Harvard Sample
Content
Running Head: OBESITY
Prevalence of Obesity in USA
[Name of the Writer]
[Name of the Institution]
Obesity
1
Prevalance of Obesity in USA
Introduction
Obesity has emerged as the most pressing nutritional problem facing the developed
world. This trend has occurred over a relatively short period of time; in the United States, it
appears to have begun in the last quarter of the 20th century. The epidemic in children followed
shortly thereafter. The most recent data (1999–2000) from national surveys in the United States
suggest that almost two thirds of the adult population is overweight, and almost one third is
obese (Flegal et.al, 2002, p. 1724). In children, current estimates (1999–2000) put the prevalence
of overweight at 15%, a threefold increase over the past 30 years (Ogden et.al, 2002, pp. 1729).
Although this epidemic has spared no subgroup of the population and has been documented in
individuals of all ages and racial/ethnic and socioeconomic subgroups, the problem is greatest in
minority populations and among persons living in poverty. Obesity is a global public health
problem, affecting virtually every region of the world with the exception of sub-Saharan Africa.
Discussion
Identification
The World Health Organization (2000) defines obesity as a condition of abnormal or
excess accumulation of adipose tissue (body fat) to an extent that an individual's health may be
impaired. Because the precise measurement of adipose tissue requires invasive laboratory
measures, in the population context, a simpler measure on which to base an obesity definition is
required. Although imperfect, the Body Mass Index (BMI), defined as weight in kilograms
divided by height in meters squared, has been adopted by consensus in the United States by the
Obesity
2
National Institutes of Health (1998) and the Centers; for Disease Control and Prevention (CDC)
and internationally by WHO (2000). Consensus definitions of overweight and obesity have been
set at 25 (overweight) and 30 (obesity), with severity classes of obesity defined as follows:
overweight, 25.0 to 29.9; Class I obesity, 30.0 to 34.9; Class II obesity, 35.0 to 39.9; and Class
III obesity, 40.0+. The WHO (2000) terminology differs slightly, but the cutoff points are the
same.
In growing children, in whom weight and height are both changing (and at different
rates), the definition of obesity is inherently more complicated. Although no universally agreed
on standard exists for assessing overweight and obesity in children and adolescents, there is a
growing consensus that BMI should be adopted as an indirect measure of adiposity for children
and adolescents, as well (Barlow & Dietz, 1998, pp. 223). Because BMI varies substantially by
age and gender during childhood and adolescence, the specific BMI cutoffs used to classify
obesity must be gender- and age-specific and must be referenced against a standard. In the
United States, the standard used is the CDC Revised Growth Reference (Barlow & Dietz, 1998,
pp. 228). Internationally, several standards (Cole et.al, 1995, pp. 27; Ogden et al., 2002, pp.
1728), including one based on a pooled international sample (Cole et.al, 2000, pp. 1241), are also
in use.
Several periods in development have been proposed as critical periods in the
development of persistent obesity and its comorbid consequences. These include the prenatal
period (when intrauterine exposures may influence adiposity), early childhood, and adolescence.
Some evidence suggests that breast-feeding may protect against later obesity. Likelihood of
persistence in adulthood of obesity from childhood is related both to age at onset and severity.
Obesity
3
Sequelae
Childhood obesity has a number of immediate, intermediate, and long-term health
consequences (Must & Strauss, 1999, pp. S3). These include classic cardiovascular risk factors,
such as high blood pressure, abnormal blood lipid levels, and impaired glucose tolerance.
Respiratory conditions include sleep-disordered breathing. In addition, early menarche and
menstrual abnormalities are linked to overweight. Of particular concern is the emergence of type
2 diabetes, once considered an adult-onset disease, as a disease of childhood. The psychological
impact may represent one of the most damaging effects of obesity given that stigmatization and
social isolation may result in lower self-esteem and depression. In a recently replicated classic
study, children were asked to rank order a series of drawings of children with various handicaps
(crutches, wheelchair, missing a hand, facial disfigurement, obesity) based on which child they
would “like best” (Latnerm & Stunkard, 2003, p. 456). The obese child was ranked last
irrespective of the ranking child's sex, race, socioeconomic status, living environment, and own
disability. According to Schwimmer et.al, (2003), “ratings of quality of life for children with
obesity were similar to those of children undergoing chemotherapy for cancer” (p. 1814).
Although obesity in adulthood that has been present from childhood may carry an
additional burden due to increased severity, much adult obesity arises through adult weight gain.
The health consequences of obesity present in adulthood are enormous, both in magnitude and
impact on quality of life. In developing its clinical guidelines, the NIH report identified an
extensive list of health conditions for which obesity increased risk. These include hypertension,
type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea
and respiratory problems, many cancers, and depression. The number of deaths per year in the
United States attributable to obesity has been estimated at about 300,000.
