Separating Fat from Fiction: Exploring Myths, Realities, and - - PowerPoint PPT Presentation

Separating Fat from Fiction: Exploring Myths, Realities, and Assumptions

Ellen Perrella MS, ATC, CSCS Head Athletic Trainer Mount Holyoke College

Sobering Statistics

 1 1 6 m illion

adults dieting

 8 0 % US teenage

girls have dieted

 Age 1 3 , 1 / 2 girls

unhappy w ith bodies

‘Unreal’istic Images

 Average m odel, dancer, or

actress is thinner than 9 5 % of population

 A generation ago m odels

w eighed 8 % less than avg. w om an; today,2 3 % less

http:/ / w w w .dove.us/ # / feature s/ videos/ default.aspx[ cp- docum entid= 7 0 4 9 5 7 9 ] /

 W om en, w eight, and

fem inism

Is Obesity a disease? Is body fat pathological?

 W ho benefits from obesity being

considered a disease?

 Scientists and academ ics researching

• besity

 Pharm aceutical com panies  Bariatric surgeons  Public health establishm ent

Is Obesity a disease? Is body fat pathological?

 W ho benefits from obesity being

considered a disease?

 Scientists and academ ics researching

• besity

 Pharm aceutical com panies  Bariatric surgeons  Public health establishm ent

 $ 5 0 Billion Diet I ndustry

Fat Phobic Society



Diet Drugs

 Usage am ong fem ale adolescents

(Journal of Preventive Medicine Feb. 2007)

 Fen-Phen Fiasco

Fat Phobic Society



Diet Drugs

 Usage am ong fem ale adolescents  Fen-Phen Fiasco 

Bariatric Surgery: Liposuction

 Elective surgery, high m ortality rate.  Hospitalization rate doubled in the year post-

surgery com pared to year prior to surgery. At Least 2 0 % w ill need m ore surgery.

 Health benefits? ( Klein, Sam uel, M.D., 2 0 0 4 )

Fat Phobic Society



Diet Drugs

 Usage am ong fem ale adolescents  Fen-Phen Fiasco 

Bariatric Surgery: Liposuction

 Elective surgery, high m ortality rate.  Hospitalization rate doubled in the year post-

surgery com pared to year prior to surgery. At Least 2 0 % w ill need m ore surgery.

 Health benefits? ( Klein, Sam uel, M.D., 2 0 0 4 ) 

Bariatric Surgery: Gastric Bypass

 AHRQ ( w / in 6 m onths) ; 4 in 1 0  1 3 -1 5 years out  Post surgery-3 ounces fills stom ach  8 0 0 -1 2 0 0

cal/ day.

MYTH #1: Eat Too Much; Exercise Too little?

 Food environm ent

 Increased portion size, Snack-foods heavy on refined

sugars and saturated fats.

 Most studies: overw eight people eat few er calories

than those of norm al w eight. ( Nat’l Academ y of Sciences, Diet and

Health, 1 9 8 9 )

MYTH #1: Eat Too Much; Exercise Too little?

 Food environm ent

 Increased portion size, Snack-foods heavy on refined

sugars and saturated fats.

 Most studies: overw eight people eat few er calories

than those of norm al w eight.

( Nat’l Academ y of Sciences, Diet and Health, 1 9 8 9 )

 Physical environm ent

 Technology has stripped our lives of natural exercise.  Screen time= video games, computers, TV  1 9 7 0 ’s Fitness Revolution  SES, incom e, and education are inversely related to

• besity.

 Poor people m ore likely to w ork in physically

dem anding jobs, yet have m uch higher obesity rates.

MYTH #1: Eat Too Much; Exercise Too little?

 Food environm ent

 Increased portion size, Snack-foods heavy on refined

sugars and saturated fats.

 Most studies: overw eight people eat few er calories

than those of norm al w eight.

( Nat’l Academ y of Sciences, Diet and Health, 1 9 8 9 )

 Physical environm ent

 Technology has stripped our lives of natural exercise.  Screen time= video games, computers, TV  1 9 7 0 ’s Fitness Revolution  SES, incom e, and education are inversely related to

• besity.

