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Background Increasing obesity is alarming health experts, politicians, and the public. Latest estimates in the United States indicate that 64% of adults are overweight and 31% are clinically obese. The rise of obesity in children has been especially rapid: 10-15% of children in the United States are overweight, compared to 56% in 1976-80. Other developed and developing countries are experiencing similar trends. Obesity in adults is associated with higher mortality, increased risk of high blood pressure and cardiac disease, diabetes, gallbladder disease, osteoarthritis, and some forms of cancer. In children, obesity is associated with short- and long-term health consequences, including diabetes, increased blood pressure, the development of cardiac risk factors, and orthopedic disorders. For both adults and children, obesity has powerful social and psychological effects, including low self-esteem and discrimination. It is not known why the prevalence of obesity has increased so suddenly and markedly. Experts agree that the rise is unlikely to be related to a sudden shift in genetic or biological factors within individuals. The causes are largely environmental or a consequence of the mismatch between our physiology and an environment where food is abundant and physical activity unnecessary. Apart from recreational exercise, daily energy expenditure is probably much less than in the past because of technological change and the abundance of labor-saving devices. Calorie intake may also have increased recently, although this is controversial. Irrespective of the reasons for obesity's increase, interventions for its prevention and treatment are urgently needed. Many experts recommend a two-pronged approach: treating the already overweight and obese while directing efforts to prevent obesity, particularly during childhood. Objective The purpose of this paper is to summarize the research evidence behind interventions to treat and prevent obesity. In the manner of Clinical Evidence, we will present and summarize up-to-date research on studies that aim to prevent or treat obesity in individuals or groups. It is intended that this paper will be a useful tool for primary care physicians, professionals, and policy-makers. It is beyond the scope of this paper to carry out systematic reviews so instead we will report their results and assess the amount and quality of research found. Methods We searched Medline, the Cochrane Library, Embase, PsycInfo, and the ERIC database for relevant systematic reviews, references, and studies through March 2004. We also consulted a panel of experts for additional studies on the prevention and treatment of obesity in adults and children. We searched within each category of intervention. So lifestyle interventions included specific searches on dietary maneuvers, exercise programs and behavioral treatments, and surgical interventions included specific searches for each type of procedure used. After gathering the research, we summarized the studies found and described the conclusions reached by authors of the systematic reviews. Where research was.
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This work was supported in part by the Canton of Basel and Swiss National Science Foundation Grant 31-61 757.00 to S. G. and M. N. H. ; The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked "advertisement" in accordance with 18 U.S.C. Section 1734 solely to indicate this fact. The atomic coordinates and structure factors code 1W1N ; have been deposited in the Protein Data Bank, Research Collaboratory for Structural Bioinformatics, Rutgers University, New Brunswick, NJ : rcsb ; . Chemical shift assignments have been deposited in the BioMagResBank under accession number 6228. Supported by a postdoctoral fellowship from the Treubel Fonds Basel, Switzerland ; . To whom correspondence should be addressed. Tel.: 41-61-2672107; Fax: 41-61-2672109; E-mail: sonja.dames unibas.ch. Supported by a postdoctoral fellowship from the "Ministerio Espanol ~ de Educacion, Cultura y Deporte" and the European ACE Network. 1 The abbreviations used are: TOR, target of rapamycin; mTOR, mammalian TOR; NOE, nuclear Overhauser effect; NOESY, NOE spectroscopy; FKBP12, peptidyl-prolyl isomerase FK506-binding protein of 12 kDa; IPAP-HSQC, in phase antiphase-heteronuclear single quantum correlation; ROESY, rotational nuclear Overhauser effect spectroscopy; SED, spin echo difference; TOCSY, total correlation spectroscopy and artane.
