The correlates of long-term weight loss: a group comparison study of obesity

OBJECTIVE: Although the majority of weight loss attempts are unsuccessful, a small minority succeed in both weight loss and maintenance. The present study aimed to explore the correlates of this success. METHOD: A group comparison design was used to examine differences between women who were classified as either weight loss maintainers (had been obese (body mass index, BMI=30+ kg/m2) and had lost weight to be considered non-obese (BMI<30 kg/m2) and maintained this weight loss for a minimum of 3 y; n=44), stable obese (maintained an obese weight (BMI=30+ kg/m2) for longer than 3 y; n=58), and weight loss regainers (been obese (BMI=30+ kg/m2), lost sufficient weight to be considered non-obese (BMI<30 kg/m2) and regained it (BMI=30+ kg/m2), n=40). In particular, the study examined differences in profile characteristics, historical factors, help-seeking behaviours and psychological factors. RESULTS: The results showed that in terms of profile and historical factors, the weight loss maintainers had been lighter, were currently older and had dieted for longer than the other groups but were matched in terms of age, class and ethnic group. In terms of help-seeking behaviours, the weight loss maintainers reported having tried healthy eating more frequently but were comparable to the other subjects in terms of professionals contacted. Finally, for psychological factors the weight loss maintainers reported less endorsement for medical causes of obesity, greater endorsement for psychological consequences and indicated that they had been motivated to lose weight for psychological reasons. CONCLUSIONS: Weight loss and maintenance is particularly correlated with a psychological model of obesity. This has implications for improving the effectiveness of interventions and the potential impact of current interest in medical approaches to obesity.     

Do baseline serum leptin levels predict weight regain after dieting in obese women?

SUMMARY
Aim   Weight loss achieved during weight reduction programme is difficult to maintain. We investigated the possible role of circulating leptin in failure or success in maintaining weight loss.
Methods   Serum leptin levels were measured in 30 healthy premenopausal obese women before and after 12 weeks of dietary intervention and after 5 months of follow-up.
Results   After intervention body mass index (BMI) decreased from 30.6 to 25.4 kg/m² (p < 0.01) and leptin levels decreased from 16.7 to 7.7 ng/ml (p < 0.01). After 5 months follow-up 12 women regained reduced weight and 18 women maintained weight loss. In the regainers leptin levels increased again, but remained low in the maintainers. Baseline leptin concentrations were lower in the regainers than in the maintainers (12.1 vs. 21.2 ng/ml, p = 0.04). During intervention leptin levels decreased three times more in the maintainers than in the regainers, although weight loss was similar in both groups.
Conclusions   This study shows that obese women who regain weight after dieting have significantly lower baseline leptin levels than women who maintain weight loss. Our results suggest that differences in leptin resistance might exist in similarly obese women which could influence the success of dieting.     

A descriptive study of weight loss maintenance: 6 and 15 year follow-up of initially overweight adults

OBJECTIVE: To describe factors associated with long-term maintenance of weight loss. DESIGN AND SUBJECTS: We identified initially overweight individuals (body mass index >27 kg/m2, n=911) from the nationwide Finnish Twin Cohort and studied those who lost at least 5% of their body weight between 1975 and 1981. Subjects who had maintained weight loss until 1990 (38 men, 17 women) were compared to both regainers (28 men, 26 women) and the other overweight subjects in the cohort. MEASUREMENTS: Self-report data on weight, height, health behaviours and perceived well-being; self-report and register-based data on health status and use of medication. RESULTS: Only 6% of all overweight individuals lost and maintained at least 5% weight loss. In men weight loss maintenance was associated with a low level of stress and health-promoting behaviours but also with medical problems. Failure to maintain weight loss seemed to be associated with stressful life and past high alcohol intake. In women weight loss maintenance was associated with low initial well-being and health-compromising behaviours that improved after weight loss. CONCLUSION: Long-term weight loss maintenance is rare. Predictors of weight loss maintenance are different between women and men. International Journal of Obesity (2000)24, 116-125     

