What Is Gluten?

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By Annell St. Charles, Ph.D., R.D.

Gluten is the general name given to the proteins found in certain grain products — including wheat and its derivatives (wheat berries, durum, emmer, semolina, spelt, farina, faro, graham, and einkorn wheat), rye, barley, triticale (a hybrid of wheat and rye), malt, brewer’s yeast, and wheat starch (Celiac Disease Foundation, 2014).  Apparently, the hybridization that led to the production of modern bread wheat enabled the creation of a product with high amounts of the gluten complex, making modern bread wheat the worst gluten offender.

Gluten plays a significant role in nourishing plant embryos during germination.  In addition, as the name implies, “glu-ten” acts as a type of glue that holds food together, affects the elasticity of dough made from these grains, and gives shape and a chewy texture to products (such as bread) that are made from the dough.  It is also used as an additive in foods that have low-protein levels or no protein at all.  When it is used in vegetarian recipes (lacking any animal products), it helps to increase the firmness of the texture of the finished product in order to replicate that found in meats and other animal foods.

Gluten is actually made up of two different proteins, gliadin (prolamin) and glutelin, which are attached to starch in the endosperm of the grain.  Because the starch is water-soluble but the gluten isn’t, gluten can be obtained by dissolving away the starch with cold water.  (Salty cold water works best).  When gluten enters the digestive system, the proteins are broken down into smaller units called peptide chains, which are made up of amino acids.  Apparently, these peptide chains are the source of gluten sensitivity in some people, resulting in an array of symptoms, potentially contributing to more serious conditions such as celiac disease.  Whereas glutelin is water-soluble, gliadin is alcohol-soluble.  Gliadin is considered the most toxic.  Among the problematic disorders related to gluten, approximately six percent may be due to non-celiac gluten sensitivity, 10 percent may be the result of wheat allergy, and only one percent would be celiac disease.  However, despite its lower occurrence, celiac disease is considered the most serious of the bunch.

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Binge Eating Disorder

Posted on Posted in Continuing Education, Homestudy, Nutrition, Psychology, Seminars, Webinars

fat-foods-binge-eatingBy Nikita Katz, MD, PhD

Binge eating disorder is an illness that resembles bulimia nervosa.  Like bulimia, the disorder is characterized by episodes of uncontrolled eating or binging—occurring, on average, at least once a week for three months, according to DSM-5.  However, binge eating disorder differs from bulimia because its sufferers do not purge their bodies of excess food.

Individuals with binge eating disorder feel that they lose control of themselves when eating. While they commonly eat fewer meals than people without eating disorders.  When they do eat, they eat rapidly, consuming large quantities of food and do not stop until they are uncomfortably full.  When binging, they typically do so alone because they feel embarrassed by how much they are eating, and they tend to feel disgusted with themselves, depressed, or very guilty afterward.  Usually, they have more difficulty losing weight and keeping it off than do people with other serious weight problems. Most people with the disorder are obese and have a history of weight fluctuations.

Binge eating disorder is found in about two percent of the general population—more often in women than men.  Recent research shows that binge eating disorder occurs in about 30 percent of people participating in medically supervised weight-control programs.

Because people with binge eating disorder are usually overweight, they are prone to the serious medical problems associated with obesity, such as high cholesterol, high blood pressure, and diabetes. Obese individuals also have a higher risk for gallbladder disease, heart disease, and some types of cancer. Research at the National Institutes of Health and elsewhere has shown that individuals with binge eating disorder have high rates of co-occurring psychiatric illnesses, especially depression.

Cognitive behavioral therapy and interpersonal therapy are the treatments found to produce the greatest degree of remission in patients with binge eating disorder.  Also, there can be improvements in specific eating-disorder psychopathology, associated psychiatric problems such as depression and psychosocial functioning.

Epidemiology of Eating Disorders

Estimates of the incidence or prevalence of eating disorders vary depending on the sampling and assessment methods.