 Poor people m ore likely to w ork in physically

dem anding jobs, yet have m uch higher obesity rates.

 The relationship betw een exercise and food and

• besity is not clear.

Intervention school studies

 5 ,1 0 6 3 rd graders from 9 6 schools  5 6 schools-2 year I ntervention:

healthy foods, nutrition instruction, extra physical activity.

 Students decreased fat in diet,

exercised m ore, …

 No difference in w eights from 4 0

control schools



Nader, PR., Stone, EJ, Lytle, LA et al.

What is the cause of obesity?

 I ntrinsic m etabolic, enzym atic, or

horm onal abnorm ality induces + caloric balance…..fat accum ulation.

 Defect of fat m etabolism ; horm onal

and m etabolic, release of fat is im peded, or the deposition/ synthesis

• f fat is prom oted.

 Appetite and w eight regulation have

strong biological underpinnings.

Myths and Misconceptions

 People can control their body

size; they can lose w eight if they really w ant to.

Myths and Misconceptions

 People can control their body

size; they can lose w eight if they really w ant to.

 You w ill lose w eight w hen you

exercise

 Heritage Family Study (Wilmore, Jack H. , et al)  500 men and women; 20 weeks,

stationary bicycle 3x/ week

 55% -75% of VO2 Max; 30-50 min.  Lost < 1 lb.; % body fat < 1 %

More Myths

 People are thin or fat based on a

sim ple relationship betw een ‘calories in and calories out’

 “no basis in m edical science”  Overfed 12 sets of identical twins 1,000

cal./ day, 6 days/ week, 12 weeks

 identical levels of physical activity  7 w eeks later; w eight gain am ong 2 4

m en varied 3 0 0 % , from 9 -3 0 lbs.

( Bouchard, C., Despres, J.P., Nadeau, A., et al. )

More Myths

 People are thin or fat based on a

sim ple relationship betw een ‘calories in and calories out’

 “no basis in m edical science”  Overfed 12 sets of identical twins 1,000

cal./ day, 6 days/ week, 12 weeks

 identical levels of physical activity  7 w eeks later; w eight gain am ong 2 4

m en varied 3 0 0 % , from 9 -3 0 lbs.

(Bouchard, C., Despres, J.P., Nadeau, A., et al. )

 Obesity causes poor health and

increased m ortality

Obesity is a poor predictor of:

 Hypertension.

 No history of dieting; 1 2 5 / 7 9  History of yo-yo dieting (5 + weight

losses of 10 + pounds last 5 years); 1 4 7 / 9 0

 BP positively correlated w ith total

• lbs. yo-yo-ers had regained.

( Guagnano, MT, E. Ballone, V. Pace-Pallitti, et al. 2 0 0 0 )

Obesity is a poor predictor of:

 Hypertension.

 No history of dieting; 1 2 5 / 7 9  History of yo-yo dieting (5 + weight losses of

10 + pounds last 5 years); 1 4 7 / 9 0

 BP positively correlated w ith total lbs.

yo-yo-ers had regained.

( Guagnano, MT, E. Ballone, V. Pace-Pallitti, et al 2 0 0 0 )

 High Cholesterol

 31 obese women put on 6 month aerobic

• program. most lost avg. 6 lbs.; 11 gained 6 lbs

 Both gainers and losers im proved cv

fitness the sam e am ount

 Also im proved cholesterol levels and

insulin sensitivity ( Lam arche, B, J-P Despres, M-C Pouliot,

et al. 1 9 9 2 )

Obesity is a poor predictor of:

(continued)

 Atherosclerosis ( “clogged arteries”)  1 9 6 0 ( I nt’l Atherosclerosis Project) . 2 3 ,0 0 0

autopsies; concluded “no association”.

 1 9 9 1 . Dr. Applegate ( U. of Tenn.) 4 ,5 0 0

angiogram s of m iddle aged and elderly. Fattest people had cleanest arteries.

