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PubMed1999

Exercise training and substrate utilisation in obesity.

Together with diet and behavioural modification, regular exercise is one of the key components of programs for the treatment of obesity. It appears to be one of the major factors determining the long-term success of weight loss programs. One of the mechanisms that may underlie this and other beneficial effects of regular exercise is the effect of exercise training on substrate utilisation. Exercise training increases fat oxidation in lean subjects. The capacity to mobilise and oxidise fat has been shown to be impaired in obese and post-obese subjects. Thus, an increase in the capacity for fat oxidation may help to maintain fat and energy balance at a lower fat mass in individuals with a predisposition for obesity. However, in view of the impaired fat oxidation in obese and post-obese individuals the question arises whether exercise training also increases fat oxidation in the obese. Few studies have addressed this question and have investigated the effect of exercise training on substrate utilisation in obesity. Addition of an exercise training program has been shown to prevent the reduction of basal fat oxidation that is associated with diet-induced weight loss in two studies. No effect of additional exercise training on substrate oxidation during exercise was found. In post-obese subjects exercise training caused no change in 24 h substrate oxidation in one study and increased carbohydrate, rather than fat oxidation in another. In obese subjects neither low (40% maximal aerobic fitness (VO2max)) nor high (70% VO2max) intensity training was found to affect resting substrate oxidation. During exercise fractional fat oxidation was increased after low, but not after high intensity training. The question, whether exercise training increases fat oxidation in obese and post-obese as in lean subjects therefore cannot be answered conclusively at this point in time and requires further study. The role of exercise intensity and type of exercise needs to be studied as well.

Adipose Tissue↗

PubMed1980

Extremely obese patients: improvements in exercise tolerance with physical training and weight loss.

The relationship between improvements in exercise tolerance and body weight was determined for 11 extremely obese patients (mean entry weight = 189kg) concomitantly participating in progressive physical training (walking-jogging) and severe caloric restriction (600kcal/day) to induce weight loss as part of a residential multidisciplinary rehabilitation program. Two standardized tests (treadmill mile-walk and graded-exhaustive) to quantitatively evaluate exercise performance were administered periodically. Significant weight reductions and improvements in exercise tolerance were observed, with measures of the latter occurring relatively sooner. Correlation coefficients between body weight and performance or physiologic response measures were extremely low, indicating widespread individual responsiveness to training and the probable separateness of training and dietary effects. A moderate inverse correlation was found between body weight and a simple measure of work performance: endurance time to volitional exhaustion (r = -0.45). Training programs of moderate rather than higher intensity, duration, and progression rate were used with this obese group. Such programs can be safely administered and will be well tolerated but therapists should recognize the inability to predict improvements in exercise performance on the basis of the current body weights of individual patients. The major application of results from standardized exercise tests, therefore, resides in direct reinforcement of patient progress.

Adult↗

PubMed1995

Nutrition and health practices of diabetic and nondiabetic men and women from two southeastern New England communities.

Diabetes occurs in at least 13 million persons in the United States and is a major cause of morbidity and premature mortality. Diet is the cornerstone of diabetes management, and the purpose of this investigation was to examine dietary intakes and health practices among diabetic and nondiabetic individuals from a recently surveyed population-based sample from two communities in southeastern New England. Data were collected during cross-sectional home health surveys conducted in random population samples of two New England communities during 1987-1988, 1989-1990, and 1992-1993. A food frequency questionnaire was completed by 1,897 of 2,077 eligible respondents who made up our study sample. Statistical analyses suggest that diabetic individuals do not appear to be adhering to measures known to improve metabolic control (i.e., weight reduction and physical activity). Furthermore, both diabetic and nondiabetic individuals alike should be targeted for educational programs aimed at improving dietary intakes which lead to a reduction in consumption of total and saturated fatty acid.

Adolescent↗

PubMed2003

Diet and exercise in the prevention of diabetes.

