Obesity and Disease in an Interconnected World: A Systems Approach to Turn Huge Challenges into Amazing Opportunities


by

Judith Wylie-Rosett, Sunil S. Jhangiani

eISBN: 978-1-68108-036-9, 2015
ISBN: 978-1-68108-037-6



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Globalization and economic progress has been accompanied with an increase in the incidence of obesity, cardiovascular disease and othe...[view complete introduction]

Table of Contents

Foreword

- Pp. i-ii (2)

Peter A. Selwyn

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Preface

- Pp. iii-iv (2)

Judith Wylie-Rosett and Sunil S. Jhangiani

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List of Contributors

- Pp. v-viii (4)

Judith Wylie-Rosett and Sunil S. Jhangiani

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Biographies

- Pp. ix

Judith Wylie-Rosett and Sunil S. Jhangiani

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Short Summary with Salient Features

- Pp. x

Judith Wylie-Rosett and Sunil S. Jhangiani

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Lifestyle Diseases in the Modern Era: A Major Threat to Global Health!

- Pp. 3-29 (27)

Sirakarn Tejavanija and Sunil S. Jhangiani

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Overweight and Obesity: It All Starts Here

- Pp. 30-54 (25)

Lindy Fenlason and Doug Heimburger

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Physical Inactivity: A Lazy World

- Pp. 55-67 (13)

Sarah Litman Rendell and Charles Swencionis

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From Starvation to Obesity: How Insulin Resistance Affects Global Health

- Pp. 68-84 (17)

Pooja Raghavan, Dhyan Rajan and Meredith Hawkins

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Moving Beyond Metabolic Syndrome: Assessing Diabetes and Cardiometabolic Risk

- Pp. 85-101 (17)

K. Indulekha, C.S. Pitchumoni and V. Mohan

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Diabetes Mellitus: Is it Type 1 or Type 2? It May Not Be So Easy

- Pp. 102-113 (12)

Jason C. Baker

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From Fatty Liver to Cirrhosis: The Toll Rises!

- Pp. 114-131 (18)

Harmit S. Kalia and Allan W. Wolkoff

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Obesity: Update on Nutrition and Behavioral Strategies

- Pp. 132-148 (17)

Judith Wylie-Rosett and Carlos Marquez

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Obesity and Health: A Primer on Sleep

- Pp. 239-253 (15)

Yasmin Mossavar-Rahmani and Kathryn J. Reid

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The Healthy Diet: Easy as 1, 2 and 3

- Pp. 149-162 (14)

Jeannette M. Beasley and Beth A. Conlon

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Regular Physical Activity: A Prescription for Lifelong Health in the Community

- Pp. 163-191 (29)

Philip Haberstro, Lynn Rivers and Mary Stottele

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Prevention of Cardiovascular Disease: Behavioral Modification

- Pp. 192-214 (23)

Lekshmi Dharmarajan

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Cardiovascular Disease: Addressing Risk Factors

- Pp. 215-238 (24)

Lekshmi Dharmarajan and T.S. Dharmarajan

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Yoga and Meditation: Antidotes to Civilization

- Pp. 254-280 (27)

Sonia Suchday, Yvette Fruchter, Lauren Hagemann and Anthony F. Santoro

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Prescribing Medications for Older Adults: Dealing with Obesity, Misuse, Polypharmacy and Adverse Drug Events!