 NOTE: individuals that are overw eight/ obese

and have atherosclerosis have low er risk of heart attack, stroke or early death.

Obesity is a poor predictor of:

(continued)

 Type I I diabetes: condition

im proves w ith changes in diet and exercise, independent of w eight changes

 I nsulin resistance ( I R) is the m ost

im portant m etabolic factor relating to w eight, diet, and health.

 Obesity and diabetes: consequences

• f the sam e underlying defects;

hyperinsulinem ia and I R

Weight and Cardiometabolic Abnormalities

 5 4 4 0 subjects; 1 9 9 9 -2 0 0 4



W ildm an, R.P. et. al. 2 0 0 8

 “A considerable proportion of

• verw eight and obese US adults are

m etabolically healthy, w hereas a considerable proportion of norm al w eight adults express a clustering of cardiom etabolic abnorm alities.”

Correlation is not Causality

 “The m ere presence of 2 or m ore

variables in the sam e individual does not infer an inherent causal relationship.”

 Dr. Glenn Gaesser “…it is

absolutely unjustifiable to equate behavioral patterns ( poor diet and physical inactivity) w ith a physical characteristic ( obesity) .”

Myth: Obesity Kills

 Cooper I nstitute for Aerobics Research

 1 9 7 0 . 2 6 ,0 0 0 m en; 8 ,0 0 0 w om en ( ages 2 0 -9 0 )  Being heavy did not increase the risk of

prem ature death

 = fitness levels  being overw eight better than

being underw eight

 Obese fit m en and lean-fit m en: sim ilar low

death rates -1 / 2 that of lean-unfit m en-

Myth: Obesity Kills

 Cooper I nstitute for Aerobics Research

 1 9 7 0 . 2 6 ,0 0 0 m en; 8 ,0 0 0 w om en ( ages 2 0 -9 0 )  Being heavy did not increase the risk of

prem ature death

 Fitness levels  being overw eight better than

being underw eight

 Obese fit m en and lean-fit m en: sim ilar low

death rates -1 / 2 that of lean-unfit m en-

 Harvard Alum ni Study

 1 7 ,0 0 0 m en w ho attended Harvard betw een

1 9 1 6 -1 9 5 0

 W ho has the best chance of living a long life?

BMI vs. Relative Risk of Death

Fle legal, Kath therine, G , Graubard, Barry, Willa illamson, D , David id, e , et t al.

• l. 2005

Diets: Atkins to Zone

 Dieters: 1 8 x m ore likely to

develop an eating disorder

Diets: Atkins to Zone

 Dieters: 1 8 x m ore likely to

develop an eating disorder

 Recidivism rate from 9 0 -9 8 %

Diets: Atkins to Zone

 Dieters: 1 8 x m ore likely to

develop an eating disorder

 Recidivism rate from 9 0 -9 8 %  Needs deprivation leads to

• vercom pensation

 Dieting begets bingeing.  Dieting intensifies preferences for

high-fat and sugar-loaded foods.

 Starving……… Stuffed.

Landmark diet study

 Keys Study ( 1 9 4 4 )

 32 conscientious objectors  24 weeks caloric restriction/ one-half of

what they were used to eating

 All lost w eight, all gained it back

plus som e ( avg. 1 0 lbs.)

 Men w ere irritable, depressed,

apathetic, preoccupied w ith food

Landmark diet study

 Keys Study ( 1 9 4 4 )

 32 conscientious objectors  24 weeks caloric restriction/ one-half of

what they were used to eating

 All lost w eight, all gained it back

plus som e ( avg. 1 0 lbs.)

 Men w ere irritable, depressed,

apathetic, preoccupied w ith food

 W hat do Treblinka and Jenny

Craig have in com m on?

