Chapter 9 KNS 350

What does food restriction and fat depletion lead to?

"hungry brain" that is motivated to increase energy intake and reduce energy expenditure through decreased activity

How much is obesity in the US in 2008 and what percent is it of ALL MEDICAL COSTS?

$147 billion 10%

Direct per capita costs in the United States were estimated in 2010 as _______ over a lifetime and, in 2013, as _____ across 5 years and _____ across 10 years

$171,483 $33,900 $70,200

Obesity is further categorized as class I______ , class II _______, and class III _______

(BMI 30-34.9) (BMI 35-39.9) (BMI equal to or greater than 40)

Hadza men BMI? Hadza men PAL who hunted and gathered honey PAL? Hadza women who gathered plant food PAL? Overall EE in women? Men?

- low BMI 20kg/m'2 -2.25 -1.8 - women 829 kcals (19 kcal/kg of body weight) , - men 1477 kcals (29 kcal/kg of body weight)

Studies that used doubly labeled water to estimate energy expenditure in nearly 1000 children aged 4 to 18, as well as 1400 adults aged 18 to 98, found that each 10% increase in energy intake was associated with an increase in body weight of about ___ in children and ____ in adults. That translates to an energy gap of ____ kcal/day needed to reverse the population weight gain by U.S. adults during the past 40 years

-4.5%, 7.1% adults gained more weight than kids - 400

In the American Cancer Society: Cancer Prevention Study I and II The average 10-year increase in BMI (kg/m2) was ___ (standard deviation [SD] = 1.7) in men and___ (SD = 1.9) in women. The increase in BMI was_______ less among men who had said they jogged or did aerobics or calisthenics either 1 to 3 h or 4 or more h per week in 1982 (or when they were age 40) and also in 1992 compared to men who said they didn't engage in those activities. Women who said they jogged 1 to 3 h per week or did 4 or more h per week of aerobics or calisthenics at both of those times had ______ less gain in BMI than women who did not report doing those activities

.6 1.4 0.22 to 0.34 kg/m2 0.27 to 0.29 kg/m2

In the Study of Women's Health Across the Nation it was about ethnic diverse women A standard deviation increase in self-reported level of sports or exercise was longitudinally related to decreases of 0.32 kg (___ lb) in weight but not to change in waist circumference. Similar inverse relations (a decrease of 0.21 kg [0.5 lb]; 95% CI = −0.01 to 0.41 kg [0.9 lb]) were observed for daily routine physical activity (biking and walking for transportation and less television viewing). Thus, maintaining or increasing physical activity levels helped protect against ________

0.7 midlife increases in body weight and girth that women commonly experience.

Weight loss after resistance exercise training is usually less than ___ kg, but that can be misleading when the training produces an increase in fat-free mass

1

obese or overweight adults concluded that carriers of the risky FTO allele from either one or both parents responded with reductions in weight or waist circumference similarly to noncarriers after diet, exercise, or drug treatment. A separate meta-analysis of 10 weight loss trials of diet or diet plus exercise that included nearly 7000 participants agreed that carriers of a single risky FTO allele did not lose more weight than noncarriers but that carriers of the allele from both parents lost on average 0.5 kg (_____) more weight than noncarriers

1 lb

In the ACLS weight cycling study,, For each extra____ of endurance on a maximal treadmill test at baseline, or for each 1 min increase in endurance between clinic visits (a difference of 7% in women and 5% in men), initial weight or weight gain was 0.2 kg (___ lb) lower for women and 0.55 kg (____ lb) lower for men.

1 min 0.4 1.5

In the STRRIDE TRIAL, People in the control group had a 1% increase in body weight and an 8.6% increase in intra-abdominal fat, while the two exercise groups that expended about 14 kcal/kg each week had about a __ decrease in body weight. The highest dose of exercise (i.e., about 23 kcal/kg each week) produced a nearly ___ decrease in weight and 7% decreases in intra-abdominal fat and subcutaneous abdominal fat without changes in caloric intake.

1% 3%

n the Women's Ischemia Syndrome Evaluation each _____level of estimated fitness was associated with an _____ decrease in the risk of major adverse cardiovascular events during follow-up independently of CAD risk factors.

1-MET 8%

in the Coronary Artery Risk Development in Young Adults Study Decreased physical fitness was strongly associated with weight gain in both sexes. Each _______ in maximal treadmill endurance time predicted a 1.5kg (3.3 lb) weight gain for men and a 2.1kg (4.6 lb) gain for women. In a follow up, The predicted weight change associated with change in physical activity was_______ larger in participants who were overweight at baseline than with those who were not overweight. Compared to people who decreased their physical activity, the average five-year weight gain was blunted by 0.8 to 2.8 kg (1.8-6.2 lb) among those who increased physical activity by at least _______, six or more months each year, during the first two to three years of follow-up In another follow up, Adjustment was made for race, baseline BMI, age, education, smoking, alcohol use, and calorie intake. Compared to the lowest activity groups, men maintaining high activity gained nearly ____ fewer kg (6 lb) and 3 fewer centimeters (1.2 in.) of waist girth each year, and women maintaining high activity gained ____ fewer kg (13.5 lb) and nearly 4 fewer centimeters (1.6 in.) of waist girth each year.

1-min decrease four to five times 2 h each week 2.7 6.1

The American Heart Association (2001) suggests that the desirable waist-to-hip ratio is less than _____ for men and less than ____ for women.

1.00 0.80

In the U.S. Male Health Professionals Middle-aged men who increased their vigorous physical activity, decreased TV viewing, and stopped eating between meals lost an average weight of ____ kg (3.1 lb; 95% CI: 1.6-1.1 kg), compared with a weight gain of 1.4 kg (3.1 lb) in the total cohort. Each ____ increase in weekly vigorous physical activity predicted a ____ (4.4 lb) weight loss in men ages 45 to 54.

1.4 1.5-h 2kg

The range of variation in body mass due to variation in slenderness has been estimated as ___ standard deviations in weight-for-height ranks among children and ____ kg/m2 in BMI among adults. Globally, it has been estimated that currently used BMI cutoffs underestimate global overweight in adults by more than ________ million cases

1.5 6.5 400 to 500

In the WHS, compared with risk for active normal-weight women, the relative risks were ____ for overweight and physically active, ___ for obese and physically active, ____ for normal weight and physically inactive, ___ for overweight and physically inactive, and ____ for obese and physically inactive women. The risk of CHD associated with high BMI was reduced but not eliminated by physical activity

1.54 1.87 1.08 1.88 2.53

In the NHS, what was the relative risk for of all cause death for inactive women with a low BMI, active obese women, and obese inactive women?

1.55, 1.91, 2.42

In the study of New South Wales, Australia avg body weight increased by _____. There was a _____ reduction in the odds of being in the highest tertile of weight gainers (gaining 2 kg [4.4 lb] or more) for participants who reported 300 min/week or more of MVPA (two-thirds of the cohort) compared to those with less than 150 min of MVPA (one-sixth of the cohort). The proportion of MVPA that was vigorous was not associated with weight change. At least _____ min of MVPA was required to protect against weight gain

1.5lbs 10% 300

The WHO recommendation is that people's daily physical activity level (PAL) should be ____ times their RMR (total energy expenditure/resting metabolic rate) when averaged across the day

1.75

The average weight loss in dietary interventions with people who are obese is about _____ over an average period of ___ weeks; two-thirds of the loss is maintained for ____ year, but most or all of pretreatment weight is regained within _______ unless high activity is maintained

10 kg (22 lb) 18 one three to five years

For example, in one study, overweight or obese women recruited from a hospital-based weight loss center were asked to increase physical activity by 1000 to 2000 kcal/week and told to reduce intake to 1200 to 1500 kcal/day. After six months, physical activity had increased on average by about 1200 kcal/week, but that increase dropped to about 700 kcal/week after 24 months. The women who maintained a loss of _____ or more of initial body weight after 24 months reported more physical activity (an increase of 275 min/week) than those who sustained a weight loss of less than 10% (increases of 75 to 125 min/week

10%

A META-ANALYSIS THAT included nearly 77,000 people and 14,000 incident cases of metabolic syndrome found risk of metabolic syndrome was lowered by ______ for each _____ MET-minutes of physical activity per week

10% 600

National Health and Nutrition Surveys between 1971 and 2008 estimated that BMI and caloric intake in the United States increased by ______ , but calories per kg of body weight did not change.

10% to 14%

For example, the relation between BMI and percent body fat in 665 black and white men and women 17 to 65 years of age from the HERITAGE Family Study cohort was quadratic, not linear, for both men and women. At a BMI under 20 or over 35, percent fat was lower than would be expected from a linear relation. After adjusting the relation to be linear, the percent body fat at each BMI was _____ higher for women than men. The relation also differed according to age and BMI among men and according to age, BMI, and race among women. Regardless of age, BMI underestimated percent fat in black women by ____ and overestimated percent fat in white women by ____, but only when BMI was less than 25 kg/m2. Regardless of race, BMI underestimated percent fat by ____ in men who were younger than 30 years and who had a BMI greater than 30. Also, at any age, BMI, or waist circumference, abdominal fat mass was higher in _______ than ________

10.4% 2% 0.8% 3.3% white men and women in black men and women

How much higher was RMR in the Hadza people in men/ women than in the US and Europe?

10.5% higher in men and 29% higher in women than average men and women in the United States and Europe

An estimated _______ deaths in the United States are attributed each year to obesity, which mainly results from overeating and physical inactivity

100,000

Depending on body size, fitness level, and exercise intensity, adults can easily expend an extra ____ kcal per week by exercising ____ min ____ days a week. By comparison, a person on a diet can easily consume an extra 1000 kcal each week by miscalculating portion sizes or by have a few extra snacks or beverages

1000 30 five

In the follow up study of the Fred Hutchinson Cancer Research Center—Seattle on overweight people, Compared to a control group (n = 86) that met once a week for 45 min of stretching, the intervention group increased its aerobic capacity by about ___ and had decreases in body weight (1.4 kg [3.1 lb]), percent body fat (1.0%), intra-abdominal fat mass (8.6 g/cm2), and subcutaneous abdominal fat mass (28.8 g/cm2).

11%

what was the total energy cost of daily physical activities lost to the use of labor-saving devices?

110 kcals a day

after adjustment in the US burden of disease study obesity (BMI ≥30) was associated with only about _____ excess deaths in 2000 compared with the number for normal-weight people (BMI 18.5 to 25)

112,000

In the American Cancer Society: Cancer Prevention Study I and II in a subsequent analysis of postmenopausal women The odds of weight gain greater than 10 lb (4.5 kg) were _____ lower for normal-weight women (BMI <25) who reported more than 18 MET-hours per week of leisure-time physical activity (n = 2609) compared with those who reported 4 or fewer MET-hours per week (n = 2278). Physical activity did not protect against weight gains between ________ (2.3-4.1 kg) or weight gain greater than______(4.5 kg) in women who were initially overweight (BMI ≥25)

12% 5 and 9 lb 10 lb

Findings from the 34 studies say that annual health care costs for overweight and obesity combined are ____ of adult health care expenditure in the UK and ____ in the US

12% 15%

Results of 34 studies, annual health care costs were about how much higher for people who are overweight and OBESE and compared to people with a healthy BMI of 18.5 to 25? and what was the cost breakdown?

12% overweight 36% obese Breakdown: Extra costs were highest for medications (18% for overweight and 68% for obese), followed by inpatient care (12% for overweight and 34% for obese) and ambulatory care (4% for overweight and 26% for obese)

According to the Pediatric Nutrition Surveillance System (PedNSS) of the Centers for Disease Control and Prevention (CDC), the prevalence of obesity in low-income, preschool-aged children increased from ____ in 1998 to ____ in 2003. It leveled off at ____ in 2008 except among American Indian or Alaska Native children, who had the highest prevalence (21.2%) compared to Hispanic (18.5%), non-Hispanic white (12.6%), non-Hispanic black (11.8%), and Asian or Pacific Islander (12.3%) children.

