Peer Reviewed Articles on Heart Disease and Its Connection With Weight and Easting Habits

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J Am Assoc Nurse Pract. 2017 Oct; 29(Suppl one): S3–S14.

Obesity: Take chances factors, complications, and strategies for sustainable long‐term weight management

Sharon G. Fruh

¹ College of Nursing, University of South Alabama, Mobile, Alabama,

Received 2017 Apr 26; Revised 2017 Jul xx; Accepted 2017 Jul 25.

Abstract

Background and Purpose

The aims of this article are to review the effects of obesity on health and well‐beingness and the evidence indicating they can be ameliorated by weight loss, and consider weight‐management strategies that may help patients achieve and maintain weight loss.

Methods

Narrative review based on literature searches of PubMed up to May 2016 with no date limits imposed. Search included terms such as "obesity," "overweight," "weight loss," "comorbidity," "diabetes," cardiovascular," "cancer," "depression," "management," and "intervention."

Conclusions

Over ane tertiary of U.Southward. adults have obesity. Obesity is associated with a range of comorbidities, including diabetes, cardiovascular disease, obstructive sleep apnea, and cancer; however, small weight loss in the 5%–10% range, and above, can significantly better wellness‐related outcomes. Many individuals struggle to maintain weight loss, although strategies such as realistic goal‐setting and increased consultation frequency tin greatly improve the success of weight‐management programs. Nurse practitioners have key roles in establishing weight‐loss targets, providing motivation and support, and implementing weight‐loss programs.

Implications for Practice

With their in‐depth understanding of the enquiry in the field of obesity and weight direction, nurse practitioners are well placed to event meaningful changes in weight‐management strategies deployed in clinical practice.

Keywords: Obesity, nurse practitioner communication, weight management, health, effects

Introduction

Obesity is an increasing, global public health issue. Patients with obesity are at major risk for developing a range of comorbid conditions, including cardiovascular disease (CVD), gastrointestinal disorders, type two diabetes (T2D), joint and muscular disorders, respiratory bug, and psychological issues, which may significantly affect their daily lives besides equally increasing bloodshed risks. Obesity‐associated weather condition are manifold; however, even modest weight reduction may enable patients to reduce their chance for CVD, diabetes, obstructive sleep apnea (OSA), and hypertension among many other comorbidities (Cefalu et al., 2015). A relatively pocket-sized and simple reduction in weight, for example, of around 5%, tin improve patient outcomes and may deed every bit a catalyst for farther change, with sustainable weight loss accomplished through a series of incremental weight loss steps. In facilitating the process of losing weight for patients, nurse practitioners play an essential part. Through assessing the patient's risk, establishing realistic weight‐loss targets, providing motivation and back up, and supplying patients with the necessary knowledge and treatment tools to help achieve weight loss, followed by tools for structured lifestyle support to maintain weight lost, the nurse practitioner is ideally positioned to help patient's attain their weight‐loss—and overall wellness—targets.

The obesity epidemic

The Earth Health Organisation (WHO) defines overweight and obesity as abnormal or excessive fatty aggregating that presents a risk to wellness (WHO, 2016a). A body mass index (BMI) ≥25 kg/m² is mostly considered overweight, while obesity is considered to be a BMI ≥ thirty kg/gⁱⁱ. It is well known that obesity and overweight are a growing trouble globally with high rates in both developed and developing countries (Capodaglio & Liuzzi, 2013; WHO, 2016a, 2016b).

In the United States in 2015, all states had an obesity prevalence more twenty%, 25 states and Guam had obesity rates >30% and four of those 25 states (Alabama, Louisiana, Mississippi, and West Virginia) had rates >35% (Centres for Affliction Control and Prevention, 2016; Figure ​ i). Approximately 35% and 37% of adult men and women, respectively, in the United States have obesity (Yang & Colditz, 2015). Adult obesity is nigh mutual in non‐Hispanic black Americans, followed by Mexican Americans, and not‐Hispanic white Americans (Yang & Colditz, 2015). Individuals are also getting heavier at a younger age; birth cohorts from 1966 to 1975 and 1976 to 1985 reached an obesity prevalence of ≥20% past twenty–29 years of age, while the 1956–1965 cohort merely reached this prevalence by age 30–39 years (Lee et al., 2010). Additionally, the prevalence of childhood obesity in ii‐ to 17‐year‐olds in the United States has increased from 14.6% in 1999–2000 to 17.4% in 2013–2014 (Skinner & Skelton, 2014). Childhood obesity is an increasing health issue because of the early onset of comorbidities that take major adverse health impacts, and the increased likelihood of children with obesity going on to become adults with obesity (50% take chances vs. 10% for children without obesity; Whitaker, Wright, Pepe, Seidel, & Dietz, 1997).

Clan of obesity with bloodshed and comorbid illness

Mortality

Obesity is associated with a significant increase in mortality, with a life expectancy decrease of five–ten years (Berrington de Gonzalez et al., 2010; Kuk et al., 2011; Prospective Studies Collaboration et al., 2009). There is evidence to betoken that all‐crusade, CVD‐associated, and cancer‐associated mortalities are significantly increased in individuals with obesity, specifically those at Stages 2 or three of the Edmonton Obesity Staging System (EOSS; Kuk et al., 2011; Figure ​ 2). Mortality related to cancer is, even so, also increased at Stage ane, when the physical symptoms of obesity are marginal (Figure ​ two). Recently, a large‐scale meta‐analysis that included studies that had enrolled over 10 million individuals, indicated that, relative to the reference category of 22.5 to <25 kg/m^two, the gamble ratio (HR) for all‐cause mortality rose sharply with increasing BMI (The Global BMI Mortality Collaboration, 2016). For a BMI of 25.0 to <xxx.0 kg/yard², the Hour was i.11 (95% confidence interval [CI] 1.10, ane.eleven), and this increased to one.44 (1.41, 1.47), 1.92 (1.86, 1.98), and 2.71 (2.55, two.86) for a BMI of 30.0 to <35.0, 35.0 to <twoscore.0, and 40.0 to <sixty.0 kg/m², respectively.

Association between EOSS stage and risk of all‐cause (A), CVD (B), cancer (C), and non‐CVD or noncancer mortality (D) in men and women. © 2011.

Source. Reproduced with permission from NRC Enquiry Press, from Kuk et al. (2011). CVD, cardiovascular disease; NW, normal weight.

Comorbidities

Obesity is a chronic disease that is associated with a wide range of complications affecting many different aspects of physiology (Dobbins, Decorby, & Choi, 2013; Guh et al., 2009; Martin‐Rodriguez, Guillen‐Grima, Marti, & Brugos‐Larumbe, 2015; summarized in Table ​ i). To examine these obesity‐related morbidities in detail is beyond the telescopic of this review and therefore only a brief overview of some of the key pathophysiological processes is included next.

