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Cover Page -- Title Page -- Copyright Page -- Contents -- Foreword -- Introduction -- Chapter 1: Weight and Health in America -- Chapter 2: Why Are Americans Overweight? -- Chapter 3: Eating Habits and Lifestyle Among American Youth -- Chapter 4: The Role of the Food Industry -- Chapter 5: Changing Attitudes and Waistlines -- Notes -- Discussion Questions -- Organizations to Contact -- For More Information -- Index -- Picture Credits -- About the Author -- Back Cover

Presents an overview of Australia's weight problem. How is body weight measured? What are the health risks and costs? General advice offered on how to achieve and maintain healthy weight. Also includes: worksheets and activities, fast facts, glossary, web links, index

Annotation.

Directly caused by long-term imbalance in energy intake and energy expenditure, obesity and overweight are conditions of excess body fat bringing with them a range of adverse health effects. What is less well understood is their intimate connection with the action of the hormone insulin in the body, a hormone which promotes the use of ingested glucose as a primary fuel source and blocks the metabolism of stored fat. In a large number of people, genetic pre-disposition and/ or the presence of overweight leads to insulin resistance, where higher levels of the hormone are required for the same blood glucose regulating effect - a state that is highly conducive to weight gain. Indigenous populations, among them Indigenous Australian people, have a greater incidence of insulin resistance, and exposed to some elements typical of Western lifestyle, are at greater risk of developing overweight and obesity. Generally, overweight and obesity are defined in relation to the body mass index, or BMI. The BMI is a weight-for-height ratio with categories based on increasing health risk. Its universal suitability, particularly as regards muscular individuals and different ethnic groups, is contested. Generally, Aboriginal people will have a higher proportion of body fat, and Torres Strait Islander people a lower proportion of body fat than will a non-Indigenous person for a given BMI. Nevertheless, the available national data on obesity and overweight among the Indigenous population (most recently from the 2004-05 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS)) are based on the BMI as calculated from selfreported height and weight measurements (as opposed to waist circumference, where abdominal fat has a strong correlation with insulin resistance and cardiovascular and diabetic risk). The 2004-05 NATSIHS found that overweight and obesity were substantial and increasing problems for Indigenous people. The greatest disparities were observed in levels of obesity, where 29% of Indigenous people were classified as obese compared with 17% of non-Indigenous people, and in the comparison between Indigenous and nonIndigenous females. Overall, Indigenous people were 1.2 times more likely than non-Indigenous people to be overweight or obese. For Torres Strait Islanders, the difference was even greater. The socioeconomic gradient of obesity, where higher levels of obesity are observed among groups of lower socioeconomic status, plays a distinctive role in this problem for Indigenous people. A wide range of environmental factors contribute to the higher prevalence of overweight and obesity among Indigenous people, of which the indirect contributors are perhaps the most important. In the main, immense changes to the dietary and physical activity patterns of Indigenous people have taken place since European settlement. The Indigenous diet has changed from one that was typically low energydensity and nutrient-rich to one that is typically energy-dense and nutrient-poor, high in refined carbohydrate, saturated fat and salt. Closely linked has been a substantial reduction in physical activity. Widespread poor dental health has a negative impact on nutritional health and high alcohol consumption contributes to excess energy intake and the diversion of income away from the purchase of healthy foods and other related household items. Across all countries of the Organisation for Economic Co-operation and Development (OECD), the highest proportion of low birthweight babies are born to Indigenous mothers, babies which are likely programmed from the very beginning of life for insulin resistance, a propensity to obesity and eventual chronic disease. Dispossession and social exclusion, which have affected the lifestyle choices of Indigenous people since almost the earliest point of contact with European settlers, cannot be seen as anything other than centrally important contributors due to their role in preserving the socioeconomic disadvantage so strongly correlated with the high presence of this condition. Obesity and overweight are significant risk factors for a long list of adverse health conditions, among them some of the principal causes of Indigenous morbidity and mortality- cardiovascular disease, type 2 diabetes and chronic renal disease. High and rising rates of obesity and its consequent conditions are particularly burdensome in the light of the continuing and parallel existence of problems of malnutrition and infectious disease in many Indigenous communities. It is difficult, and likely of little use, to single out obesity and overweight in Indigenous people for targeted and narrow policy response due firstly to its uniquely cross-sectoral, multi-factoral nature and secondly to the holistic conception of health of many Indigenous people. The government has committed to ambitious targets in Indigenous health, has sharply increased Indigenous health spending and is concentrating resources on early intervention and prevention in the areas of maternal and child health and early childhood development (a significant juncture for the promotion of healthy weight). The Council of Australian Governments (COAG) process, the School Nutrition Program and adapted income management appear to hold particular promise for progress in Indigenous health as it relates to overweight and obesity. Pivotal areas of encounter include the push for an evidence base in Indigenous policy, the division of resources between the Northern Territory and the other states and territories, funding to meet commitments and need across the spectrum of Indigenous Affairs into the future, and the interface between Aboriginal Community Controlled Health Services and external expertise.

