Obesity, hazards and complications
Excess weight is an independent risk factor for coronary disease, in addition to its contribution to the incidence of diabetes, hyperlipidemia, & hypertension.
Mounting evidence suggests that modification
of caloric intake, particularly the quality of calories, can result in decreased
morbidity and mortality from cardiovascular disease, cancer, and diabetes.
Excess weight is an independent risk factor for coronary disease, in addition
to its contribution to the incidence of diabetes, hyperlipidemia, and hypertension.
Between 20 and 30% of Americans are overweight, defined as 20% above the
acceptable body-mass index (kg/m2), and more than 40% of certain subpopulations,
such as black, Native American, and Mexican-American women, are overweight.
Despite concern about the risk of weight cycling, the health hazards of
obesity appear to outweigh the potential harm of repeated weight loss and
Americans derive excess calories from fats, particularly saturated fats, rather than from more beneficial sources such as complex carbohydrates, monounsaturated fats, and fiber. Since intake of saturated fat correlates with cholesterol level, and coronary heart disease is reduced by 2 to 3% for every 1% reduction in plasma cholesterol level, dietary modification will play a central role in decreasing the primary cause of mortality in America. Excess dietary fat intake has also been associated with breast, colon, prostate, and lung cancer in epidemiologic studies. The once widely accepted goals of reducing calories from all fats to 30% and from saturated fat to 10% have been challenged as the impact of types of fat (not simply fat itself) on morbidity and mortality is further elucidated. Increasing the intake of dietary fiber, such as from plant, legume, and grain sources, may contribute specifically to a decrease in colon cancer incidence.
Dietary sodium restriction may benefit those who have salt-sensitive hypertension, although the need for such restriction in the general population is unclear. Calcium and vitamin D are protective against osteoporosis, particularly in young women prior to reaching menopause, and evidence suggests that females at all ages have an inadequate intake. Menstruating women are at risk for iron-deficiency anemia. To achieve the recommended daily intake of vitamins and minerals, a varied diet including fish, lean meats, dairy products, whole grains, and five to six servings of fruits and vegetables daily is recommended, rather than the use of vitamin supplements. However, certain nutrients, such as adequate folate to prevent neural tube defects in developing fetuses, are not readily obtained from the typical American diet and may be best found in supplements. While evidence supporting the use of antioxidants such as vitamins E and C is still incomplete, the recommended quantities of these micronutrients can be obtained from a balanced diet.
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