Overweight & Obesity: Fall 2024 Module 8 PDF

CEXP 538 OVERWEIGHT & OBESITY Fall 2024 Module 8 OUTLINE OVERWEIGHT & OBESITY INTRODUCTION ETIOLOGY RISK FACTORS TREATMENT PHYSICAL ACTIVITY RESEARCH IN PHYSICAL ACTIVITY OVERWEIGHT & OBESITY: INTRODUCTION  OVERWEIGHT & OBESITY What do these te...

CEXP 538 OVERWEIGHT & OBESITY Fall 2024 Module 8 OUTLINE OVERWEIGHT & OBESITY INTRODUCTION ETIOLOGY RISK FACTORS TREATMENT PHYSICAL ACTIVITY RESEARCH IN PHYSICAL ACTIVITY OVERWEIGHT & OBESITY: INTRODUCTION  OVERWEIGHT & OBESITY What do these terms mean to you with regard to your health and chronic disease?  OVERWEIGHT & OBESITY Obesity is a complex, heterogeneous, chronic, and progressive disease, which substantially affects health, quality of life, and mortality. (Lingvay et al., 2024) CDC (2024) Labels for ranges of weight that are greater than what is generally considered healthy for a given height Identify ranges of weight that have been shown to increase the likelihood of certain diseases and other health problems. Definitions (WHO, 2024) Overweight is a condition of excessive fat deposits (BMI > 25) Obesity is a chronic complex disease defined by excessive fat deposits that can impair health (BMI > 30) Definitions (CDC, 2024) BMI between 25 and 29.9 is considered overweight BMI of 30 or higher is considered obese BMI of 40 or higher is considered severely obese  OVERWEIGHT & OBESITY Prevalence (CDC, 2024) Global public health epidemic In 2022, 1 in 8 people in the world were living with obesity. Worldwide adult obesity has more than doubled since 1990, and adolescent obesity has quadrupled. In 2022, 2.5 billion adults (18 years and older) were overweight. Of these, 890 million were living with obesity. In 2022, 43% of adults aged 18 years and over were overweight and 16% were living with obesity. In 2022, 37 million children under the age of 5 were overweight. Over 390 million children and adolescents aged 5–19 years were overweight in 2022, including 160 million who were living with obesity.  OVERWEIGHT & OBESITY Prevalence (Stierman et al., 2021) In the United States (2017-March 2020) NHANES data The prevalence of obesity among U.S. adults 20 and over was 41.9% during 2017–March 2020. ○ During the same time, the prevalence of severe obesity among U.S. adults was 9.2%. This means that more than 100 million adults have obesity, and more than 22 million adults have severe obesity. The prevalence of obesity increased from 30.5% in 1999-2000 to 41.9% in 2017–March 2020. ○ During the same time, the prevalence of severe obesity increased from 4.7% to 9.2%. More than 2 in 5 U.S. adults have obesity. 58% of U.S. adults with obesity have high blood pressure, a risk factor for heart disease Approximately 23% of U.S. adults with obesity have diabetes.  OVERWEIGHT & OBESITY Prevalence (Stierman et al., 2021) In the United States (2017-March 2020) Differences by age group were not statistically significant ○ 39.8% among U.S. adults aged 20–39 years ○ 44.3% among adults aged 40–59 years ○ 41.5% among adults aged 60 years and older.. Ethnicity differences: ○ Non-Hispanic Black adults had the highest obesity prevalence (49.9%) ○ Hispanic (45.6%) ○ Non-Hispanic White (41.4%) ○ Non-Hispanic Asian (16.1%) Educational differences in U.S. adults: ○ High school diploma or some college education (46.4%) ○ Less than a high school diploma (40.1%) ○ College degree or above (34.2%).  OVERWEIGHT & OBESITY Prevalence (CDC, 2024) Combined BRFSS data from 2021–2023 show notable differences in adult obesity prevalence by race and ethnicity. Among states, territories, or DC with enough data, the number with an obesity prevalence of 35% or higher is: Asian adults do not have an obesity prevalence at or above 35% in any state (among 37 states, 1 territory, and DC). In 16 states, White adults have an obesity prevalence at or above 35% (among 47 states, 2 territories, and DC). In 30 states, American Indian or Alaska Native adults have an obesity prevalence at or above 35% (among 44 states). In 34 states, Hispanic adults have an obesity prevalence at or above 35% (among 47 states, 3 territories, and DC). In 38 states, Black adults have an obesity prevalence at or above 35% (among 46 states, 1 territory, and DC). In 2023, the prevalence of adult obesity decreased as education level increased. 36.5% of adults without a high school diploma or equivalent had obesity. 34.7% of adults with a high school diploma or equivalent had obesity. 