Study conducted in three villages of Bastrict District, Chhattisgarh, India

The study examined the prevalence of overweight cases in a sample of 151 deaf children aged 6-11 years. Participants were deaf students attending six elementary schools, both regular and special, in four states. Body mass index (BMI) was calculated using height and weight, plotted on the Center for Disease Control and Prevention (CDC) U.S. BMI-for-age growth charts, then compared to national values for same age and gender (CDC, 2006a, 2006b; National Center for Health Statistics, 2005). The results indicated that the prevalence of overweight deaf children aged 6-11 years was above the national percentage for same age and gender. A larger percentage of boys was overweight (24.7%) than girls (20.4%). After age 8 years, girls showed a consistent decrease in BMI with increasing age, a trend not demonstrated by boys. As a group, deaf children demonstrate a higher prevalence of overweight than national averages.

Purpose of the studyDarunavir (DRV) boosted with ritonavir is now regularly used in HIV infection. With an increasing population of HIV‐infected patients receiving antiretroviral therapy and having overweight problems we decided to conduct a transversal study on DRV plasma concentration in overweight patients.MethodsMeasures of drug plasma level were proposed to all patients having their routine blood test between 2010 and 2011 in our outpatient HIV clinic. With their consent they were included in our transversal study. DRV plasma concentrations (C12 h=12±3 hours) were determined using HPLC coupled with photodiode array detection (limit of quantification 0.05 mg/L), with DRV C12 h=1.3 mg/L and 0.55 (IC50) as target levels. Weight and height were also measured to calculate body mass index (BMI).ResultsWe included 52 patients; 35 women and 17 men, mean age was 40 (±8.8). Majority of them (62%) were African patients. The median CD4 cell count was: 387 [297–551]. The viral load was<35 copies for 77% of the patients. We had 28 overweight patients: 12 patients had BMI ≥30 and 16 patients had BMI between 25 and 29; 87% of the patients had DRV/RTV 800/100 OAD regimen associated with tenofovir/emtricitabine (72%) or abacavir/lamivudine (17%). The mean DRV plasma trough concentrations (C12 h) according BMI are shown in Table 1. Six patients with BMI ≥25 had a low plasma concentration of DRV with OAD regimen of DRV/RTV 800/100: 2 in BMI 25–29 group and 4 in BMI≥30 group. Among the six patients no adherence issues was recorded and every patient had undetectable viral load. Only one patient has a C12 h lower than the IC50 from the DRV (0.55 mg/L) and 3 others have very probably Cmin close to the ECC50.









Body Mass Index
<25
25–29
≥30


Number of patients (n)
24
16
12


DRV plasma concentration (mg/L), Means±SD
3.54±1.60
3.07±1.57
2.58±1.62


Patients with [DRV] C12 h <1.3 mg/L (n)
0
2
4


Patients with [DRV] C12 h <0.55 mg/L (n)
0
0
1




ConclusionOur results show a possible lower plasma concentration of DRV in overweight/obese patients in a small cohort. In our data, this reduced plasma concentration is not related to detectable viral load, possibly due to ICmin of DRV. More studies are needed to manage carefully antiretroviral therapy in overweight patients.