Weight cycling during treatment of obese women

Long-term treatment of obese patients shows that the majority of them regains weight or has weight cycling (WC). We have studied the frequency of WC (weight lost and regain of at least 5% of initial weight, IW) in 218 obese women selected from a University Hospital with a follow-up of >12 months admitted between 1992 and 2000. Patients with psychiatric, infectious or chronic disease (except metabolic syndrome), pregnancy, or using glucocorticoids were excluded. Mean age was 38+/-10 years (range 18 to 68) and the mean BMI was 41.0+/-6.6 kg/m2 (range 30 to 76). All were treated with a hypocaloric diet and increased physical activity. Anti-obesity medications were used in 61% of them for short periods of time. In the follow-up of 28+/-16 months (range 12 to 92 mo, median 23 mo), WC was observed in 62/218 (28.4%) of them and 53 had weight lost followed by weight regain. In the weight-cyclers, 59.1% of patients regained weight before the first year of treatment. WC was associated with alcohol consumption higher than 60 g/week, (RR 2.4; 95% CI= 1.2-4.7) but not with obesity class, smoking or smoke cessation. We conclude that WC is highly frequent and alcohol consumption is a predictive risk factor.     

Modest weight loss and physical activity in overweight patients with chronic liver disease results in sustained improvements in alanine aminotransferase, fasting insulin, and quality of life

BACKGROUND AND AIM: Obesity is a risk factor for progression of fibrosis in chronic liver diseases such as non-alcoholic fatty liver disease and hepatitis C. The aim of this study was to investigate the longer term effect of weight loss on liver biochemistry, serum insulin levels, and quality of life in overweight patients with liver disease and the effect of subsequent weight maintenance or regain. PATIENTS: Thirty one patients completed a 15 month diet and exercise intervention. RESULTS: On completion of the intervention, 21 patients (68%) had achieved and maintained weight loss with a mean reduction of 9.4 (4.0)% body weight. Improvements in serum alanine aminotransferase (ALT) levels were correlated with the amount of weight loss (r = 0.35, p = 0.04). In patients who maintained weight loss, mean ALT levels at 15 months remained significantly lower than values at enrollment (p = 0.004), while in regainers (n = 10), mean ALT levels at 15 months were no different to values at enrollment (p = 0.79). Improvements in fasting serum insulin levels were also correlated with weight loss (r = 0.46, p = 0.04), and subsequent weight maintenance sustained this improvement. Quality of life was significantly improved after weight loss. Weight maintainers sustained recommended levels of physical activity and had higher fasting insulin levels (p = 0.03) at enrollment than weight regainers. CONCLUSION: In summary, these findings demonstrate that maintenance of weight loss and exercise in overweight patients with liver disease results in a sustained improvement in liver enzymes, serum insulin levels, and quality of life. Treatment of overweight patients should form an important component of the management of those with chronic liver disease.     

Who does not gain weight? Prevalence and predictors of weight maintenance in young women

OBJECTIVE: To investigate the prevalence and predictors of weight maintenance over time in a large sample of young Australian women. DESIGN: This population study examined baseline and 4 y follow-up data from the cohort of young women participating in the Australian Longitudinal Study on Women's Health. SUBJECTS: A total of 8726 young women aged 18-23 y at baseline. MEASURES: Height, weight and body mass index (BMI); physical activity; time spent sitting; selected eating behaviours (eg dieting, disordered eating, takeaway food consumption); cigarette smoking, alcohol consumption; parity; and sociodemographic characteristics. RESULTS: Only 44% of the women reported their BMI at follow-up to be within 5% of their baseline BMI (maintainers); 41% had gained weight and 15% had lost weight. Weight maintainers were more likely to be in managerial or professional occupations; to have never married; to be currently studying; and not to be mothers. Controlling for sociodemographic factors, weight maintainers were more likely to be in a healthy weight range at baseline, and to report that they spent less time sitting, and consumed less takeaway food, than women who gained weight. CONCLUSIONS: Fewer than half the young women in this community sample maintained their weight over this 4 y period in their early twenties. Findings of widespread weight gain, particularly among those already overweight, suggest that early adulthood, which is a time of significant life changes for many women, may be an important time for implementing strategies to promote maintenance of healthy weight. Strategies which encourage decreased sitting time and less takeaway food consumption may be effective for encouraging weight maintenance at this life stage.     