35.7% of adults with some college education had obesity. 27.1% of college graduates had obesity. In 2023, the prevalence of adult obesity varied by age. Young adults were half as likely to have obesity as middle-aged adults. Adults aged 18–24 years had the lowest prevalence of obesity (19.5%) while adults aged 45–54 years had the highest (39.2%).  OVERWEIGHT & OBESITY Mortality  OVERWEIGHT & OBESITY Mortality (AHA, 2023) Researchers analyzed data collected from 1999 to 2020 on 281,135 deaths in which obesity was recorded as a contributing factor in The Multiple Cause of Death database includes mortality and population counts from all U.S. counties. Among the deaths, 43.6% were in women; 78.1% of the group were white adults; 19.8% were Black adults; 1.1% were Asian or Pacific Islander adults and 1% were American Indian adults or Alaskan Native adults. Obesity-related cardiovascular disease deaths tripled between 1999 and 2020 in the U.S. Such deaths were higher among Black individuals (highest among Black women) compared with any other racial group, followed by American Indian/Alaska Native people. Black adults who lived in urban communities experienced more obesity-related cardiovascular disease deaths than those living in rural areas, whereas the reverse was true for all other racial groups.  OVERWEIGHT & OBESITY Financial trends In 2019 dollars, annual medical costs for adults with obesity were $1,861 higher per person than adults with healthy weight. For adults with severe obesity, the excess costs were $3,097 per person. Annual obesity-related medical care costs in the United States, in 2019 dollars, were estimated to be nearly $173 billion. Annual nationwide productivity costs of obesity-related absenteeism range between $3.38 billion ($79 per individual with obesity) and $6.38 billion ($132 per individual with obesity). Productivity measures include employees being absent from work for obesity-related health reasons, decreased productivity while at work, and premature death and disability. According to the WHO (2024), the global costs of overweight and obesity are predicted to reach US$ 3 trillion per year by 2030 and more than US$ 18 trillion by 2060 OVERWEIGHT & OBESITY: ETIOLOGY  OVERWEIGHT & OBESITY Etiology Two distinct process: Sustained positive energy balance (energy intake > energy expenditure) Resetting of the body weight “set point” at an increased value. Set Point Theory Homeostasis affected by neurohormonal, metabolism, and behavior Hypothesizes that the body has an internal control mechanism to maintain a certain level of body fat Factors that alter the set point: Genetics, epigenetics Obesogens, obesogenic environment Bariatric surgery Diet, exercise Disease Pharmacological therapy Settling Point Theory Weight loss and weight gain in most humans are more related to the patterns of diet and physical activity that people settle into as habits based on the interaction of their genetic dispositions, learning and environmental cues to behavior  OVERWEIGHT & OBESITY Etiology Symptoms Manifests in adulthood Diagnosis Body mass index (BMI)--Quetelet index Adolphe Quetelet–weight is based on height, quantify the “normal man” Ancel Keys coined the term body mass index in 1972 Used to assess weight relative to height and is calculated by dividing body weight in kilograms by height in meters squared (kg/m2). https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm Visceral vs. subcutaneous fat Additional measurements may be used to measure obesity Waist circumference, waist-to-hip ratio, body fat assessment, imaging techniques Limitations It may overestimate body fat in athletes and others who have a muscular build. It may underestimate body fat in older persons and others who have lost muscle.  OVERWEIGHT & OBESITY Etiology AMA policy (2023) Data collected from previous non-Hispanic white populations Suggests that it be used in conjunction with other valid measures of risk such as, but not limited to, measurements of visceral fat, body adiposity index, body composition, relative fat mass, waist circumference and genetic/metabolic factors Recognizes that relative body shape and composition differences across race/ethnic groups, sexes, genders, and age-span is essential to consider when applying BMI as a measure of adiposity BMI is significantly correlated with the amount of fat mass in the general population but loses predictability when applied on the individual level BMI should not be used as a sole criterion