  • Eating disorders have generally been recognized as affecting a narrow population of Caucasian adolescent or adult young women from developed Western countries.  In recent years, data are steadily accumulating to document that:
  • The prevalence of anorexia nervosa and bulimia nervosa in children and younger adolescents is unknown.
  • Approximately 0.5–1 percent of adolescents suffer from anorexia nervosa and 1–5 percent suffer from bulimia nervosa. Female college students are at highest risk of the latter.
  • An estimated 85 percent of eating disorders have their onset during adolescence.
  • Estimates of the lifetime prevalence of bulimia nervosa among women have ranged from 1.1 to 4.2 percent. Some studies suggest that the prevalence of bulimia nervosa in the United States may have decreased slightly in recent years.
  • The reported lifetime prevalence of anorexia nervosa among women has ranged from 0.5 percent for narrowly defined to 4 percent for more broadly defined anorexia nervosa.
  • Estimates of the male-female prevalence ratio range from 1:5 to 1:10 (although 19-30 percent of younger patient populations with anorexia nervosa are male).
  • An estimated five million Americans suffer from eating disorders at any given time, including approximately 5 percent of women and <1 percent of men with either anorexia nervosa, bulimia nervosa, or binge eating disorder.
    • eating disorders have become more common in pre-pubertal children and women in middle and late adulthood in such countries
    • ethnic and racial minority groups in these countries are vulnerable to eating disorders, and
    • there is nothing uniquely “Western” about eating disorders, which are a global health problem.

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Cold Symptoms and Complications

Posted on Posted in Continuing Education, Homestudy, Nutrition, Seminars, Webinars

Couple suffering from cold in bed

By Ben Hayes, MD, PhD, FAAD

Cold symptoms generally emerge between one and three days after a cold virus enters the body and resolve in a week, with or without medication.  One cold in four lasts up to 14 days; this most often occurs in children, the elderly, and people who are in poor health.  Smokers often have more severe, extended cold symptoms than nonsmokers.

Fewer than five percent of colds lead to such complications as bronchitis, middle ear infection, or sinusitis accompanied by a prolonged cough.  But between five and 15 percent of children who have colds develop acute ear infection when bacteria or viruses infiltrate the space behind the eardrum.  A cold can produce wheezing, even in children who do not have asthma. Symptoms of asthma, bronchitis, and emphysema can be exacerbated for many weeks.  Symptoms that persist for more than two weeks or that recur might be more allergy than infection-related.

Post-infectious cough, which usually produces phlegm, may disrupt sleep and persist for weeks or months following a cold. This complication has been associated with asthma-like symptoms and can be treated with asthma medications prescribed by a physician.  Medical attention is indicated if symptoms progress to:

  • sinusitis
  • ear pain
  • high fever
  • a cough that worsens as other symptoms abate
  • a flare-up of asthma or of another chronic lung problem
  • significantly swollen glands
  • strep throat
  • bronchiolitis
  • pneumonia
  • croup

Babies can have between five to seven colds during their first two years of life. This enhanced susceptibility results both from immature immune systems and from exposure to older children who are often careless abut washing their hands or covering coughs and sneezes.  Nasal congestion and runny nose are the most common symptoms of colds in babies.  Treatment consists of breathing moist air and drinking plenty of fluids.  Medical attention is recommended at the first sign of a cold in infants less than three months of age because of a heightened risk for pneumonia, coup, and other complications.

Physician evaluation is also necessary if a baby of any age:

  • has an uncomplicated cold, the symptoms of which last for more than seven days.
  • does not wet a diaper properly.
  • refuses to nurse or accept fluids.
  • coughs up blood-tinged sputum or coughs hard enough to cause vomiting or changes in skin color.
  • has trouble breathing.
  • has bluish-tinted lips or mouth.
  • has a temperature higher than 102°F for one day
  • has a temperature higher than 101°F for more than three days.
  • shows signs of having ear pain.
  • has reddened eyes or yellow-eye discharge.
  • has a cough or thick green nasal discharge for more than a week.
  • has any other symptoms that concern parents and/or caregivers.

PREVENTION

Common sense plays an important part in preventing the common cold.  Absolute avoidance of cold viruses is virtually impossible to achieve, but experts advise keeping a healthy distance from anyone who is ill.  The actions the human body takes to clear infection are the same actions that spread the infection to others.  Sneezing, for example, is a response to irritation of the nose and mouth.  Sneezing as well as a runny nose is the body’s attempt to expel cold viruses before they can invade the nasal passages more deeply. Unfortunately, a sneeze sends infectious particles hurtling through the air at a speed of more than 100 miles an hour.

Simply being in the company of someone who has a cold can contaminate the hands of another person.  Touching one’s eyes, nose, or mouth can transfer the infection.  It is imperative to wash hands thoroughly after touching someone who has a cold or something that has been touched by someone who has a cold.  Playthings touched by a child who has a cold should be washed before being put away. Cleaning surfaces with antiviral disinfectant may help prevent the spread of infection, and increasing interior humidity can reduce susceptibility.