The worldwide epidemic of obesity is being mirrored in worldwide epidemics of metabolic syndrome and of type 2 diabetes. The theme of the 2002 Future Forum conference is that these conditions are a certainty, given that the changing worldwide environment requires less physical activity for daily living and assures an abundant, energy-dense food supply at all times. This paper focuses on the roles of physical activity and weight reduction in reducing the risk for development of type 2 diabetes and the metabolic syndrome. The mechanisms by which obesity and detraining lead to insulin resistance and type 2 diabetes are discussed and, conversely, the mechanisms by which insulin resistance might be reversed by physical activity are addressed. Finally, the evidence from recent randomised clinical trials is reviewed. The Finnish Diabetes Prevention Study and the Diabetes Prevention Program in the USA both demonstrate that lifestyle change can significantly reduce the risk of development of type 2 diabetes in individuals with impaired glucose tolerance. Furthermore, these studies demonstrate that modest weight change and achievable physical activity goals can translate into significant risk reduction. Societies cannot afford to ignore the evidence of health benefit associated with physical activity and healthy weight in favour of medicating when morbidities develop. For a successful public health approach to chronic disease prevention, we cannot rely completely on pharmaceuticals, but must implement environmental changes to encourage healthy lifestyles.

Diabetes Mellitus↗

PubMed2002

Role of a synthetic pyrimidine compound, MS-818, in reduction of infarct size and amelioration of sensorimotor dysfunction following permanent focal cerebral ischemia in rats.

OBJECT: A synthetic heterocyclic pyrimidine compound, MS-818 (2-piperadino-6-methyl-5-oxo-5,6-dihydro-(7H) pyrrolo-[3,4-d] pyrimidine maleate) is reported to have a variety of biological activities including neurite outgrowth, astrocyte differentiation, suppression of neuronal apoptosis, regeneration of injured peripheral nerves, fracture repairs, angiogenesis, and superovulation. To be able to explicate the neurotrophic effects of MS-818, the authors evaluated its effect on the reduction of infarct volume and amelioration of sensorimotor dysfunction in a rat model of focal ischemia. METHODS: Forty male Sprague-Dawley rats were subjected to right middle cerebral artery occlusion and assigned to one of four treatment groups (10 animals in each group). The MS-818 (1, 5, or 10 mg/kg) or phosphate-buffered saline (control group) was administered intraperitoneally at onset of ischemia and again 24 hours later. The rats were killed 48 hours after they underwent surgery to induce stroke, and infarct volume was determined using an image-analysis computer software program following staining with 2,3,5-triphenyltetrazolium chloride. Postischemic neurological deficit and body weight were also assessed. CONCLUSIONS: Significant reductions in infarct volume (total and cortical infarction) were found in all the MS-818-treated groups compared with the control group. Furthermore, MS-818 induced significant amelioration of sensorimotor dysfunction, as indicated by the results of forelimb and hindlimb placing tests. The present findings suggest that MS-818, which has a much smaller molecular weight than neurotrophic peptides. represents a new approach to the treatment of focal cerebral ischemia.

Animals↗

PubMed2006

Reduction of global cardiovascular risk with nutritional versus nutritional plus physical activity intervention in Colombian adults.

BACKGROUND: Cardiovascular disease is a major cause of morbidity/mortality in non-developed countries. Reports of the effects of non-pharmacological interventions on global cardiovascular risk in Latin American adults, however, are scarce. OBJECTIVE: To compare the change in global cardiovascular risk induced by a tailored, Adult Treatment Panel-III compliant nutrition program versus the same program with addition of supervised, regular physical activity in Colombian adults. DESIGN: The study was a randomized, controlled trial. METHODS: Seventy-five Colombian patients aged 40-70 years and with Framingham-estimated global cardiovascular risk of 1% or higher were randomly assigned to a nutritional intervention program or a combined nutritional intervention-physical exercise program for 16 weeks. Patients underwent medical and anthropometric evaluation, bioelectrical impedance, lipid profile and Framingham global cardiovascular risk determination at baseline and at the end of follow-up. RESULTS: The groups were comparable at baseline; 21 persons in the nutritional intervention program group and 27 in the nutritional intervention-physical exercise program group completed the follow-up. Global cardiovascular risk modification (mean+/-SE) was -2.04+/-1.1 absolute percentage points (relative reduction 19.6%) in the nutritional intervention-physical exercise program group, compared with 0.23+/-0.9 (relative increase 2.8%) in the nutritional intervention program group. Mean difference in global cardiovascular risk modification between groups reached borderline statistical significance in ANCOVA (P=0.054). Reductions in systolic and diastolic blood pressure, waist circumference and low-density lipoprotein cholesterol were similar, but the nutritional intervention-physical exercise program group achieved significantly greater improvements in body weight, body mass index, percentage body fat and high-density lipoprotein cholesterol. CONCLUSIONS: Our data suggest that a structured nutritional intervention-physical exercise program is more efficacious than a nutritional intervention program in the reduction of global cardiovascular risk and cardiovascular risk factors, in only 16 weeks.