12.4% 14.5% 14.6%

On average, physical activity that expends______ kcal · kg−1 · week−1 (about 180 min of moderate exercise or 115 min of vigorous exercise) will lead to small weight losses of 1% to 3%. Though modest for weight loss purposes, those amounts can be very useful for _______

13 to 26 helping people keep their weight stable as they age and for maintaining weight loss after a diet.

In the Avon Longitudinal Study of Parents and Children Total and moderate-to-vigorous physical activity (measured by an accelerometer for seven days) at age 12 was predictive of body fat mass (measured by DXA) at age ___. An extra ____ of moderate-to-vigorous physical activity per day at age 12 was associated with lower fat mass at age 14 in boys

14 15 min

The US age adjusted rate of obesity increased nearly ____ between 2012-2016?

14%

Sedentary adults in the United States have an average RMR of about ____ kcal, so adding an extra 500 kcal in physical activity each day to their current expenditure of _____ kcal would yield a PAL of nearly 1.75, which would require nearly _____ current PA levels

1450 580 doubling

The advisory committee for the Physical Activity Guidelines for Americans, second edition (Physical Activity Guidelines Advisory Committee 2018), concluded that the threshold for lowered risk of incident obesity and increased odds that people maintain a healthy weight was a threshold of ____ min of moderate-to-vigorous physical activity per week, but that the changes in risk were stronger when physical activity exposure is ____ min per week or more.

150 300

(ACSM) recommends that adults participate in at least ___ min/week of moderate-intensity physical activity to protect against excessive weight gain and reduce chronic disease risk factors, especially in adults with a BMI ___or a waist circumference above ___ cm (35 in.) in women and ___ cm (40 in.) in men. The ACSM recommends a weight loss of ______ of body weight for those people, with additional health benefits expected for those who sustain weight loss of more than ___

150 ≥25 88 102 5% to 10% 10%

In kids, n average, the studies reported reductions in body weight (change of −2.7 kg; 95% CI: −6.1 to −0.8 kg) and percent body fat (change of −0.4%; 95% CI: −0.7 to −0.01%). Although those effects are modest in size, they are clinically meaningful. And they were dose related, with larger effects generally seen after ________ min each week than after 120 to 150 min each week. BUT the studies only had few that took diet into account, and no study used more than 200 mins of weekly PA (guidelines are 420). Body weight typically doesn't change after increased physical activity when the study was _______

155 to 180 not designed with weight or fat loss as the primary outcome; kids obesity will take alot of work and much on the environments that put kids at risk for excess weight gain

In the Australian Longitudinal Study on Women's Health In a follow-up survey in 2012, 60% remained normal weight, 29% had become overweight, and 11% had become obese over the ___ years. Compared with the least active women (<40 MET-minutes/week), odds of maintaining a normal BMI after 16 years were 18% higher in women who spent 40 to 500 MET-minutes/week in physical activity; 23% higher for women who spent 500 to 1000 MET-minutes/week in physical activity; and ___ higher for women who spent 1000 or more MET-minutes/week in physical activity

16 49%

A review of 10 prospective cohort studies of intentional weight loss by adults in the United States, Great Britain, and Finland found that mortality risk was reduced by ___, but only among obese people who were also ______ (i.e., had chronic disease or risk factors other than obesity) at baseline. Weight loss did not affect mortality risk among those who were otherwise healthy or were just overweight (did not examine whether PA or fit modified effect of weight loss on mortality)

16% unhealthy

In the Norway Nord-Trøndelag Health Study Hunt participants and this study found The average weight gain across 22 years of follow-up was 7.7 kg (___ lb) in men and 8.5 kg ( ____ lb) in women. Compared to inactive people for any 11-year period, meeting the recommended physical activity level was associated with about ___ lb (0.7 kg) less weight gain in both men and women. Exceeding the recommended level was associated with 1.8 kg (___ lb) less weight gain in men and 2.1 kg (4.5 lb) less weight gain in women. Compared with inactive participants, the odds of gaining excess weight of ≥2.3 kg (5 lb) were _______ who exceeded the recommended level of physical activity, but they weren't lowered by lower amounts of physical activity.

17 19 1.5 4 20% lower in men and 30% lower in women

In the HERITAGE Family Study, 105 people (_____) had metabolic syndrome before exercise training. After 20 weeks of training, 32 people no longer had metabolic syndrome: 43% decreased triglycerides, 16% improved HDL-C, 38% decreased blood pressure, 9% improved fasting plasma glucose, and 28% decreased their waist circumference

17%

In the Look AHEAD (Action for Health in Diabetes) Trial, the goal was ________ of moderate-intensity physical activity) or to usual medical care and diabetes support and education. Body weight was reduced by nearly 7 kg (____ lb) in women (7%) and 9 kg (____ lb) in men (10%) after intervention, with corresponding reductions in total adipose tissue (mainly subcutaneous) of nearly 5 kg (11 lb; 12%) in women and 8 kg (17.6 lb; 26%) in men.

175 min/week 7.4 19.8

In people who are obese, weight-reducing diets, with or without exercise, reduce all-cause mortality by....

18% (6 fewer deaths per 1000 participants)

In the St. Lukes Roosevelts Hospital New York City study, Their formula diet had an energy content that was 70% of their RMR (about 1230 ± 255 kcal/day). Three weekly supervised exercise sessions were roughly equivalent in energy expenditure. All groups lost about 9.0 kg (______). The strength training group lost less fat-free mass than the aerobic and diet-only groups but nonetheless had a similar drop in RMR. Thus, strength training protected________.

19.8 lb lean mass during dieting but did not prevent the decline in RMR commonly seen when overweight people lose weight

An evolutionary case can be made that the global obesity pandemic that began in the _____ has resulted largely because of technologies that supply food and reduce the need to work for it.

1950s

According to a summary of global statistics from WHO, nearly _____ people aged 18 or older were overweight (____) in 2016; _____ were obese (____).

2 billion- 39% 650 million- 13%

A review of 11 prospective cohort studies concluded that physical activity or increased fitness measured by maximal treadmill endurance is associated with minimizing weight gain or with a reduction in the risk of large weight gains (e.g., 5-10 kg [11-22 lb]) among adults over periods ranging from ______ years

2 to 10

Improvements in chronic disease risk factors can occur with just a__________ reduction in excess body weight.

2% to 3%

In us how many kids 2-5, 6-11, and 12-19 obese?

2-5: 13.9% 6-11: 18.4% 12-19: 20.6%

Rates of weight loss with a successful program average approximately 1 kg (______) per week

2.2 lb

In the Dose-Response to Exercise in Women, all groups WC decreases and all groups lost ___ lbs. This study shows?

2.2-4.4lbs practical problems of gauging the impact of exercise on weight loss, as people may eat more than normal or decrease daily nonexercise activities when they undertake a new exercise program

How much did Americans gain independently of self-reported changes in energy intake or expenditure on AVERAGE

2.3 kg/m^2, but many confounders for increases BMI could not be controlled for here (body density and resting metabolic rate, which could explain differing BMI)

Modern adults highest PAL occurring under normal life conditions?

2.5

In the studies of DLW how much of the weight gained in those studies was fat free, lean, mass?

2/3, (3.1%/4.5% in children and 4.8%/7.1% in adults)

In a systematic review of overweight/obese people on a diet plan and a diet plus exercise plan, Differences were small in each study, but when the studies were averaged, diet plus exercise resulted in ___% greater initial weight loss (13 kg ± 10 kg [28.7 ± 22 lb]) than diet alone (9.9 kg ± 9.6 kg [21.8 ± 21.2 lb]) and a ____% greater sustained weight loss after one year (6.7 kg ± 8.3 kg [14.8 ± 18.3 lb]) than diet alone (4.5 kg ± 11.3 [9.9 lb ± 24.9]). BUT NEARLY HALF THE INITIAL WEIGHT WAS REGAINED AFTER A YEAR REGARDLESS OF WHICH PLAN. THE OTHER STUDY favored ______. the average weight loss was 1.14 kg (____ lb; 95% CI: 0.21-2.07) and the average reduction in BMI was 0.50 kg/m2 (95% CI: 0.21-0.79) greater after diet plus exercise than after diet alone. Again, much of the lost weight was regained after the interventions ended.

20 20 combination of diet and exercise 2.5

How many adults are obese worldwide?

20%

The population attributable risk of obesity from variations in the FTO gene has been shown to be about _____.

20%

Adults who are sedentary or who have low customary leisure-time physical activity typically gain about ____ more weight over 10 to 20 years than people who are physically active, and studies show the risk of incident obesity is also reduced by ___ or more. In people who are obese, diets that include exercise for at least six months commonly result in 20% more weight loss and 20% better maintenance of the weight loss one to three years later.

20% 20%

Even among normal weight postmenopausal women, those with a risky girth have about ________ higher risk of dying from cancer or cardiovascular disease

20% to 25%

NHANES 2015-2016 Prevalence in both adults and youths did not change between....

2013 to 2014 and 2015 to 2016.

Vigorous-intensity (65%-80% of aerobic capacity) activities that expended ________ each week (e.g., jogging 20 miles/week) were most effective for improving all components of metabolic syndrome except blood glucose levels, and results were generally more favorable in men than in women.

23 kcal/kg

In the Black Women's Health Study found a a dose-dependent reduction in obesity incidence (BMI ≥30) with increasing level of vigorous exercise. Incidence of obesity was ______ lower for women who reported ≥7 h/week of vigorous exercise compared to little or no exercise both among women with a healthy weight (BMI <25) at baseline and among women who were overweight (BMI 25-30). Hours per week of walking was not related to obesity risk. There was a slight dose-response gradient. Compared to less than 1 h/week, the incidence of developing obesity reduced by 13% for 1 to 2 h/week, 18% for 3 to 4 h/week, and 21% for 5 to 6 h/week.

23%

Obesity rates in American Indian youths 5 to 17 years of age increased from ____ in 1995-1996 to ____in 2002-2003

24% 28% (increased 4%)

The NIH defines people as overweight when BMI is in the range of ______ kg/m2 and as obese when BMI equals or exceeds ____ kg/m2

25 to 29.9 30

In 2011, 10 states and the District of Columbia had a rate less than 25%, and no state had a rate of 35% or more. By 2017, only Colorado, Hawaii, and the District of Columbia had a rate less than____. Seven states (Alabama, Arkansas, Iowa, Louisiana, Mississippi, Oklahoma, and West Virginia) each had ___ or more adults who were obese. These estimates from the BRFSS come from people's self-reported weights, which are underestimates compared to measured weights.