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Managing Holiday Stress

Posted on Posted in Continuing Education, Homestudy, Nutrition, Psychology

They’re coming: Thanksgiving; Hanukkah; Christmas; and New Year. Weeks of potential, nonstop stress are right around the corner. And, all of that is followed by seemingly endless bills, three or four months of miserable weather, and tax season. What could be better? Medically speaking, all of this can lead to a perfect storm of illness. Too much stress and too little sleep can set the stage for everything from colds, flu, and pneumonia, to hypertension, heart disease, and diabetes out of control. The discussion about holiday stress aggravating anxiety and depression could fill a book.

The reality is difficult to deny. During this wonderful but weird time, millions of people will go places they really don’t want to go. They will do things they really don’t want to do. And, in many cases, they will visit people they don’t even like. This is not necessary. Too many activities, too much chaos, noise, and stress, not to mention too many calories and too little sleep, combine to create a physiologic disaster. Before the madness begins, a few principles of prevention may help:

  • Minimize caffeine and alcohol. Alcohol is loaded with empty calories and will disrupt normal sleep architecture.
  • Avoid holiday exhaustion. It’s okay to decline invitations. Try not to go out two nights in a row and schedule some quiet time instead.
  • Make time for exercise. It will help dissipate stress, boost energy, and facilitate better sleep.
  • Avoid unrealistic expectations. Don’t try to recreate a Norman Rockwell scene. It puts too much pressure on everyone.
  •  Aim for a few lovely memories—not a credit card extravaganza. Overspending is a major contributor to holiday stress.
  • Be prepared to overlook a lot. Everyone has annoying relatives. We can’t control what they say or do, but we can control our response to it. Don’t let a thoughtless remark ruin the day for everyone.

In short, managing holiday stress involves a healthy dose of common sense. Don’t overeat, overindulge, overreact, or overspend. Do try to have a healthy routine with a little less food, a lot less chaos, and for more rest. That’s a good plan for any time of the year.webinarsSeminars-CTA

 

Binge Eating Disorder

Posted on Posted in Brain Science, Continuing Education, Nutrition, Seminars, Webinars

binge-eatingBinge eating disorder is an illness that resembles bulimia nervosa. Like bulimia, the disorder is characterized by episodes of uncontrolled eating or binging—occurring, on average, at least once a week for three months, according to DSM-5 (“Diagnostic and Statistical Manual, ” version 5).  However, binge eating disorder differs from bulimia because its sufferers do not purge their bodies of excess food.

Individuals with binge eating disorder feel that they lose control of themselves when eating. While they commonly eat fewer meals than people without eating disorders, when they do eat, they eat rapidly, consuming large quantities of food.  They do not stop until they are uncomfortably full. When binging, they typically do so alone because of feeling embarrassed by how much they are eating.  They tend to feel disgusted with themselves, depressed, or very guilty afterward. Usually, they have more difficulty losing weight and keeping it off than do people with other serious weight problems. Most people with the disorder are obese and have a history of weight fluctuations.

Binge eating disorder is found in about two percent of the general population—more often in women than men. Recent research shows that binge eating disorder occurs in about 30 percent of people participating in medically-supervised, weight-control programs.

Because people with binge eating disorder are usually overweight, they are prone to the serious medical problems associated with obesity, such as high cholesterol, high blood pressure, and diabetes. Obese individuals also have a higher risk for gallbladder disease, heart disease, and some types of cancer. Research at the National Institutes of Health and elsewhere has shown that individuals with binge eating disorder have high rates of co-occurring psychiatric illnesses, especially depression.

Cognitive behavioral therapy and interpersonal therapy are the treatments found to produce the greatest degree of remission in patients with binge eating disorder.  These therapies result in improvements in specific eating disorder psychopathology and associated psychiatric problems, such as depression and psychosocial functioning (Wilson, 2011).

Epidemiology of Eating Disorders

 Estimates of the incidence or prevalence of eating disorders vary depending on the sampling and assessment methods.