Adult↗

PubMed1990

Impact of smoking, physical training and weight reduction on FVII, PAI-1 and hemostatic markers in sedentary men.

The variations of FVII, PAI-1, TAT complexes, fibrinopeptide A, D-Dimers and beta thromboglobulin plasma levels were studied on 30 sedentary men, smokers and non-smokers, who were admitted to a 6 months' program of physical training and smoking cessation. After 3 months of intervention, sustained physical training was associated with the decrease of FVII and PAI-1 levels. Mild exercise performed during a second 3-month period could maintain normal FVII and PAI-1 activities but participants who stopped the training increased their FVII and PAI-1 plasma levels. FVII was not influenced by smoking habits. Smoking cessation seemed to slightly potentiate the decrease of PAI-1 levels associated with mild exercise. Overweight, FVII and PAI-1 levels were correlated and the weight reduction induced by training was related to the changes in the factors. In smokers, physical exercise was associated with a significant increase of hemostatic markers. This exercise-induced variation disappeared after 3 months of intervention in participants who stopped smoking and reappeared in those who smoked again after 6 months of intervention. This finding was not influenced by the physical training program.

Antithrombin III↗

PubMed1993

Adolescent obesity and cardiovascular risk: a rational approach to management.

Ten obese adolescents, referred because of elevated cardiovascular disease risk, were treated in a pediatric atherosclerosis prevention center. The focus of treatment was an increase in exercise tolerance and aerobic capacity and a decrease in the percentage of fat in the diet. Weight loss was not a goal of treatment, but continued growth with a slowing of the rate of weight gain was emphasized. All patients were at elevated cardiovascular risk at the entry to the study, and nine of the ten had significant improvements in one or more of their cardiovascular risk parameters. Furthermore, with regard to body composition, eight of the ten patients were able to improve their body mass index. On average, triceps skinfold thicknesses declined 25 percent. Total cholesterol declined 14%, triglycerides declined 33%, LDL cholesterol declined 13%, and HDL cholesterol did not change with this form of treatment. As for systolic and diastolic blood pressure, four of the ten patients who had elevated blood pressures at the initiation of treatment were able to decrease their blood pressure, in absolute terms and on the basis of their percentiles for age and sex. We conclude that, in obese adolescents, improved diet and body composition, a slowed rate of weight gain, and a reduction of cardiovascular risk shown through lipid profiles and blood pressures can be achieved from a multidisciplinary treatment program focused on achievable goals. These goals include (1) increased habitual exercise and increased aerobic exercise and (2) a decrease in the percentage of energy intake from fat and saturated fat, with a concomitant decrease in the balance of energy intake to energy output. It is important to remember that we did not focus on weight loss per se and that the treatment was individualized to the developmental stage of the adolescent.

Adolescent↗

PubMed1989

[Follow-up study of severely overweight adolescents 4 years following inpatient weight loss with a low calorie protein-carbohydrate diet].

Very low calorie protein/carbohydrate diets have proved to be efficient and safe in the treatment of obesity in childhood and early adolescence. The follow-up study at issue shows that subsequent to short-term therapy no further reduction in weight is to be expected without adequate care following the diet. Between 1980 and 1983, 27 adolescent patients were treated for severe obesity (78.12% +/- 18.3% overweight, mean +/- s.e.m.) at the metabolic ward of the department of pediatrics, University of Vienna. The administration of a very low calorie protein/carbohydrate diet (VLCD) for 26 (+/- 7) days led to a considerable reduction in overweight (8.1 +/- 2.9 kg). On dismission the percentual overweight had decreased to 59.4 (+/- 24)%. After 4.4 (+/- 0.7) years the weight of 11 of the 27 patients could be controlled, 10 patients refused further cooperation and the remaining 6 could not be addressed. The body mass index (weight/height) had risen from 29.4 (+/- 1.2) to 43.0 (+/- 6.0) with 10 of 11 patients, corresponding to a percentual overweight of 88.2 (+/- 18.1)% at the follow-up date. Only one girl had reduced overweight by 45%, the BMI had fallen from 33.9 to 27.1. Furthermore, our data suggest that obesity induces a significant increase in blood pressure in adolescents. This rise is apparently independent of the age related increase in blood pressure and revertible by weight loss. The results we have to hand show that long-term weight reduction has only been achieved in 1 of 11 cases, with none of the adolescents having participated regularly in an outpatient after-care program.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1991

Effects of intense sweeteners on hunger, food intake, and body weight: a review.