Disordered eating behaviours and cognitions in young women with obesity: relationship with psychological status

OBJECTIVE: To examine levels of eating disorder behaviours and cognitions of young women with obesity in the Australian Capital Territory, Australia and assess the impact upon psychological status. DESIGN: General population cross-sectional survey. SUBJECTS: A total of 4891 young women from the community aged 18-42 years, of which 630 were in the obese weight range. MEASUREMENTS: Body mass index (BMI), eating disorder psychopathology (eating disorder examination questionnaire), and psychological distress (K-10). RESULTS: Women with obesity had significantly higher levels of dietary restraint, eating concern, weight concern, shape concern, binge eating, misuse of diuretics, use of diet pills and fasting compared to other women in the community. These eating disorder cognitions and behaviours were associated with increased levels of psychological distress. In women with obesity, eating concern, weight concern, shape concern, dietary restraint and decreased age predicted psychological distress in a multivariate model. Among other women in the community, behaviours such as laxative misuse, 'hard' exercise and subjective bulimic episodes also contributed to the model predicting psychological distress. CONCLUSION: As disordered eating psychopathology is high in young obese women and negatively impacts upon psychological status, obesity prevention and treatment should consider eating disorder psychopathology and mental health outcomes.     

Body image in middle-aged HIV-infected and uninfected women

We assessed factors associated with negative body image among 225 HIV-infected and 207 uninfected women. Standardized interviews obtained sociodemographic data and elicited agreement with the statement: 'Overall I am satisfied with my body shape'. Height and weight were measured. Overall, 39% of the women were obese and 47% had a negative body image. Factors independently associated with negative body image were HIV-infection, BMI, and depression. Given the high prevalence of obesity and negative body image, interventions aimed at assisting women with weight loss are warranted.     

Pretreatment predictors of attrition and successful weight management in women

OBJECTIVE: This study analyzed baseline behavioral and psychosocial differences between successful and nonsuccessful participants in a behavioral weight management program. Success was defined by commonly used health-related criteria (5% weight loss). Noncompletion was also used as a marker of a failed attempt at weight control. SUBJECTS: A total of 158 healthy overweight and obese women (age, 48.0+/-4.5 y; BMI, 31.0+/-3.8 kg/m(2); body fat, 44.5+/-5.3%). INTERVENTION: Subjects participated in a 16-week lifestyle weight loss program consisting of group-based behavior therapy to improve diet and increase physical activity, and were followed for 1 y after treatment. METHODS: At baseline, all women completed a comprehensive behavioral and psychosocial battery assessing dieting/weight history, dietary intake and eating behaviors, exercise, self-efficacy, outcome evaluations, body image, and other variables considered relevant for weight management. Participants who maintained a weight loss of 5% or more at 16 months (or 10% or more of initial fat mass) were classified as successful. Nonsuccessful participants were those who dropped out and completers who had not lost weight at follow-up. RESULTS: Of all participants, 30% (n=47) did not complete initial treatment and/or missed follow-up assessments (noncompleters). Noncompletion was independently associated with more previous weight loss attempts, poorer quality of life, more stringent weight outcome evaluations, and lower reported carbohydrate intake at baseline. In logistic regression, completion status was predicted correctly in 84% of all cases (chi(2)=45.5, P<0.001), using baseline information only. Additional predictors of attrition were initial weight, exercise minutes, fiber intake, binge eating, psychological health, and body image. A large variation in weight loss/maintenance results was observed (range: 37.2 kg for 16-month weight change). Independent baseline predictors of success at 16 months were more moderate weight outcome evaluations, lower level of previous dieting, higher exercise self-efficacy, and smaller waist-to-hip ratio. Success status at follow-up was predicted correctly in 74% of all starting cases (chi(2)=33.6, P<0.001). CONCLUSION: Psychosocial and behavioral variables (eg, dieting history, dietary intake, outcome evaluations, exercise self-efficacy, and quality of life) may be useful as pretreatment predictors of success level and/or attrition in previously overweight and mildly obese women who volunteer for behavioral weight control programs. These factors can be used in developing readiness profiles for weight management, a potentially important tool to address the issue of low success/completion rates in the current management of obesity.     