Table 1

Morbidities associated with obesity (Hamdy, 2016; Petry, Barry, Pietrzak, & Wagner, 2008; Pi‐Sunyer, 2009; Sakai et al., 2005; Smith, Hulsey, & Goodnight, 2008; Yosipovitch, DeVore, & Dawn, 2007)

Class of event	Comorbidities associated with obesity
Cancer/malignancy	Postmenopausal chest, endometrial, colon and rectal, gallbladder, prostate, ovarian, endometrial renal cell, esophageal adenocarcinoma, pancreatic, and kidney cancer
Cardiovascular	Coronary avenue disease, obesity‐associated cardiomyopathy, essential hypertension, left ventricular hypertrophy, cor pulmonale, accelerated atherosclerosis, pulmonary hypertension of obesity, dyslipidemia, chronic heart failure (CHD), left ventricular hypertrophy (LVH), cardiomyopathy, pulmonary hypertension, lymphedema (legs)
Gastrointestinal (GI)	Gall bladder affliction (cholecystitis, cholelithiasis), gastroesophageal reflux disease (GERD), reflux esophagitis, nonalcoholic steatohepatitis (NASH), nonalcoholic fatty liver disease (NAFLD), fatty liver infiltration, astute pancreatitis
Genitourinary	Stress incontinence
Metabolic/endocrine	Type two diabetes mellitus, prediabetes, metabolic syndrome, insulin resistance, and dyslipidemia
Musculoskeletal/orthopedic	Pain in back, hips, ankles, feet and knees; osteoarthritis (peculiarly in the knees and hips), plantar fasciitis, back pain, coxavera, slipped upper-case letter femoral epiphyses, Blount disease and Legg‐Calvé‐Perthes illness, and chronic lumbago
Neurological and key nervous organisation (CNS)	Stroke, dementia idiopathic intracranial hypertension, and meralgia paresthesia
Obstetric and perinatal	Pregnancy‐related hypertension, fetal macrosomia, very depression birthweight, neural tube defects, preterm birth, increased cesarean delivery, increased postpartum infection and pelvic dystocia, preeclampsia, hyperglycemia, gestational diabetes (GDM)
Skin	Keratosis pilaris, hirsutism, acanthosis nigricans, and acrochondons, psoriasis, intertrigo (bacterial and/or fungal), and increased risk for cellulitis, venous stasis ulcers, necrotizing fasciitis, and carbuncles
Psychological	Depression, anxiety, personality disorder, and obesity stigmatization
Respiratory/pulmonary	Obstructive slumber apnea (OSA), Pickwickian syndrome (obesity hypoventilation syndrome), higher rates of respiratory infections, asthma, hypoventilation, pulmonary emboli take a chance
Surgical	Increased surgical take a chance and postoperative complications, deep venous thrombosis, including wound infection, pulmonary embolism, and postoperative pneumonia
Reproductive (Women)	Anovulation, early on puberty, polycystic ovaries, infertility, hyperandrogenism, and sexual dysfunction
Reproductive (Men)	Hypogonadotropic hypogonadism, polycystic ovary syndrome (PCOS), decreased libido, and sexual dysfunction
Extremities	Venous varicosities, lower extremity venous and/or lymphatic edema

The progression from lean state to obesity brings with it a phenotypic alter in adipose tissue and the development of chronic low‐grade inflammation (Wensveen, Valentic, Sestan, Turk Wensveen, & Polic, 2015). This is characterized by increased levels of circulating free‐fatty acids, soluble pro‐inflammatory factors (such every bit interleukin [IL] 1β, IL‐6, tumor necrosis factor [TNF] α, and monocyte chemoattractant protein [MCP] 1) and the activation and infiltration of immune cells into sites of inflammation (Hursting & Dunlap, 2012). Obesity is too usually centrolineal to a specific dyslipidemia profile (atherogenic dyslipidemia) that includes small, dense low‐density lipoprotein (LDL) particles, decreased levels of high‐density lipoprotein (HDL) particles, and raised triglyceride levels (Musunuru, 2010). This chronic, low‐grade inflammation and dyslipidemia profile leads to vascular dysfunction, including atherosclerosis formation, and dumb fibrinolysis. These, in turn, increment the risk for CVD, including stroke and venous thromboembolism (Blokhin & Lentz, 2013).

The metabolic and cardiovascular aspects of obesity are closely linked. The chronic inflammatory state associated with obesity is established equally a major contributing factor for insulin resistance, which itself is one of the key pathophysiologies of T2D (Johnson, Milner, & Makowski, 2012). Furthermore, central obesity defined by waist circumference is the essential component of the International Diabetes Federation (IDF) definition of the metabolic syndrome (raised triglycerides, reduced HDL cholesterol, raised blood force per unit area, and raised fasting plasma glucose; International Diabetes Federation, 2006).

Obesity is also closely associated with OSA. To start, a number of the conditions associated with obesity such as insulin resistance (Ip et al., 2002), systemic inflammation, and dyslipidemia are themselves closely associated with OSA, and concurrently, the obesity‐associated deposition of fat around the upper airway and thorax may affect lumen size and reduce breast compliance that contributes to OSA (Romero‐Corral, Caples, Lopez‐Jimenez, & Somers, 2010).

The development of sure cancers, including colorectal, pancreatic, kidney, endometrial, postmenopausal breast, and adenocarcinoma of the esophagus to name a few, have also been shown to be related to backlog levels of fatty and the metabolically agile nature of this excess adipose tissue (Booth, Magnuson, Fouts, & Foster, 2015; Eheman et al., 2012). Cancers have shown to be impacted by the complex interactions betwixt obesity‐related insulin resistance, hyperinsulinemia, sustained hyperglycemia, oxidative stress, inflammation, and the production of adipokines (Booth et al., 2015). The wide range of morbidities associated with obesity represents a significant clinical upshot for individuals with obesity. However, as pregnant equally this array of hazard factors is for patient health, the hazard factors can be positively modified with weight loss.

Obesity‐related morbidities in children and adolescents

As was referred to earlier, children and adolescents are becoming increasingly affected by obesity. This is particularly concerning because of the long‐term adverse consequences of early on obesity. Obesity adversely affects the metabolic health of young people and can result in dumb glucose tolerance, T2D, and early on‐onset metabolic syndrome (Pulgaron, 2013).There is as well strong support in the literature for relationships between childhood obesity and asthma, poor dental health (caries), nonalcoholic fatty liver disease (NAFLD), and gastroesophageal reflux disease (GERD; Pulgaron, 2013). Obesity can as well affect growth and sexual development and may delay puberty in boys and advance puberty in some girls (Burt Solorzano & McCartney, 2010). Childhood obesity is too associated with hyperandrogenism and polycystic ovary syndrome (PCOS) in girls (Burt Solorzano & McCartney, 2010). Additionally, obesity is associated with psychological problems in young people including attention deficit hyperactivity disorder (ADHD), anxiety, depression, poor cocky‐esteem, and problems with sleeping (Pulgaron, 2013).

Minor weight loss and its long‐term maintenance: Benefits and risks

Guidelines endorse weight‐loss targets of v%–10% in individuals with obesity or overweight with associated comorbidities, as this has been shown to significantly improve health‐related outcomes for many obesity‐related comorbidities (Cefalu et al., 2015; Figure ​ 3), including T2D prevention, and improvements in dyslipidemia, hyperglycemia, osteoarthritis, stress incontinence, GERD, hypertension, and PCOS. Further benefits may be evident with greater weight loss, particularly for dyslipidemia, hyperglycemia, and hypertension. For NAFLD and OSA, at least 10% weight loss is required to detect clinical improvements (Cefalu et al., 2015).

Benefits of modest weight loss. Lines demonstrate the ranges in which weight loss has been investigated and shown to have clinical benefits. Arrows indicate that additional benefits may be seen with further weight loss.

Source. Figure adapted from Cefalu et al. (2015).

Importantly, the weight‐loss benefits in terms of comorbidities are also reflected in improved all‐cause bloodshed. A recent meta‐analysis of fifteen studies demonstrated that relatively small amounts of weight loss, on average 5.5 kg in the treatment arm versus 0.two kg with placebo from an average baseline BMI of 35 kg/m², resulted in a substantial xv% reduction in all‐crusade mortality (Kritchevsky et al., 2015).

Cardiovascular wellness

Weight loss is associated with beneficial changes in several cardiovascular risk markers, including dyslipidemia, pro‐inflammatory/pro‐thrombotic mediators, arterial stiffness, and hypertension (Dattilo & Kris‐Etherton, 1992; Dengo et al., 2010; Goldberg et al., 2014; Haffner et al., 2005; Ratner et al., 2005). Importantly, weight loss was found to reduce the gamble for CVD mortality by 41% up to 23 years later the original weight‐loss intervention (Li et al., 2014; Effigy ​ 4). Show including the biological effects of obesity and weight loss, and the increased chance for stroke with obesity indicates that weight loss may exist constructive for primary‐ and secondary‐stroke prevention (Kernan, Inzucchi, Sawan, Macko, & Furie, 2013).