The sweet taste of aspartame, saccharin, and acesulfame-K has been reported to increase ratings of hunger and, after saccharin consumption, to increase food intake. However, most investigators have found that aspartame consumption is associated with decreased or unchanged ratings of hunger. Even if aspartame consumption increases ratings of hunger in some situations, it apparently has little impact on the controls of food intake and body weight. Aspartame has not been found to increase food intake; indeed, both short-term and long-term studies have shown that consumption of aspartame-sweetened foods or drinks is associated with either no change or a reduction in food intake. Preliminary clinical trials suggest that aspartame may be useful aid in a complete diet-and-exercise program or in weight maintenance. Intense sweeteners have never been found to cause weight gain in humans.

Aspartame↗

PubMed1997

The effects of health beliefs on weight loss in individuals at high risk for NIDDM.

OBJECTIVE: To determine whether perceived risk and other health beliefs held by individuals at high risk for developing NIDDM predict weight loss and behavior change during a behavioral weight loss program to reduce the risk of NIDDM. RESEARCH DESIGN AND METHODS: Health beliefs and objective risk factors for diabetes were examined in 154 overweight men and women with a family history of NIDDM. The effects of these factors on adherence, dietary intake, weight loss, and changes in glucose levels were examined in a subset of 79 of these subjects who participated in a 2-year behavioral weight control program. RESULTS: Those subjects who perceived themselves at highest risk of developing diabetes had a stronger family history of the disease and were more likely to be women than subjects considering themselves at more moderate risk. These participants also rated diabetes as a more serious disease, but were less likely to believe that weight loss would lower their risk. None of these health beliefs were related to attendance at meetings, dietary intake, weight loss, or fasting glucose, but higher perceived seriousness predicted larger reductions in BMI at 1 year. Of the objective risk factors for NIDDM, higher baseline BMI predicted larger weight losses throughout the program, and a stronger family history of diabetes was related to greater weight regain after an initial weight loss. CONCLUSIONS: Perceived risk of developing diabetes and other health beliefs did not predict performance in a behavioral weight loss program. These data suggest that efforts to modify health beliefs by educating high-risk individuals about their risk and benefits of weight loss may not be effective in improving long-term weight loss results.

Adult↗

PubMed2000

Exercise and weight loss reduce blood pressure in men and women with mild hypertension: effects on cardiovascular, metabolic, and hemodynamic functioning.

BACKGROUND: Lifestyle modifications have been recommended as the initial treatment strategy for lowering high blood pressure (BP). However, evidence for the efficacy of exercise and weight loss in the management of high BP remains controversial. METHODS: One hundred thirty-three sedentary, overweight men and women with unmedicated high normal BP or stage 1 to 2 hypertension were randomly assigned to aerobic exercise only; a behavioral weight management program, including exercise; or a waiting list control group. Before and following treatment, systolic and diastolic BPs were measured in the clinic, during daily life, and during exercise and mental stress testing. Hemodynamic measures and metabolic functioning also were assessed. RESULTS: Although participants in both active treatment groups exhibited significant reductions in BP relative to controls, those in the weight management group generally had larger reductions. Weight management was associated with a 7-mm Hg systolic and a 5-mm Hg diastolic clinic BP reduction, compared with a 4-mm Hg systolic and diastolic BP reduction associated with aerobic exercise; the BP for controls did not change. Participants in both treatment groups also displayed reduced peripheral resistance and increased cardiac output compared with controls, with the greatest reductions in peripheral resistance in those in the weight management group. Weight management participants also exhibited significantly lower fasting and postprandial glucose and insulin levels than participants in the other groups. CONCLUSIONS: Although exercise alone was effective in reducing BP, the addition of a behavioral weight loss program enhanced this effect. Aerobic exercise combined with weight loss is recommended for the management of elevated BP in sedentary, overweight individuals.

