Co-Planar Stereotaxic Atlas of the Human Brain—3-Dimensional Proportional System: An Approach to Cerebral Imaging, J. Talairach, P. Tournoux. Georg Thieme Verlag, New York (1988), 122 pp., 130 figs. DM 268

The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents

To revise 1998 recommendations on childhood obesity, an Expert Committee, comprised of representatives from 15 professional organizations, appointed experienced scientists and clinicians to 3 writing groups to review the literature and recommend approaches to prevention, assessment, and treatment. Because effective strategies remain poorly defined, the writing groups used both available evidence and expert opinion to develop the recommendations. Primary care providers should universally assess children for obesity risk to improve early identification of elevated BMI, medical risks, and unhealthy eating and physical activity habits. Providers can provide obesity prevention messages for most children and suggest weight control interventions for those with excess weight. The writing groups also recommend changing office systems so that they support efforts to address the problem. BMI should be calculated and plotted at least annually, and the classification should be integrated with other information such as growth pattern, familial obesity, and medical risks to assess the child’s obesity risk. For prevention, the recommendations include both specific eating and physical activity behaviors, which are likely to promote maintenance of healthy weight, but also the use of patient-centered counseling techniques such as motivational interviewing, which helps families identify their own motivation for making change. For assessment, the recommendations include methods to screen for current medical conditions and for future risks, and methods to assess diet and physical activity behaviors. For treatment, the recommendations propose 4 stages of obesity care; the first is brief counseling that can be delivered in a health care office, and subsequent stages require more time and resources. The appropriateness of higher stages is influenced by a patient’s age and degree of excess weight. These recommendations recognize the importance of social and environmental change to reduce the obesity epidemic but also identify ways healthcare providers and health care systems can be part of broader efforts.

/pdf/expert-committee-recommendations-regarding-the-prevention-38kyxmdgpa.pdf

Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report

Erratum to: DiabetologiaDOI 10.1007/s00125-012-2534-0In the text box ‘Properties of currently available glucose-lowering agents that may guide treatment choice in individualpatients with type 2 diabetes mellitus ’ vildagliptin was incor-rectly assigned footnote ‘a’ (Limited use in the USA/Europe)instead of footnote ‘b’ (Not licensed in the USA).

/pdf/management-of-hyperglycaemia-in-type-2-diabetes-a-patient-5azut0n4q1.pdf

Management of hyperglycaemia in type 2 diabetes: a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

Ten per cent of the world’s school-aged children are estimated to be carrying excess body fat (Fig. 1), with an increased risk for developing chronic disease. Of these overweight children, a quarter are obese, with a significant likelihood of some having multiple risk factors for type 2 diabetes, heart disease and a variety of other co-morbidities before or during early adulthood. The prevalence of overweight is dramatically higher in economically developed regions, but is rising significantly in most parts of the world. In many countries the problem of childhood obesity is worsening at a dramatic rate. Surveys during the 1990s show that in Brazil and the USA, an additional 0.5% of the entire child population became overweight each year. In Canada, Australia and parts of Europe the rates were higher, with an additional 1% of all children becoming overweight each year. The burden upon the health services cannot yet be estimated. Although childhood obesity brings a number of additional problems in its train – hyperinsulinaemia, poor glucose tolerance and a raised risk of type 2 diabetes, hypertension, sleep apnoea, social exclusion and depression – the greatest health problems will be seen in the next generation of adults as the present childhood obesity epidemic passes through to adulthood. Greatly increased rates of heart disease, diabetes, certain cancers, gall bladder disease, osteoarthritis, endocrine disorders and other obesityrelated conditions will be found in young adult populations, and their need for medical treatment may last for their remaining life-times. The costs to the health services, the losses to society and the burdens carried by the individuals involved will be great. The present report has been written to focus attention on the issue and to urge policy-makers to consider taking action before it is too late. Specifically, the report:

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1467-789X.2004.00133.x

Obesity in children and young people: a crisis in public health.

Background Since many successful dieters regain the weight they lose, programs that teach maintenance skills are needed. We developed a maintenance program based on self-regulation theory and tested the efficacy of delivering the program face to face or over the Internet. Methods We randomly assigned 314 participants who had lost a mean of 19.3 kg of body weight in the previous 2 years to one of three groups: a control group, which received quarterly newsletters (105 participants), a group that received face-to-face intervention (105), and a group that received Internet-based intervention (104). The content of the programs in the two intervention groups was the same, emphasizing daily self-weighing and self-regulation, as was the frequency of contact with the groups. The primary outcome was weight gain over a period of 18 months. Results The mean (±SD) weight gain was 2.5±6.7 kg in the face-to-face group, 4.7±8.6 kg in the Internet group, and 4.9±6.5 kg in the control group, with a significant difference ...

https://www.nejm.org/doi/pdf/10.1056/NEJMoa061883

A Self-Regulation Program for Maintenance of Weight Loss

The primary goal of childhood obesity interventions is regulation of body weight and fat with adequate nutrition for growth and development. Ideally, these interventions are associated with positive changes in the physiologic and psychological sequelae of obesity. To contribute to long-term weight maintenance, interventions should modify eating and exercise behaviors such that new, healthier behaviors develop and replace unhealthy behaviors, thereby allowing healthier behaviors to persist throughout development and into adulthood. This overview of pediatric obesity treatment, using predominantly randomized, controlled studies, highlights important contributions and developments in primarily dietary, activity, and behavior change interventions, and identifies characteristics of successful treatment and maintenance interventions. Potential positive (eg, reduction in blood pressure, serum lipids, and insulin resistance) and negative (eg, development of disordered eating patterns) side effects of treatment also are described. Recommendations for improving implementation of childhood obesity treatments, including application of behavioral choice theory, improving knowledge of response extinction and recovery in regards to behavior relapse, individualization of treatment, and integration of basic science with clinical outcome research, are discussed.

https://pediatrics.aappublications.org/content/pediatrics/101/Supplement_2/554.full.pdf

Treatment of pediatric obesity.