- Pp. 281-305 (25)

T.S. Dharmarajan and S. Davuluri

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Using Systems Thinking to Understand the Dynamics of Obesity in Low and Middle Income Countries

- Pp. 306-325 (20)

David William Lounsbury, Judith Wylie-Rosett and Beth A. Conlon

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The Effectiveness of Wellness Program Incentives in Reducing the Burden and Cost of Obesity

- Pp. 326-354 (29)

Chloe Cheng and Richard H. Bernstein

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Obesity Interventions: Integration with Community- Based Systems

- Pp. 355-368 (14)

Nichola Davis, Kristie Lancaster and Marcelle Pigananelli

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Life-Course Approach to Obesity Management: The Role of Family and Environment

- Pp. 369-394 (26)

Denise C. Tahara

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From Intervention to Innovation: Health Information Technology

- Pp. 395-415 (21)

Denise C. Tahara and Guy Laufer

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Index

- Pp. 420-428 (9)

Judith Wylie-Rosett and Sunil S. Jhangiani

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Foreword

I recall a lecture about prevention early in medical school, given by a wise, silver-haired professor, in which he made the provocative remark, “If we could only get people to stop smoking, drink less, be physically active and eat right, half of you could go home and do something else with your lives: we wouldn’t need so many doctors.” While one could argue with his math, thirty years of providing medical care in the United States-though this would be increasingly applicable to the developing as well as the developed world-have convinced me of the truth which was highlighted by this offhand comment. Despite-or rather in parallel to-a quarter century of progress in medical management and pharmacotherapeutics, a few basic interventions, affecting how people eat, engage in physical activity, and use substances, can have a profound impact on the health of patients and communities. A recent meta-analysis in the British Medical Journal confirmed the equivalence or superiority of exercise vs standard medical therapy in improving disease outcomes and even mortality in patients with stroke, cardiovascular disease, and diabetes [1]. This study echoed the landmark findings of the Diabetes Prevention Program (DPP), which demonstrated the superiority of lifestyle interventions vs metformin in preventing the progression of pre-diabetes to diabetes [2]. The YMCA now offers the DPP intervention as the Y-DPP which could potentially be available at any YMCA across the globe. Yet if these basic interventions are so effective, why have they not been more widely implemented? Basic, but perhaps not simple, in terms of how behavior is influenced and ultimately determined and changed. The factors that influence health-related behaviors have an impact at the individual patient, family, local community, and larger societal levels. Likewise, any strategies that would hope to change these behaviors must be thoughtfully pursued and engaged at each of these levels as well. Fortunately, this volume, Obesity and Disease in an Interconnected World: A Systems Approach to Turn Huge Challenges into Amazing Opportunities!, edited by Judith Wylie-Rosett, EdD, RD & Sunil S. Jhangiani, MD, MBA, FACP, AGAF, is a welcome and useful tool to help elucidate and frame this multi-level strategy. Specifically, as implied by the title, this is a systematic and systems-oriented examination of how to address the global epidemic of obesity and related chronic disease prevention and mitigation, in a comprehensive and coordinated way.

Recent advances in the basic science of fat metabolism, and adiposity, the related endocrinopathies and disease pathogenesis, and the multi-morbidity that affects even some organ systems not traditionally believed to be affected by obesity, have broadened the basis for understanding both the clinical impact of this epidemic and potential biomedical approaches for intervention. At the individual patient level, advances in behavioral science-for example, recent work in the area of motivational interviewing and behavior change [3]-have helped increase clinicians’ skills and sensitivity in the area of health-promotion. Local community interventions, including the promotion of local coalitions of health care providers, public health agencies, local governmental officials, and community-based organizations and advocates, have been found to improve local conditions and increase resources for healthy eating, active living, and smoking cessation and prevention [4]. An important challenge to be overcome is in encouraging and supporting the coordination between clinical (i.e., medical, health care delivery-related) and public health (i.e., population-level) systems, since these two arena have traditionally been disconnected and even potentially discordant. The advent of the Accountable Care Organization (ACO) model in the United States, particularly the beginning of an era in which population-level health outcomes become part of the measurable goals and priorities of large ACOs, provide a structural opportunity to promote this broader approach to health promotion, extending beyond the medical exam room into the local community where patients’ behaviors are largely determined and expressed [5, 6]. This approach will start to focus on creative and potentially powerful collaborations across sectors, such as strategies to implement the standardized Y-DPP educational program not only within health care delivery sites but also local community agencies, faith-based organizations, and schools, as outlined in this volume as well.