  • An estimated five million Americans suffer from eating disorders at any given time, including approximately five percent of women and less than one percent of men.  The disorders include anorexia nervosa, bulimia nervosa, and binge eating disorder.
  • Estimates of the male-female prevalence ratio range from 1:5 to 1:1 (although 19 to 30 percent of younger patient populations with anorexia nervosa are male).
  • The reported lifetime prevalence of anorexia nervosa among women has ranged from 0.5 percent for narrowly defined cases to four percent for more broadly defined cases of anorexia nervosa.
  • Estimates of the lifetime prevalence of bulimia nervosa among women have ranged from 1.1 to 4.2 percent. Some studies suggest that the prevalence of bulimia nervosa in the United States may have decreased slightly in recent years.
  • An estimated 85 percent of eating disorders have their onset during adolescence.
  • Approximately 5 to 1.0 percent of adolescents suffer from anorexia nervosa and one to five percent suffer from bulimia nervosa. Female college students are at highest risk of the latter.
  • The prevalence of anorexia nervosa and bulimia nervosa in children and younger adolescents is unknown.
  • While eating disorders have generally been recognized as affecting a narrow population of Caucasian adolescent or adult young women from developed Western countries, in recent years, data are steadily accumulating to document that:
  1. eating disorders have become more common in pre-pubertal children and women in middle and late adulthood in such countries.
  2. ethnic and racial minority groups in these countries are vulnerable to eating disorders.
  3. there is nothing uniquely “Western” about eating disorders, which are a global health problem (Pike et al, 2013).

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Anaphylaxis: Always an Emergency

Posted on Posted in Continuing Education, Homestudy, Nutrition, Seminars, Webinars

anaAbout 30 of every 100,000 people experience food-induced anaphylaxis.  An anaphylactic reaction should always be considered a medical emergency. Symptoms generally appear as soon as someone who is hypersensitive swallows a food allergen. The symptoms may not appear until up to four hours after exposure. How swiftly an anaphylactic reaction begins and how severe it becomes depends on:

  • the sensitivity of an individual to the allergen.
  • the amount of allergen swallowed.
  • how many different food allergens were consumed.
  • food preparation.
  • precipitating medical conditions.

An anaphylactic reaction may begin with tingling, itching, or a metallic taste in the mouth. Even the mildest symptoms can become severe within a short time. Anaphylactic reactions can go on for hours. They may include:

  • wheezing and other breathing problems.
  • swelling of the mouth and throat.
  • cramps and nausea.
  • rapid pulse and sudden drop in blood pressure.
  • hives and flushing.
  • itching of the palms of the hands and the soles of the feet.
  • loss of consciousness.

Anaphylaxis can be a biphasic reaction: New, more severe symptoms sometimes appear as long as two to six hours after the initial wave of symptoms has receded. These recurring symptoms often involve the respiratory system and can be deadly.

Peanuts and tree nuts are the foods most likely to cause severe food-allergic reactions. The other most common causes of anaphylaxis attributed to food allergies are:

  • shellfish
  • fish
  • milk
  • eggs

People who have asthma and food allergies are thought to have a greater than average risk of developing a food-allergic anaphylactic reaction. Having experienced one or more severe allergic reactions also increases the likelihood that an individual will have an anaphylactic reaction in the future.

The risk of fatal anaphylactic reaction is greatest among adolescents who have asthma and allergies to peanuts and tree nuts but disregard early food allergy symptoms and do not have ready access to epinephrine. Used to halt the progress of an anaphylactic reaction and reverse its symptoms, this drug is self-administered by injection. Epinephrine is often prescribed for individuals with a history of severe allergic reaction

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Understanding Blood Pressure

Posted on Posted in Continuing Education, Homestudy, Nutrition, Seminars, Webinars

blood-pressure-monitor-350930_640By Dr. Mary O’Brien MD

Blood pressure (BP) is a measurement of the force exerted against the walls of the arteries as the heart pumps blood to all the tissues and organs of the body. The more blood the heart pumps and the narrower the arteries, the higher the blood pressure.

BP is measured using an inflatable arm cuff and a pressure gauge. The reading is given in millimeters of mercury (mmHg) and includes two numbers: an upper number (systolic pressure) that reflects the pressure in the arteries when the heart contracts and pumps blood into the arteries [comma deleted] and a lower number (diastolic pressure) that is a measure of the pressure in the arteries as the heart relaxes after contraction (between beats).

When BP readings are found to be consistently elevated, a diagnosis of high blood pressure (hypertension) can be made. Chronic hypertension increases the risk of serious health problems, including heart attack, heart failure, kidney failure, and stroke. These complications are often referred to as end-organ damage because damage to these organs is the end result of long-standing hypertension.       Unfortunately, hypertension may be undetected for many years because it is typically slow to develop — and quite often asymptomatic. It has been estimated that one out of every five U.S. adults with high BP does not know that she has it.