to deny appropriate insurance reimbursement  OVERWEIGHT & OBESITY Consequences WHO (2024) Leads to a greater risk of NCD CDC (2024) High blood pressure and high cholesterol which are risk factors for CHD Type 2 diabetes Breathing problems, such as asthma and sleep apnea Joint problems such as osteoarthritis and musculoskeletal discomfort Gallstones and gallbladder disease Cancers of the breast, uterus, esophagus, colon, pancreas, and kidney  RISK FACTORS: OVERWEIGHT & OBESITY  OVERWEIGHT & OBESITY Risk Factors Lifestyle factors Access to healthy, affordable foods and beverages Access to safe places for physical activity Community design to support activity-friendly routes to everyday destinations Supportive childcare and school environments Access to high-quality health care services Safe housing and transportation Economic stability Energy imbalance Consuming more calories than you are expending Diet High-fat, high-sugar, too little fruits and vegetables Lack of physical activity Lack of good-quality of sleep High amounts of stress→↑cortisol  OVERWEIGHT & OBESITY Risk Factors  OVERWEIGHT & OBESITY Risk Factors Disease Cushing syndrome Polycystic ovarian syndrome Underactive thyroid Genetics Rare–Bardet-Biedl syndrome and Prader-Willi syndrome Medications Psychiatric medications, such as antipsychotics and antidepressants Steroids Certain types of hormonal birth control, such as progestins Anti-seizure or mood-stabilizing drugs Certain blood pressure and diabetes medications Lack of health system response to early weight gain and progression  OVERWEIGHT & OBESITY Treatment  OVERWEIGHT & OBESITY Treatment Lifestyle factors Diet Caloric restriction, reduced energy intake Bariatric, Gastric Bypass, Type II Diabetes, CHD My Plate Heart-healthy–NIH DASH Diet Physical Activity 7-8 hours/night of sleep Behavioral-based interventions Pharmacological Bariatric surgery  OVERWEIGHT & OBESITY Treatment Behavioral-based interventions Individual or group Offers the service of multiple professionals, such as registered dietitians, doctors, nurses, psychologists, and exercise physiologists Provides goals that have been customized for you and that consider things such as the types of food you like, your schedule, your physical fitness, and your overall health Teaches long-term strategies to deal with problems that can lead to future weight gain Involves self-monitoring, social support, cognitive restructuring, physical activity, meal- planning and patient-centered care  OVERWEIGHT & OBESITY Treatment (US Preventive Task Force, 2018) Behavioral-based interventions U.S Preventive Services Task Force Adequate evidence that intensive, multicomponent behavioral interventions in adults with obesity can lead to clinically significant improvements in weight status Adequate evidence that behavior-based weight loss maintenance interventions are of moderate benefit. The harms of intensive, multicomponent behavioral interventions (including weight loss maintenance interventions) in adults with obesity are small to none Designed to help participants achieve or maintain a 5% or greater weight loss through a combination of dietary changes and increased physical activity. The US Food and Drug Administration considers a weight loss of 5% as clinically important. Interventions ○ 1 to 2 years, and the majority had 12 or more sessions in the first year ○ One-third of the interventions had a “core” phase (ranging from 3-12 months) followed by a “support” or “maintenance” phase (ranging from 9-12 months) ○ Encouraged self-monitoring of weight and provided tools to support weight loss or weight loss maintenance (eg, pedometers, food scales, or exercise videos)  OVERWEIGHT & OBESITY Treatment(CDC, 2024) Environmental changes Fewer than 1 in 10 children and adults eat the recommended daily amount of vegetables. Fewer than 1 in 4 youth get enough aerobic physical activity. Just 1 in 4 adults fully meet physical activity guidelines. CDC’s Division of Nutrition, Physical Activity, and Obesity (DNPAO) helps national, state, and local partners make healthy living easier through public health strategies. State Physical Activity and Nutrition (SPAN) High Obesity Program (HOP) Racial and Ethnic Approaches to Community Health (REACH) Nutrition and Obesity Policy Research and Evaluation Network (NOPREN) National Collaborative for Childhood Obesity Research (NCCOR) Physical Activity Policy Research and Evaluation Network (PAPREN)  OVERWEIGHT & OBESITY