solutions to begin to deal effectively with obesity and courage to implement changes that will be successful in the long term. And it will require time, compassion, and understanding from all of us.

Works Cited:

AHA American Heart Association, Metabolic Syndrome, June 20, 2006, ©2006 American Heart Association, Inc. All rights reserved. Unauthorized use prohibited.
http://www.americanheart.org/presenter.jhtml?identifier=4756
This is an article by the AHA outlining metabolic syndrome, what characterizes it and risk factors involved.

AOA American Obesity Association, Childhood Obesity, Copyright © 2002. Llast updated on May 2, 2005.
http://www.obesity.org/subs/childhood/prevention.shtml
This is a website that contains information, articles, research and offers solutions to the obesity epidemic.

Barnett, Robert, Kid’s Health, Parenting. San Francisco: Jul 2006. Vol.20, Iss. 6; PG. 34, 1 pgs.
http://library.cardean.edu/pqdweb?did=1046724601&sid=3&Fmt=3&clientId=46 656&RQT=309&VName=PQD
This is a short article about the importance of review a child’s BMI once a year from the age of 2 to ensure that he is not becoming fat.

Bove, Mary ND, The Super-Sized Syndrome, The Doctor Is In, ,Better Nutrition, Atlanta: Oct 2005.Vol.67, Iss. 10;  pg. 28, 2 pgs
http://library.cardean.edu/pqdweb?did=902010551&sid=9&Fmt=4&clientId=466 56&RQT=309&VName=PQD
This is an article about Syndrome X which is a type of disorder that includes insulin resistance, excessive abdominal fat, high blood pressure and dyslipidemia that eventually leads to heart disease, type 2 diabetes and stroke. This disorder is driven by overeating processed foods and lack of exercise and it ups the odds of developing all kinds of other troubles such as Alzheimer’s disease and obesity. Bove offers some tips on how to avoid syndrome X, including eating more fresh, high-fiber foods, eating only protein, and losing few pounds.

CDC, Center for Disease Control, Overweight and Obesity: Home, Department of Health and Human Services, Division of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health Promotion, 05/23/2006
http://www.cdc.gov/nccdphp/dnpa/obesity/
This is the Center for Disease Control website. This particular page focuses on Overweight and Obesity overview information as well as links to they pyramid info, eating plans, exercise info and more.

COPI, California Obesity Prevention Initiative, The Obesity Problem, © 2004 State of California
http://www.dhs.ca.gov/cdic/copi/html/problem.htm
This is a website that outlines causes of obesity and calls for action to prevent the epidemic from becoming worse. The website states that California is experiencing an unparalleled obesity epidemic that represents a public health challenge of equal magnitude to that of tobacco and outlines causes and cures.

Crawford, Krysten, Features/The Big Opportunity, Krysten Crawford. Business 2.0. San Francisco: Jun 2006.Vol.7, Iss. 5;  pg. 94
http://library.cardean.edu/pqdweb?did=1038677811&sid=11&Fmt=3&clientId=4 6656&RQT=309&VName=PQD
This article is about the big opportunity there is in Americans becoming fat by business people taking advantage of the new market. The fastest growing consumer segment is the overweight population and business people are investing.

CSPI, Center for Science in the Public Interest, Obesity Epidemic “Deadly” Result of Societal Shifts in the 20th Century, March 9, 2000, Public Health Reports is a journal published by the United States Public Health Services.
http://www.cspinet.org/new/obesity.html
This is the Center for Science in the Public Interest website. This page focuses on an article about obesity which states that obesity is a result of the societal changes including technology, lack of exercise, and new eating patterns which include fast foods and pre-packaged processed foods. There are many suggestions for ways to combat this epidemic focusing on legislators, educators and businesses.

Gunter, M.J., M.F. Leitzmann, Obesity Pathogenesis; Genetic variations related to obesity, insulin resistance, and cancer discussed Medical Letter on the CDC & FDA. Atlanta: May 3, 2006.  pg. 131
http://library.cardean.edu/pqdweb?did=1026706951&sid=9&Fmt=3&clientId=46 656&RQT=309&VName=PQD
This is an article about how obesity-induced insulin resistance leads to elevated levels of plasma insulin, glucose and fatty acids which can lead to colorectal cancer.

Jelovsek, Frederick R. MD, Insulin Resistance Syndrome, Women’s Diagnostic Cyber,
http://www.wdxcyber.com/ngen10.htm
This is an article describing insulin resistance, tests to determine if you have it and what insulin resistance can cause.