Adult↗

PubMed1999

Short-term health and economic benefits of smoking cessation: low birth weight.

OBJECTIVES: To estimate excess direct medical costs of low birth weight from maternal smoking and short-term cost savings from smoking cessation programs before or during the first trimester of pregnancy. METHODS: Simulations using data on neonatal costs per live birth. Outcome measures are mean US excess direct medical cost per live birth, total excess direct medical cost, reductions in low birth weight, and savings in medical costs from an annual 1 percentage point drop in smoking prevalence among pregnant women. RESULTS: Mean average excess direct medical cost per live birth for each pregnant smoker (in 1995 dollars) was $511; total cost was $263 million. An annual drop of 1 percentage point in smoking prevalence would prevent 1300 low birth weight live births and save $21 million in direct medical costs in the first year of the program; it would prevent 57,200 low birth weight infants and save $572 million in direct medical costs in 7 years. CONCLUSIONS: Smoking cessation before the end of the first trimester produces significant cost savings from the prevention of low birth weight.

California↗

PubMed1990

[The "Ashkelon" hypertension detection and follow-up program].

The program described aims at enhancing awareness of high blood pressure and other risk factors for cardiovascular disease (CVD) and promoting a healthy lifestyle. The study population consisted of 11,000 workers at worksites and visitors to community centers, aged 25-65 years. The program was carried out in cooperation with primary care clinics and non-pharmacological control of high blood pressure was by a community center for prevention of CVD. In 1980, 56.0% of hypertensives were unaware of their condition, while by 1988 this was reduced to 6.1%. Body weight reduction resulted in lowering of blood pressure which enabled cessation of all antihypertensive treatment in 25%. Deep muscle relaxation enabled cessation in 47%. The savings effected in terms of antihypertensive treatment outweight the total cost of the program 3-fold.

Adult↗

PubMed1994

Nonpharmacologic therapy improves functional and emotional status in congestive heart failure.

PURPOSE: To compare the effects of a multimodal nonpharmacologic intervention to digoxin and to placebo in patients with congestive heart failure receiving background therapy with angiotensin-converting enzyme inhibitors. DESIGN: Randomized, parallel assignment to three treatment groups of 20 patients with congestive heart failure (New York Heart Association Class II and III). INTERVENTION: Nonpharmacologic treatment program included the following: (1) graduated exercise training, three to five times per week; (2) structured cognitive therapy and stress management; and (3) dietary intervention aimed at salt reduction and weight reduction in the overweight. Digoxin was titrated to achieve a blood level between 0.8 and 2.0 ng/ml. Placebo and digoxin were administered in a randomized, double-blind fashion. RESULTS: Echocardiographic ejection fraction improved (p < 0.05) in the digitalis group (change = +4.4 +/- 6.5) compared with both placebo (change = -3.2 +/- 3.9) and nonpharmacologic therapy (change = -3.2 +/- 3.9). The nonpharmacologic treatment program was well tolerated by all patients and resulted in significant improvement (p < 0.05) in exercise tolerance (digoxin = +51 +/- 50 s, placebo = +91 +/- 76, nonpharmacologic therapy = +182 +/- 139), as well as Beck Depression Inventory score (digoxin = +1.2 +/- 4.4, placebo = +2.0 +/- 4.2, nonpharmacologic therapy = -5.0 +/- 4.2), Hamilton Scale scores of anxiety (digoxin = +3.0 +/- 6.8, placebo = +6.0 +/- 2.6, nondrug therapy = -5.2 +/- 5.4), and depression (digoxin = +1.0 +/- 4.9, placebo = +5.0 +/- 5.0, nonpharmacologic therapy = -6.6 +/- 10.1). In addition, weight loss was significantly greater with nonpharmacologic therapy (digoxin = +0.32 +/- 1.76 kg; placebo = -1.35 +/- 1.44 kg; nonpharmacologic therapy = -4.37 +/- 4.50 kg) compared with both digoxin and placebo. CONCLUSIONS: Nonpharmacologic therapy improved functional capacity, body weight, and mood state in patients with congestive heart failure. In contrast, digoxin improved ejection fraction without corresponding changes in exercise tolerance or quality of life.

Aged↗

PubMed1998

The effectiveness of dietary instruction in obese school children of southern Taiwan.