Treatment Evidence-based behavioral-based interventions Healthy People 2030 The Community Preventive Services Task Force (CPSTF) recommends physical activity promotion interventions that include activity monitors based on sufficient evidence of effectiveness in increasing physical activity in adults with overweight or obesity. Physical activity interventions that include activity monitors provide participants with a combination of the following: ○ Behavioral instruction in the form of counseling, group-based education, or web-based education ○ Activity monitors that are used to provide regular feedback (i.e., pedometers or accelerometers) and may include enhancements to support or promote physical activity Interventions must focus on physical activity or promote physical activity within a weight management program. ○ These interventions may include one or more follow-up appointments with a healthcare provider.  OVERWEIGHT & OBESITY Treatment Evidence-based behavioral-based interventions Findings support: The integration of activity monitors into behavioral interventions as an effective way to promote graduated increases in daily walking ○ Most studies promoted gradual increases in daily or regular walking to encourage participation and reduce risks of musculoskeletal injury to participants with overweight or obesity. The use of basic pedometers, which may be more cost-efficient for scalable interventions and more affordable for communities with limited budgets. Activity monitors and related capabilities in smartphones are increasing in popularity. Clinicians and health systems are encouraged to incorporate these devices into interventions to promote and support physical activity among their patients. Enhanced functions of newer activity monitors, such as interactive features and access to social support resources, may lead to improvements in recruitment, participation, and sustained engagement.  OVERWEIGHT & OBESITY Treatment (NHLBI, 2022) Medications used to treat obesity Brain: Several medicines change the way the brain regulates the urge to eat, reducing your appetite. These include liraglutide, which is now approved for both children and adults age 12 or older with obesity. Other medicines that work in a similar way are naltrexone/bupropion, diethylpropion, and phendimetrazine. Setmelanotide is used to treat rare genetic conditions that cause obesity and increases resting metabolism. GI tract: Orlistat blocks your intestines from absorbing fat from foods in your diet Pancreas: Semaglutide is an injectable medicine that works by helping the pancreas release the right amount of insulin when blood sugar levels are high. Insulin helps move sugar from the blood into other body tissues, where it is used for energy. The injections also work by slowing the movement of food through the stomach and may reduce appetite and cause weight loss. Considerations A history of epilepsy excludes bupropion/naltrexone Pancreatitis excludes liraglutide and semaglutide Cardiac arrhythmia excludes phentermine, and glaucoma Renal stone disease and planning a pregnancy would exclude topiramate Cost Safety for use long-term  OVERWEIGHT & OBESITY Treatment Medications used to treat obesity https://www.youtube.com/watch?v=P6gt4A_3Whs  OVERWEIGHT & OBESITY Treatment Medical devices used to treat obesity Gastric balloons are placed in the stomach via a swallowable capsule attached to a thin catheter or via an endoscope (a long flexible tube with a small camera and a light at the end). Then, depending on the device, the balloons may be filled with gas or liquid (such as salt water) and sealed. Later, they are removed. Gastric bands are surgically implanted around the stomach, limiting the amount of food a person can eat at one time and increasing digestion time. This helps people eat less. Gastric emptying systems include a tube placed in the stomach via an endoscope and a port that lies against the skin of the abdomen. The tube drains a portion of the stomach contents into a container 20 to 30 minutes after meals. The device is removed when the patient reaches their goal weight.  OVERWEIGHT & OBESITY Treatment Bariatric surgery used to treat obesity Gastrectomy A big portion of the stomach is removed to reduce the amount of food that you can eat. Gastric banding The gastric band mentioned above is placed around the upper part of the stomach. This creates a smaller stomach. Gastric bypass surgery A small part of the stomach is connected to the middle part of the intestine, bypassing the first part of intestine. This reduces the amount of food that you can eat and the amount of fat your body can take in and store.  