Portions of the mixture, 75% yolk by vol ume, were used to prepare the following nutrient solutions : 1. Whole yolk. A portion of the pooled yolk mixture was diluted with water to make doses 1.5 ml of yolk dose ; of the desired volume. This added water con tained the ingredients of Salts 26 in amounts required to convert all added water to Salts 26 solution. 2. Supernatant plasma. Pooled yolk mixture was adjusted to contain 50% added water, then was centrifuged at 25, 000 X g, 0, or 15 minutes to sediment f the yolk granules. The resulting superna tant was adjusted to the desired volume with deionized distilled water. After the ingredients of Salts 26 were added to con vert all added water to Salts 26 solution, the mixture was sterilzed by filtration.5 3. YoZfe granules. The yolk granules obtained by centrifugation were covered with the desired volume of Salts 26 solu tion and stirred to obtain a smooth suspen sion. 4. Floating fraction. Supernatant plas ma, obtained as described above, was di luted with water to 20 times the volume of the yolk from which it was obtained. The resulting mixture was centrifuged at 25, 000 X g, at 14, for 7 minutes. The yellow fatty layer floating fraction ; which formed on the surface was carefully re moved, dissolved in Salts 26 solution, and sterilized by filtration.6 The diluted material which remained after preparation of floating fraction was not tested for activity, since it contained some of the floating fraction in addition to other components, and since it was in such diluted form. Technical problems involved in reconcentrating it and removing the re maining floating fraction precluded its use in these experiments. Yolk and the fractions were analyzed by paper-strip electrophoresis with the veronal buffer system described by McCully et al. 12 ; . The same materials and the yolksac contents of embryos on each treatment were also analyzed by starch-gel electro phoresis, using the method of Smithies 13, 14 ; and the discontinuous buffer sys tem of Poulik 15 ; . Electrophorograms of yolk-sac contents taken near the beginning and the end of the experimental period.
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Investigator, Xyotax Study PGT-302, A Phase III study for non-small cell lung cancer with CT-2103 versus docetaxel for second line treatment, West Michigan Regional Cancer and Blood Center. Investigator, Protocol POI02788, A phase II study of exemestane Aromasin ; with or without celecoxib for the treatment of post-menopausal woman with estrogen receptor positive metastatic breast cancer, West Michigan Regional Cancer and Blood Center. Investigator, Amgen Synchronicity Protocol, "A study to evaluate the effectiveness of Aranesp at 300mcg Q3W on clinical outcomes in cancer patients with anemia due to chemotherapy." Investigator, Amgen Protocol 20030125, "A Randomized, Open- label, Multicenter Study of darbepoetin alfa Administered Once Every 2 Weeks Q2W ; Compared with rHuEPO Administered Once Every Week QW ; for the Treatment of Anemia in Subjects with Non-myeloid Malignancies Receiving Multicycle Chemotherapy." Investigator, Millennium Protocol No. M34102-049-VELCADETM for Injection: "A Randomized, Multicenter, Openlabel, Phase 2b Study of VELCADE Alone and VELCADE plus Irinotecan in Patients with Relapsed or Refractory Colorectal Carcinoma" Investigator, Amgen Protocol No. 20020139 "A Randomized, Open-Label Study to Assess Time to Hemaglobin Response of a Front Load Dosing Regimen fo Darbepoetin Alfa Compared to a Weekly Dose Regimen for Recombinant Human Erythropoetin in Patients with Non-Myeloid Malignancies Receiving Chemotherapy." Investigator, "An Expanded Access Clinical Program with ZD1839 IRESSATM ; for Patients with Advanced Non-small Cell Lung Cancer NSCLC ; , Trial Number 1839IL 0050" Volunteer Services: Medical Camp of the Peace Corps in Zaire, Kenya and Ghana, summers of 1980, 1981, 1982. Director of Hospice of Mason County and aspirin.