Diet is a four letter word

 Em otional toll: disheartened,

disillusioned, and depressed

Diet is a four letter word

 Em otional toll: disheartened,

disillusioned, and depressed

 Body conserves energy/ survival

m echanism

 BMR ( basal m etabolic rate) accounts for

6 0 -7 0 % of total energy used by body

 BMR drops w ithin 2 4 hrs. of food

deprivation, m ay reduce 2 0 % in 2 w eeks

Diets

 I m proves body’s

ability to store fat and lim its ability to burn it

 I ncreases lipogenic

( fat-storage) enzym es

 Decreases lipolytic

( fat-releasing) enzym es

 Decreased m uscle-

used for energy and reduced to low er m etabolism

Diets

 I m proves body’s

ability to store fat and lim its ability to burn it

 I ncreases lipogenic

( fat-storage) enzym es

 Decreases lipolytic

( fat-releasing) enzym es

 Decreased m uscle-

used for energy and reduced to low er m etabolism

 I deology reinforces

split betw een dieter’s m ind and body.

Yo-Yo, Uh Oh

 W eight loss begets w eight gain - serious

health consequences

 Fram ingham Heart Study

Yo-Yo, Uh Oh

 W eight loss begets w eight gain - serious

health consequences

 Fram ingham Heart Study  Harvard Alum ni Study ( follow -up 1 9 9 8 )  Men w ith stable w eights vs. those w ho

had lost and gained the m ost pounds:

 8 0 % higher risk of heart disease  1 2 3 % higher rate of type I I diabetes

 alum ni w ho dieted frequently

( com pared to non-dieters) :

 2 x risk of diabetes, hypertension, and

coronary heart disease

Consequences of weight loss/gain cycling

 The observations confirm …a basic

relationship betw een starvation, re- deeding diet, and cv disease.

(Univ. of Illinois, 1964)

 “W eight cycling is associated w ith

low er HDL cholesterol in w om en of a m agnitude … associated w ith an increased risk of cardiac event”.

(Marian B. Olson, MS 2000)

Athletics

 Scales are scarce  Educate the coaches/ staff  Mandatory Program m ing for

athletes

 No w eigh-ins or % body fats

Athletic Traits vs. ED Symptoms

 Mental toughness  Com m itm ent to

training

 Pursuit of

excellence

 Coachability  Unselfishness  Perform ance

despite pain

Athletic Traits vs. ED Symptoms

 Mental toughness  Com m itm ent to

training

 Pursuit of

excellence

 Coachability  Unselfishness  Perform ance

despite pain

 Asceticism  Excessive exercise  Perfectionism  Over com pliance  Selflessness  Denial of discom fort

( Thom pson and Sherm an 1 9 9 9 )

Ready, Set Point, Go

 “Hom e” w eight; w here your body

feels at hom e ( hom eostasis)

 Natural w eight

Ready, Set Point, Go

 “Hom e” w eight; w here your body

feels at hom e ( hom eostasis)

 Natural w eight  Verm ont State Prison. Set out to

m ake thin m en fat. Concluded “m arked difference in their ability to gain w eight”.

Ready, Set Point, Go

 “Hom e” w eight; w here your body

feels at hom e ( hom eostasis)

 Natural w eight  Verm ont State Prison. Set out to

m ake thin m en fat. Concluded “m arked difference in their ability to gain w eight”

 7 0 % of our w eight is genetically

determ ined

Location, location, location

 Upper-body fat ( abdom en)  More prevalent in m ales  Visceral ( or deep) body fat-

m etabolically hyperactive, high levels

• f FFA ( free fatty acids) released in

the bloodstream , etc.

 I ncreased risk for atherosclerosis and

diabetes.

Location, location, location

 Low er body fat ( hips and thighs)  More prevalent in fem ales  Subcutaneous fat  Associated w ith a low er risk of heart

disease and diabetes

 Stanford University, 1 9 9 1 . 1 3 3 m en and

1 3 0 w om en, ages 2 5 -4 9 . Fatter thighs = low er heart disease risks ( low LDL, high levels HDL, i.e. blood fat profiles) .