25% 35%

Based on Medical Expenditure Panel surveys, the cost of obesity increased by ____ from 1998 to 2011

25% ($1360)

In the Health Worker Cohort Study in Mexico, odds of metabolic syndrome were about_________ in men who said they got 30 or more min/day of leisure-time physical activity and in women who reported at least 3 h/day of workplace physical activity

25% lower

After adjustments for age and education levels, household income, smoking status, and alcohol consumption, the prevalence of metabolic syndrome among nearly 12,000 Koreans 30 to 79 years of age who said they got no leisure-time physical activity was ________ higher in men and _______ higher in women compared to people in the top two-thirds of physical activity

25% to 30% 50% to 85%

Not only was exercise as effective as diet for weight loss but adding an exercise program at the end of the diet also prevented participants from regaining weight 8 and 18 months later. The amount of physical activity needed to keep weight off after a diet is not fully known, but experts have suggested it may be as much as ________ , two to three times as much as recommended for reducing other health risks

2500 to 2800 kcal/week

The National Weight Control Registry is a registry of more than 3000 individuals who have successfully maintained at least a 30 lb (13.6 kg) weight loss for a minimum of one year. These individuals have reported using a variety of methods to lose weight initially, but more than 90% report exercise as crucial to their long-term weight loss maintenance. They report expending, on average, _____ kcal per week in exercise, an energy equivalent of walking _____ (6.4 km) seven days a week

2682 4 miles

In the diet study, the average weight loss was 12.3 kg (___ lb). Compared to control subjects after the diet period ended, weight loss maintenance was better by 3.5 kg (7.7 lb) 12 to 36 months after three trials of antiobesity drugs; by 3.9 kg (8.6 lb) 10 to 26 months after four trials of meal replacements; 1.5 kg (3.3 lb) 3 to 12 months after six trials of high-protein diets; and 0.8 kg (1.8 lb; 95% CI: −1.2 to 2.8 kg) 6 to 12 months after five trials of exercise. However, exercise programs varied widely. In one trial of walking that expended either 1000 (2-3 h/week) or 2000 kcal/week (4-6 h/week), weight loss maintenance was improved by about 2.7 kg (6 lb) and waist circumference was reduced by about 2.5 cm (1 in.) after 40 weeks compared to diet counseling. Two years later, without exercise supervision, weight loss maintenance remained better than in control subjects (−3.8 kg; −8 lb) but only in the _____ kcal/day group

27 1000

In the STRRIDE trial of overweight men and women who had dyslipidemia (i.e., risky levels of cholesterol), 69 (40%) had metabolic syndrome. After eight months of exercise training, that percentage was decreased to ___

28%

The number of deaths in the United States among adults aged 18 years or older attributable to obesity in 1991 was estimated to be approximately _____

280,000

One theory is that a return to a ratio near ___, achievable by increasing daily physical activity by ____ kcal, would slow worldwide obesity by resetting resting metabolic rate (RMR) at the rate of our prehistoric ancestors; they are believed to have had an RMR that was ____ higher than that of today's sedentary adults

2:1 500 15%

A meta-analysis of 31 trials lasting four weeks or more found similar effects on body composition in normal weight and obese or overweight participants after high-intensity interval training or after moderate-intensity continuous training (Keating et al. 2017). Total body fat (%) and fat mass (kg) were reduced by 1.26% and 1.38 kg (__ lb) after interval training and 1.48% and 0.91 kg (2 lb) after continuous training. Another review of 13 trials also found similar reductions in total body fat mass and waist circumference after high-intensity interval training or moderate-intensity continuous training averaging 10 weeks in overweight or obese participants aged 18 to 45 years

3

If a change in body weight less than ___ is used as the standard for weight maintenance and a change of ___ or more is judged as clinically meaningful for reducing health risks (Stevens et al. 2006), an obese person weighing 200 lb (91 kg) would need to lose and keep off ___lb (2.7 kg) to reduce excess weight and lose and keep off ___ lb (4.5 kg) for a health benefit

3% 5% 6 10

Experts generally agree that an increase of _____ of body weight in adults is excess weight gain and ________is risky for health

3% or more more than 5%

A low level of physical activity reported in the follow-up survey was strongly related to major weight gain. The relative risk of major weight gain (>13 kg) for the lowest physical activity category in the follow-up survey compared with the high-activity category was ____ (95% CI: 1.6-6.0) for men and ___ (2.3-6.5) for women. The relative risk for people who reported low physical activity at both the initial and follow-up surveys was ___ (0.9-5.8) in men and ___ (2.2-23.3) in women.

3.1 3.8 2.3 7.1 (women always have a higher risk)

In the Exercise Training Studies, Among normal-weight men and women, exercise training studies that followed the ACSM guidelines for increasing or maintaining cardiorespiratory fitness showed that on average, body weight was lowered by 1.5 kg (___) and fat mass was lowered by ____. The American Dietetic Association has concluded that few studies have used a large enough "dose" of physical activity to achieve a ___ weight loss with a physical activity intervention alone

3.3 lb 2.2% 5%

In the Exercise Only Study, Six-month and 12-month programs similarly were associated with modest reductions in weight of 1.6 and 1.7 kg (______ lb) and in waist circumference of about 2 cm (____in)

3.5-3.7 0.8

a BMI of 30 equates to being about ________ overweight.

30 lb (13.6 kg)

physical activity and physical fitness each cut mortality risk in people who are overweight. So, being fit may protect the health of people who are as much as _______ overweight.

30 lb (13.6 kg)

What does the NHS say you should do to reduce risk and how much will it help?

30 or more min of moderate-to-vigorous physical activity each day reduced CVD mortality risk by about 40% to 50% at each level of BMI. In contrast, that amount of physical activity reduced cancer mortality risk by 25% but only in women with low BMI. The attributable risk of a combination of excess weight (BMI ≥25) and physical inactivity was about 30% of all premature deaths, 60% of cardiovascular deaths, and 20% of cancer deaths among women who were not smokers.

People that have the genome FTO who are physically active how what percent of a lower risk of obesity than those who are inactive?

30%

The scientific advisory committee of the Physical Activity Guidelines for Americans concluded that many people need more than ____ min of moderate-intensity activity each week to meet their weight control goals. A doubly labeled water study of women who had lost about 12 kg (26.5 lb) to achieve a target BMI of 20 to 30 kg/m2 estimated that a daily energy expenditure from physical activity of 11 to 12 kcal/kg might be needed to prevent weight regain after weight loss (equivalent to nearly _____ min of moderate-intensity exercise or about half that amount of vigorous exercise each day

300 90

ACSM says Overweight and obese individuals will likely benefit from ___ or more min each week to experience greater weight reduction and prevent weight regain. The ACSM also recommends _______ to increase or maintain fat-free mass and further reduce health risks

300 strength training

Among people with BMIs in the range of 27 to 35 (overweight) that goal can be achieved by a decrease of ______ kcal per day, which will result in weight losses of about _____ (0.2-0.5 kg) per ____.

300 to 500 0.5 to 1 lb week

NHANES says the age adjusted prev of metabolic syndrome among US adults has been ____ since 2007, but its prevelance increases with ____

34% age; from 19% in young adults 20 to 39 years of age to nearly 40% in middle-aged adults 40 to 59 years of age, to 55% in people 60 years or older

Among 6400 men residing in Oslo, Norway, those who said they engaged in moderate-to-vigorous leisure-time physical activity in 1972 had ________ age-adjusted risk of developing metabolic syndrome 28 years later (explained by the men's lower glucose and trig levels)

35% lower

Other worldwide estimates derived from 2,416 population-based studies measuring BMI in 129 million people are that ____ million women and ____ million men 20 years or older were obese in 2016 and another ___ billion adults were overweight

390 281 1.3

In the American Cancer Society: Cancer Prevention Study I and II Walking___________ was associated with modest protection (0.08 and 0.16 kg/m2 less) against BMI gain in both men and women.

4 or more h per week

How many deaths worldwide did high BMI account for in 2016?

4.7 million deaths

An eight-month randomized controlled trial tested the FitKid Project (40 min of homework and healthy snacks plus about an hour of physical activity [20 min of warm-up and skills instruction; 40 min of MVPA, about 200 kcal expended; and 10 min of cool-down]) in 600 3rd-grade girls and boys (61% black, 31% white, 3% Asian or Hispanic) from 18 public schools. Children who attended at least ______ of the daily sessions (n = 182) decreased their percent body fat by ____ (95% CI: −1.42 to −0.09%) compared to the children in the control group (n = 265), who did not change (Yin et al. 2005). Results were not different according to race, sex, or school (including the percentage of students receiving a free or reduced-price lunch). Among these children, 164 students from the control group and 42 students who attended at least 40% of all sessions were still attending the same schools two years later. Each year the children attending the FitKid program had a reduction in percent body fat while the control group children had an increase. This occurred despite a larger increase in BMI among the intervention children. The intervention children returned to the level of the control group during the _____ when the program was not offered, suggesting the need for _______

40% 0.76% summers year-round physical activity programming during elementary school

How many people are obese in the United states?

40%, more than 93 million people

Obese/overweight kids under 5 ww? Obese/overweight kids 5-19 ww?

41 mill 340 mill

Severe caloric restriction has been shown to depress resting metabolism by as much as ___

45%

The scientific advisory committee for the 2008 Physical Activity Guidelines for Americans concluded that adults who want to lose more than ___ of their body weight through an exercise program must also ______

5% keep their food intake constant or restrict it through diet

The U.S. Institute of Medicine estimated that EPOC is 15% of energy expenditure during exercise, but recent simulations of daily physical activities by men under laboratory conditions showed that it was _____ of the total energy expended during moderately or vigorously strenuous days. So, adults who increase their physical activity by 500 kcal each day might burn as many as 75 extra kilocalories after the exercise ends if they are vigorously active. For most people, though, 25 to 30 extra kilocalories is more likely.

5% to 6%

Obese people have ___ to ___ times the risk of developing gallstones and they are more likely to die younger from ANY CAUSE compared to normal weight people

5-6

In the The Women's Health Study (randomized trial testing low-dose aspirin and vitamin E for preventing CVD and cancer among healthy women) Women gained an average of ______ (2.6 kg) throughout the study. There was no differences in weight gain between the two less active groups, but they gained a lot more weight than the most active. The two least active were more likely to gain ___ lbs over a three year period. More active= less weight ONLY IN WOMEN WITH NORMAL BMI. The women who maintained their BMI exercised for ___ a day.

5.7 lb 5 60 mins

Among children and adolescents aged 5 to 19 years, ___ million girls and ___ million boys worldwide were obese in 2016, while ____ million girls and ___ million boys were moderately or severely underweight

50 74 75 117

US burden of disease study, a ____ increase in obesity levels from 1990 to 2016, which accounted for 400,000 deaths and ____ of disability-adjusted life-years, second only to tobacco use (studies have likely overestimated mortality risk attributable to obesity because they did not adequately account for other mortality risk factors that differ according to people's weight status)

50% 11%

Genome-wide association studies have identified more than ____ variant alleles associated with obesity traits, mainly BMI and waist-to-hip ratio in people of European ancestry. those associated with high BMI are mainly in ________ pathways, whereas gene variants associated with girth are mainly in _______ pathways in adipose cell. _____ genes contribute to obesity, but account for a small portion less than 1% of variation among people.

500 brain neural metabolic 22

For obese people with BMIs over 35, deficits of up to _______ kcal per day are required to achieve those goals. After six months, the rate of weight loss usually _____ , and weight tends to stabilize at a plateau because of the reduction in RMR resulting from the lower body mass

500 to 1000 declines

In Womens Healthy lifestyle project, (premenopausal women had to to exercise and eat a certain amount) After 4.5 years, ____ of intervention participants but just 26% of control participants were at or below their initial body weight. The mean weight change in the diet plus physical activity group was 0.2 lb (0.1 kg; SD = 5.2 kg [11.5 lb]) below their entry weight, compared with an average gain of ____ lb in the control group body mass increased in the control group but did not change in the intervention group. percent body fat measured by skinfolds and DXA decreased by 0.5% (SD = 4%) in the diet-plus-physical-activity group while increasing by 1% (SD = 4%) in the control group. Waist circumference decreased more in the intervention group (mean = 2.9 cm lost; SD = 5.3) than in the control groups

55% 5.2

the risk of type 2 diabetes among U.S. adults aged 18 to 44 years increases by____ for each ____ (2.3-3.6 kg) of body mass

6% 5-8lbs

In us nearly ___ of men and ____ of women are SEVERLY obese

6% 10%

2005 Dietary Guidelines say adults who've lost weight may need _______ min of daily activity to help avoid regaining weight

60 to 90; kids overall 1 hour a day

How many US adults have a BMI of 40 or higher in 2016?