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Aarhus, Denmark , H. Fynbo Barcelona, Spain, Univ.Politcnica Catalua, F. Calvio Bordeaux, France, B. Blank Bucharest, Romania, IFIN-HH, N.V. Zamfir, M. Ionescu-Bujor et al. Camerino, Italia, Univ. Camerino, D.L. Balabanski Daresbury. UK, CCLRC, J. Simpson, D ner, I.Lazarus, V.Pucknell and Daresbury engineers Darmstadt , Gremany, GSI, D. Ackerman, M. Grska, J. Gerl, I. Kojouharov , C. Scheidenberger et al. Debrecen, Hungary, Institute of Nuclear Research, A. Algora Edinburgh , UK, Univ. Edinburg, P.J. Woods, T. Davinson Gatchina, Russsia, PNPI, L. Batist Giessen, Germany, W. Plass Guelph, Canada, Univ of Guelph, P.Garrett Jyvskyl , Finland, Univ. of Jyvskyl , J. yst, A. Jokinen, P. Jones, R. Julin, M. Leino, H. Penttil., J. Uusitalo , C. Scholey Leuven, Belgium, Univ. of Leuven, M. Huyse, G. Neyens, P. v.Duppen Liverpool, UK, Univ. of Liverpool, R. D. Page Louvain-la-Neuve, Belgium, C. Angulo Lund, Sweden, Univ. Lund, D. Rudolph Kln, Germany, Univ. Kln, J. Jolie, P. Reiter Krakow, Poland, IFJ PAN, A. Maj et al. Madrid, Spain, CIEMAT, D. Cano-Ott, E. Gonzlez, T. Martnez Madrid, Spain, Univ. Autnoma, A. Jungclaus Mainz, Germany, Univ. Mainz, K.-L. Kratz B. Rubio, NUSTAR 07 Manchester, UK, Univ. Manchester, D. Cullen Munchen, Germany, T. Faestermann, R. Krcken and astemizole.
The designations employed in this publication do not imply the expression of any opinion on the part of the United Nations Population Fund concerning the legal status of any country, territory or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Data for small countries or areas, generally those with population of 200, 000 or less in 1990, are not given in this table separately. They have been included in their regional population figures. * ; + ; More-developed regions comprise North America, Japan, Europe and Australia-New Zealand. Less-developed regions comprise all regions of Africa, Latin America and Caribbean, Asia excluding Japan ; , and Melanesia, Micronesia and Polynesia. Least-developed countries according to standard United Nations designation. Including British Indian Ocean Territory and Seychelles. Including Agalesa, Rodrigues and St. Brandon. Including Sao Tome and Principe. Formerly Zaire. Including Western Sahara. Including St. Helena, Ascension and Tristan da Cunha. Regional averages and totals exclude Japan and Australia-New Zealand. Including Macau. On 1 July 1997, Hong Kong became a Special Administrative Region SAR ; of China. This entry is included in the more developed regions aggregate but not in the estimate for the geographical region. Turkey is included in Western Asia for geographical reasons. Other classifications include this country in Europe. Including Channel Islands, Faeroe Islands and Isle of Man. Including Andorra, Gibraltar, Holy See and San Marino. 14 ; Including Leichtenstein and Monaco. 15 ; Including Anguilla, Antigua and Barbuda, Aruba, British Virgin Islands, Cayman Islands, Dominica, Grenada, Montserrat, Netherlands Antilles, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Turks and Caicos Islands, and United States Virgin Islands. 16 ; Including Falkland Islands Malvinas ; and French Guiana. 17 ; Including Bermuda, Greenland, and St. Pierre and Miquelon. 18 ; Including Christmas Island, Cocos Keeling ; Islands and Norfolk Island. 19 ; Including New Caledonia and Vanuatu. 20 ; The successor States of the former USSR are grouped under existing regions. Eastern Europe includes Belarus, Republic of Moldova, Russian Federation and Ukraine. Western Asia includes Armenia, Azerbaijan and Georgia. South Central Asia includes Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan. Regional total, excluding subregion reported separately below. 21 ; Regional total, excluding subregion reported separately below. 22 ; These subregions are included in the UNFPA Arab States and Europe region. 23 ; Estimates based on previous years' reports. Updated data are expected. 24 ; Total for Eastern Europe includes some South European Balkan States and Northern European Baltic States. 25 ; This figure includes Belgium and Luxembourg. 26 ; More recent reports suggest this figure might have been higher. Future publications will reflect the evaluation of this information. 27 ; Comprising Federated States of Micronesia, Guam, Kiribati, Marshall Islands, Nauru, Northern Mariana Islands, Pacific Islands Palau ; and Wake Island. 28 ; Comprising American Samoa, Cook Islands, Johnston Island, Pitcairn, Samoa, Tokelau, Tonga, Midway Islands, Tuvalu, and Wallis and Futuna Islands.
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