Popular Torture Devices

Discrimination…...Humiliation

 Acknow ledge the anxiety, pain, and

grief this issue elicits for so m any.

 1 5 0 Science Studies: noted

stigm atization of obese adults by em ployers, educators, health care providers, the m edia, etc.

( Rudd Center for Food Policy and Obesity/ Yale)

 W eight bias is a social injustice as

w ell as a public health issue.

 See Cynthia’s w ords ( handout)

HAES (Health At Every Size)



Accept and respect the diversity of body shapes and sizes.



Health and w ell-being are m ulti-dim ensional including physical, social, spiritual,

• ccupational, em otional, and intellectual

aspects.



Prom oting all aspects of health and w ell- being for people of all sizes.



Prom oting eating in a m anner w hich balances individual nutritional needs, hunger, satiety, appetite, and pleasure.



Prom oting individually appropriate, enjoyable, life-enhancing physical activity, rather than exercise focused on w eight loss.

New Year’s Resolutions

 # 1 w ish every year-to lose

w eight

New Year’s Resolutions

Drink more champagne. Watch more sunsets. Listen to more music. Climb a mountain.

Suggestions, Solutions, Solace

 Marcia Germ aine Hutchinson,

“Fem inist Perspectives on Eating Disorders”, “So w hat does it m ean to have a healthy body im age?....”

Suggestions, Solutions, Solace

 Marcia Germ aine Hutchinson,

“Fem inist Perspectives on Eating Disorders”, “So w hat does it m ean to have a healthy body im age?....”

 W hat if??? W hat if everyone

collectively w oke up tom orrow m orning and w as happy and content w ith their bodies?

More Suggestions, Solutions, Solace

 Substance over im age.

More Suggestions, Solutions, Solace

 Substance over im age.  Redefine beauty. Accept your size.  Challenge the im ages/ m edia.

More Suggestions, Solutions, Solace

 Substance over im age.  Redefine beauty. Accept your size.  Challenge the im ages/ m edia.  Be critical consum ers of inform ation.  I nfluence of the w eight loss industry  Food industry and nonprofit health

• rganizations

More Suggestions, Solutions, Solace

 Substance over im age.  Redefine beauty. Accept your size.  Challenge the im ages/ m edia.  Be critical consum ers of inform ation.  I nfluence of the w eight loss industry  Food industry and nonprofit health

• rganizations

 Avoid m entioning w eight.

Peace with food

 Shift focus: w eight & dieting 

enhanced quality of life & health.

 Reject diet m entality  Unconditional perm ission to eat  “Enjoy a variety of real food,

prim arily plants” Linda Bacon

 “Gentle Nutrition”

Intuitive Eating

 Honor your hunger

Intuitive Eating

 Honor your hunger  Feel your Fullness

Intuitive Eating

 Honor your hunger  Feel your Fullness  Eating w ith Pleasure

Intuitive Eating

 Honor your hunger  Feel your Fullness  Eating w ith Pleasure  Respect your Body

Accept your genetic blueprint

Wonderful Websites

 www.bodypositive.com  www.naafa.org (National Association to

Advance Fat Acceptance)

 http: / / www.sizediversityandhealth.org

(Association for Size Diversity and Health)

 www.bbwmagazine.com  www.melpomene.org  http: / / www.haescommunity.org  www.healthyweight.net  http: / / loveyourbody.nowfoundation.org/

Resources



Bacon, Linda. Health at Every Size: The Surprising Truth about your W eight. Dallas, TX: Benbella Books, I nc. 2 0 0 8 .



Bouchard, C., Despres, JP, Nadeau, A., et al. The Response to Long-term Overfeeding in I dentical Tw ins. New England Journal of Medicine. May 1 9 9 0 . 3 3 2 ( 2 1 ) : 1 4 7 7 - 1 4 8 2 .



Cam pos, Paul. The Obesity Myth: W hy Am erica’s Obsession w ith W eight is Hazardous to Your Health. New York, New York: Gotham Books, 2 0 0 4 .