7.6%

Another Lipid Research Clinics study in Russian men, fitness was associated with all-cause and CVD mortality, but fatness was not. Men who were fit and fat had the same mortality risk as those who were fit and not fat, but the risk ratios were about ____ higher in unfit men regardless of fatness. Among U.S. men, low fitness and fatness each increased mortality risks by about ________ . Thus, fitness eliminated the risks of obesity in Russian men; but in American men, fitness and fatness were associated with mortality independently of each other.

75% 40% to 50%

European Prospective Investigation into Cancer and Nutrition-Norfolk Study . People with the risky version of the FTO gene who said they had a sedentary job and got no leisure-time physical activity had _____ higher risk of elevated BMI and ____ higher risk of greater waist circumference than those who said they got at least some physical activity during a typical week

75% 60%

Out of 195 countries and territories, high BMI is forecast as the leading risk factor in __ by 2040, followed by tobacco in __and high systolic blood pressure in __

76 48 35

Averaged across 15 small, randomized controlled trials lasting 6 to 36 weeks and including 556 overweight and obese adolescents, exercise interventions reduced body weight (3.7 kg;______ lb); BMI (2.0 kg/m2); body fat percentage (3.1%); and waist circumference (3.0 cm; 1.2 in.) In a follow-up analysis of those trials, plus five more, each ______ of physical activity was associated with a 0.33 kg (0.75 lb) decrease in body weight and 0.13 kg/m2 decrease in BMI

8 MET-hour/week

Among 12 normal-weight women, an energy deficit of about ____ kcal by food restriction increased appetite and feeding, coincident with increased acylated ghrelin (hungrier) and lowered peptide YY (lowered satiety) . However, an equivalent energy expenditure elicited by a ____-min run had no effect on appetite, feeding, or hormone levels (Alajmi et al. 2016). After an hour of vigorous-intensity running, appetite and ghrelin levels were lower in both men and women but feeding wasn't altered (Alajmi et al. 2016). More recently, ______ of vigorous-intensity treadmill running after fasting reduced appetite coincident with decreased ghrelin levels (not as hungry) and increased peptide YY (satisfied) in 15 active, normal-weight men, but the hormone responses and how much hunger was suppressed varied widely among them

850 90 an hour

For children ages 6 to 19, a girth (either the narrowest waist circumference or midway between the iliac crest and the floating rib) at the ____ percentile is commonly used to define high risk.

90th

What gene has a strong obesity related influence, how many people have that gene, how much more do they weigh, and how much more a of risk of high bmi do they have?

A stronger association has been found for the FTO (fat mass and obesity-associated) gene. People of European ancestry who inherit a risky variation in the FTO gene from one or both parents (30%-50% of the populations studied) weigh on average 1 to 4 kg (2.2-8.8 lb) more and have a 15% to 65% increased risk of having high BMI, perhaps because the gene contributes to eating more or storing more fat

The most convincing evidence for a positive health benefit of fitness, independent of fatness, has come from the

Aerobics Center Longitudinal Study (ALCS) at the Cooper Clinic in Dallas

What did the muscular strength portion of of the ACLS study find?

After adjustment for age, physical activity, smoking, alcohol intake, BMI, baseline medical conditions, and family history of CVD, men in the lowest third of strength had about 40% higher risk for deaths from CVD, cancer, and all causes. The elevated risks for all-cause and cancer mortality, but not for CVD, were independent of cardiorespiratoryfitness.

In the American Indian Schoolchildren what was found?

After adjustment for body composition measures in 2nd grade, higher levels of total physical activity (recorded from accelerometry counts) predicted lower percentage body fat by 5th grade among normal-weight children but not overweight children. Among overweight children, higher physical activity was unrelated to change in percent body fat and was paradoxically associated with increases in BMI. Although an objective measure of physical activity was used in this study, it was performed for only one day of observation. Also, skinfolds, bioelectrical impedance, and BMI are imprecise measures of body fatness.

All FDA approved for long term obesity have what side effects

All the drugs have common side effects such as nausea, headache, dry mouth, diarrhea, constipation, or fatty stool

What minority group of kids had the highest prevalence of obesity in low-income preschool ages kids

American Indian or Alaska Native children, who had the highest prevalence (21.2%)

What did the Minnesota Strength Training in Women Study find?

At 39 weeks of follow-up, there was no effect of strength training on weight change, but the exercise group had changed the composition of their body weight. They gained 0.89 kg (2 lb) more fat-free mass, lost 1.0 kg (2.2 lb) more fat mass, and lost 1.63% more percent body fat compared to the control group who did not exercise. This study shows not only that resistance training can be effective in helping women lose body fat but also why it is wrong to judge the effectiveness of exercise by body weight alone. There is also evidence that aerobic exercise and resistance exercise can preserve fat-free mass while people lose weight by dieting.

10th century who devoted an entire chapter to obesity in her Cannon of Medicine?

Avicenna

these techniques( med tech DXA) have not as yet been widely used in large, population-based studies of physical activity to determine whether they provide better estimates of CHD morbidity and mortality than do_____

BMI and waist girth measurements

IN the WHS, high BMI and Physical inactivity were related to elevated risk of

CHD

In a study of 30- to 65-year-old residents of Canada, men and women of European ancestry were compared with minority groups of Aboriginal, Chinese, and South Asian origin. At each BMI, percent body fat was similar between people of _____ origin and those with ______ ancestry. However, BMI underestimated percent fat in people of South Asian origin by _____. Compared with Europeans at a BMI of 25 or 30, Chinese had less total body fat but more _______, while South Asians had more total body fat and more intra-abdominal fat. At each BMI, intra-abdominal fat was higher in all the ________ groups

Chinese European 3.9% intra-abdominal fat non-European

_______________, an exercise physiologist while at the University of Virginia, challenged the consensus view that being fat is life threatening and that being thin guarantees health. He proposed that any person can have good health regardless of body weight by achieving and maintaining metabolic fitness, which we defined in chapter 3. Gaesser argued that the scientific evidence is not sufficiently strong to allow the conclusion that overweight and obesity are directly responsible for early death

Dr. Glenn Gaesser

An increased rate of triglyceride to fatty acid cycling and a shift from carbohydrate to fat as fuel can contribute to the prolonged component of _____

EPOC

_____ is proportional to the duration of exercise at intensities above 50% to 60% of aerobic capacity. A prolonged EPOC (3-24 h) can follow durations of 50 min or more at vigorous intensities of at least 70% of aerobic capacity, but even prolonged EPOC durations yield only 6% to 15% of oxygen cost of the exercise

EPOC

In the study of MVPA and the prev of overweight/obese in youth over 34 countries each day of weekly PA did what to the odds of being overweight?

Each day of weekly physical activity reduced the odds of being overweight or obese rather than normal weight. Odds ranged from 0.80 (95% CI: 0.76-0.85) in Austria to 0.95 (95% CI: 0.90-1.00) in Greece and were 0.90 (95% CI: 0.87-0.94) in the United States.

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 (specific to population; U.S. shown):

Elevated waist circumference:Men—greater than 40 in. (102 cm)Women—greater than 35 in. (88 cm) Elevated triglycerides:Equal to or greater than 150 mg/dl Reduced HDL ("good") cholesterol:Men—less than 40 mg/dlWomen—less than 50 mg/dl Elevated blood pressure:Equal to or greater than 130/85 mmHg Elevated fasting glucose:Equal to or greater than 100 mg/dl

_________ does not return to preexercise resting levels immediately after exercise ends.

Energy expenditure (RMR oxygen remains elevated)

_______ tissue leads to metabolic disturbances coincident with fat storage in muscle, liver, heart, and β-cells in the pancreas. Hence, reduction of __________ is key in primary and secondary prevention of cardiometabolic diseases. __________, but not resistance exercise, reduced visceral fat by _____ SD compared to control subjects. Nine studies that directly compared aerobic exercise with resistance exercise found a small benefit for ________. aerobic training of moderate or high intensity, without restriction of dietary calories, reduced visceral adipose tissue measured with computed tomography by about ___ cm2 (5.7 in.2) in women and ____ cm2 (7.3 in.2) in men

Excess visceral adipose visceral adipose tissue Aerobic exercise one-third aerobic exercise 37 47

What did the Midwest Exercise Trial find?

Exercise prevented weight gain in women and produced weight loss in men while the control groups experienced weight gain The study confirmed that adherence to a regular, moderate-intensity exercise program is effective for managing weight without dieting in overweight young adults if it is sustained for 16 months. However, because more than half the exercisers dropped out of the program, the study also shows that the public health effectiveness of exercise in weight management is limited by people's willingness or ability to sustain a regular exercise program

t or f? Waist circumference adds to the accuracy of predicting disease risk in people who have a BMI of 35 kg/m2 or more

FALSE IT DOES NOT

T or F? childhood obesity does NOT track into adulthood

False it does

Well-executed research such as the ________ at the Medical College of Georgia has shown positive effects of physical activity for weight loss in children. In this project, a 10-month randomized controlled trial tested the effect of a daily after-school program consisting of 30 min of schoolwork and healthy snack time and 80 min of MVPA (25 min of skills instruction, 35 min of aerobic physical activity, and 20 min of strengthening and stretching) on body composition in 118 black girls aged 8 to 12 years. What were the results?

FitKid Project Girls in the control group had gotten fatter or had stayed about the same 10 months later. Girls in the intervention stayed about the same or lost body fat, even after adjustment the intervention group showed larger decreases in percent body fat 2%, BMI .45kg/m'2 and abdominal fat mass 14.6 cm'3 but not waist circumference even though attendance was just 54%. HIGHER ATTENDANCE= GREATER DECREASES IN BODY FAT AND BMI AND GIRLS WHO EXERCISED MORE VIG HAD LESS PERCENT BODY FAT

Opposing ghrelin's stimulation of appetite are anorexigenic (appetite-suppressing) hormones produced in the intestine, including glucagon-like peptide 1 (GLP-1) and peptide YY. ______regulates glucose levels, insulin secretion, and gastric emptying to promote satiety. _____ increases after a meal and also delays gastric emptying to promote satiety.

GLP-1 Peptide YY

Risk girth weight in men? women?

Girth at the waist greater than 102 cm (40 in.) for men and 88 cm (35 in.) for women is considered risky

By 2040 High BMI is forecasted as what leading global risk of premature death behind only high BP?

High BMI is forecast as the second leading global risk for premature death, behind only high blood pressure, by 2040

What are the 8 Health risk of obesity?

Hypertension Gallbladder disease Hypercholesterolemia Osteoarthritis Type 2 diabetes Cancer (uterus, prostate, breast, colon) Coronary heart disease Stroke

However, a large study using pooled data from 19 prospective studies of 1.46 million white adults, 19 to 84 years of age, observed that after taking biases from smoking and ill health into consideration and adjusting for physical activity, there was a ______ relationship between BMI and all-cause mortality

J-shaped, most deaths 40-49 BMI, Least 20-25

What theory does this relate to and who said it? His idea is that weight loss and gain in most humans are more related to the patterns of diet and physical activity that people settle into as habits based on the interaction of their genetic dispositions, learning, and environmental cues to behavior

James Hill; Settling Point

_______ induces feelings of satiety by binding with receptors in the hypothalamus that affect appetite, mainly by suppressing secretion of _______ by cells in the arcuate nucleus—in the same way that insulin does. It also activates other brain systems involved in finding food, smelling and tasting food, and in regulating the rewarding effects of food

Leptin neuropeptide Y

What did the Fred Hutchinson Cancer Research Center—Seattle study find?

Men actually averaged 370 min/week, and women averaged 295 min/week. Women who exercised lost 1.4 kg (3.1 lb) of body weight and 1.9 kg (4.2 lb) of fat mass, while women in the nonexercising control group gained 0.7 kg (1.5 lb) of body weight. The authors estimated that the extra physical activity should have led to a weight loss of 7.8 kg (17.2 lb) had caloric intake remained stable, so the study shows that some people tend to eat more when they exercise more, a practical problem of using exercise alone for short-term weight loss.