Lifestyle intervention of hypocaloric dieting and walking reduces abdominal obesity and improves coronary heart disease risk factors in obese,postmenopausal, African-American and Caucasian women

BACKGROUND: There are few empirical data to support the claim that weight loss improves coronary heart disease (CHD) risk factors in postmenopausal women; nor is it known if there are racial differences in changes of body fat distribution, lipids, glucose tolerance, and blood pressure with weight loss. This study determined the efficacy of a lifestyle weight loss intervention in reducing total and abdominal obesity and improving CHD risk factors in obese Caucasian and African-American postmenopausal women. METHODS: Body composition (dual-energy x-ray absorptiometry), abdominal fat areas (computed tomography scan), lipoprotein lipids, insulin, glucose tolerance, and blood pressure were measured before and after 6 months of hypocaloric diet and low-intensity walking in 76 overweight or obese (body mass index > 25 kg/m(2)), Caucasian (72%) or African-American (28%), postmenopausal (age = 60 +/- 5 years) women who completed the study. RESULTS: Absolute amount of body weight lost was similar in Caucasians (-5.4 +/- 3.6 kg) and African Americans (-3.9 +/- 3.6 kg), but Caucasian women lost relatively more fat mass (p <.05). Both groups decreased their subcutaneous abdominal fat, and Caucasian women decreased their visceral fat area, but there were no racial differences in the magnitude of abdominal fat lost. The intervention decreased triglyceride and increased high-density lipoprotein and high-density lipoprotein 2 cholesterol in both races, and it decreased total and low-density lipoprotein cholesterol in Caucasian women (p <.05-.0001). Fasting glucose and glucose area during the oral glucose tolerance test decreased (p <.0001) in Caucasian women, whereas insulin area decreased in both Caucasian (p <.01) and African-American (p <.05) women. Blood pressure decreased the most in women with higher blood pressures at baseline. Changes in lipids, fasting glucose and insulin, their responses during the oral glucose tolerance test, and blood pressure were not different between racial groups. CONCLUSIONS: Weight loss achieved through a lifestyle intervention of energy restriction and increased physical activity is an equally effective therapy in African-American and Caucasian obese, postmenopausal women for improving glucose and lipid CHD risk factors.     

Long-term weight patterns and risk for cholecystectomy in women

BACKGROUND: Obesity and rapid weight loss in obese persons are known risk factors for gallstones. However, the effect of intentional, long-term, moderate weight changes on the risk for gallstones is unclear. OBJECTIVE: To study long-term weight patterns in a cohort of women and to examine the relation between weight pattern and risk for cholecystectomy. DESIGN: Prospective cohort study. SETTING: 11 U.S. states. PARTICIPANTS: 47,153 female registered nurses who did not undergo cholecystectomy before 1988. MEASUREMENTS: Cholecystectomy between 1988 and 1994 (ascertained by patient self-report). RESULTS: During the exposure period (1972 to 1988), there was evidence of substantial variation in weight due to intentional weight loss during adulthood. Among cohort patients, 54.9% reported weight cycling with at least one episode of intentional weight loss associated with regain. Of the total cohort, 20.1% were light cyclers (5 to 9 lb of weight loss and gain), 18.8% were moderate cyclers (10 to 19 lb of weight loss and gain), and 16.0% were severe cyclers (> or = 20 lb of weight loss and gain). Net weight gain without cycling occurred in 29.3% of women; net weight loss without cycling was the least common pattern (4.6%). Only 11.1% of the cohort maintained weight within 5 lb over the 16-year period. In the study, 1751 women had undergone cholecystectomy between 1988 and 1994. Compared with weight maintainers, the relative risk for cholecystectomy (adjusted for body mass index, age, alcohol intake, fat intake, and smoking) was 1.20 (95% CI, 0.96 to 1.50) among light cyclers, 1.31 among moderate cyclers (CI, 1.05 to 1.64), and 1.68 among severe cyclers (CI, 1.34 to 2.10). CONCLUSION: Weight cycling was highly prevalent in this large cohort of middle-aged women. The risk for cholecystectomy associated with weight cycling was substantial, independent of attained relative body weight.     

Effect of weight reduction on respiratory function and airway reactivity in obese women

BACKGROUND: Population-based studies have documented an association between obesity and an increased prevalence of asthma in women. METHODS: We prospectively studied 58 obese women with a body mass index of > 30 kg/m(2), 24 of whom had asthma, who were enrolled in an intensive 6-month weight loss program to determine whether loss of body mass would be correlated with improvements in bronchial reactivity, lung function, and disease-specific health status. RESULTS: Patients lost an average of 20 kg over the 6-month period. For every 10% relative loss of weight, the FVC improved by 92 mL (p = 0.05) and the FEV(1) improved by 73 mL (p = 0.04), however, bronchial reactivity did not significantly change with weight loss (p = 0.23). Patients who lost > 13% of their pretreatment weight experienced improvements in FEV(1) (p = 0.01), FVC (p = 0.02), and total lung capacity (p = 0.05) compared to patients in the lowest quartile who failed to lose significant amounts of weight. Neither group experienced any significant change in methacholine responsiveness (p = 0.57). Patients who completed the 6-month weight loss program experienced improvements in respiratory health status, irrespective of weight loss. CONCLUSION: We concluded that weight loss can improve lung function in obese women, however, the improvements appear to be independent of changes in airway reactivity.     