Diet and Health: I m plications for Reducing Chronic Disease Risk / Com m ittee on Diet and Health, Food and Nutrition Board, Com m ission on Life Sciences, National Research

• Council. W ashington, D.C. : National Academ y Press, 1 9 8 9 .



Flegal, Katherine, Graubard, Barry, W illam son, David, et al. Excess Deaths Associated w ith Underw eight, Overw eight, and Obesity. Journal of Am erican Medical Association. 2 0 0 5 . 2 9 3 ( 1 5 ) : 1 8 6 1 - 1 8 6 7 .

Resources (Continued...)



Flum , DR, Salem L., Broeckel Elrod, JA, Dellinger P., Cheadle A., Chan, L. : Early Mortality Am ong Medicare Beneficiaries Undergoing Bariatric Surgical Procedures. Journal of Am erican Medical Association. 2 0 0 5 ; 2 9 4 :1 9 0 3 - 1 9 0 8 .



Gard, Michael and Jan W right. The Obesity Epidem ic: Science, m orality, and ideology. New York, New York: Routledge, 2 0 0 5 .



Gaesser, Glenn A. Big Fat Lies: The Truth about Your W eight and Your Health. Carlsbad, CA: Gurze Books, 2 0 0 2 .



Guagnano, MT, E. Ballone, V. Pace-Pallitti, et al. Risk factors for hypertension in obese w om en. The role of w eight cycling. European Journal of Clinical Nutrition. April 2 0 0 0 . Vol. 5 4 : 3 5 6 -3 6 0 .



Kater, Kathy. An Effective Model for Preventing the Full Spectrum of Body I m age, Eating, Fitness and W eight Problem s. The Renfrew Center Foundation Perspective. W inter 2 0 0 6 : pgs. 1 5 - 1 8 .

Resources (Continued…)



Klein, Sam uel, M.D., Luigi Fontana, M.D., Ph.D., V. Leroy Young, M.D., Andrew R. Coggan, Ph.D., Charles Kilo, M.D., Bruce W . Patterson, Ph.D., and B. Selm a Moham m ed, M.D., Ph.D. Absence of an Effect of Liposuction on I nsulin Action and Risk Factors for Coronary Heart Disease. The New England Journal of Medicine. June 1 7 , 2 0 0 4 . Vol. 3 5 0 : 2 5 4 9 -2 5 5 7 .



Kratina, K. A Com passionate Alternative to the ‘W ar on Obesity: Clinical Applications of Health At Every Size ( HAES) . Lecture: Fem inist Perspectives and Beyond: Hungers, Health, and Healing. Renfrew Center Foundation Conference for Professionals. Philadelphia, PA. Novem ber 4 -7 , 2 0 0 4 .



Kolata, Gina. Rethinking Thin: The New Science of W eight Loss-and the Myths and Realities of Dieting. New York, New York. Farrar, Straus, and Giroux. 2 0 0 7 .



Lam arche, B, J-P Despres, M-C Pouliot, et al. I s body fat loss a determ inant factor in the im provem ent of carbohydrate and lipid m etabolism follow ing aerobic exercise training in obese w om en? Metabolism , Vol. 4 1 , 1 9 9 2 , pgs. 1 2 4 9 - 1 2 5 6

Resources (Continued)



Lew is, Katharine, Man, Lynne. Overw eight and Obesity in Massachusetts: Epidem ic, Hype or Policy Opportunity? The Massachusetts Health Policy Forum . 2 0 0 7 .



Matz, Judith, MSW , LCSW , Frankel, Judith MSW , LCSW . “Attitudes tow ards Disordered Eating and W eight: I m portant Considerations for Therapists and Health Professionals.” The Journal of Health at Every Size, Volum e 1 9 , No. 1 . Spring 2 0 0 5 .



Nader, PR., Stone, EJ, Lytle, LA et al. Three-Year Maintenance of I m proved Diet and Physical Activity: The CATCH Cohort. Archives of Pediatric Adolescent Medicine. 1 9 9 9 ; 1 5 3 : 6 9 5 - 7 0 4 .