In a simulation med costs of obesity were higher than for smoking until people reached what age? After that age smoking costs were higher

Mid-50s

Who recommended the current criteria for diagnosing metabolic syndrome?

National Cholesterol Education Program Adult Treatment Panel III,

What does obesity now co-occur with?

Obesity now co-occurs with undernutrition in many developing nations.

in groundbreaking study measured changes in weight gain and naturally occurring energy expenditure in young, nonobese adults who were fed 1000 kilocalories more than they needed for weight maintenance each day for eight weeks, how many calories were stored as fat and how many burned by NEAT? How much did fat gain vary?

On average, 432 of the extra calories were stored as fat, and 531 calories were burned by increased NEAT Fat gain varied among people by tenfold, ranging from a gain of about 0.40 kg to 4 kg (0.9-8.8 lb). The amount gained was inversely related to how much people increased their NEAT, which also varied widely from 298 to 1692 calories each day. The average increase in NEAT was 336 calories a day, which accounted for two-thirds of the increase in daily energy expenditure

Most successful weight loss programs incorporate

PA

_________ is typically used to estimate overweight and obesity in epidemiologic studies because they are easy to assess in large numbers of subjects

Quetelet's body mass index (BMI)

Prolonged undereating lowers? and contributes to?

RMR the yo-yo effect of increased fat gain after restrictive diets

_____ hypothesizes that the body has an internal control mechanism, that is, a set point, located in the lateral hypothalamus of the brain, that regulates metabolism to maintain a certain level of body fat

Set point theory

was proposed by obesity researcher James Hill of the University of Colorado to help explain why overweight and obesity are more than problems of metabolism.

Settling point theory

Similarities and difference in relation to obesity in Physical fitness studies to PA studies?

Similar to the studies of self-reported physical activity, studies of the joint association of physical fitness and overweight or obesity (measured by BMI, waist girth, or percent body fat) with mortality risks usually show that cardiorespiratory fitness and also muscular strength are independent influences on risk of all-cause mortality and mortality from CVD and cancer. However, in contrast to what is seen in the studies of physical activity, fitness typically reduces mortality risks associated with overweight and eliminates this excess risk in some cohorts that were initially healthy.

________ varies according to the relative length of a person's legs to his or her trunk (i.e., the ratio of sitting height to total height) and the widths of wrist and knees and the breadths of the pelvis and shoulders

Slenderness

in the study of over 600 black and white U.S. teens 14 to 18 years of age what was concluded?

So, the researchers speculated that the lower percent body fat in those who were vigorously active resulted from elevated metabolic rate and fat oxidation, similar to the concepts of energy flux and subsistence efficiency introduced at the beginning of this chapter. If this is true, the study suggests that prevention of obesity in children should focus on increasing vigorous physical activity rather than restricting energy intake

Obesity spread from

South to the West and North from 2011 to 2017

What is the difference in the results of being fit vs. physically active in regards to obesity?

Studies of physical fitness generally have observed that being fit can remove the excess risk of all-cause or cardiovascular mortality associated with being overweight or obese. In contrast, studies of physical activity generally have shown that each risk factor (i.e., inactivity or overweight/obesity) is associated with increased risk of all-cause mortality or CVD, of approximately equal magnitude, and that being physically active does not remove the excess risk associated with increased adiposity.

T or F? Someone can be overweight but not obese, but if you are obese you are also overweight

T

T or F? white and Hispanic, but not black, adolescents who have a large waist circumference (another index of obesity) are more likely to also have high triglycerides, high blood sugar (boys only), and low HDL-C

T

T or F? Among U.S. four-year-old children in 2005, the rate of obesity in American Indian or Native Alaskans (31%) was double the rates in non-Hispanic white (16%) or Asian (13%) children and half again higher than the rates in non-Hispanic black (21%) and Hispanic (22%) children

T (write this down)

In the HAS, what did it find?

The 25% to 33% reduction in all-cause deaths among men who expended at least 2000 kcal/week was still present regardless of smoking, high BMI, or gains in body weight during the years of follow-up. Low net weight gain since the college years was associated with a 33% increase in relative risk, though that finding might be explained by smoking or wasting diseases such as cancer, which were not controlled for.

what did the groundbreaking overeating study find?

The authors surmised that when people overeat, some increase NEAT to preserve leanness, while others are vulnerable to weight gain because they do not naturally increase NEAT

PAGA concluded that many adults need how many minutes of MVPA

The committee concluded that the optimal amount of physical activity needed for weight maintenance (<3% change in body weight) over the long term is unclear, but that many people need more than 150 min of moderate-intensity activity each week to maintain their weight at a stable level

Obesity is considered a _____, but there is controversy about?

Though obesity is considered a disease, there is controversy about whether it is an independent cause of premature death or whether it is deadly because of the constellation of risk factors for mortality that accompanies it.

Nations with the highest prevelance of BMI over 30 kg/m'2?

US

_______ is positively correlated with abdominal fat content and provides a clinically acceptable measurement for assessing a patient's abdominal fat content before and during weight loss treatment

Waist circumference, or girth,

In the exercise and diet section, where was the largest weight lose seen

Weight loss after each named diet was similar. Compared to no diet, the largest weight loss was after low-carbohydrate diets (8.73 kg [19.2 lb] after 6 months and 7.25 kg [16 lb] after 12 months) and low-fat diets (7.99 kg [17.6 lb] after 6 months and 7.27 kg [16 lb] after 12 months). The estimated independent effects on weight loss after 6 months and 12 months were 3.23 kg and 1.08 kg (7.1 and 2.4 lb) for behavioral support and 0.64 kg and 2.13 kg (1.4 and 4.7 lb) for exercise.

according to the global burden of disease worldwide how much has obesity levels increased and how much increase in there in disability adjusted life years from 1990-2017

Worldwide, there was a 70% increase in obesity levels and a 130% (20% age-standardized) increase in disability-adjusted life years from 1990 to 2017

What is metabolic syndrome?

a combo of conditions that raise your risk for things like cardiovascular disease, hypertensoin etc

Excess fat ____ the waist, so-called ____ fat, increases risk for CHD more than does excess fat ______ the waist, so-called _______ fat.

above; androidal below; gynoidal

How could most people accomplish resetting their RMR?

adding an extra hour of moderate-to-vigorous physical activity each day

One of those hormones, _______, is secreted by fat cells to help regulate the metabolism of glucose and fatty acids. Higher levels of _______ are associated with reduced risks of metabolic diseases such as type 2 diabetes, atherosclerotic diseases, nonalcoholic fatty liver disease, and metabolic syndrome. Although acute exercise does not seem to affect the level of adiponectin in the blood, the long-term effects of regular physical activity are not yet known

adiponectin

Excess weight gain manifests its health risks mostly during _____, contributing to chronic but reversible diseases.

adulthood

Blood levels of leptin are not changed after exercise lasting less than _____ or expending less than _____kcal but are decreased after longer sessions that stimulate release of free fatty acids in the blood or expend more than 800 kcal. Ghrelin levels are _______ by acute sessions of moderate-to-vigorous aerobic exercise; but hypothetically, leptin should be _______ after chronic exercise that leads to weight loss.

an hour; 800 not affected decreased

low socioeconomic development is defined as

annual income per person less than $1000

Food restriction produces a decline in _______ that accompanies the decline in body weight. Basal metabolic rate (BMR) and the _______ are reduced during food restriction. Basal metabolic rate declines as total mass and fat-free mass decline. Because physical activity, especially resistance exercise, can decrease the percentage of body mass that is fat while increasing fat-free mass, it has the potential to retard the reduction in BMR common during restrictive diets

basal energy expenditure thermic effect of food

Though weight losses after the use of stimulant drugs, nicotine, and exercise seem consistent with the concept of an altered set point, these effects can also be explained by the alteration of _______ in ways that do not require a change in the set point.

basal metabolism

Interventions designed to alter diet and reduce weight have used principles of ______ with modest success, particularly among the obese

behavior therapy

overweight and obesity in modern humans who are genetically prone to gain weight are ........., though unhealthy

biologically normal

Levels of leptin in the blood are proportional to _______ , so people who are obese typically have high levels, suggesting that they are resistant to the normal effect of leptin to suppress energy intake. Their levels return to normal after weight loss

body fat

In a study of Amish who are physically active, in FTO variant was associated with high BMI only in those in the________ of age- and sex-adjusted physical activity measured by an accelerometer for seven days (about 2600 and 3100 kcal/day) . There was no increased risk of being overweight or obese in people with the risky FTO gene if they were in the _____ in physical activity (about 3600 and 4000 kcal/day). However, even the least active Amish were spending about ______ h each day in moderate physical activity, a level much higher than that of the typical American who has a more sedentary lifestyle

bottom 25% top 25% 3 to 4

Large waist circumference in white and hispanic but not african american kids are result in high blood pressure levels for what gender only?

boys

There is no evidence to say that there is a direct association between in the US pop

calorie intake and increased BMI

A systematic, quantitative review of 25 years of weight loss interventions published through 1994 reported that studies had focused on middle-aged adults who had _______ (BMI = 33.2 ± 0.5 kg/m2; percent body fat 33.4% ± 0.7%) using short-term interventions (15.6 ± 0.6 weeks; Miller, Koceja, and Hamilton 1997). The average diet or diet-plus-exercise intervention each resulted in a weight loss of about 11 kg (______). About 6.6 ± 0.5 and 8.6 ± 0.8 kg (14.6 ± 1.1 and 19 ± 1.8 lb) of weight loss was maintained after one year following diet only or diet plus exercise, respectively

class 1 obesity 24.3 lb

THE CARDIOVASCULAR risk associated with metabolic syndrome depends on the _______ of its components. Having central obesity, elevated BP, and high blood sugar more than _____ the risk of cardiovascular disease (CVD) and _____ the risk of all-cause death

combination doubles triples

A related laboratory study showed that NEAT is substantially reduced by the

common use of labor-saving devices

Also, total fat mass (including subcutaneous abdominal fat and intra-abdominal or visceral fat) can be measured by _______ and compared with waist circumference as an index of body fatness. These more direct measures show that the accuracy of BMI and measures of waist girth as estimates of body fatness can _____ across age, sex, and race-ethnicity. This is the case mainly because BMI and girth scores used to define overweight and obesity were derived using data primarily from ______

computer-assisted tomography differ white adults

A sedentary human living in a wealthy society energy expenditure and intake?

consume about 2030 kcal each day but expend only about 580 kcal (less than 9 kcal/kg), a subsistence efficiency of 3.5:1

What is another word for being overweight?

corpulent

In a five year follow up of the ACLS, There was a _______weight gain over the follow-up among the men who maintained their physical activity level between the first and third clinic visit. The acceleration in weight gain was greater among men who decreased their PAL. A shift from a low PAL (<1.45 METs per 24 h) to a moderate (1.45-1.60 METs per 24 h) or high (>1.60 METs per 24 h) PAL was necessary for weight loss over time. Men with initially the _____ had the greatest benefit from increasing activity to levels that can be achieved by incorporating 45 to 60 min of brisk walking, gardening or yard work, or cycling into the daily routine.

curvilinear lowest PAL

What is NEAT?

daily energy expenditure that results from the routine activities of daily living, maintaining an upright posture (e.g., standing rather than sitting), and spontaneously arising movements (e.g., pacing or fidgeting), which has been termed nonexercise activity thermogenesis, or NEAT

Studies show collectively show small ______ in circulating levels of acylated ghrelin (appetite stimulate) (−0.20 SD; −16.5%) and similarly small _____ in peptide YY (feeling of satiety) (0.24 SD; 9%) and GLP-1 (0.28 SD; 13%)

decreases increases

obesity is associated worldwide with increased risk of.....

diabetes, cardiovascular diseases, some cancers, and poor health-related quality of life

WEIGHT LOSS after an exercise program is usually small, but weight loss is sustained much better after____ plus exercise than after a diet alone.

diet

The results from studies of physical fitness ____ somewhat from those relating to physical activity

differ

MODERATE PHYSICAL activity can help lower blood pressure among overweight and obese people even when they _______

do not lose weight.