Reduction in cardiovascular mortality with modest weight reduction. Cumulative incidence of CVD mortality during 23 years of follow‐up in the Da Qing study (Li et al., 2014). Figure © 2014 Elsevier.

Source. Reproduced with permission from Li et al. (2014).

Type two diabetes

Three major long‐term studies, the Diabetes Prevention Programme (DPP), the Diabetes Prevention Written report (DPS), and the Da Qing IGT and Diabetes (Da Qing) study, accept demonstrated that modest weight loss through short‐term lifestyle or pharmacologic interventions tin reduce the risk for developing T2D by 58%, 58%, and 31%, respectively, in individuals with obesity and prediabetes (DPP Inquiry Grouping et al., 2009; Pan et al., 1997; Tuomilehto et al., 2001). Long‐term benefits were maintained following the interventions; for case, in the DPP, the take a chance reduction of developing T2D versus placebo was 34% at 10 years and 27% at 15 years following the initial weight‐loss intervention (DPP Enquiry Group, 2015; DPP Research Grouping et al., 2009). Weight loss increased the likelihood of individuals reverting from prediabetes to normoglycemia (DPP Research Group et al., 2009; Li et al., 2008; Lindstrom et al., 2003, 2006; Tuomilehto et al., 2001), and also improved other aspects of glycemic control including fasting and postprandial glucose, and insulin sensitivity (Haufe et al., 2013; Li et al., 2008).

Sleep apnea

Data signal that weight loss is beneficial, although not curative, in patients with obesity who experience OSA. Meta‐analyses of patients who underwent handling with either intensive lifestyle intervention (Araghi et al., 2013) or bariatric surgery (Greenburg, Lettieri, & Eliasson, 2009) demonstrated improvements in apnea‐hypopnea alphabetize (AHI) following treatment. In the start of these meta‐analyses, in randomized controlled trials, lifestyle intervention lead to a mean reduction in BMI of 2.iii kg/thousand², which was associated with a subtract in mean AHI of 6.0 events/h. As expected, weight loss was much higher in the 2nd meta‐assay that investigated the consequence of bariatric surgery on measures of OSA, and this was associated with greater reductions in AHI; the mean BMI reduction of 17.9 kg/chiliad² resulted in AHI events beingness reduced by a mean of 38.2 events/h. Once these improvements in AHI have occurred, they seem to persist for some time, irrespective of a certain caste of weight regain. In one report, an initial hateful weight loss of 10.vii kg resulted in a persistent improvement in AHI over a 4‐year period despite weight regain of approximately 50% by Twelvemonth four (Kuna et al., 2013).

Cancer

Intentional weight loss of >9 kg reduced the gamble for a range of cancers including breast, endometrium, and colon in the large‐scale Iowa Women's Wellness Study (Parker & Folsom, 2003). The overall reduction in the incidence rate of any cancer was 11% (relative risk, 0.89; 95% CI 0.79, ane.00) for participants who lost more 9 kg compared with those who did not achieve a more than nine kg weight loss episode. Additionally, weight loss in participants with obesity has been established to be associated with reductions in cancer biomarkers including soluble E‐selectin and IL‐6 (Linkov et al., 2012).

Additional health benefits

The substantial weight loss associated with bariatric surgery has been shown to ameliorate asthma with a 48%–100% improvement in symptoms and reduction in medication use (Juel, Ali, Nilas, & Ulrik, 2012); however, in that location is a potential threshold result so that modest weight loss of 5%–10% may lead to clinical improvement (Lv, Xiao, & Ma, 2015). Similarly, small-scale weight loss of v%–10% improves GERD (Singh et al., 2013) and liver role (Haufe et al., 2013). A study utilizing MRI scanning to examine the effects of weight loss on NAFLD has reported a reduction in liver fat from eighteen.3% to 13.half dozen% (p = .03), a relative reduction of 25% (Patel et al., 2015). Taking an active role in addressing obesity through behavioral modifications or do can too reduce the symptoms of depression (Fabricatore et al., 2011), improve urinary incontinence in men and women (Breyer et al., 2014; Brownish et al., 2006), and ameliorate fertility outcomes in women (Kort, Winget, Kim, & Lathi, 2014). Additionally, weight loss tin reduce the joint‐hurting symptoms and disability caused by weight‐related osteoarthritis (Felson, Zhang, Anthony, Naimark, & Anderson, 1992; Foy et al., 2011).

Mitigating risks

Despite the array of benefits, weight loss can also be linked with certain risks that may need to be managed. 1 such example is the adventure for gallstones with rapid weight loss, which is associated with gallstone formation in 30%–71% of individuals. Gallstone formation is particularly associated with bariatric surgery when weight loss exceeds 1.5 kg/week and occurs particularly within the first 6 weeks following surgery when weight loss is greatest. Slower rates of weight loss appear to mitigate the gamble for gallstone formation compared to the full general population just may not eliminate it entirely; as was noted in the year‐long, weight‐loss, SCALE trial that compared liraglutide three.0 mg daily utilize to placebo and resulted in gallstone formation in 2.5% of treated subjects compared to 1% of subjects taking placebo. For this reason, the adventure for cholethiasis should be considered when formulating weight‐loss programs (Weinsier & Ullmann, 1993).

Strategies to help individuals achieve and maintain weight loss

Rogge and Gautam have covered the biology of obesity and weight regain inside another department of this supplement (Rogge & Gautam, 2017), so here we focus on some of the clinical strategies for delivering weight loss and weight loss maintenance lifestyle programs. Structured lifestyle support plays an important role in successful weight management. A full of 34% of participants receiving structured lifestyle support from trained‐nursing staff accomplished weight loss of ≥five% over 12 weeks compared with approximately 19% with usual intendance (Nanchahal et al., 2009). This particular structured program, delivered in a master healthcare setting, included initial assessment and goal setting, an eating programme and specific lifestyle goals, personalized activity plan, and communication about managing obstacles to weight loss. Additionally, data from the National Weight Control Registry (NWCR), which is the longest prospective compilation of data from individuals who accept successfully lost weight and maintained their weight loss, confirm expectations that sustained changes to both diet and activity levels are primal to successful weight management (Table ​ 2). Therefore, an understanding of unlike clinical strategies for delivery‐structured support is essential for the nurse practitioner.

Tabular array 2

Lifestyle factors associated with achieving and maintaining weight loss

Action	Percentage
Modified nutrient intake	98
Increased physical activitya	94
Exercised on boilerplate for i h each day	90
Ate breakfast every day	78
Weighed themselves weekly	75
Watched less than ten h of television weekly	62
Lost weight with the aid of a weight‐loss program	55

Realistic weight‐loss targets

From the outset, a patient's gauge of their achievable weight loss may be unrealistic. Setting realistic weight‐loss goals is oftentimes difficult considering of misinformation from a variety of sources, including friends, media, and other healthcare professionals (Osunlana et al., 2015). Many individuals with obesity or overweight have unrealistic goals of 20%–30% weight loss, whereas a more realistic goal would be the loss of 5%–15% of the initial body weight (Fabricatore et al., 2007). Promoting realistic weight‐loss expectations for patients was identified as a key difficulty for nurse practitioners, primary care nurses, dieticians, and mental health workers (Osunlana et al., 2015). Visual resources showing the health and health benefit of modest weight loss may thus be helpful (Osunlana et al., 2015). Healthcare practitioners should focus on open discussion well-nigh, and re‐enforcement of, realistic weight‐loss goals and appraise outcomes consistently co-ordinate to those goals (Bray, Expect, & Ryan, 2013).