Beyond the individual and local community level, as suggested by the chapters in this eBook that address larger societal and even global issues, advocacy and coordinated policy development are essential in helping to shape the broad social priorities that have such an important impact on these health-promoting behaviors. Urban planning, local zoning, financing (from micro-finance to venture capital), health insurance incentives, taxation, marketing and the communications industry, all are examples of the kinds of key factors and areas for strategic intervention that can help determine the health of individuals, and societies. With the United Nations and World Health Organization estimating that over 50% of the chronic disease morbidity and mortality in the world is now due to non-communicable diseases [7], it is clear that one of the unintended consequences of development is to import the familiar array of obesity- and lifestyle-related diseases to many countries that had not previously experienced this-Mexico, India, and China are only a few examples of this phenomenon.

While the behaviors that need to change are basic -- again, how we eat, move, and use substances-and while the impact of behavior change on disease outcomes is clear-cut, it is the challenge of this decade and perhaps this century to create the kind of environments and communities in which these changes can and will take place. As scientists, as clinicians, as public health advocates and educators, and as citizens of our communities and the world, there is no more pressing agenda with the potential of impacting the health of billions of people worldwide. This eBook is an important addition to our efforts to accomplish this agenda for our own and future generations.

Peter A. Selwyn, MD, MPH
Professor and Chairman
Department of Family and Social Medicine
Director, Office of Community Health
Montefiore Medical Center
Albert Einstein College of Medicine
Bronx, NY, USA
Tel: (718) 920-8434
Emails: peter.selwyn@einstein.yu.edu, pselwyn@montefiore.org

REFERENCE

[1] Naci H. Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study. BMJ 2013;347:f5577 doi: 10.1136/bmj.f5577 (Published 1 October 2013)

[2] Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346:393-403.

[3] Lakerveld et al. International Journal of Behavioral Nutrition and Physical Activity 2013, 10:47. Available at http://www.ijbnpa.org/content/10/1/47

[4] Cantor J, et al. Community-centered health homes: bridging the gap between health services and community prevention. Prevention Institute, 2011. Available at http://www.preventioninstitute.org/co mponent/jlibrary/article/id-298/127.html

[5] Gourevitch et al. The challenge of attribution: Responsibility for Population Health in the Context of Accountable Care. Am J Prev Med 2012;42(6S2):S180-S183.

[6] Noble DJ, Casalino LP. Can accountable care organizations improve population health? Should they try? JAMA, 2013; 309(11):1119-20.

[7] Global status report on noncommunicable diseases 2010. World Health Organization, April, 2011.


Preface

A 20-something woman, on over-the-counter appetite suppressant pills for an overweight condition, stays up all night to complete a paper due the next day. To stay alert she takes a stimulant drug along with a few beers. She then takes an herbal sleep aid and sends an email to her professor at 4 am that she will hand deliver the paper herself later that morning. A few hours later, she begins to feel sick with vomiting, dizziness and calls poison control for help. She arrives at a local hospital by ambulance and is given a sedative that puts her in deep sleep. Later that evening she is found to have brain damage, is put on life support and dies six days later. After five years and a four week trial, the jury finds the hospital and its staff not negligent and in the jury’s opinion the 20-something had “an overexerted lifestyle” with lack of sleep and a cocktail of drugs.

While tragic indeed, not a day goes by that we don’t hear about an illness, condition or even death brought on all as a result of the way we live, work and go about our everyday lives; what we call “Lifestyle Diseases”. In a world which is “hyper-connected”, urbanized, technologically advanced, and scientifically enriched; sleep, alcohol abuse, drug and tobacco use are usually an after-thought and where physical activity and healthy eating have become an exception rather than the norm. As per the World Health Organization (WHO), our altered lifestyles that result in chronic non-communicable diseases (NCDs) such as obesity, diabetes, heart disease, metabolic syndrome, chronic lung and many cancers account for 50% of the global burden of disease. Furthermore, of the sixty million global deaths that will occur this year, nearly two-thirds or forty million will be secondary to NCDs.