At present, evidence does not support a linear __________ between the intensity of exercise and fat reduction among typical middle-aged or older adults who have been sedentary and embark on a new physical activity program. Weight and fat loss are ______ related to total energy expenditure from increased physical activity in programs that last about four months or less. However, that relationship is lost in longer-lasting programs, probably because people have difficulty adhering to a diet and exercise program for long periods of time.

dose-response gradient linearly

Based on cumulative data from the National Health and Nutrition Examination Survey III and the Framingham Heart Study, moderately obese (BMI >32.5 kg/m2) middle-aged men and women have about _____ the risk of hypertension, ____ the risk of type 2 diabetes, and a _____ reduction in life expectancy compared with their nonobese peers

double triple one-year

More recently, 14 participants who had lost on average 58 kg (128 lb) or 60% of their initial weight during The Biggest Loser televised weight loss competition were followed up six years later. They collectively had regained 88% of their weight. However, on average the seven people who maintained a weight loss of 25% (measured by DXA) had more than ______ their physical activity (by______ to 12 kcal · kg · day; measured by doubly labeled water), while the seven who had regained the weight they lost during the competition had increased their physical activity by just _____ to 8 kcal · kg · day since leaving the competition. In contrast, energy intake had decreased about the same amount (9% and 7.5%) in weight loss maintainers and regainers (Kerns et al. 2017). The amount of activity among the weight loss maintainers was equivalent to roughly ____ min of walking each day.

doubled 160% 34% 80

Several risk factors for cardiovascular disease are ________ in children who are overweight (BMI 85th to 94th percentile) and who have high a waist-to-height ratio

doubled or tripled

Similarly, in younger children, obesity _______ the risk of high blood pressure and low HDL-C

doubles or triples

PAGA noted that increased use of labor-saving tools at work and home, as well as more time spent in sedentary activities (e.g., Internet use and online social networking) during discretionary leisure, has shifted the energy cost of activities of daily living ______ in ways that put extra importance on __

downward planned physical activities above daily routines in order to achieve energy balance

Studies show that a high (≥30 kg/m²) BMI classification yields similar results to ______, but BMI can have _____

dual-energy X-ray absorptiometry low sensitivity

Most commonly, mineral content is measured by.....; body water is measured by .......; and body density is measured by.....

dual-energy X-ray absorptiometry (DXA) dilution with deuterium underwater weighing or air displacement plethysmography.

In Norway study, being highly active protected against the risk of cardiovascular death in obese women, but the mortality risk of obese men who were highly active remained ______ compared to that in equally active men who had normal body weight.

elevated

Ghrelin levels in men were not affected by exercise, but they were _____ in women after exercise regardless of whether energy cost was balanced with more intake. Appetite was inhibited in the men after energy-balanced exercise, but exercise did not change women's appetite. One interpretation of the results is that mechanisms to maintain body fat are more effective in women than in men. In a separate study, women's feelings of hunger were suppressed during a session of walking that expended 550 kcal, but they were not affected between meals despite an increase in ghrelin and a delayed and short-term decrease in leptin after exercise

elevated (hungrier)

In the ACLS study, mod to high fitness does what?

elevated risk of all-cause, CVD, and cancer mortality associated with obesity.

The NHS found that higher levels of physical activity reduced, but did not ______, the elevated risk of death associated with high BMI

eliminate

Studies have examined the effect of exercise on leptin and ghrelin, two hormones that regulate

energy balance in part by affecting appetite

Define subsistence efficiency

energy consumption divided by energy expended in daily living

Body fat cannot be measured directly, so it is calculated from

estimates of mineral content of bone, body water, and body density

Another risk factor for obesity is?

excess abdomen fat (waist circumference or girth) proportional to total body fat

Overweight and obesity are characterized by _________ resulting from a positive energy balance, which is? .

excess body fat, (i.e., an energy intake greater than energy expenditure)

Prehistoric ancestor energy expenditure and intake?

expended about 1200 kcal a day in physical activity (nearly 22 kcal/kg of body weight) while consuming about 2900 kcal, their subsistence efficiency was 2.4:1

What is the major determinant of RMR

fat free mass

Studies using mainly dietary restriction have shown that weight loss is accompanied by a decrease in

fat-free body mass and basal energy expenditure

Define weight loss cycling

five or more episodes of losing at least 2.3 kg (5.1 lb)

Evidence suggests that obese people are more sensitive to _______ in the social and physical environment, which influence their energy intake, than to the stimuli for energy expenditure.

food-related stimuli

In NHS protection against mortality was strongest?

for cardiovascular deaths

The rates of obesity are highest in groups of people who have less ______ and _______ and in some minority groups, especially American Indians or Alaska Natives and African American and Mexican American women

formal education and lower income

How is obesity ranked in regards to the leading risk factors according the the global burden of disease study?

fourth leading risk factor behind high blood pressure, smoking, and high blood sugar

When did PA increase?

from 1988-1994 to 1999-2000 but not thereafter.

it is important to remember throughout this chapter that BMI and _________ are not equivalent indexes of body fatness or abdominal fatness among men and women of differing ages, race, or ethnicity.

girth measurements

what has the WHO coined as a term that refers to global epidemic of overweight and obesity?

globesity

The mechanism responsible for this metabolic change is an increased insulin sensitivity because of an upregulation of receptors on muscle and liver cells. In addition, the insulin-like effect of exercise increases blood glucose clearance in the absence of insulin because of the action of the _______

glucose transporter GLUT4

A summary of six weight loss studies found that groups who exercised more as part of their weight loss dietary intervention lost the same amount of weight (about 21 kg [46.3 lb]) but had ___________ after two to three years (15 kg [33.1 lb], 12.5% of their initial body weight and 54% of their weight loss) than those who exercised less (7.5 kg [16.5 lb], 6.7% of their initial body weight and 27% of their weight loss)

greater weight loss maintenance

in the Lipid Research Clinics Mortality Study later study, Cancer mortality was lower by ___ in the most fit quintile relative to the other four quintiles for men but not for ______ (HR = 0.84; 95% CI: 0.52-1.36). Cancer mortality was _____ higher in the highest BMI quintile relative to the other four BMI quintiles for ______ but not for men (HR = 1.05; 95% CI: 0.77-1.43). In this investigation, high fitness was a ________ of cancer mortality than was high BMI in men, but high BMI was a stronger predictor of cancer mortality than was high fitness in women.

half women 50% women stronger predictor

Some research has suggested that during aging, people who maintain a ________ with high physical activity have higher RMR because of higher body density (i.e., more muscle and less fat) or elevated activity by the sympathetic nervous system

high energy flux

The concept of subsistence efficiency complements the hypothesis of _______ stemming from research conducted by world-renowned nutritionist _____ in the 1950s

high energy flux Jean Mayer

Based on available evidence, it does not seem that ________ of exercise lead to greater losses in weight or total fat than moderate intensities when time is adjusted to keep energy expenditure the same for each. The ACSM concluded that there is a dose response that is effective between about _______ h of moderate-intensity exercise (55%-69% of maximal heart rate or about 3 to 6 METs depending on age) that results in an energy expenditure of at least 1200 to 2000 kcal/week. That amount of activity, combined with reduced calorie intake of 1000 to 1500 kcal/week, will yield healthful weight loss (1 to 2 lb/week [0.5-1 kg]). Intermittent periods of physical activity (e.g., 10-min sessions that accumulate to 30 to 40 min per day) seem to be as effective as continuous sessions.

high intensities 2.5 and 4.5

Some evidence indicates that extra fat stored above the waist indicates ________, which is believed to be more biologically active, that is, more readily mobilized from adipose cells into the bloodstream, where it can contribute to _______. Other evidence indicates that intra-abdominal adipose cells are more likely to secrete inflammatory factors that lead to vessel and organ damage

high visceral fat atherosclerosis

Differences between ethnic groups in their slenderness can create different relationships between BMI and actual body fatness. People with a slender build rank _____ on body fatness at a given BMI than people who have a stockier or more muscular build.

higher

In a cross-sectional study of 846 healthy Finnish men, BMI and waist circumference were _____ in those homozygous for the risky FTO allele and were lower in those with higher cardiorespiratory fitness. people lost weight regardless of FTO genotype, but among people who had the largest increases in cardiorespiratory fitness, carriers of the risky FTO allele lost ______ than noncarriers

higher; less weight

people who inherited a risky GTO variant from both parents and were also physically inactive had the _______. However, physical activity did not modify the risk of high BMI associated with that FTO variant in cohorts from Sweden and Finland

highest BMI

A study of over 600 black and white U.S. teens 14 to 18 years of age found that regardless of age or race, boys and girls with the lowest percent body fat spent the most time in vigorous physical activities but also had the ______. Also, the vigorously active consumed about ____ kcal a day more than those who said they got no vigorous activity, but their moderate physical activity and TV watching were _____.

highest daily intake of calories 440 the same

The scientific advisory committee for the 2005 Dietary Guidelines for Americans concluded that moderate physical activity for an ___ each day can increase energy expenditure by about ______ calories, which can be helpful in preventing unhealthy weight gain if the extra calories used aren't offset by an equal increase in calorie intake

hour 150 to 200

This difference may reflect that the two attributes, lack of fitness and inactivity, do not represent _________ . Also, physical fitness tends to be more _________ than physical activity

identical characteristics precisely measured

BMI has a high specificity for

identifying obesity in pops

Because RMR naturally decreases as people get smaller, the optimal way to reduce obesity and maintain a high energy flux is to

increase physical activity as people lose body weight

Trunk fat_______ risk for CHD independently of ______. For example, in the Paris Prospective Study, subcutaneous fat distribution and incidence of CHD was examined among 6718 men ages 42 to 53 after a follow-up period of 6.6 years. Fat distribution was described as the measurement of 13 skinfold thicknesses (five on the trunk, four at the triceps level, four at midthigh). The trunk measurements were correlated with BMI (r ~0.50) but were better predictors of myocardial infarction and angina pectoris, independent of their moderate correlations with systolic blood pressure, serum cholesterol, and serum triglycerides

increases serum lipids

The prevalence of overweight and obesity in the United States _____ steadily after the 1970s, finally leveling off at record highs near the beginning of this ______

increasing millennium

IN the Kuopio and North Karelia, Finland study, Self-reported physical activity during leisure and occupation had an _______ with lowered mortality rates

independent dose relation

Studies on the joint association of self-reported physical activity and high BMI typically show that each is an________ for all-cause mortality and mortality from CVD and cancer. The mortality risk of obesity is not eliminated by physical activity, but it was usually _________ .

independent risk factor reduced substantially in population cohorts that did not initially have a chronic disease

Low glucose stimulates appetite, while high levels of glucose and insulin inhibit appetite. Exercise lowers ________ levels, so it might affect appetite. Whether exercise stimulates or inhibits appetite in the short term has not as yet been clearly determined, but studies generally show that appetite is _______ shortly after an exercise session

insulin and glucose, suppressed

Moreover, as_________appears to be a key catalyst that induces the cascade of risks associated with metabolic syndrome, the demonstrated protective role of physical activity against impaired glucose tolerance assumes special importance for people who are overweight.

insulin resistance

Because the energy needs of _______ exceed those of skeletal muscle, it remains unclear whether increases in muscle mass explain the increase in RMR reported after resistance exercise training. In one study, RMR was increased by about 10%, or 180 kcal per day, 15 h after a session of resistance exercise

internal organs

the scientific advisory committee for the 2008 Physical Activity Guidelines for Americans located nine prospective cohort studies published since 1995, with follow-ups of at least one year to more than six years, that showed an ______

inverse association between physical activity and body weight outcome.

some studies seem to show that physical activity habits during adulthood influence obesity _______, genetic inheritance or childhood habits

just as strongly as, or more strongly than

why are many nations today obesogenic?

largely because of relentless advertising of food that cues the desire to eat, easy access to affordable high-energy foods, and sedentary lifestyles

Growth in rates of overweight and obesity in adults has begun to ___ in the last _____ years

level off 15

In the ACLS During that time, men gained an average of 0.6 kg (1.3 lb), and women gained an average of 1.5 kg (3.3 lb). However, there was wide variation in weight change (the standard deviation was about 5 kg [11 lb]) that was _________ Among both men and women, each _____ of improved treadmill endurance reduced weight gain by 0.6 kg (_____); it reduced the risk of a weight gain of 5 kg (11 lb) or more by 14% in men and 9% in women and reduced the risk of a weight gain of 10 kg (22 lb) or more by ____ in both men and women.

linearly dependent on the changes in fitness minute 1.3 lb 21%

Fat loss is proportional to the amount of energy expenditure in short-term exercise studies but not _______. The weight loss during short-term studies is about ____ of what would be predicted based on energy expenditure, assuming a controlled diet. weight loss is only about _____ of that expected in long-term studies, suggesting poor adherence by the participants to either the prescribed physical activity or the prescribed diet

long-term studies 85% 30%

Thus, improvement in metabolic syndrome from either diet or exercise depended on the______

loss of body fat.