Maintaining a food diary

The 2013 White Paper from the American Nurse Practitioners Foundation on the Prevention and Handling of Obesity considers a nutrient diary as an of import prove‐based nutritional intervention in aiding weight loss (ANPF). Consistent and regular recording in a food diary was significantly associated with long‐term weight‐loss success in a group of 220 women (Peterson et al., 2014). This grouping lost a mean of 10.four% of their initial body weight through a vi‐calendar month grouping‐based weight‐management program and then regained a mean of 2.3% over a 12‐month follow‐upward period, during which participants received bimonthly support in person, past phone, or by east‐mail (Peterson et al., 2014). Over the 12‐month follow‐upward, women who self‐monitored consistently (≥fifty% of the extended‐care year) had a mean weight loss of 0.98%, while those who were less consistent (<50%) gained weight (5.1%; p < .01). Therefore, frequent and consistent food monitoring should be encouraged, particularly in the weight‐maintenance phase of any plan.

Motivating and supporting patients

Motivational interviewing is a technique that focuses on enhancing intrinsic motivation and behavioral changes past addressing ambivalence (Barnes & Ivezaj, 2015). Interviews focus on "modify talk," including the reasons for alter and optimism about the intent for change in a supportive and nonconfrontational setting, and may help individuals maintain behavioral changes.

For patients that have achieved weight loss, the behavioral factors associated with maintaining weight loss include strong social support networks, limiting/avoiding disinhibited eating, avoiding rampage eating, avoiding eating in response to stress or emotional issues, being accountable for 1's decisions, having a strong sense of autonomy, internal motivation, and self‐efficacy (Grief & Miranda, 2010). Therefore, encouraging feelings of "self‐worth" or "self‐efficacy" tin assistance individuals to view weight loss as existence within their own control and achievable (Cochrane, 2008).

Strengthening relationships with patients with overweight or obesity to enhance trust may also better adherence with weight‐loss programs. Patients with hypertension who reported having "complete trust" in their healthcare practitioner were more than than twice as likely to engage in lifestyle changes to lose weight than those who lacked "consummate trust" (Jones, Carson, Bleich, & Cooper, 2012). It may be prudent to ensure the healthcare staff implementing weight‐loss programs accept sufficient time to foster trust with their patients.

Connected support from healthcare staff may help patients sustain the necessary motivation for lifestyle changes. A retrospective analysis of 14,256 patients in primary care identified consultation frequency as a factor that can predict the success of weight‐management programs (Lenoir, Maillot, Guilbot, & Ritz, 2015). Individuals who successfully maintained ≥x% weight loss over 12 months visited the healthcare provider on average 0.65 times monthly compared with an boilerplate of 0.48 visits/month in those who did not maintain ≥10% weight loss, and 0.39 visits/month in those who failed to achieve the initial ≥10% weight loss (p < .001; Lenoir et al., 2015).

Educational and environmental factors

It is important to consider a patient's education and environment when formulating a weight loss strategy equally environmental factors may need to be challenged to aid facilitate weight loss. A family history of obesity and childhood obesity are strongly linked to developed obesity, which is likely to be because of both genetic and behavioral factors (Kral & Rauh, 2010). Parents create their kid's early nutrient experiences and influence their child's attitudes to eating through learned eating habits and nutrient choices (Kral & Rauh, 2010). Families can also impart cultural preferences for less healthy food choices and family food choices may exist affected past customs factors, such equally the local availability and price of healthy food options (Castro, Shaibi, & Boehm‐Smith, 2009). Aslope this, genetic variation in taste awareness may influence the dietary palate and influence food choices (Loper, La Sala, Dotson, & Steinle, 2015). For example, sensitivity to 6‐n‐propylthiouracil (PROP) is genetically determined, and PROP‐tasting ability ranges from super taster to nontaster. When offered buffet‐style meals over 3 days, PROP nontasters consumed more than energy, and a greater proportion of energy from fat compared with super tasters. So it is possible that a family's genetic contour could contribute to eating choices. To address behavioral factors, it is important to ensure that families have appropriate support and information and that any early signs of weight gain are dealt with promptly.

A good for you home food surroundings can assistance individuals improve their diet. In children, central factors are availability of fresh fruit and vegetables at home and parental influence through their ain fresh fruit and vegetable intake (Wyse, Wolfenden, & Bisquera, 2015). In adults, unhealthy home food environment factors include less salubrious nutrient in the home and reliance on fast nutrient (p = .01) are all predictors of obesity (Emery et al., 2015).

Family mealtimes are strongly associated with better dietary intake and a randomized controlled trial to encourage good for you family unit meals showed a promising reduction in backlog weight gain in prepubescent children (Fulkerson et al., 2015). Some other report showed that adolescents with whatsoever level of baseline family meal frequency, 1–2, iii–4, and ≥five family meals/week, had reduced odds of beingness affected by overweight or obesity 10 years later than adolescents who never ate family meals (Berge et al., 2015). Community health advocates have identified the failure of many families to plan meals or prepare nutrient as a barrier to healthy family eating patterns (Fruh, Mulekar, Hall, Fulkerson et al., 2013). Meal planning allows salubrious meals to be prepared in accelerate and frozen for later consumption (Fruh, Mulekar, Hall, Adams et al., 2013) and is associated with increased consumption of vegetables and healthier meals compared with meals prepared on impulse (Crawford, Ball, Mishra, Salmon, & Timperio, 2007; Hersey et al., 2001).

The office of the nurse practitioner

The initial and ongoing interactions between patient and nurse practitioner are keys for the determination of an effective arroyo and implementation of a weight loss plan and subsequent weight maintenance. The initial interaction tin be instigated by either the nurse practitioner or the patient and once the decision has been made to manage the patient's weight, the evaluation includes a risk cess, a give-and-take about the patient's weight, and treatment goal recommendations (American Nurse Practitioner Foundation, 2013). Beyond this process, it may be advantageous to approach this using objective data and language that is motivational and/or nonjudgmental. Patients may struggle with motivation, and therefore, ongoing discussions effectually the wellness benefits and improvements to quality of life as a upshot of weight loss may be required (American Nurse Practitioner Foundation, 2013). It may be valuable to allocate personalized benefits to the weight loss such as playing with children/grandchildren (American Nurse Practitioner Foundation, 2013). Treatment approaches cover nonpharmacological and pharmacological strategies; notwithstanding, it is important to remember that any pharmacological agent used should exist used every bit an offshoot to nutritional and physical activity strategies (American Nurse Practitioner Foundation, 2013). Pharmacotherapy options for weight management are discussed further in the article by Gold in this supplement.

Conclusions/summary

The importance of obesity management is underscored both by the serious health consequences for individuals, only also by its increasing prevalence globally, and across age groups in particular. Obesity promotes a chronic, low‐grade, inflammatory state, which is associated with vascular dysfunction, thrombotic disorders, multiple organ damage, and metabolic dysfunction. These physiological effects ultimately lead to the development of a range of morbidities, including CVD, T2D, OSA, and sure cancers forth with many others, as well every bit causing a meaning affect on bloodshed.

However, even modest weight loss of v%–x% of total body weight tin can significantly ameliorate health and well‐being, and further benefits are possible with greater weight loss. Weight loss can assistance to prevent development of T2D in individuals with obesity and prediabetes and has a positive long‐term touch on cardiovascular mortality. Beneficial, although not curative, effects have also been noted on OSA post-obit >x% weight loss. In addition, weight loss reduces the take a chance for sure cancer types and has positive effects on most comorbidities including asthma, GERD, liver role, urinary incontinence, fertility, joint pain, and depression.