The American Heart Association (AHA) estimates that hypertension affects approximately one in three adults in the United States. However, the prevalence of elevated BP that is either below the cut-off point for hypertension or undetected is much higher. For example, in 2012, 31 percent of all U.S. adults aged 18 years and older were hypertensive, and an additional 31 percent had pre-hypertension (blood pressure that is higher than normal but not yet in the high BP range).

Moreover, among individuals with hypertension, only about half (47 percent) have their condition under control even though seven in 10 hypertensive U.S. adults use medication to treat the condition.  These numbers are consistent with the most recent National Health and Nutrition Examination Survey.

Despite recent advances in the medical treatment of hypertension, and the introduction of public health campaigns designed to increase awareness of this condition, hypertension remains a significant public health problem in the United States. Our home-study course will address the definition, symptoms, causes, risk factors, complications, and treatment options for hypertension. Information about these components can provide the necessary tools to reduce the prevalence of hypertension and related health problems.

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Chocolate: Friend or Foe?

Posted on Posted in Continuing Education, Homestudy, Nutrition, Webinars

chocolate-1220655_640By Mary O’Brien, M.D.

Research suggests that chocolate is the most widely craved food. There is a special questionnaire designed with the sole purpose of assessing chocolate cravings. While only 15 percent of men report craving chocolate, approximately 45 percent of women do, and 75 percent of the women indicated that only chocolate would satisfy their food craving. Explanations of why chocolate is desired by so many are numerous and include the possibility that chocolate is addictive, replaces deficient nutrients,  triggers the release of mood-altering chemicals, and  stimulates the pleasure centers in the brain.

The desire for chocolate appears to be increased by visual cues, such as looking at pictures of chocolate  or holding a chocolate bar.  Persons who have been subjected to dietary restriction prior to encountering these cues are more likely to experience cravings combined with feelings of guilt, anxiety, and depression. Findings have demonstrated that exercise is effective in reducing chocolate cravings in persons exposed to chocolate cues.  Exercise, by reducing stress, may also be effective.

While the reasons behind chocolate cravings may be unclear, the fact that chocolate is a highly desired food is certain. This raises the question of whether giving in to the chocolate urge is harmful. One could certainly argue that a daily dose of chocolate could add to an already precarious calorie balance in some people — or that responding to the craving is establishing a habitual pattern that could manifest in other, more deleterious cravings.

However, if unsweetened chocolate is viewed strictly from a nutritional point of view, it can be described as a food consisting of saturated (palmitic and stearic) and monounsaturated (oleic) fats.  Chocolate can also be described as containing starchy and fibrous carbohydrates that have very few simple sugars and few flavonoid antioxidants.  Chocolate has several minerals, including magnesium, calcium, iron, zinc, copper, potassium, and manganese.  Chocolate has vitamins A, B-1, B-2, B-3, C, E , and pantothenic acid.  Chocolate has roughly 150 kilocalories per ounce. Unfortunately, the preferred form of chocolate for most people is not the unsweetened but the sweetened form, in which the amount of fats, sugars, and calories is increased.

Chocolate also contains the stimulants theobromine and caffeine.  Chocolate has the hormone precursors phenylethylamine and tryptophan, which are thought to have mildly anti-depressant effects. These chemicals are present naturally in the cocoa bean from which chocolate is derived. Cocoa products also contain pharmacological substances such as n-acetylethanolamines that have some chemical similarities to cannabis (marijuana), and compounds that stimulate the brain to release an opiate-like substance called anandamide. Despite the scary-sounding nature of these latter two compounds, the pleasurable effects of cocoa and chocolate do not appear to stem from their drug-like effects, but from the hedonic reaction of the mouth to the feel and smell of the combined fat and sugar. For example, when chocolate-cravers were given cocoa capsules they reported no satisfaction at all.

The moral of the chocolate story, like that of many other guilty pleasures in life, is that while a little is possibly acceptable and can even give a boost to physical and emotional health, too much pushes the pendulum in the other direction. The oft-quoted statement in this regard is “moderation in all things,” but perhaps we should also keep in mind the words of William Somerset Maugham: “Excess on occasion is exhilarating. It prevents moderation from acquiring the deadening effect of a habit.”