In the Norway study, In middle age, obesity (BMI ≥30 kg/m2) was associated with increased risk of cardiovascular death. At all ages, a ______ of physical activity was associated with high cardiovascular mortality. Among men and women who were obese, cardiovascular mortality was lower in those who said they got ___ or more min of moderate-to-vigorous activity more than once a week compared to those who reported no regular physical activity. Also, the mortality risk of obese women was not higher than for normal-weight women if they participated in that much activity

low level 30

Although high BMI is more common in many economically developed regions (e.g., Canada, the United States, and Europe) and developing regions (e.g., Mexico and Brazil), it is now also common in many areas with _______ (e.g., annual income per person less than $1000

low socioeconomic development

In the Whitehall II Cohort Study—London, PA at baseline was NOT associated with change in BMI or waist girth over the follow up. Compared to participants whose physical activity remained stable between 1997 and 2002 (change of <2.5 h/week), those that reported an increase in moderate-to-vigorous physical activity of at least 2.5 h/week had ______ (−0.40 kg/m2) and waist girth (−1.10 cm).

lower BMI

In South Asian and East Asian populations, risks for diabetes, metabolic disorders, cardiovascular disease, and all-cause mortality occur at _______ than for European populations. This is the so-called _______ paradox

lower BMIs thin-but-fat

In a study of obese teens, eight months of moderate or vigorous exercise training did not change leptin levels on average, but youths who had the _________ in cardiovascular fitness tended to have the _________ in leptin levels

lowest increase highest increase

PA helps?

maintain body density and resting metabolic rate) while burning excess calories.

Lost weight is usually regained unless a weight maintenance program consisting of dietary therapy, physical activity, and behavior therapy is continued indefinitely. After six months of successful weight loss, efforts to ______ should be undertaken

maintain weight loss

The committee also concluded that a moderate amount of evidence indicates that the association between physical activity and weight gain is consistent between __________ but there is insufficient evidence to determine whether the association varies by race or ethnicity, socioeconomic status, or a person's initial weight status (The conclusions were based on evidence from 26 prospective cohort studies having follow-ups lasting 1 to 22 years. Most of the studies assessed physical activity two or more times, permitting an estimate of change in physical activity exposure)

men and women across age,

Exercise training programs that allow people who are overweight to eat as they wish frequently lead to fat loss in ________, possibly because of sex differences in the way energy-regulating hormones and appetite respond to increased energy expenditure

men but not women

the co-occurrence of obesity with diabetes or prediabetes, hypertension, and dyslipidemia partly define the _______ an absolute risk for CHD and cardiovascular mortality

metabolic syndrome

NHANES 2015-2016 Prevalence of obesity was higher in _______ (42.8%) than younger adults (35.7%).

middle-aged adults

Most modern adults achieve their PAL by _______ physical activities such as walking, while children achieve theirs by a combination of _______ physical activities

moderately intense high- and low-intensity

During the 1980s and 1990s, it was estimated that _______ of U.S. adults gained more than ______ across periods of three and four years

more than half 5 lb

Intentional weight loss had a small benefit for people with obesity-related risk factors (RR = 0.87; 95% CI: 0.77-0.99), especially when they were also obese (RR = 0.84; 95% CI: 0.73-0.97). However, weight loss was associated with a small increase in______ among people without obesity-related risk factors (RR = 1.11; 95% CI: 1.00-1.22) and people who were overweight but not obese

mortality risk

What stimulates appetite?

neuropeptide Y

There was _________ of weight loss among obese people who were otherwise healthy.

no apparent benefit

NHANES 2015-2016 Prevalence of obesity was higher in __________ than in non-Hispanic white and non-Hispanic Asian adults and youths.

non-Hispanic black and Hispanic adults and youths (blacks and hispanics all have higher obesity than whites)

RESISTANCE EXERCISE training can increase basal metabolic rate by an extra 50 to 75 kcal on average. Most of the increase is explained by increased ________, not by extra use of protein as fuel

nonfat body mass

About half of all adults in Western populations who are likely overfat are believed to be defined as ______ according to BMI, and ______ of children and adolescents defined as having a healthy BMI for age will likely be overfat if measured by objective _______. In Asia and sub-Saharan Africa, BMI ________ obesity even more

nonobese 25% to 50% densitometry underestimates

In the Lipid Research Clinics Mortality Study, Body mass index was ____ an independent risk factor for mortality. However, among the lowest levels of physical fitness, the relative risks were _____ for CVD deaths and ______ for CHD deaths after adjustment

not 2.7 to 3.0 2.8 to 3.2

In the Women's Ischemia Syndrome Evaluation, BMI and girth measures were

not associated with CAD or CVD events after adjustment

In the simulation ____ costs were still higher in obesity because smokers died at a young age

obesity

define metabolic healthy obesity

obesity without elevated blood glucose, lipids, or blood pressure

In the study of twins, he total energy deficit above RMR caused by exercise was about 58,000 kcal. Average fat loss was 11 lb (5.0 kg). Although the difference in weight loss between sets of twins was six times greater than the average difference within each pair of twins, about _______ of the weight loss couldn't be explained by the fact that twins had the same DNA Weight gain between 1975 and 2005 was 5.4 kg (_____lb) less, and waist circumference in 2005 was ______ less, in the active compared to inactive twins.

one-fourth 2.4 lb 8.4 cm

Other proteins produced in the hypothalamus (e.g., __________) stimulate eating and contribute to obesity. _______ also stimulates physical activity and is elevated in obesity-resistant rats (Teske et al. 2006), but the effects of exercise on orexin A and neuropeptide Y in humans are not known.

orexin A and neuropeptide Y Orexin A

Obesity in mainly caused by____ ____ which is under peoples control but it is hard to make a change.

overeating and insufficent PA

Obesity experts say that is it caused more by ___ and less by ____. but the relative importance of eating less or exercising more as a means to stall or reverse global obesity is not yet known

overeating and less by insufficient PA

not only does regular physical activity independently reduce the risk of all-cause, cancer, and CVD mortality, but it also can help protect against CVD indirectly by favorably affecting its major risk factors—hypertension, dyslipidemia, and hyperglycemia—in _______ people even when they don't lose weight

overweight

How many adults in the US 20+ years old are overweight and obese in 2016?

overweight 72% obese 40% (93million)

studies also show that people who already have CVD paradoxically have better survival when they are ____________. However, __________ modifies this paradox. (In a study of 10,000 patients with CHD, only those in the bottom third of fitness showed the obesity paradox. In another study of 2000 patients with heart failure, obese patients had a better prognosis than normal-weight patients, but patients with average or higher fitness had a better prognosis regardless of BMI)

overweight or mildly obese; cardiorespiratory fitness

An observational study that defines physical activity exposure only at follow-up or only as change from baseline to follow-up, without showing that baseline activity was related to lower initial weight or predicted subsequent weight gain, would be misleading if _________ this would suggest?

people with high initial weight become less active Reverse causality

The U.S. National Institutes of Health (NIH) regards obesity as a chronic disease that develops from an interaction of a....

person's genotype (i.e., the DNA), the environment, and the person's dietary and physical inactivity habits

WITHOUT SUSTAINED ________ , the average weight loss after dieting among people who are obese is about ______; ______ is typically gained back within a year, and nearly all is gained back within _________ years

physical activity 10 kg (22 lb) one-third three to five

a systematic review done for the 2020 to 2025 Dietary Guidelines for Americans could NOT quantify the association between dietary patterns and obesity risk, in part because the influence of ..... as a confounder or moderator of the association, had been often overlooked

physical activity,

the general consensus remains that people who are overweight or obese have increased risks, independent of _________, of developing hypertension; hypercholesterolemia; type 2 diabetes; CHD; stroke; gallbladder disease; osteoarthritis; and cancers of the uterus, breast (postmenopausal women), esophagus, colon, pancreas, and kidney.

physical inactivity

Those estimates indicated that the rising trend in children's and adolescents' BMI has _____ at high levels in many high-income countries but has ______ in parts of Asia.

plateaued accelerated

Overweight among American schoolkids ______ at around ____

plateaued 1/3

The scientific advisory committee for the Dietary Guidelines for Americans concluded that.... directly contribute to obesity

poor dietary patterns, overconsumption of calories, and physical inactivity

Part of the challenge to maintaining weight loss is that overeating followed by undereating (dietary restriction) of an equal amount for the same amount of time results in a________ that then requires even more ______ to return to energy balance

positive energy balance undereating

What does leptin do?

primary energy balance hormone released from fat cells, partly in response to insulin. Together with other energy-regulating hormones released from the gut, fat cells, and skeletal muscle, low leptin levels activate peripheral and brain systems to restore energy balance. High levels suppress eating and increase energy expenditure

Though evidence in ____ has supported the theory, there is no scientific consensus that such a metabolic set point exists in _______

rats humans for fat maintenance

In the study University of Virginia, (middle aged women with metabolic syndrome) Computed tomography scans were used to determine abdominal fat. Percent body fat was assessed by air displacement plethysmography. High-intensity training, but not low-intensity training______

reduced total abdominal fat, subcutaneous abdominal fat, and intra-abdominal fat.

Reversal of obesity and food diseases may have to result from

reintroducing intermittent fasting and exercise

ACSM says Although _________ added to aerobic exercise doesn't typically enhance weight loss, it can increase _________ by retarding loss of muscle (sarcopenia) during aging and dieting.

resistance exercise basal metabolic rate

Define excess postexercise oxygen consumption (EPOC)

results from higher body temperature, breathing, and circulation and acts to replenish oxygen in tissues, to resynthesize adenosine triphosphate and creatine phosphate in muscle, and to replenish glycogen stores in muscle and the liver (EPOC shows a rapid, steep decline within the first 2 h after exercise that is followed by a longer-lasting gradual decline, which can last for 24 h or so depending on the person's fitness level and how strenuous the exertion was)

In the study of MVPA and the prev of overweight/obese in youth over 34 countries where was prev particularly high? The highest? How many countries was PA levels lower in overweight youths?

s particularly high in countries located in North America, Great Britain, and southwestern Europe (Greece, Italy, Malta, Portugal, and Spain). The two countries with the highest prevalence of obese and overweight youth were Malta (7.9% and 25.4%) and the United States (6.8% and 25.1%). Physical activity levels were lower in overweight youth in 30 of 34 countries

Although there is a general view that an increase in physical activity will increase hunger and eating to offset any benefit of exercise for weight loss, the actual evidence for that view is ______. Exercise studies lasting up to two weeks, with a negative energy balance up to 1000 kcal/day, show that increased food intake follows initial weight loss but is only about ____of the energy expended by exercise. Also, some people show no compensation by extra eating. On the other hand, when active people become sedentary, they typically ______ to balance off the decrease in energy expenditure

scant 30% don't eat less

What does Ghrenlin do?

secreted mainly by the stomach and by epsilon cells in the pancreas; about 20% of circulating ghrelin is acylated, which stimulates appetite, mainly by stimulating neuropeptide Y secretion. It increases in the blood before meals and decreases after meals.