Weight‐loss programs that include realistic weight loss goals, frequent check‐in, and meal/activity diaries may help individuals to lose weight. Setting realistic weight‐loss goals tin can be difficult; however, visual resources showing the health and wellness benefit of weight loss may be helpful in discussing realistic goals, and help motivate the patient in maintaining the weight loss. Techniques such as motivational interviewing that focus on addressing resistance to behavioral change in a supportive and optimistic manner may help individuals in integrating these changes to allow them to become part of normal everyday life and thus help with maintaining the weight loss. Positive reinforcement in terms of marked early‐weight loss may also assist in improving adherence, so this should be a key goal for weight‐loss programs. Encouraging feelings of "self‐worth" or "cocky‐efficacy" tin can help individuals to view weight loss every bit being within their own command.

Nurse practitioners play a major role in helping patients achieve weight loss through all aspects of the process including assessment, support, motivation, goal‐setting, management, and treatment. With their in‐depth understanding of the inquiry in the field of obesity and weight management, nurse practitioners are well placed to effect meaningful changes in the weight‐management strategies deployed in clinical practice.

List of helpful resources

The Obesity Activity Coalition (OAC): http://www.obesityaction.org	This site has educational resources for providers and patients. It likewise has information on advocacy for patients.
Stop Obesity Brotherhood: https://stopobesityalliance.org/	This site has many helpful resources to assist forestall obesity bias and helpful educational materials for patients. Information technology likewise has an excellent tool to help providers discuss the topic of obesity with patients.
UConn Rudd Center: http://world wide web.uconnruddcenter.org/weight-bias-stigma	This site is an fantabulous resource for providers in clinical do. This site has modules to help providers improve obesity direction.

Acknowledgments

The authors are grateful to Watermeadow Medical for writing aid in the evolution of this manuscript. This aid was funded by Novo Nordisk, who also had a office in the review of the manuscript for scientific accuracy. The author discussed the concept, drafted the outline, commented in detail on the starting time iteration, made disquisitional revision of later drafts, and has revised and approved the final version for submission.

Notes

Disclosures

Dr. Sharon Fruh serves on the Novo Nordisk Obesity Speakers Bureau. In compliance with national ethical guidelines, the author reports no relationship with business or industry that would postal service a conflict of involvement.

Writing and editorial back up was provided past Watermeadow Medical, and funded by Novo Nordisk.

The copyright line in this article was inverse on 9 August 2018 subsequently online publication.