Disinhibition, as assessed by the Three-Factor Eating Questionnaire, is inversely related to psychological well-being in postmenopausal women

Psychological correlates of obesity remain under controversy. As eating behaviors and dieting history have been previously related to obesity status, these dietary variables may contribute to identify overweight and obese individuals who are at higher risk of having an impaired psychological well-being. OBJECTIVE: The main purpose of this cross-sectional study was to verify the hypothesis of a relationship between weight status and psychological well-being, and to examine whether cognitive dietary restraint, disinhibition, susceptibility to hunger and dieting history could be related to psychological well-being. DESIGN AND SUBJECTS: In a sample of 101 postmenopausal women, we performed anthropometric measurements (weight, height and body mass index (BMI)), and measured psychological well-being (PER Questionnaire). The Three-Factor Eating Questionnaire (TFEQ) and a questionnaire about dieting history (dieters: had already been on a diet; non-dieters: had never been on a diet) were also administrated. RESULTS: A trend for a significant relationship was observed between BMI and psychological well-being (r=-0.17; P=0.08). Significant negative relationships were observed for disinhibition, susceptibility to hunger and all their subscales with psychological well-being (-0.28相似文献   

Exercise and obesity

The prevalence of obesity has increased dramatically during the past decade in the USA. This is despite an estimated 50 million Americans who try to lose weight each year. The increasing prevalence of obesity is particularly alarming due to the numerous health implications associated with this condition, including coronary artery disease, hypertension, diabetes, hyperlipidemia, cancer, and various musculoskeletal conditions. The economic impact of treating illnesses associated with obesity has been estimated to be US$40 billion in the USA. Dieting is largely ineffective in maintaining initial weight loss as numerous studies suggest the majority of dieters regain all lost weight with 3-5 years. On, the other hand, regular exercise has been shown to be one of the best predictors of successful weight maintenance. Moreover, studies indicate that improved fitness through regular physical activity reduces cardiovascular morbidity and mortality for overweight individuals even if they remain overweight. Providing advice about exercise to overweight or obese individuals requires explicit information about the frequency, intensity, duration, and type of physical activity that should be performed. The ultimate goal for the exercising obese patient is to make a life-long commitment to achieving reasonable energy expenditure through routine physical activity.     

Association of body mass and body fat distribution with serum melatonin levels in obese women either non-operated or after jejunoileostomy

The association of body mass index (BMI) and body fat distribution (as measured by waist-to-hip circumference ratio; WHR) with serum melatonin (MEL) levels determined at 02 and 14 h were examined in 22 non-operated obese women and 21 obese women who underwent jejunoileostomy for morbid obesity 2 to 6 years earlier as well as in 20 gender and age-matched healthy controls with normal body weight. All non-operated obese women either with moderate or morbid obesity had significantly higher MEL concentration at 14 h compared with controls, whereas the amount of MEL secreted at 02 h was elevated only in morbidly obese women. The mean differences between serum MEL levels at 14 h and 02 h (delta MEL) was reduced in morbidly obese women - it may be due to desynchronisation of its circadian rhythmicity. Among women who underwent jejunoileostomy for morbid obesity the values of MEL were normalized only in those with a noted body mass reduction and with BMI and WHR indexes less than 28 kg/m2 and 0.83, respectively. MEL correlated positively with BMI and WHR indexes at 14 h in all subjects studied. Negative correlation was noted between the relative values of delta MEL and BMI in both non-operated and operated obese women with BMI indexes >31 kg/m2.     