Two common theories about the etiology of overweight and obesity, __________, address how physical activity can play a role in the treatment or prevention of overweight and obesity. The concept of _______, discussed later in this chapter, provides an alternative view of weight goals for obese people.

set point and settling point reasonable weight

Data from BRFSS maintained by the Centers for Disease Control and Prevention, obese U.S. adults with a BMI of 40 or higher (7.6% of U.S. adults in 2016) have about ______ times higher risk of diabetes, ___ times higher risk of hypertension, _____ the risk of high cholesterol, and _____ times the risk of self-rated fair or poor health compared to adults with normal weight

seven six double four

With regard to type 2 diabetes, the findings from studies of physical fitness and physical activity have been more ______ , showing that adiposity drastically increases the risk associated with type 2 diabetes and that neither physical fitness nor physical activity removes ______

similar the excess risk associated with being overweight or obese

n one study of obese women (You et al. 2006), adding either low-intensity (nearly an hour at 50% of aerobic capacity) or high-intensity (30 min at about 70% of capacity) walking three days a week to a 20-week diet to yield a 2800 kcal/week energy deficit produced reductions in body weight (11%-13%), fat mass (17%-20%), fat-free mass (6%-8%), waist girth (9%-10%), and percent body fat (7%-10%) similar to those with diet alone. However, only diet plus exercise, not diet alone, decreased the ________

size of subcutaneous fat cells in the abdomen, a risk factor for type 2 diabetes

Studies have shown that weight training led to reductions in body fat only ________ than those produced by aerobic exercise and that weight training also produced more substantial increases in fat-free mass, which may have the added benefit of increasing energy expenditure.

slightly less

PAGA noted that in most weight loss studies that included dieting, the contribution of physical activity to the overall calorie reduction and weight loss was _____

small

quantitative review of 43 randomized controlled trials including 3476 overweight or obese adults found that exercise combined with diet resulted in a ___________ compared with diet alone, but exercise alone led to large reduction in diastolic blood pressure, glucose) SO exercise was accompanied by improvements in several CVD risk factors even when _________

small added weight loss no weight was lost.

The American Dietetic Association concluded that weight loss studies have shown only _______ in body weight with physical activity treatment compared to no-treatment control groups. This likely reflects the fact that energy deficits that can be induced through physical activity alone—at least, in amounts tolerable for most individuals—are ______

small reductions relatively small.

In the Framingham Children's Study eight-year follow-up of 94 children found that boys and girls in the highest one-third of average daily activity from ages 4 to 11 years had ______ gains in BMI and skinfold thickness throughout childhood than the other children (Moore et al. 2003). The difference was most pronounced in girls. By age 11, BMI was about ___ lower and skinfold thickness about ___ lower in the most active children.

smaller 7% 20%

What was Jean Mayers study and what did it lead to?

study of male jute mill workers in India, Mayer observed that food intake was high in sedentary clerks and supervisors, who were heavy, but also in laborers, who were lean - His observation led to the hypothesis that healthy body weight is best maintained at high levels of both energy intake and energy expenditure (i.e., high energy flux or throughput

poverty and malnutrition are leading risk factors in

sub-Saharan Africa countries

What did the Weight Gain after Pregnancy study show?

that exercise alone did not contribute to weight loss (two trials of 53 women), but that averaged across seven trials; n = 573; MD -1.93 kg; 95% CI -2.96 to -0.89 seven trials including 573 women, diet plus exercise led to nearly 2 kg (4.4 lb; 95% CI: −1.9 to -0.90 kg) greater weight loss than usual medical care

Define reverse causality

that higher weight led to lower activity rather than that higher weight resulted from low activity (need randomized control trials to determine causality)

How many minutes do you need to put out in a week to keep extra weight off

that most people need to spend 300 min or more engaging in at least moderate-intensity exercise each week to keep extra weight off (Physical Activity Guidelines Advisory Committee 2018).

What is energy gap?

the change in energy expenditure relative to energy intake needed to reverse excess body weight in a population (eating less and exercise are important in closing this)

In any case, the evidence is clear that physical activity can favorably modify

the impact of overweight and moderate obesity on several health risk factors, including metabolic syndrome.

waist to hip ratio predicts?

the patterning of visceral fat

The Bogalusa Heart Study observed nearly 2400 children aged 5 to 14 for 17 years into young adulthood. Among the obese children, 65% of white girls and 84% of black girls were obese (BMI ≥30) as adults. Those rates were 71% for white boys and 82% for black boys.

the white girls and boys were both lower than the black girl and boys

Bc the pooled anaylsis of 5 cohort studies where 6% of 54,000 people who had metabolic healthy obesity who were said to have an increased risk of mortality, but ended up not having an increased risk compared to people with a healthy BMI what was concluded?

there is not agreement among researchers about the true number of deaths attributable to obesity each year, in large part because national estimates have not uniformly adjusted for other risks common to both obesity and mortality, especially physical inactivity.

Obesity drugs only work when?

they are in combo with healthy diet and reg exercise resulting in additional 5lbs or so beyond than with diet and exercise alone

It is possible to maintain body weight at low energy flux but most people dont bc

they are not willin got eat less

even a one-day fast can reduce a person's subsequent calorie intake over the next_____ by _____, and intermittent fasting typically results in weight loss (e.g., ______ in a month)

three days 30% 2% to 3%

Resting muscle cells require about ______ more energy at rest than fat cells (about 6 vs. 2 kcal per lb per day

three times

HERITAGE Family Study, men and women who had a nonrisky variant of the FTO gene lost __________ body weight, fat mass, and percent body fat than people who got the risky variant from both parents rather than just one parent. The FTO genotype explained ______ of the variation in fat loss. FTO was not associated with weight loss among 259 black participants. The same FTO variant was examined in the Dose-Response to Exercise in Women trial that studied 234 white, postmenopausal women (Mitchell et al. 2009). The women who inherited the risky variant from both parents had ______ before starting the exercise program than those who lacked the risky gene, but they lost a similar amount of weight after six months of moderate-intensity exercise. However, among women who met or exceeded the amount of physical activity recommended for weight loss, those who were homozygous for the risky FTO allele lost ______ weight (about 3 kg [6.6 lb]) as women without the risky allele or women who got it from only one parent

three to four times more 2% higher BMI twice as much

What have experts agreed that has evolved in humans to defend against fat loss?

thrifty genes

Initial goal for most overweight people of a prudent weight loss program?

to lose about 5% to 10% of weight over a period of six months

What is the goal of public health?

to reduce excess fat not muscle, so PA is perfect because it preserves FAT FREE MUSCLE

The obesity rates in youth are

too high

THE PREVALENCE of obesity in the United States nearly _____ from 1990 to 2020 to 40% in adults and 21% in youths. The economic burden of obesity is estimated between _____ billion to _____ billion a year.

tripled $147 $210

In adolescents, obesity (body mass index [BMI] ≥95th percentile) roughly _____ the risks for high levels of blood sugar, blood pressure, and triglycerides and low levels of high-density lipoprotein cholesterol (HDL-C), the "good" cholesterol

triples

In the ACLS intial 8 year follow up, lean men had _____ the risk of all-cause mortality that fit, lean men had. Unfit, lean men also had a ____ risk of all-cause and CVD mortality than did men who were fit and obese. Additionally, unfit men had a higher risk of all-cause and CVD mortality than did fit men regardless of total fat mass and fat-free mass. Similarly, unfit men with _________ (<87 cm) had greater risk of all-cause mortality than did fit men with high waist girths (≥99 cm)

twice higher low waist girths

The collective evidence shows that people's ratings of hunger are _______ after a session of vigorous exercise, but corresponding changes in eating behavior and feeding hormones are less consistently seen. Human appetite does not depend on homeostatic control unless ________ (Borer 2010). Hence, a change in appetite after acute exercise likely depends not only on the energy-regulating roles of feeding hormones but also on ___________; the incentive value of food (i.e., anticipated pleasure); and on other brain responses to exercise that affect appetite, such as changes in mood.

usually reduced access to food is restricted or weight loss is marked social and environmental cues

Med tech (DXA) has been used in many lab and clinical setting mainly to

validate the accuracy of BMI, girth, or other anthropometric measures that are feasible to use with large numbers of people in population-based studies of disease risk and in smaller clinical trials designed to change total or regional body fatness

When was being overweight valued and what is it now in the 21st century?

valued in 17th century europe as portrayed by the English dramatist John Dryden in the quotation that opens this chapter, it has become a 21st-century burden to the public health of developed nations

at the same time the prevalence of obesity in the United States was increasing, more adults were engaging in _______ 1950-60s 7% of men and 14% women trying to lose weight in 1989 how many men/ women were trying to lose weight?

voluntary weight loss 25% men and 40% women, avg man wanted to lose 30 lbs weighing 178 lbs and women wanted to lose 31 lbs weighing 133 lbs

In the US and Europe what is the how much do women expend? men?

w: 13 kcal-kg a day m: 16 kcal-kg a day

Precise measurement of the percentage of body mass that is fat and its regional distribution requires laboratory measurements that estimate the four tissue components constituting body mass:

water, mineral, protein, and fat

REGULAR PHYSICAL activity can help offset the

weight fluctuations, loss of nonfat body mass, and subsequent health risk of restrictive yo-yo dieting.

What did the ACLS weight cyclying study find?

weight gain was similar between men and women who weight cycled and those who didn't weight cycle. Even though a history of weight cycling did not increase the risk of long-term weight gain, cardiorespiratory fitness at baseline and increased fitness over the follow-up were associated with less weight gain in both women and men

The factors that influence the behaviors of eating and physical activity, which determine energy balance and gains or loss of body fat, are even less

well understood

Among college students 17 to 35 years of age who were attending the University of Houston, percent body fat was higher in _____ than in _____ at any BMI, and the size of the discrepancy differed according to race or ethnicity. Among women, percent body fat at any BMI was _____ lower in non-Hispanic blacks but higher in Hispanics (by 1.65%), Asians (by 2.65%), and Asian Indians (by 6%) compared to non-Hispanic whites. Among men, at any BMI, percent body fat was lower by ______ in non-Hispanic blacks, was higher by 4.6% in Asian Indians, and was similar in Hispanics and Asians compared to non-Hispanic whites.

women men 1.76% 4.6% (black men and women BMI is lower than whites but almost every other ethnicity is higher)

IN the Kuopio and North Karelia, Finland study Physically active men and women had lower age-adjusted mortality rates from all causes (_________) and from CVD (~20%-45% reduction) and cancer (~15%-20% reduction), even after adjustment for BMI and other CVD risk factors. ( obese had higher all cause than those or normal weight and obese people who were sedentary in leisure time had an elevated mort risk compared to normal weight and active)

~25%-40% reduction

Based on the relative portions of these four components measured directly in cadavers, predictive equations have been developed that have a standard accuracy for estimating body fat percentage of _______, compared with ±5% to ±7% for BMI

±2% to ±3%