References

• American Nurse Practitioner Foundation . (2013). Nurse practitioners and the prevention and treatment of developed obesity—A White Paper of the American Nurse Practitioner Foundation (electronic version). Summertime. Retrieved from https://international.aanp.org/Content/docs/ObesityWhitePaper.pdf
• Araghi, G. H. , Chen, Y. F. , Jagielski, A. , Choudhury, S. , Banerjee, D. , Hussain, Due south. , … Taheri, Due south. , et al. (2013). Effectiveness of lifestyle interventions on obstructive sleep apnea (OSA): Systematic review and meta‐analysis. Sleep, 36(10), 1553–1562, 1562a–1562e. [PMC free commodity] [PubMed] [Google Scholar]
• Barnes, R. D. , & Ivezaj, Five. (2015). A systematic review of motivational interviewing for weight loss among adults in primary care. Obesity Reviews, sixteen(4), 304–318. [PMC free article] [PubMed] [Google Scholar]
• Berge, J. M. , Wall, Thousand. , Hsueh, T. F. , Fulkerson, J. A. , Larson, N. , & Neumark‐Sztainer, D. (2015). The protective role of family meals for youth obesity: 10‐twelvemonth longitudinal associations. Journal of Pediatrics, 166(2), 296–301. [PMC free article] [PubMed] [Google Scholar]
• Berrington de Gonzalez, A. , Hartge, P. , Cerhan, J. R. , Flintstone, A. J. , Hannan, L. , MacInnis, R. J. , … Thun, M. J. , et al. (2010). Body‐mass index and bloodshed among ane.46 meg white adults. New England Journal of Medicine, 363(23), 2211–2219. [PMC gratis article] [PubMed] [Google Scholar]
• Blokhin, I. O. , & Lentz, S. R. (2013). Mechanisms of thrombosis in obesity. Current Opinion in Hematology, twenty(five), 437–444 [PMC free article] [PubMed] [Google Scholar]
• Berth, A. , Magnuson, A. , Fouts, J. , & Foster, K. (2015). Adipose tissue, obesity and adipokines: Role in cancer promotion. Hormone Molecular Biological science and Clinical Investigation, 21(i), 57–74. [PubMed] [Google Scholar]
• Bray, One thousand. , Look, Thousand. , & Ryan, D. (2013). Treatment of the obese patient in principal care: Targeting and coming together goals and expectations. Postgraduate Medical Journal, 125(five), 67–77. [PubMed] [Google Scholar]
• Breyer, B. N. , Phelan, S. , Hogan, P. E. , Rosen, R. C. , Kitabchi, A. E. , Fly, R. R. , … the Look Alee Inquiry Group , et al. (2014). Intensive lifestyle intervention reduces urinary incontinence in overweight/obese men with blazon 2 diabetes: Results from the Wait AHEAD trial. Journal of Urology, 192(1), 144–149. [PMC free commodity] [PubMed] [Google Scholar]
• Dark-brown, J. Southward. , Wing, R. , Barrett‐Connor, E. , Nyberg, L. M. , Kusek, J. W. , Orchard, T. J. , … Diabetes Prevention Plan Enquiry Grouping , et al. (2006). Lifestyle intervention is associated with lower prevalence of urinary incontinence: The Diabetes Prevention Program. Diabetes Care, 29(two), 385–390. [PMC gratuitous article] [PubMed] [Google Scholar]
• Burt Solorzano, C. M. , & McCartney, C. R. (2010). Obesity and the pubertal transition in girls and boys. Reproduction, 140(3), 399–410. [PMC gratis article] [PubMed] [Google Scholar]
• Capodaglio, P. , & Liuzzi, A. (2013). Obesity: A disabling illness or a status favoring disability? European Journal of Concrete and Rehabilitation Medicine, 49(iii), 395–398. [PubMed] [Google Scholar]
• Castro, F. K. , Shaibi, G. Q. , & Boehm‐Smith, East. (2009). Ecodevelopmental contexts for preventing type 2 diabetes in Latino and other racial/ethnic minority populations. Journal of Behavioral Medicine, 32(ane), 89–105. [PMC free article] [PubMed] [Google Scholar]
• Cefalu, West. T. , Bray, G. A. , Habitation, P. D. , Garvey, W. T. , Klein, S. , Pi‐Sunyer, F. X. , … Ryan, D. H. , et al. (2015). Advances in the science, handling, and prevention of the disease of obesity: Reflections from a diabetes care editors' expert forum. Diabetes Care, 38(8), 1567–1582. [PMC complimentary article] [PubMed] [Google Scholar]
• Centres for Disease Control and Prevention . (2016). Overweight and obesity. Retrieved from https://www.cdc.gov/obesity/
• Cochrane, G. (2008). Role for a sense of cocky‐worth in weight‐loss treatments: Helping patients develop self‐efficacy. Canadian Family Doctor, 54(4), 543–547. [PMC free article] [PubMed] [Google Scholar]
• Crawford, D. , Ball, K. , Mishra, G. , Salmon, J. , & Timperio, A. (2007). Which food‐related behaviours are associated with healthier intakes of fruits and vegetables among women? Public Health Nutrition, x(three), 256–265. [PubMed] [Google Scholar]
• Dattilo, A. M. , & Kris‐Etherton, P. M. (1992). Effects of weight reduction on blood lipids and lipoproteins: A meta‐analysis. American Journal of Clinical Diet, 56(2), 320–328. [PubMed] [Google Scholar]
• Dengo, A. L. , Dennis, E. A. , Orr, J. S. , Marinik, East. L. , Ehrlich, E. , Davy, B. G. , & Davy, One thousand. P. (2010). Arterial destiffening with weight loss in overweight and obese centre‐anile and older adults. Hypertension, 55(4), 855–861. [PMC free article] [PubMed] [Google Scholar]
• Diabetes Prevention Programme ( DPP) Research Group . (2015). Long‐term effects of lifestyle intervention or metformin on diabetes development and microvascular complications over fifteen‐year follow‐up: The Diabetes Prevention Plan Outcomes Study. Lancet Diabetes & Endocrinology, three(eleven), 866–875. [PMC free article] [PubMed] [Google Scholar]
• Diabetes Prevention Programme ( DPP) Inquiry Group , Knowler, Due west. C. , Fowler, Due south. E. , Hamman, R. F. , Christophi, C. A. , Hoffman, H. J. , … Nathan, D. Grand. , et al. (2009). ten‐twelvemonth follow‐up of diabetes incidence and weight loss in the Diabetes Prevention Plan Outcomes Written report. Lancet, 374(9702), 1677–1686. [PMC free article] [PubMed] [Google Scholar]
• Dobbins, 1000. , Decorby, K. , & Choi, B. C. (2013). The association between obesity and cancer gamble: A meta‐analysis of observational studies from 1985 to 2011. ISRN Preventive Medicine, 2013, 680536 ten.5402/2013/680536. [PMC costless article] [PubMed] [CrossRef] [Google Scholar]
• Eheman, C. , Henley, Southward. J. , Ballard‐Barbash, R. , Jacobs, E. J. , Schymura, Chiliad. J. , Noone, A. M. , … Edwards, B. K. , et al. (2012). Annual Report to the Nation on the status of cancer, 1975–2008, featuring cancers associated with backlog weight and lack of sufficient physical activity. Cancer, 118(9), 2338–2366. [PMC free commodity] [PubMed] [Google Scholar]
• Emery, C. F. , Olson, K. Fifty. , Lee, Five. S. , Habash, D. L. , Nasar, J. 50. , & Bodine, A. (2015). Habitation environs and psychosocial predictors of obesity condition amidst community‐residing men and women. International Journal of Obesity, 39(9), 1401–1407. [PMC free commodity] [PubMed] [Google Scholar]
• Fabricatore, A. Due north. , Wadden, T. A. , Higginbotham, A. J. , Faulconbridge, L. F. , Nguyen, A. M. , Heymsfield, S. B. , & Faith, Thousand. S. (2011). Intentional weight loss and changes in symptoms of depression: A systematic review and meta‐analysis. International Journal of Obesity, 35(11), 1363–1376. [PMC gratuitous article] [PubMed] [Google Scholar]
• Fabricatore, A. North. , Wadden, T. A. , Womble, L. G. , Sarwer, D. B. , Berkowitz, R. I. , Foster, Yard. D. , & Brock, J. R. (2007). The role of patients' expectations and goals in the behavioral and pharmacological handling of obesity. International Periodical of Obesity, 31(11), 1739–1745. [PubMed] [Google Scholar]
• Felson, D. T. , Zhang, Y. , Anthony, J. K. , Naimark, A. , & Anderson, J. J. (1992). Weight loss reduces the risk for symptomatic human knee osteoarthritis in women. The Framingham Study. Annals of Internal Medicine, 116(7), 535–539. [PubMed] [Google Scholar]
• Foy, C. G. , Lewis, C. E. , Hairston, 1000. G. , Miller, G. D. , Lang, W. , Jakicic, J. M. , … the Look Alee Research Grouping , et al. (2011). Intensive lifestyle intervention improves physical function among obese adults with articulatio genus hurting: Findings from the Expect AHEAD trial. Obesity (Silver Spring), 19(one), 83–93. [PMC free article] [PubMed] [Google Scholar]
• Fruh, S. M. , Mulekar, M. South. , Hall, H. R. , Adams, J. R. , Lemley, T. , Evans, B. , & Dierking, J. (2013). Repast‐planning practices with individuals in wellness disparity zip codes. Journal for Nurse Practitioners, 9(6), 344–349. [PMC gratis article] [PubMed] [Google Scholar]