Lane, Harlan, The Mask of Benevolence, New York, Knopf, 1992
This is our text which deals primarily with disabling the deaf community, but has information that correlates to the stigmas attached to obesity.

Leung, Frank K. M.D, No-Drug, Anti-Inflammatory Diet Yields Positive Clinical-Trial Results, Including Marked Improvement Of Metabolic Abnormalities And Rapid Weight Loss, Main Category: Obesity / Weight Loss / Fitness News
 Article Date: 20 Jun 2006 – 0:00am (PDT) http://www.medicalnewstoday.com/medicalnews.php?newsid=45447
This is an article that introduces the Anti Inflammatory Diet as an informational service. This site can link you to a number you can call to pay for the diet, but does not divulge the diet itself.

Lipchitz, Rebecca, BU researchers find common genetic link to obesity, Variant occurs in 10 percent of people of European and African descent, BU Today, News and Events for the BU Community,
http://www.bu.edu/phpbin/news-cms/news/?dept=4&id=38999&template=4
An article outlining new research by Boston University with Harvard School of Public Health stating that a 24 year study has discovered a genetic variant that may predispose 10 percent of people of European or African descent to obesity.

NCHS, National Center for Health Statistics, Obesity Still a Major Problem, New Data Show, Wednesday, October 6, 2004, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Disease Control and Prevention
http://www.cdc.gov/nchs/pressroom/04facts/obesity.htm
This is a website that gathers and publishes statistics for a variety of health issues. This page is dedicated to obesity statistics.

Obesity, online reference, Obesity: Strategies to Fight a Rising Epidemic
 Updated: 01/19/2006, Life Extension, Fulop T, Larbi A et al. Insulin receptor and ageing. Pathol Biol ( Paris ) . 2003 Dec;51(10):574–580.
http://www.lef.org/protocols/metabolic_health/obesity_01.htm
This is a website with many articles including ones pertaining to obesity. All articles are used to encourage use of dietary supplements sold by Life Extension so the research articles are really of more use.
Raftopoulos, Ioannis, Courcoulas, Anita P., Diabetes Forecast, Alexandria: Jul 2006. Vol. 59, Iss. 7;  pg. 57, 4 pgs, Periodical
http://library.cardean.edu/pqdweb?did=1049830221&sid=1&Fmt=4&clientId=46 656&RQT=309&VName=PQD
This is an article about morbid obesity and the treatment of gastric bypass surgery. It gives an overview of who may be eligible and definition of different levels of obesity. The article is written by Ioannis Raftopoulos, MD, PhD, FACS, an assistant professor of surgery at the University of Pittsburgh Medical Center’s (UPMC) Shadyside, Magee-Womens, and St. Margaret Hospitals in Pittsburgh, Pa., and Anita P. Courcoulas, MD, MPH, FACS, an associate professor of surgery and director of minimally invasive and bariatric surgery at UPMC Shadyside and Magee-Womens Hospital so its information is relieable.

Smith, Steven, DISCOVERIES OBESITY, Boston Globe. Boston, Mass.: Apr 17, 2006.  pg. B.9, Health Science, Copyright New York Times Company http://library.cardean.edu/pqdweb?did=1022318231&sid=8&Fmt=3&clientId=46 656&RQT=309&VName=PQD
This is an article about how genes can play a major role in determining obesity propensity from a study by an international team of researchers that included scientists from the Boston University School of Medicine and the Harvard School of Public Health. The researchers examined the genetic fingerprints of 1,320 people, using blood samples drawn as part of the Framingham Heart Study

Sponagle, Michele, Hungry for attention, Flare. Toronto: Jun 2006. Vol. 28, Iss. 6;  pg. 108, 4 pgs
http://library.cardean.edu/pqdweb?did=1042151231&sid=12&Fmt=3&clientId=4 6656&RQT=309&VName=PQD
This is an article discussing the emotional aspects of overeating which leads to obesity.

Taylor, Jeff A, Reason. Los Angeles: Jul 2006. Vol. 38, Iss. 3;  pg. 13, 1 pgs,
http://library.cardean.edu/pqdweb?did=1061008571&sid=3&Fmt=3&clientId=46 656&RQT=309&VName=PQD
A series of fun facts, one of which relates to a study by Boston University stating that there is a possible gene trait which causes obesity.

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