In large parts of the world, especially middle and low income countries, many of these diseases are detected late requiring more expensive and extensive medical care. With most if not all of this care covered through out-of-pocket payments, millions get pushed into poverty year after year. Clearly then, lifestyle diseases are a consequence of man’s inability to adapt to this rapidly and constantly changing environment, where immediate gratification takes precedence over everything else, and where affluence and material possession are a fight to the finish line. Can we then change our behaviors, our environments and the way we deliver health care services that would help us ward off these illnesses? Research clearly indicates that lifestyle illnesses all share common risk factors, with unhealthy diets, physical inactivity, overweight, obesity and tobacco and alcohol abuse leading the way. So, prevention strategies aimed at reducing the incidence of any one chronic malady, will not only help lower the incidence of that particular condition, but also the incidence of many other chronic illnesses.

With this epidemic of NCDs showing no signs of abating, we find ourselves in the midst of the most challenging times ever - with our financial, climate and health systems in total disarray. And, the problem is expected to get even worse, with the WHO projecting 2.4 billion overweight and 700 million obese individuals worldwide by the year 2015. With “total inaction”, WHO estimates the total cost to the global economy in the range of $ 50 Trillion through 2030 mainly secondary to productivity losses and medical treatments for lifestyle ailments. We, therefore consider the World Economic Forum’s projected annual global price tag to fight these ailments at $15 Billion a real steal. We must begin now!

We are deeply indebted to Dr. Selwyn who in his foreword sets the stage by highlighting obesity and related diseases as the global challenge of this century. He calls on us to create the kinds of environments and communities in which we promote health, prevent disease and create a healthier world for one and all. This eText; “Obesity & Disease in an Inter-connected World: A Systems Approach to Turn Huge Challenges into Amazing Opportunities,” sets out to provide a roadmap to help turn the tide, by addressing first in Section One, the global burden of highly prevalent but easily preventable risk factors and related conditions, their epidemiology, and the complex biological processes for some of the different disease states, and then going on to highlight in Section Two, the evidence-based opportunities available to prevent and address risk factors via health and nutrition education, individual and group counseling, promotion of physical activity and active living, and the importance of adequate sleep, stress management, yoga, meditation and the proper use of pharmacological medications. It is in Section Three that the eBook delves into the much-needed systems approach required to strengthen health systems globally; provision of universal health insurance, the importance of greater investments in community, workplace and life-course health programs, the leveraging of health information technology for the greater good and the global leadership and accountability that will be required for the proper implementation of NCD interventions to achieve the post-2015 Millennium Development Goals (MDGs). As members of the global health community, the contributing authors toward this eBook hope to make the case that better health is a basic fundamental right of every human being, and that enhanced investments in health will help us move forward toward achieving the thus-far elusive goals of health equity, social justice, and financial protection. While the action plans and the resulting key objectives, as outlined by the various authors, may appear to be similar and at times repetitive, this was indeed our intention such that each and every chapter is complete and fully justified as a “stand-alone” and as part of the entire publication.

Acknowledgement

We thank our colleagues for sharing their insights as contributing authors. Their chapters address the challenges posed by the global rise in obesity and related co-morbidities and explore opportunities for innovative solutions using a systems approach.

Our sincere appreciation goes to Guy Laufer, MPS, who designed the eBook cover, to illustrate the interconnections we need to consider in dealing with obesity.

Our deepest gratitude goes to Maryellen P. Brucato, DPM, AACFAS, who made it all possible. She tirelessly read and made valuable editing suggestions. Her contributions also included helping us consider the widely varying systems involved in obesity prevention and control.