Viscerally obese women with normal body weight have greater brachial-ankle pulse wave velocity than nonviscerally obese women with excessive body weight

OBJECTIVE: To confirm the association of visceral obesity and brachial-ankle pulse wave velocity (baPWV) and to compare metabolic indices and baPWV between individuals who have normal body weight but are viscerally obese and individuals with excessive body weight who are not viscerally obese. PATIENTS AND MEASUREMENTS: We recruited a total of 150 women, aged 22 to 67 years. We assessed body composition, measured by computed tomography (CT), and divided the study population into four groups, based on visceral adipose tissue area (normal, normal body weight but viscerally obese, excessive body weight but not viscerally obese, and excessive body weight and viscerally obese). The baPWV was measured, using a volume plethysmographic instrument. RESULTS: Despite lower levels of total body fat, the women who had a normal body weight but were viscerally obese had a higher plasma triglyceride level and baPWV measurement and greater subcutaneous fat area (SFA) and thigh SFA than the women with excessive body weight who were not viscerally obese. After adjustment for age, mean blood pressure (BP), body mass index (BMI), triglyceride levels, fasting insulin levels, and free fatty acid (FFA) levels, baPWV was independently correlated with abdominal visceral fat area, as measured by CT (P = 0.001). CONCLUSIONS: Mean baPWV was higher in women with normal body weight who were viscerally obese than in women who had excessive body weight but were not viscerally obese, and abdominal visceral fat was an independent factor for baPWV. These results suggest that early detection and intervention in viscerally obese individuals, even those within a normal BMI range, could be needed to prevent atherosclerosis and cardiovascular disease (CVD).     

Variables predictive of adherence to diet and physical activity recommendations in the treatment of obesity and overweight, in a group of Spanish subjects

OBJECTIVE: To assess the factors that could predict a successful completion of a weight loss program. STUDY DESIGN: A single-centered, cross-sectional, prospective study conducted over 4 y. SUBJECTS: Data were obtained on 1018 overweight subjects (788 women, 230 men) aged 14.8-76.3 y (mean 38.4) and body mass index (BMI) of 31.7 (range 25.03-57.1) seeking help to lose weight at a specialist obesity clinic. MATERIALS AND METHODS: A program involving a hypocaloric, Mediterranean diet was prescribed plus recommendations for free-time exercise and day-to-day activity. Follow-up was weekly until the desired weight loss was achieved ('successful completion') or the patient dropped-out of the program ('failure'). Cox's regression analysis was used to evaluate success and the variables included were compliance with the program, age, gender, initial BMI, physical activity, alcohol consumption, smoking habit, hypertension, diabetes, hypercholesterolemia, cardiovascular disease, previous dietary programs, cause of obesity, age at which excessive weight was first noted and parental obesity. RESULTS: Factors predictive of completion were: gender (males responded better), previous dietary programs (predictive of dropout), initial BMI (higher index, lower completion), and age (younger age, poorer outcome). There was an interaction between parental obesity and offspring childhood obesity. Absence of parental obesity and adult-onset obesity had a higher probability of program completion. CONCLUSIONS: In a standard weight reduction program the recommendations of dietary restriction and moderate exercise seems less effective for women, persons with high BMI, younger age groups and those who have had other attempts at weight loss. Poorest outcomes applied to those subjects with childhood obesity and who had obese parents.     

Adaptive thermogenesis in humans

The increasing prevalence of obesity and its comorbidities reflects the interaction of genes that favor the storage of excess energy as fat with an environment that provides ad libitum availability of energy-dense foods and encourages an increasingly sedentary lifestyle. Although weight reduction is difficult in and of itself, anyone who has ever lost weight will confirm that it is much harder to keep the weight off once it has been lost. The over 80% recidivism rate to preweight loss levels of body fatness after otherwise successful weight loss is due to the coordinate actions of metabolic, behavioral, neuroendocrine and autonomic responses designed to maintain body energy stores (fat) at a central nervous system-defined 'ideal'. This 'adaptive thermogenesis' creates the ideal situation for weight regain and is operant in both lean and obese individuals attempting to sustain reduced body weights. Much of this opposition to sustained weight loss is mediated by the adipocyte-derived hormone 'leptin'. The multiple systems regulating energy stores and opposing the maintenance of a reduced body weight illustrate that body energy stores in general and obesity in particular are actively 'defended' by interlocking bioenergetic and neurobiological physiologies. Important inferences can be drawn for therapeutic strategies by recognizing obesity as a disease in which the human body actively opposes the 'cure' over long periods of time beyond the initial resolution of symptomatology.