Oliver, Eric. Fat Politics: The Real Story Behind Am erica’s Obesity Epidem ic. New York, New York. Oxford University Press, I nc. 2 0 0 6 .



Rom ero-Corral, Abel, Victor M Montori, Virend K Som ers, Josef Korinek, Randal J Thom as, Thom as G Allison, Farouk Mookadam , Francisco Lopez-Jim enez. Lancet 2 0 0 6 ; 3 6 8 : 6 6 6 – 7 8

Resources (Continued)



Sherm an, R. T, & Thom pson, R.A. ( 2 0 0 1 ) Athletes and Disordered Eating: Four Major I ssues for the Professional

• Psychologist. Professional Psychology: Research and

Practice, v3 2 ( 1 ) , 2 7 - 3 3 .



Sherm an, R. T, & Thom pson, R.A. ( 2 0 0 1 ) Athletes and Disordered Eating: Four Major I ssues for the Professional

• Psychologist. Professional Psychology: Research and

Practice, v3 2 ( 1 ) , 2 7 - 3 3 .



Seid, Roberta Pollack. Never Too Thin: W hy W om en Are at W ar w ith Their Bodies. New York, New York. Prentice Hall, 1 9 8 9 .



Spake, Am anda. Stop Dieting. US New s and W orld Report. January 1 6 , 2 0 0 6 : 6 1 - 6 6 .



Taubes, Gary. Good Calories, Bad Calories: Challenging the Conventional W isdom on Diet, W eight Control, and

• Disease. New York. Random House, 2 0 0 7 .



Thom pson, RA, Sherm an, RT. Good Athlete Traits and Characteristics of Anorexia Nervosa: Are they Sim ilar? Eating Disorders: Journal of Treatm ent and Prevention ( 1 9 9 9 ) , 7 3 : 1 8 1 - 1 9 0 .

Resources (Continued)



Tribole, Evelyn, Resch, Elyse. I ntuitive Eating: A Revolutionary Program that W orks. New York. St. Martin’s Press, 2 0 0 3 .



W aterhouse, Debra. Outsm arting the Fem ale Fat Cell. New York. Hyperion, 1 9 9 3 .



W ildm an, R.PhD, Muntner, P. PhD, Reynolds, K. PhD, McGinn, A. PhD, Rajpathak, S. DrPH, W ylie-Rosett, J., Sow ers, MR, PhD. The Obese w ithout Cardiom etabolic risk Factor Clustering and the Norm al W eight w ith Cardiom etabolic Risk Factor Clustering: Prevalence and Correlates of 2 Phenotypes Am ong the US Population. Archives of I nternal Medicine. Volum e 1 6 8 ( 1 5 ) . August 1 1 , 2 0 0 8 : 1 6 1 7 - 1 6 2 4 .



W ilm ore, Jack H. , et al, “Alterations in Body W eight and Com position Consequent to 2 0 W eeks of Endurance Training: The Heritage Fam ily Study, “ Am erican Journal

• f Clinical Nutrition 7 0 , no. 3 ( 1 9 9 9 ) : 3 4 6 - 5 2 .

Resources (Continued)



Yoho RA, Rom aine JJ, O'Neil D. Review of the liposuction, abdom inoplasty, and face-lift m ortality and m orbidity risk

• literature. Derm atol Surgical. 2 0 0 5 Jul;3 1 ( 7 Pt 1 ) :7 3 3 - 4 3 ;

discussion 7 4 3 .



Young, M.D., Andrew R. Coggan, Ph.D., Charles Kilo, M.D., Bruce W . Patterson, Ph.D., and B. Selm a Moham m ed, M.D., Ph.D. Absence of an Effect of Liposuction on I nsulin Action and Risk Factors for Coronary Heart Disease. The New England Journal of Medicine. June 1 7 , 2 0 0 4 . Vol. 3 5 0 : 2 5 4 9 -2 5 5 7 .