We thank Bentham Science with a special appreciation to Ms. Hira Aftab of the eBooks Publications Department for her valuable assistance towards the completion of this eBook.

Judith Wylie-Rosett, EdD, RD
Atran Foundation Chair in Social Medicine, Professor and Division Head for Health Promotion
and Nutrition Research, Department of Epidemiology and Population Health, Albert Einstein
College of Medicine
Bronx, NY, USA

&

Sunil S. Jhangiani, MD, MBA, FACP, AGA
Division of Gastroenterology and Clinical Nutrition
Department of Medicine (Wakefield Campus)
Montefiore Medical Center
Clinical Assistant Professor of Medicine and Family and Social Medicine
Albert Einstein College of Medicine
Bronx, NY, USA

List of Contributors

Editor(s):
Judith Wylie-Rosett


Sunil S. Jhangiani




Contributor(s):
Jason Baker
Weill Cornell Medical Associates
New York
NY
USA


Jeannette Beasley
Department of Epidemiology and Population Health
Albert Einstein College of Medicine
Bronx
NY
USA


Richard Bernstein
Departments of Preventive Medicine and Geriatrics & Palliative Medicine
Icahn School of Medicine at Mount Sinai
New York
NY
USA


Chloe Cheng
Frenkel Benefits
LLC
New York
NY
USA


Beth E. Conlon
Department of Epidemiology and Population Health
Albert Einstein College of Medicine
Bronx
NY
USA


S. Davuluri
Division of Geriatrics, Montefiore Medical Center (Wakefield Campus)
University Hospital of Albert Einstein College of Medicine
Bronx
NY
USA


Nichola Davis
North Bronx Healthcare Network, Departments of Medicine and Clinical Epidemiology Population Health
Albert Einstein College of Medicine
Bronx
NY
USA


L. Dharmarajan
Professor of Clinical Medicine, Weill Medical College of Cornell University
New York, Chief, Division of Cardiology, Lincoln Medical and Mental Health Center
Bronx
NY
USA


T.S. Dharmarajan
Department of Medicine, Clinical Director, Geriatrics, Montefiore Medical Center (Wakefield Campus)
University Hospital of Albert Einstein College of Medicine
Bronx
NY
USA


Lindy Fenlason
Division of General Pediatrics, Department of Pediatrics
Vanderbilt Children’s Hospital
Nashville
TN
USA


Yvette Fruchter
Department of Psychology
Ferkauf Graduate School of Psychology of Yeshiva University
Bronx
NY
USA


Hagemann Lauren
Ferkauf Graduate School of Psychology of Yeshiva University
Bronx
NY
USA


Philip Haberstro
Wellness Institute of Greater Buffalo and WNY
Buffalo
NY
USA


Meredith Hawkins
Department of (Endocrinology) Medicine, Global Diabetes Institute
Albert Einstein College of Medicine
Bronx
NY
USA


Doug Heimburger
Vanderbilt Institute for Global Health
Nashville
TN
USA


K. Indulekha
Department of Diabetology & Epidemiology
Madras Diabetes Research Foundation & Dr.Mohan’s Diabetes Specialties Centre
Chennai
India


Sunil Jhangiani
Division of Gastroenterology and Clinical Nutrition, Department of Medicine, Montefiore Medical Center (Wakefield Campus)
Albert Einstein College of Medicine
Bronx
NY
USA


Harmit Kalia
Division of Gastroenterology and Liver Diseases, Marion Bessin Liver Research Center
Albert Einstein College of Medicine and Montefiore Medical Center
Bronx
NY
USA


Kristie Lancaster
Department of Nutrition, Food Studies & Public Health
New York University
New York
NY
USA


Guy Laufer
Global Digital Learning Director for McCann Worldgroup
New York
NY
USA


David Lounsbury
Department of Epidemiology and Population Health
Albert Einstein College of Medicine of Yeshiva University
1300 Morris Park Avenue, Belfer Building, 13th Floor
Bronx
NY
USA