• Fruh, S. Chiliad. , Mulekar, M. Southward. , Hall, H. R. , Fulkerson, J. A. , Hanks, R. S. , Lemley, T. , … Dierking, J. , et al. (2013). Perspectives of community health advocates: Barriers to healthy family eating patterns. Journal for Nurse Practitioners, ix(seven), 416–421. [PMC complimentary article] [PubMed] [Google Scholar]
• Fulkerson, J. A. , Friend, South. , Flattum, C. , Horning, M. , Draxten, M. , Neumark‐Sztainer, D. , … Kubik, M. , et al. (2015). Promoting healthful family meals to prevent obesity: HOME Plus, a randomized controlled trial. International Journal of Behavioral Nutrition and Concrete Activity, 12, 154. [PMC gratuitous article] [PubMed] [Google Scholar]
• Goldberg, R. B. , Temprosa, M. Yard. , Mather, Thousand. J. , Orchard, T. J. , Kitabchi, A. E. , & Watson, K. E. , for the Diabetes Prevention Program Enquiry Group . (2014). Lifestyle and metformin interventions accept a durable event to lower CRP and tPA levels in the diabetes prevention program except in those who develop diabetes. Diabetes Intendance, 37(8), 2253–2260. [PMC costless article] [PubMed] [Google Scholar]
• Greenburg, D. L. , Lettieri, C. J. , & Eliasson, A. H. (2009). Effects of surgical weight loss on measures of obstructive sleep apnea: A meta‐analysis. American Journal of Medicine, 122(6), 535–542. [PubMed] [Google Scholar]
• Grief, South. N. , & Miranda, R. 50. (2010). Weight loss maintenance. American Family Physician, 82(6), 630–634. [PubMed] [Google Scholar]
• Guh, D. P. , Zhang, W. , Bansback, N. , Amarsi, Z. , Birmingham, C. 50. , & Anis, A. H. (2009). The incidence of co‐morbidities related to obesity and overweight: A systematic review and meta‐analysis. BMC Public Wellness, 9, 88. [PMC gratuitous commodity] [PubMed] [Google Scholar]
• Haffner, South. , Temprosa, M. , Crandall, J. , Fowler, S. , Goldberg, R. , Horton, E. , … Diabetes Prevention Program Research Grouping , et al. (2005). Intensive lifestyle intervention or metformin on inflammation and coagulation in participants with impaired glucose tolerance. Diabetes, 54(five), 1566–1572. [PMC gratuitous article] [PubMed] [Google Scholar]
• Hamdy, O. (2016). Obesity . Retrieved from https://emedicine.medscape.com/article/123702-overview
• Haufe, S. , Haas, V. , Utz, West. , Birkenfeld, A. L. , Jeran, S. , Bohnke, J. , … Engeli, Southward. , et al. (2013). Long‐lasting improvements in liver fatty and metabolism despite body weight regain after dietary weight loss. Diabetes Care, 36(11), 3786–3792. [PMC gratuitous article] [PubMed] [Google Scholar]
• Hersey, J. , Anliker, J. , Miller, C. , Mullis, R. Chiliad. , Daugherty, S. , Das, Southward. , … Olivia, A. H. , et al. (2001). Food shopping practices are associated with dietary quality in depression‐income households. Journal of Nutrition Education, 33(Suppl 1), S16–S26. [PubMed] [Google Scholar]
• Hursting, S. D. , & Dunlap, Southward. One thousand. (2012). Obesity, metabolic dysregulation, and cancer: A growing concern and an inflammatory (and microenvironmental) issue. Annals of the New York Academy of Sciences, 1271, 82–87. [PMC complimentary commodity] [PubMed] [Google Scholar]
• International Diabetes Federation . (2006). The IDF consensus worldwide definition of the metabolic syndrome (electronic version). Retrieved from https://www.idf.org/webdata/docs/IDF_Meta_def_final.pdf
• Ip, M. S. , Lam, B. , Ng, Thousand. M. , Lam, W. Thousand. , Tsang, Grand. W. , & Lam, K. S. (2002). Obstructive sleep apnea is independently associated with insulin resistance. American Journal of Respiratory and Critical Intendance Medicine, 165(5), 670–676. [PubMed] [Google Scholar]
• Johnson, A. R. , Milner, J. J. , & Makowski, L. (2012). The inflammation highway: Metabolism accelerates inflammatory traffic in obesity. Immunological Reviews, 249(one), 218–238. [PMC free article] [PubMed] [Google Scholar]
• Jones, D. E. , Carson, G. A. , Bleich, S. North. , & Cooper, L. A. (2012). Patient trust in physicians and adoption of lifestyle behaviors to command high claret pressure. Patient Instruction and Counseling, 89(1), 57–62. [PMC complimentary article] [PubMed] [Google Scholar]
• Juel, C. T. , Ali, Z. , Nilas, Fifty. , & Ulrik, C. S. (2012). Asthma and obesity: Does weight loss improve asthma control? A systematic review. Journal of Asthma and Allergy, 5, 21–26. [PMC free article] [PubMed] [Google Scholar]
• Kernan, W. North. , Inzucchi, S. E. , Sawan, C. , Macko, R. F. , & Furie, K. L. (2013). Obesity: A stubbornly obvious target for stroke prevention. Stroke, 44(1), 278–286. [PubMed] [Google Scholar]
• Kort, J. D. , Winget, C. , Kim, S. H. , & Lathi, R. B. (2014). A retrospective cohort study to evaluate the bear upon of meaningful weight loss on fertility outcomes in an overweight population with infertility. Fertility and Sterility, 101(5), 1400–1403. [PubMed] [Google Scholar]
• Kral, T. V. , & Rauh, E. 1000. (2010). Eating behaviors of children in the context of their family environment. Physiology & Behavior, 100(5), 567–573. [PMC gratuitous article] [PubMed] [Google Scholar]
• Kritchevsky, Southward. B. , Beavers, K. M. , Miller, M. E. , Shea, M. Thousand. , Houston, D. K. , Kitzman, D. W. , & Nicklas, B. J. (2015). Intentional weight loss and all‐cause bloodshed: A meta‐assay of randomized clinical trials. PLoS One, 10(3), e0121993. [PMC gratuitous commodity] [PubMed] [Google Scholar]
• Kuk, J. Fifty. , Ardern, C. I. , Church, T. Southward. , Sharma, A. Chiliad. , Padwal, R. , Sui, X. , … Blair, S. N. , et al. (2011). Edmonton obesity staging system: Association with weight history and mortality risk. Applied Physiology, Nutrition, and Metabolism, 36(4), 570–576. [PubMed] [Google Scholar]
• Kuna, S. T. , Reboussin, D. Grand. , Borradaile, K. E. , Sanders, M. H. , Millman, R. P. , Zammit, K. , … Sleep AHEAD Research Group of the Look AHEAD Research Grouping , et al. (2013). Long‐term event of weight loss on obstructive sleep apnea severity in obese patients with type 2 diabetes. Sleep, 36(5), 641–649A. [PMC free article] [PubMed] [Google Scholar]
• Lee, J. M. , Pilli, Due south. , Gebremariam, A. , Keirns, C. C. , Davis, M. M. , Vijan, S. , … Gurney, J. G. , et al. (2010). Getting heavier, younger: Trajectories of obesity over the life course. International Journal of Obesity, 34(4), 614–623. [PMC free article] [PubMed] [Google Scholar]
• Lenoir, L. , Maillot, M. , Guilbot, A. , & Ritz, P. (2015). Primary care weight loss maintenance with behavioral nutrition: An observational study. Obesity (Silver Spring), 23(9), 1771–777. [PMC free article] [PubMed] [Google Scholar]
• Li, G. , Zhang, P. , Wang, J. , An, Y. , Gong, Q. , Gregg, E. West. , … Bennett, P. H. , et al. (2014). Cardiovascular bloodshed, all‐cause bloodshed, and diabetes incidence afterward lifestyle intervention for people with impaired glucose tolerance in the Da Qing Diabetes Prevention Report: A 23‐year follow‐up written report. Lancet Diabetes & Endocrinology, 2(six), 474–480. [PubMed] [Google Scholar]
• Li, Yard. , Zhang, P. , Wang, J. , Gregg, E. W. , Yang, W. , Gong, Q. , … Bennett, P. H. , et al. (2008). The long‐term issue of lifestyle interventions to prevent diabetes in the Communist china Da Qing Diabetes Prevention Study: A 20‐yr follow‐upward study. Lancet, 371(9626), 1783–1789. [PubMed] [Google Scholar]
• Lindstrom, J. , Eriksson, J. G. , Valle, T. T. , Aunola, S. , Cepaitis, Z. , Hakumaki, Yard. , … Tuomilehto, J. , et al. (2003). Prevention of diabetes mellitus in subjects with impaired glucose tolerance in the Finnish Diabetes Prevention Report: Results from a randomized clinical trial. Journal of the American Guild of Nephrology, 14(seven Suppl 2), S108–S113. [PubMed] [Google Scholar]
• Lindstrom, J. , Ilanne‐Parikka, P. , Peltonen, M. , Aunola, S. , Eriksson, J. One thousand. , Hemio, Chiliad. , … Finnish Diabetes Prevention Study Group , et al. (2006). Sustained reduction in the incidence of type two diabetes by lifestyle intervention: Follow‐up of the Finnish Diabetes Prevention Study. Lancet, 368(9548), 1673–1679. [PubMed] [Google Scholar]
