Objective To develop an internationally acceptable definition of child overweight and obesity, specifying the measurement, the reference population, and the age and sex specific cut off points. Design International survey of six large nationally representative cross sectional growth studies. Setting Brazil, Great Britain, Hong Kong, the Netherlands, Singapore, and the United States. Subjects 97 876 males and 94 851 females from birth to 25 years of age. Main outcome measure Body mass index (weight/height 2 ). Results For each of the surveys, centile curves were drawn that at age 18 years passed through the widely used cut off points of 25 and 30 kg/m 2 for adult overweight and obesity. The resulting curves were averaged to provide age and sex specific cut off points from 2›18 years. Conclusions The proposed cut off points, which are less arbitrary and more internationally based than current alternatives, should help to provide internationally comparable prevalence rates of overweight and obesity in children.

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Establishing a standard definition for child overweight and obesity worldwide: international survey

A cluster of risk factors for cardiovascular disease and type 2 diabetes mellitus, which occur together more often than by chance alone, have become known as the metabolic syndrome. The risk factors include raised blood pressure, dyslipidemia (raised triglycerides and lowered high-density lipoprotein cholesterol), raised fasting glucose, and central obesity. Various diagnostic criteria have been proposed by different organizations over the past decade. Most recently, these have come from the International Diabetes Federation and the American Heart Association/National Heart, Lung, and Blood Institute. The main difference concerns the measure for central obesity, with this being an obligatory component in the International Diabetes Federation definition, lower than in the American Heart Association/National Heart, Lung, and Blood Institute criteria, and ethnic specific. The present article represents the outcome of a meeting between several major organizations in an attempt to unify criteria. It was agreed that there should not be an obligatory component, but that waist measurement would continue to be a useful preliminary screening tool. Three abnormal findings out of 5 would qualify a person for the metabolic syndrome. A single set of cut points would be used for all components except waist circumference, for which further work is required. In the interim, national or regional cut points for waist circumference can be used.

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Harmonizing the Metabolic Syndrome A Joint Interim Statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity

XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(03)15268-3.pdf

Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies.

Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013

Efficacy and safety of the weight-loss drug rimonabant – Authors' reply

A recent, rigorously conducted factorial cross-over feeding study by Sacks et al. (1) in JAMA examined the effects of diets high and low in carbohydrate and glycemic index on insulin sensitivity, lipids, and blood pressure in 163 adults. After 3.5-5 weeks with each of four treatment arms, the outcomes for glycemic index were largely null. Perhaps not surprisingly, the international media ran stories about the study with sensational headlines, such as this from the Daily Mail: “The GI diet debunked: glycemic index is irrelevant for most healthy people” (2). In the New York Times, a preeminent nutrition expert expressed the hope “that ultimately the glycemic index will be left on the shelf” (3).

The glycemic index: Reports of its demise have been exaggerated

[Obesity, the metabolic syndrome and cardiovascular disease].

Osteopenia and osteoporosis leading to fractures affect a huge proportion of the population older than 50 years of age, and osteoporosis is considered a serious public health problem. Currently, mo...

Calcium Supplementation and Coronary Artery Disease: Time to Act?

Book Review The Metabolic Syndrome: Epidemiology, Clinical Treatment, and Underlying Mechanisms (Contemporary Endocrinology.) Edited by Barbara Caleen Hansen and George A. Bray. 401 pp., illustrated. Totowa, NJ, Humana Press, 2008. $149. 978-1-58829-738-9

Arne Astrup

Papers

Efficacy and safety of the weight-loss drug rimonabant – Authors' reply

The glycemic index: Reports of its demise have been exaggerated

[Obesity, the metabolic syndrome and cardiovascular disease].

Calcium Supplementation and Coronary Artery Disease: Time to Act?

Book Review The Metabolic Syndrome: Epidemiology, Clinical Treatment, and Underlying Mechanisms (Contemporary Endocrinology.) Edited by Barbara Caleen Hansen and George A. Bray. 401 pp., illustrated. Totowa, NJ, Humana Press, 2008. $149. 978-1-58829-738-9