Carlos Marquez
Ferkauf Graduate School of Psychology of Yeshiva University
Bronx
NY
USA


V. Mohan
Department of Diabetology & Epidemiology
Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Centre
Chennai
India


Yasmin Mossavar-Rahmani
Clinical Epidemiology and Population Health in the Division of Health Promotion and Nutrition Research
Albert Einstein College of Medicine of Yeshiva University
Bronx
NY
USA


Marcelle Pigananelli
Universidad Iberoamericana
Santo Domingo
Dominican Republic


C.S. Pitchumoni
Clinical Professor of Medicine Rutgers University
New York Medical College
Valhalla
NY
USA


Pooja Raghavan
Clinical Endocrinology Fellow
National Institutes of Health (NIH)
Bethesda
Maryland
USA


Dhyan Rajan
Division of Gastroenterology
Nassau University Medical Center
East Meadow
NY
USA


Kathryn J. Reid
Department of Neurology
Northwestern University, Feinberg School of Medicine

Chicago
IL
USA


Sarah Litman Rendell
Ferkauf Graduate School of Psychology of Yeshiva University
Bronx
NY
USA


Lynn Rivera
Department of Physical Therapy
D’Youville College
Buffalo
NY
USA


Anthony Santoro
Ferkauf Graduate School of Psychology of Yeshiva University
Bronx
NY
USA


Mary Stottele
AmeriCorps VISTA
Buffalo
NY
USA


Sonia Suchday
Chair of Department of Psychology
Pace University
New York
NY
USA


Charles Swencionis
Ferkauf Graduate School of Psychology of Yeshiva University
Bronx
NY
USA


Denise Tahara
Department of Health Policy and Management
School of Health Sciences and Practice at New York Medical College
Bronx
NY
USA


Sirakarn Tejavanija
Division of Clinical Nutrition, Department of Internal Medicine
Phramongkutklao Army Hospital and Medical College
Bangkok
Thailand


Allan Wolkoff
Division of Gastroenterology and Liver Diseases, Director, Marion Bessin Liver Research Center
Albert Einstein College of Medicine and Montefiore Medical Center
Bronx
NY
USA


Judith Wylie-Rosett
Division of Health Promotion and Nutrition Research, Department of Epidemiology and Population Health
Albert Einstein College of Medicine
Bronx
NY
USA




Reviews

“I am impressed with the scope of the publication entitled Obesity and Disease in an Interconnected World: A Systems Approach to turn Huge Challenges into Amazing Opportunities. The chapters on how obesity drives risks for the non-communicable diseases (so-called NCDs) are excellent and I commend the editors on addressing not just metabolic syndrome, but going beyond that to Non-Alcoholic Fatty Liver Disease and cirrhosis. The strength of the book is its emphasis on lifestyle intervention and the editors have taken a broader approach, including chapters on sleep hygiene and yoga, in addition to thorough review of the comprehensive lifestyle change elements we are all used to - diet, physical activity and behavioral intervention.

The public health challenges of the twenty-first century are the non-communicable diseases (NCDs) and obesity is a major driver of these conditions. The emphasis of this eBook to make the solutions "interconnected" is a good one. It will take more than medical management to address this epidemic and community and public health partnerships are indeed of paramount importance. "

Donna H. Ryan, MD
Professor Emerita, Pennington Biomedical Research Center


“This book is a must read for physicians and patients alike. It covers not only a broad range of topics, including obesity, non-alcoholic fatty liver disease, cardiovascular disease, and metabolic syndrome, but it also provides information on how these issues are interconnected. The book tries to explain the issues in a way that a non-medical professional can understand it, making it a great reference for patients looking to gain a basic understanding of the pathophysiology of obesity and how to manage it.”

Thakor G. Patel, MD, MACP,
Medical Director, U.S. Naval Hospital, Portsmouth, Retd


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