Results: Changes over 1 year showed that treatment influenced targeted parent and child fruit and vegetable intake and high-fat/high-sugar intake, with the Increase Fruit and Vegetable group also decreasing their consumption of high-fat/high-sugar foods. Parents in the increased fruit and vegetable group showed significantly greater decreases in percentage of overweight than parents in the decreased high-fat/high-sugar group. Discussion: These results suggest that focusing on increasing intake of healthy foods may be a useful approach for nutritional change in obese parents and their children.

/pdf/increasing-fruit-and-vegetable-intake-and-decreasing-fat-and-459qqoyxby.pdf

Increasing fruit and vegetable intake and decreasing fat and sugar intake in families at risk for childhood obesity.

Fast Food Consumption and Breakfast Skipping: Predictors of Weight Gain from Adolescence to Adulthood in a Nationally Representative Sample

Increased variety in the food supply may contribute to the development and maintenance of obesity. Thirty-nine studies examining dietary variety, energy intake, and body composition are reviewed. Animal and human studies show that food consumption increases when there is more variety in a meal or diet and that greater dietary variety is associated with increased body weight and fat. A hypothesized mechanism for these findings is sensory-specific satiety, a phenomenon demonstrating greater reductions in hedonic ratings or intake of foods consumed compared with foods not consumed. Nineteen studies documenting change in preference, intake, and hedonic ratings of food after a food has been eaten to satiation in animals and humans are reviewed, and the theory of sensory-specific satiety is examined. The review concludes with the relevance of oral habituation theory as a unifying construct for the effects of variety and sensory-specific satiety, clinical implications of dietary variety and sensory-specific satiety on energy regulation, and suggestions for future research. The prevalence of obesity in the United States is increasing for adults (Kuczmarski, Flegal, Campbell, & Johnson, 1994) and children (Troiano, Flegal, Kuczmarski, Campbell, & Johnson, 1995). Obesity results from positive energy balance, in which more energy is consumed than expended. One factor that may contribute to overconsumption and the increase in obesity is dietary variety, particularly variety from energy-dense foods (McCrory et al., 1999). Dietary variety occurs when a meal or diet is composed of foods that differ on at least one sensory characteristic (e.g., color, flavor, shape). Studies have investigated the effect of variety on intake by examining food consumption in single-food or mixed meals, or in single-food diets versus varied meal or cafeteria diets. The review begins by examining research on the effects of varying dietary variety on energy consumption, followed by studies exploring the effects of manipulating dietary variety on anthropometric status. One hypothesis for the influence of variety versus single-food meals on increased intake and body composition is differential experience with the sensory characteristics of foods in meals and diets containing more variety. This hypothesis has led to research on sensory-specific satiety (Hetherington & Rolls, 1996), a phenomenon in which hedonic ratings of a food eaten to satiation decrease more than hedonic ratings of foods not eaten to satiation. We next review studies examining sensory-specific satiety. This body of research tests how sensory characteristics of food influence food consumption, including factors that provide a comparison of the effects of sensory versus nonsensory and nutritional factors, such as energy density or macronutrient composition in food intake. This section concludes with a critical discussion of how sensory-specific satiety influences food consumption. The effects of variety on intake and the model of sensoryspecific satiety are consistent with basic research in animals and humans on habituation (Swithers & Hall, 1994). Research on how habituation to food cues influences intake, and the relevance of habituation theory as a unifying construct for variety and sensoryspecific satiety, is then considered. Finally, this article discusses implications of research reviewed for obesity treatment, as well as ideas for research on dietary variety and sensory-specific satiety. We located articles for this review through computerized searches of social science and biomedical databases (MedLine 1966-1999; PsycINFO 1967-1999) using the key phrases dietaryvariety, cafeteria diet, body composition, and sensory-specific satiety. References were also located through cross-references within the articles. Thirty-nine studies were identified that manipulated dietary variety and studied the effects on food intake and/or body composition. The review of research on sensory-specific satiety included 19 studies that documented changes in preference or intake after a food has been eaten to satiation in animals and changes in hedonic ratings of food or intake after a food has been eaten to satiation in normal-weight, nondieting humans. Studies examining which characteristics of food (e.g., nutrient composition, shape, color) affect sensory-specific satiety were included.

/pdf/dietary-variety-energy-regulation-and-obesity-3x8vhcpbiu.pdf

Hollie A. Raynor

Papers

A Self-Regulation Program for Maintenance of Weight Loss

Treatment of pediatric obesity.

Increasing fruit and vegetable intake and decreasing fat and sugar intake in families at risk for childhood obesity.

Fast Food Consumption and Breakfast Skipping: Predictors of Weight Gain from Adolescence to Adulthood in a Nationally Representative Sample

Dietary variety, energy regulation, and obesity.