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Cuisine for the Brain

Posted on Posted in Brain Science, Continuing Education, Homestudy, Nutrition

carrot-1085063_640By Laura Pawlak, PhD, RD emeritus

What weighs a mere four pounds and has a workload that demands 20 percent of all the oxygen inhaled?  Answer:  the human brain.

As technology opens the door to the unique metabolic functions of the brain, scientists are investigating the nutrients required to keep mentally sharp over the decades.

With dementia rising at an alarming rate — along with obesity, diabetes, heart disease, and other ailments — let’s eat with purpose, using sound, nutrition-related science applicable to the brain and the rest of the body.

Starting with the belief that what we eat plays a significant role in determining who gets dementia, Martha Clare Morris, Ph.D. and colleagues developed the MIND Diet as an intervention against the most common cause of neurodegeneration:  Alzheimer’s disease.

The work of Morris and her colleagues is based on research completed at Rush Medical University in Chicago, Illinois.  The term “MIND” is an acronym for Mediterranean-DASH Intervention for Neurodegenerative Delay.

The DASH diet plan is based on research sponsored by the U.S. National Institutes of Health.  The plan was developed to lower blood pressure without the use of medication.

The Mediterranean and DASH diets are models of healthy eating for the body.  The Morris team chose foods that improve brain function significantly and also added to overall body wellness.

Adherence to the MIND diet may lower the risk of Alzheimer’s disease by as much as 53%, offering more protection for the brain than any other dietary regimen.

The MIND cuisine lists 10 brain-healthy food groups (green leafy vegetables, other vegetables, nuts, berries, beans, whole grains, fish, poultry, olive oil, and wine).  The plan limits consumption of five brain-unhealthy food groups (red meats, butter/stick margarine, cheese, pastries/sweets, and fried or fast food).

The plan suggests a minimum of three servings of whole grains, a salad, and one other vegetable every day — along with a glass of wine.  For snacks, add a variety of nuts.  Berries are the only fruits recommended.

Specifically, blueberries are noted as the powerful protectors of the brain.  Strawberries are a second choice for good cognitive function.

Use Google and enter the term “MIND Diet” for daily guidelines and recipes of a cuisine designed to maximize brain function while providing healthy foods for the rest of the body as well.


Dr. Laura Pawlak (Ph.D., R.D. emerita) is a world-renown biochemist and dietitian emerita.  She is the author of many scientific publications and has written such best-selling books as “The Hungry Brain,” “Life Without Diets,” and “Stop Gaining Weight.”  On the subjects of nutrition and brain science, she gives talks internationally.


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Obesity and Heart Disease

Posted on Posted in Continuing Education, Homestudy, Nutrition

thick-373064_640By Dr. Mary O’Brien MD

Longitudinal studies clearly indicate that obesity predicts coronary atherosclerosis in men and in women. Hypertension, a leading cause of atherosclerosis, is approximately three times more common in obese individuals than in those who are of normal weight or less than normal weight.

Body mass index (BMI) is one of the most effective ways to measure obesity. Some studies show that a BMI that is between 25 and 30 confers as much as a 70 percent increased risk of coronary heart disease.

However, a high BMI may not entirely predict heart disease risk. In women, a BMI near 30 may still not be of major concern when the increase in fat tissue is distributed over the hips and not the abdomen.  Accumulating evidence indicates that an increased waist circumference, or waist-to-hip ratio (WHR), predicts complications and mortality from obesity.

Weight-reduction seems to be effective in reducing risks of coronary heart disease (CHD) and congestive heart failure (CHF), potentially preventing heart disease in obese patients. Evidence indicates that, for obese patients, a reduction of only five percent to 10 percent of body weight improves lipid profiles, insulin sensitivity, and endothelial function.  Such a reduction also reduces thrombosis and inflammatory markers.

Maintaining a BMI of less than 25 throughout adult life is a good strategy to reduce the risk of heart disease. For most patients with a BMI between 25 and 30, lifestyle changes in diet and exercise are appropriate.

Restricting consumption of fat to less than 30 percent of total calories should be recommended, because low-fat diets also promote weight reduction. Physical training programs can reduce body mass and help bring about gradual weight loss.

Medical therapy may be necessary in patients with a BMI higher than 30. However, the safety of long-term use of anti-obesity medications has not been established. When the BMI falls within the range of 35 to 40 (or above), bariatric surgery may be an option. Unfortunately, less than five percent of patients are able to maintain their reduced weight four years after surgery. Thus, the prevention of obesity with diet and regular physical activity appears to be the most dependable way to maintain cardiovascular health.

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