OVERWEIGHT & OBESITY Treatment  DYSLIPIDEMIA Effects of physical activity (Dinas et al., 2014) Plays a vital role in the regulation of hormonal activity within adipose tissue and other major endocrine organs reduced leptin levels and enhanced leptin sensitivity increased circulating adiponectin levels may be an effective strategy for increasing growth hormone secretion that is related to the reduction of abdominal fat in obese adults increased levels of total circulating ghrelin concentrations Appears to exert anti-inflammatory effects that may be due to, at least in part, a reduction in body weight, total body fat, and visceral fat that leads to enhanced endocrine activity and reduced inflammatory biomarkers secreted by adipocytes and immune cells Insulin sensitivity may be acutely enhanced after certain exercise interventions Psychological Factors may reduce negative mood state and anxiety levels as well as depression due to, at least in part, the secretion of endorphins exercise significantly decreases the risk of depression symptoms in a general obese population  OVERWEIGHT & OBESITY Treatment (Oppert et al., 2023)  DYSLIPIDEMIA Effects of physical activity (Jakicic et al., 2019) Strong evidence to demonstrate a relationship between greater amounts of physical activity and attenuated weight gain in adults. There is also some evidence to support that this relationship is most pronounced when physical activity exposure is above 150 min·wk−1. There is limited evidence to support a dose–response relationship between physical activity and the risk of weight gain in adults. There is limited evidence suggesting that the relationship between greater amounts of physical activity and attenuated weight gain in adults varies by age, with the effect diminishing with increasing age. There is moderate evidence to indicate that the relationship between greater amounts of physical activity and attenuated weight gain in adults does not appear to vary by sex. There is insufficient evidence available to determine whether the relationship between greater amounts of physical activity and attenuated weight gain in adults varies by race/ethnicity, socioeconomic status, or initial weight status. With regard to intensity of physical activity, there is strong evidence to demonstrate that the relationship between greater time spent in physical activity and attenuated weight gain in adults is observed with moderate-to-vigorous intensity physical activity. There is, however, insufficient evidence available to determine if there is an association between light-intensity activity and attenuated weight gain in adults.  OVERWEIGHT & OBESITY Effects of physical activity ACSM exercise testing recommendations: An exercise test is often not necessary in the overweight/obese population prior to beginning a low-to-moderate intensity exercise program. Overweight and obese individuals are at risk for other comorbidities (e.g., dyslipidemia, hypertension, hyperinsulinemia, hyperglycemia), which are associated with CVD risk. The timing of medications to treat comorbidities relative to exercise testing should be considered, particularly in those who take β-blockers and antidiabetic medications. The presence of musculoskeletal and/or orthopedic conditions may necessitate the need for using leg or arm ergometry. The potential for low exercise capacity in individuals with overweight and obesity may necessitate a low initial workload (i.e., 2–3 METs) and small increments per testing stage of 0.5– 1.0 MET. Exercise equipment must be adequate to meet the weight specification of individuals with overweight and obesity for safety and calibration purposes. The appropriate cuff size should be used to measure BP in individuals who are overweight and obese to minimize the potential for inaccurate measurement.  OVERWEIGHT & OBESITY Effects of physical activity ACSM exercise prescription: The goals of exercise during the active weight loss phase are to: Maximize the amount of caloric expenditure to enhance the amount of weight loss Integrate exercise into the individual’s lifestyle to prepare them for a successful weight loss maintenance phase.  