The purpose of this study is to evaluate the short-term effectiveness of a weekly dietary instruction program to reduce obesity in elementary school children. A total of 140 third- to sixth-grade overweight children and 130 height- and age-matched overweight children were selected from two elementary schools in Kaohsiung. The primary inclusion criterion was a Rohrer's Index [RI = weight (kg)/height (cm)3 x 10(7)] greater than 150. The anthropometric measurement was performed on both the group receiving instruction and the group not receiving instruction. Biomedical monitoring of the students state of health, assessments of their nutritional knowledge, attitude and practice (K.A.P.) before and after the thirteen-week instruction were compared in the instruction group. After completion of the instruction program, a significant reduction of RI values (177.2 +/- 18.3 vs. 169.4 +/- 20.1, p < 0.01), and a significant increase in body height (144.9 +/- 7.7 cm vs. 146.7 +/- 7.7 cm, p < 0.01), with no change in body weight (54.5 +/- 11.3 kg vs. 54.3 +/- 11.3 kg) were found in the group receiving instruction. Some of the anthropometric parameters of obesity were also significantly improved. Reduction of total cholesterol and serum Glutamic Oxaloacetic Transaminase (GOT)/Glutamic Pyrvic Transaminase (GPT) levels were also observed; the later phenomena were interpreted as an improvement in the fatty metamorphosis of the liver, which usually accompanies obesity. A significantly increased nutrition knowledge and change to more healthy dietary behavior were also found in students who finished the instruction program. This reduction was a measure of the effectiveness of weekly dietary instruction sessions. An increase in NSQ scores indicated improved nutritional knowledge and behavior. Through the implementation of weekly nutritional instruction, a decrease in RI can be achieved in a thirteen-week period. We propose that frequent nutritional education should be part of the curriculum of elementary school children in order to prevent obesity-related diseases.

Aspartate Aminotransferases↗

PubMed1993

Binge eating disorder: current knowledge and future directions.

Binge eating disorder (BED) is a newly characterized eating disorder that encompasses individuals who have severe distress and dysfunction due to binge eating, but who do not regularly engage in inappropriate compensatory behaviors. While relatively uncommon in the general community, BED becomes more prevalent with increasing severity of obesity. BED is associated with early onset of obesity, frequent weight cycling, body shape disparagement, and psychiatric disorders. These associations occur independent of the degree of obesity. Although many individuals with BED have good short-term weight loss regardless of treatment modality, as a group they may be prone to greater attrition during weight-loss treatment and more rapid regain of lost weight. Current treatments geared toward binge eating behaviors include antidepressant medications, cognitive behavioral psychotherapy, and interpersonal psychotherapy; however, these treatments have little efficacy in promoting weight loss, and only modest success in long-term reduction of binge eating. As a significant proportion of obese individuals entering weight-loss treatment and research programs are likely to meet criteria for BED, those conducting clinical research should be aware of this distinct subgroup and determine the contribution of BED to outcome measures.

Adolescent↗

PubMed2000

Socioeconomic status, overweight and obesity in prepuberal children: a study in an area of Northern Italy.

The aim of this study was to determine whether socio-economical status (SES) is associated with overweight and obesity in prepuberal children. In an area of North-Western Italy a sample of 1420 children, aged 10-11 years, had his/her height and weight recorded, (overweight and obesity were defined, respectively, as relative body weight > or = 120% and > or = 140%), and parents were requested to compile a questionnaire exploring some demographic and social conditions. 23% of the sample resulted overweight or obese. Prevalence rate ratios (PRR) of overweight and obesity (together) were calculated, adjusting for parents' age, parents' area of birth, and school district. PRR for mother's lowest educational level compared to the highest was 1.59 (95% CI: 1.19-2.13), while for father's education was 1.21 (0.90-1.63). PRRs for 'unemployed' or 'manual' mother compared to 'upper non manual' were respectively 1.83 (1.20-2.79) and 2.20 (1.31-3.68), while for 'unemployed' or 'manual' father were 2.63 (1.97-2.63), and 1.63 (1.27-2.09). The cultural resources of the mother, and the economical resources of the family seem to influence the prevalence of weight gain in prepuberal children. This should be taken into account when planning programs for the prevention or reduction of obesity in children.

Child↗