• Linkov, F. , Maxwell, One thousand. 50. , Felix, A. S. , Lin, Y. , Lenzner, D. , Bovbjerg, D. H. , … DeLany, J. P. , et al. (2012). Longitudinal evaluation of cancer‐associated biomarkers before and after weight loss in RENEW study participants: Implications for cancer run a risk reduction. Gynecologic Oncology, 125(ane), 114–119. [PMC free article] [PubMed] [Google Scholar]
• Loper, H. B. , La Sala, G. , Dotson, C. , & Steinle, N. (2015). Taste perception, associated hormonal modulation, and nutrient intake. Nutrition Reviews, 73(2), 83–91. [PMC free commodity] [PubMed] [Google Scholar]
• Lv, N. , Xiao, L. , & Ma, J. (2015). Weight direction interventions in adult and pediatric asthma populations: A systematic review. J Pulm Respir Med, v(232), pii: 1000232. [PMC free article] [PubMed] [Google Scholar]
• Martin‐Rodriguez, E. , Guillen‐Grima, F. , Marti, A. , & Brugos‐Larumbe, A. (2015). Comorbidity associated with obesity in a large population: The APNA study. Obesity Inquiry & Clinical Practice, ix(5), 435–447. [PubMed] [Google Scholar]
• Musunuru, K. (2010). Atherogenic dyslipidemia: Cardiovascular risk and dietary intervention. Lipids, 45(10), 907–914. [PMC free article] [PubMed] [Google Scholar]
• Nanchahal, K. , Townsend, J. , Letley, L. , Haslam, D. , Wellings, Chiliad. , & Haines, A. (2009). Weight‐management interventions in chief intendance: A pilot randomised controlled trial. British Periodical of General Practise, 59(562), e157–e166. [PMC free article] [PubMed] [Google Scholar]
• Osunlana, A. G. , Asselin, J. , Anderson, R. , Ogunleye, A. A. , Cavern, A. , Sharma, A. M. , & Campbell‐Scherer, D. Fifty.. (2015). 5As team obesity intervention in primary care: Evolution and evaluation of shared decision‐making weight direction tools. Clinical Obesity, 5(4), 219–225. [PMC free article] [PubMed] [Google Scholar]
• Pan, Ten. R. , Li, Chiliad. W. , Hu, Y. H. , Wang, J. X. , Yang, W. Y. , An, Z. 10. , … Howard, B. 5. , et al. (1997). Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and diabetes study. Diabetes Care, 20(four), 537–544. [PubMed] [Google Scholar]
• Parker, Due east. D. , & Folsom, A. R. (2003). Intentional weight loss and incidence of obesity‐related cancers: The Iowa Women's Health Report. International Journal of Obesity and Related Metabolic Disorders: Journal of the International Association for the Study of Obesity, 27(12), 1447–1452. [PubMed] [Google Scholar]
• Patel, N. S. , Doycheva, I. , Peterson, M. R. , Hooker, J. , Kisselva, T. , Schnabl, B. , … Loomba, R. , et al. (2015). Effect of weight loss on magnetic resonance imaging interpretation of liver fat and book in patients with nonalcoholic steatohepatitis. Clinical Gastroenterology and Hepatology, xiii(three), 561–568 e561. [PMC free article] [PubMed] [Google Scholar]
• Peterson, Northward. D. , Middleton, K. R. , Nackers, L. M. , Medina, 1000. E. , Milsom, V. A. , & Perri, M. G. (2014). Dietary self‐monitoring and long‐term success with weight management. Obesity (Silver Bound), 22(ix), 1962–1967. [PMC free commodity] [PubMed] [Google Scholar]
• Petry, N. Grand. , Barry, D. , Pietrzak, R. H. , & Wagner, J. A. (2008). Overweight and obesity are associated with psychiatric disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. 70(three), 288–297. [PubMed] [Google Scholar]
• Pi‐Sunyer, Ten. (2009). The medical risks of obesity. Postgraduate Medicine, 121(vi), 21–33. [PMC gratuitous article] [PubMed] [Google Scholar]
• Prospective Studies Collaboration , Whitlock, G. , Lewington, Due south. , Sherliker, P. , Clarke, R. , Emberson, J. , … Peto, R. , et al. (2009). Body‐mass index and crusade‐specific mortality in 900 000 adults: Collaborative analyses of 57 prospective studies. Lancet, 373(9669), 1083–1096. [PMC free article] [PubMed] [Google Scholar]
• Pulgaron, E. R. (2013). Childhood obesity: A review of increased risk for concrete and psychological comorbidities. Clin Ther 35(1), A18–A32. [PMC free commodity] [PubMed] [Google Scholar]
• Ratner, R. , Goldberg, R. , Haffner, S. , Marcovina, S. , Orchard, T. , Fowler, S. , … Diabetes Prevention Programme Research Group , et al. (2005). Impact of intensive lifestyle and metformin therapy on cardiovascular disease risk factors in the diabetes prevention program. Diabetes Care, 28(4), 888–894. [PMC free commodity] [PubMed] [Google Scholar]
• Rogge, M. Thousand. , & Gautam, B. (2017). Biological science of obesity and weight regain: Implications for clinical exercise. Journal of the American Association of Nurse Practitioners, 29(Supplement 1), S15–S29. [PubMed] [Google Scholar]
• Romero‐Corral, A. , Caples, S. 1000. , Lopez‐Jimenez, F. , & Somers, V. Thou. (2010). Interactions betwixt obesity and obstructive slumber apnea: Implications for treatment. Chest, 137(3), 711–719. [PMC costless article] [PubMed] [Google Scholar]
• Sakai, R. , Matsui, S. , Fukushima, M. , Yasuda, H. , Miyauchi, H. , & Miyachi, Y. (2005). Prognostic gene analysis for plaque psoriasis. Dermatology, 211(2), 103–106. [PubMed] [Google Scholar]
• Singh, M. , Lee, J. , Gupta, North. , Gaddam, S. , Smith, B. K. , Wani, Southward. B. , … Sharma, P. , et al. (2013). Weight loss can atomic number 82 to resolution of gastroesophageal reflux disease symptoms: A prospective intervention trial. Obesity (Silver Spring), 21(2), 284–290. [PMC free article] [PubMed] [Google Scholar]
• Skinner, A. C. , & Skelton, J. A. (2014). Prevalence and trends in obesity and severe obesity amidst children in the U.s., 1999–2012. JAMA Pediatrics, 168(6), 561–566. [PubMed] [Google Scholar]
• Smith, S. A. , Hulsey, T. , & Goodnight, W. (2008). Furnishings of obesity on pregnancy. J Obstet Gynecol Neonatal Nurs, 37(ii), 176–184. [PubMed] [Google Scholar]
• The Global BMI Mortality Collaboration . (2016). Body‐mass index and all‐cause mortality: Individual participant‐data meta‐assay of 239 prospective studies in four continents. Lancet, 388, 734–736. [PMC costless article] [PubMed] [Google Scholar]
• The National Weight Control Registry ( NWCR) . (2016). NCWR facts. Retrieved from https://www.nwcr.ws/
• Tuomilehto, J. , Lindstrom, J. , Eriksson, J. 1000. , Valle, T. T. , Hamalainen, H. , Ilanne‐Parikka, P. , … Finnish Diabetes Prevention Written report Group , et al. (2001). Prevention of type ii diabetes mellitus past changes in lifestyle amongst subjects with impaired glucose tolerance. New England Journal of Medicine, 344(18), 1343–1350. [PubMed] [Google Scholar]
• Weinsier, R. L. , & Ullmann, D. O. (1993). Gallstone formation and weight loss. Obesity Research, 1(1), 51–56. [PubMed] [Google Scholar]
• Wensveen, F. M. , Valentic, S. , Sestan, Thousand. , Turk Wensveen, T. , & Polic, B. (2015). The "Big Bang" in obese fat: Events initiating obesity‐induced adipose tissue inflammation. European Journal of Immunology, 45(9), 2446–2456. [PubMed] [Google Scholar]
• Whitaker, R. C. , Wright, J. A. , Pepe, M. S. , Seidel, K. D. , & Dietz, W. H. (1997). Predicting obesity in young adulthood from childhood and parental obesity. New England Journal of Medicine, 337(thirteen), 869–873. [PubMed] [Google Scholar]
• Earth Health Organization (WHO) . (2016a). ten Facts on obesity. Retrieved from https://world wide web.who.int/features/factfiles/obesity/facts/en/
• World Health Organization (WHO) . (2016b). Obesity. Retrieved from https://world wide web.who.int/topics/obesity/en/
• Wyse, R. , Wolfenden, L. , & Bisquera, A. (2015). Characteristics of the abode food environment that mediate firsthand and sustained increases in child fruit and vegetable consumption: Mediation analysis from the Healthy Habits cluster randomised controlled trial. International Journal of Behavioral Nutrition and Concrete Activity, 12, 118. [PMC free commodity] [PubMed] [Google Scholar]
• Yang, L. , & Colditz, G. A. (2015). Prevalence of overweight and obesity in the United States, 2007–2012. JAMA Internal Medicine, 175(eight), 1412–1413. [PMC gratuitous article] [PubMed] [Google Scholar]
• Yosipovitch, M. , DeVore, A. , & Dawn, A. (2007). Obesity and the skin: Skin physiology and pare manifestations of obesity. J Am Acad Dermatol, 56(half-dozen), 901–916; quiz 917–920. [PubMed] [Google Scholar]

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