OVERWEIGHT & OBESITY Effects of physical activity ACSM exercise training considerations: The duration of moderate-to-vigorous intensity PA should initially progress to at least 30 min ∙ d-1 To promote long-term weight loss maintenance, individuals should progress to at least 250 min ∙ wk-1 (≥2,000 kcal ∙ wk-1) of moderate to vigorous exercise To achieve the weekly maintenance activity goal of ≥250 min ∙ wk-1, exercise and PA should be performed on 5–7 d ∙ wk-1 Individuals with overweight and obesity may accumulate this amount of PA in multiple daily bouts of at least 10 min in duration or through increases in other forms of moderate intensity lifestyle PA. Accumulation of intermittent exercise may increase the volume of PA achieved by previously sedentary individuals and may enhance the likelihood of adoption and maintenance of PA Resistance training does not result in clinically significant weight loss. The addition of resistance exercise to energy restriction does not appear to prevent the loss of fat-free mass or the observed reduction in resting EE. Resistance exercise may enhance muscular strength and physical function in individuals who are overweight or obese. Moreover, there may be additional health benefits of participating in resistance exercise such as improvements in CVD and DM risk factors and other chronic disease risk factors.  OVERWEIGHT & OBESITY Effects of physical activity ACSM special considerations: Utilize goal setting to target short- and long-term weight loss. Target a minimal reduction in body weight of at least 3%–10% of initial body weight over 3–6 mo. Target reducing current EI to achieve weight loss. A reduction of 500–1,000 kcal ∙ d–1 is adequate to elicit a weight loss of 1–2 lb ∙ wk-1 (0.5–0.9 kg ∙ wk-1). This reduced EI should be combined with a reduction in dietary fat intake. Weight loss beyond 5%–10% may require more aggressive nutrition, exercise, and behavioral intervention. For those who do not respond to any degree of lifestyle intervention, medical treatments such as medications or surgery may be appropriate. Medically indicated very low–calorie diets with energy restrictions of up to 1,500 kcal ∙ d-1 can result in greater initial weight loss amounts compared to more conservative EI reductions. These medically managed meal plans are typically only used for selected individuals and for short periods of time. Incorporate opportunities to enhance communication between health care professionals, registered dietitian nutritionists, and exercise professionals and individuals with overweight and obesity following the initial weight loss period. Target changing eating and exercise behaviors because sustained changes in both behaviors result in significant long-term weight loss and maintenance. Assist individuals with achieving evidence-based recommendations for aerobic exercise during both the weight loss and weight loss maintenance phases. https://www.exerciseismedicine.org /wp-content/uploads/2021/04/EIM_ Rx-for-Health_Overweight_Obesity. pdf  OBESITY: RESEARCH IN PHYSICAL ACTIVITY  OVERWEIGHT & OBESITY Physical Activity Research Bodies of Evidence Leisure-Time Physical Activity Sedentary Behavior Physical Fitness ○ Cardiorespiratory fitness ○ Strength training ○ Body composition Changes in Physical Activity/Fitness  RESEARCH IN PHYSICAL ACTIVITY Effects of Exercise Interventions on Weight, Body Mass Index, Lean Body Mass and Accumulated Visceral Fat in Overweight and Obese Individuals: A Systematic Review and Meta-Analysis of Randomized Controlled Trials (Lee & Lee, 2021) Investigated the effectiveness of exercise interventions in overweight and obese individuals in order to reduce weight, body mass index (BMI), and accumulated visceral fat, and increase lean body mass Sixteen studies were included in this meta-analysis Participation in exercise interventions reduced: Weight (d = −0.58 (95% confidence interval (CI), −0.84–−0.31; p < 0.001; k = 9)) BMI (d = −0.50 (95% CI, −0.78–−0.21; p < 0.001; k = 7)) Accumulated visceral fat (d = −1.08 (95% CI, −1.60–−0.57; p < 0.001; k = 5)) Lean body mass did not reveal statistically significant difference(d = 0.26 (95% CI, −0.11–0.63; p = 0.17; k = 6)) The average exercise intervention for overweight and obese individuals was of moderate to vigorous intensity, 4 times per week, 50 min per session, and 22 weeks duration.  OVERWEIGHT & OBESITY Physical Fitness (Lee, Blair, & Jackson, 1999) The Aerobics Center Longitudinal Study In an 8-year follow-up of 21,925 men aged 30-83 years, there were 428 deaths Unfit, lean men had twice the risk of all-cause mortality than fit, lean men Unfit, lean men also had twice the all-cause mortality and CVD mortality than fit, obese men  OVERWEIGHT & OBESITY Sedentary Behavior Ladabaum et al. (2014) Examined trends in obesity, abdominal obesity, physical activity, and caloric intake in US adults from 1988 to 2010 The researchers considered survey results from 17,430 participants from 1988 through 1994 and from approximately 5,000 participants each year from 1995 through 2010 Average body mass index (BMI) increased by 0.37% (95% confidence interval [CI], 0.30-0.44) per year in both women and men. Average waist circumference increased by 0.37% (95% CI, 0.30-0.43) and 0.27% (95% CI, 0.22-0.32) per year in women and men, respectively. The proportion of adults who reported no leisure-time physical activity increased from 19.1% (95% CI, 17.3-21.0) to 51.7% (95% CI, 48.9-54.5) in women, and from 11.4% (95% CI, 10.0-12.8) to 43.5% (95% CI, 40.7-46.3) in men Average daily caloric intake did not change significantly The associated changes in adjusted BMIs were 8.3% (95% CI, 6.9-9.6) higher among women and 11.7% (95% CI, 0.68-2.8) higher among men with no leisure-time physical activity compared with those with an ideal level of leisure-time physical activity  RESEARCH IN PHYSICAL ACTIVITY Strength of the Evidence Is exercise alone enough to manage overweight and obesity? Biological plausibility ○ Visceral fat loss ○ ↑satiety ○ Improved insulin sensitivity ○ Psychological benefits ○ Prevention of weight gain ○ Maintenance of muscle strength Dose response ○ Moderate-to-vigorous intensity exercise Consistency of Results ○ ↓weight gain, ↓ disease & mortality risk, ↑ weight loss Strength of Association ○ Maintenance is key  MODULE ASSIGNMENT Please provide a summary of a research article related to physical activity and obesity. Use the template to guide and organize your assignment. Please upload your document to the appropriate D2L dropbox. The assignment is due by Sunday, October 27, 2024 @11:59pm. REFERENCES Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: executive summary. Expert panel on the identification, evaluation, and treatment of overweight in adults. Am J Clin Nutr. 1998;68 (4):899–917. Dishman, R.K., Heath, G.W., Schmidt, M.D., & Lee, I.M. (2021). Physical activity epidemiology. Human Kinetics, Inc. Farrell, S. W., Finley, C. E., Barlow, C. E., Willis, B. L., DeFina, L. F., Haskell, W. L., & Vega, G. L. (2017). Moderate to High Levels of Cardiorespiratory Fitness Attenuate the Effects of Triglyceride to High-Density Lipoprotein Cholesterol Ratio on Coronary Heart Disease Mortality in Men. Mayo Clinic proceedings, 92(12), 1763–1771. https://doi.org/10.1016/j.mayocp.2017.08.015 Ladabaum, U., Mannalithara, A., Myer, P. A., & Singh, G. (2014). Obesity, abdominal obesity, physical activity, and caloric intake in US adults: 1988 to 2010. The American journal of medicine, 127(8), 717–727.e12. https://doi.org/10.1016/j.amjmed.2014.02.026 Liguori, G. (2021). ACSM's Guidelines for Exercise Testing and Prescription (11th Edition). American College of Sports Medicine. Wolters Kluwer. Paluch, A. E., Boyer, W. R., Franklin, B. A., Laddu, D., Lobelo, F., Lee, D. C., McDermott, M. M., Swift, D. L., Webel, A. R., Lane, A., & on behalf the American Heart Association Council on Lifestyle and Cardiometabolic Health; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Epidemiology and Prevention; and Council on Peripheral Vascular Disease (2024). Resistance Exercise Training in Individuals With and Without Cardiovascular Disease: 2023 Update: A Scientific Statement From the American Heart Association. Circulation, 149(3), e217–e231. https://doi.org/10.1161/CIR.0000000000001189 Raisi-Estabragh, Z., Kobo, O., Mieres, J. H., Bullock-Palmer, R. P., Van Spall, H. G. C., Breathett, K., & Mamas, M. A. (2023). Racial Disparities in Obesity- Related Cardiovascular Mortality in the United States: Temporal Trends From 1999 to 2020. Journal of the American Heart Association, 12(18), e028409. https://doi.org/10.1161/JAHA.122.028409 US Preventive Services Task Force. Behavioral Weight Loss Interventions to Prevent Obesity-Related Morbidity and Mortality in Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;320(11):1163–1171. doi:10.1001/jama.2018.13022 Zwald, M. L., Akinbami, L. J., Fakhouri, T. H., & Fryar, C. D. (2017). Prevalence of Low High-density Lipoprotein Cholesterol Among Adults, by Physical Activity: United States, 2011-2014. NCHS data brief, (276), 1–8.