Obesity
4
Risk Factors
In all persons, child or adult, obesity arises due to energy imbalance: When energy intake
exceeds energy expenditure, most of the excess calories are stored as adipose tissue. To give rise
to obesity, energy imbalance must occur over a long period of time and likely reflects a
combination of factors. Individual behaviors, environmental factors, and heredity, singly and in
combination, contribute to the development of obesity. The rapidity with which the obesity
epidemic emerged rules out simple genetic explanations. The current environment in the United
States has been characterized as obesogenic, meaning that it promotes high energy intakes and
low energy expenditures—the energy imbalance that gives rise to weight gain. Modern
industrialized societies provide abundant, relatively inexpensive food; modern life is organized
to reduce energy expenditure at work and at home, through technology and urbanization. For a
species that evolved to store fat in times of plenty in order to survive in leaner times, many
individuals are genetically susceptible to gain weight in the current environment.
Excessive energy intake is a primary risk factor for the development of childhood and
adult obesity, although the specific aspects of intake responsible are controversial. Dietary
factors, such as diet composition, energy density, fat intake, fruit and vegetable consumption,
snacks, sugar-rich foods, and soft drinks, have all been identified in association with obesity.
Increased consumption of fruits and vegetables can help reduce the intake of dietary fat and
calories because they are naturally low in fat and energy density compared with other foods.
Despite current recommendations that individuals over the age of 2 years consume 2 to 4
servings of fruits and 3 to 5 servings of vegetables daily, children and adolescents eat an average
of only 3.6 servings of fruits and vegetables per day, and fried potatoes account for a large
proportion of those servings. A number of other dietary variables, including soft drinks,
Obesity
5
snacking, portion sizes, and infant feeding have also been linked to childhood obesity. Studies
suggest that the increased consumption of sugar-sweetened soft drinks, snack foods (which are
often high in fat or/and sugar), and large-sized portions of foods have contributed to the increase
in energy intakes.
Physical Activity
Reduced physical activity may be the most important factor in explaining the increase of
obesity over the past two decades. Physical activity among U.S. youth is in decline, with nearly
half of young people aged 12 to 21 reporting that they do not engage in vigorous physical
activity regularly and one fourth reporting no vigorous physical activity. Whereas leisure time
physical activity has increased in men and remained constant in women over the past four
decades in the United States, activity associated with work and home life has declined over the
same period. Sedentary behavior and “inactivity,” such as watching television and playing
video/computer games, also are contributory factors. Gortmaker et al. (1996) reported an
adjusted-odds ratio (OR) for obesity of 8.3 for adolescents who watched TV more than 5 hours
per day compared with those who watched 0 to 2 hours (Gortmaker 1996, p. 4) . Compelling
evidence comes from intervention studies, which show that reducing TV viewing time can help
prevent childhood obesity. Adults in a trial of maintenance following weight loss sustained their
losses best when physical activity was high and television viewing was low (van Baak et.al,
2003, pp. 210). TV watching may promote obesity by reducing physical activity, lowering
metabolic rate, and increasing energy intake. The latter may occur due to the fact that TV
viewing may be associated with snacking and may moderate eating habits generally through
greater exposure to advertising of foods high in added sugars and fat or by conveying mixed
Obesity
6
messages about lifestyle and health in the content of advertisements. TV viewing is a major
source of inactivity among Americans. Screen time, a summary measure of time spent viewing
television and videos and engaged in computer-based activity, represents the largest proportion
of nonsleep, nonschool time for youth.
Conclusion
Obesity has emerged as the major nutritional problem facing the pediatric and adult
populations worldwide. The etiology of obesity is multifactorial and includes individual risk
factors, genetic influences, and environmental effectors. The severity of the problem, in terms of
immediate and long-term health consequences to physical and psychological health, suggests it is
a problem that will dominate the public health agenda in the 21st century.
Obesity
7
References
Barlow, S. E. and Dietz, W. H. (1998) Obesity evaluation and treatment: Expert committee
recommendations. Pediatrics vol. 102 pp. 222–228, Data retrieved from
http://pediatrics.aappublications.org/content/102/3/e29.full on December 6, 2012
Cole, T. J., Bellizzi, M. C., Flegal, K. M., and Dietz, W. H. (2000) Establishing a standard
definition for child overweight and obesity worldwide: International survey. British
Medical Journal vol. 320 pp. 1240–1243, Data retrieved from
http://www.bmj.com/highwire/filestream/350165/field_highwire_article_pdf_abri/0 on
December 6, 2012
Cole, T. J., Freeman, J. V., and Preece, M. A. (1995) Body mass index reference curves for the
U.K., 1990. Archives of Disease in Childhood vol. 73 pp. 25–29, Data retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1511150/ on December 6, 2012
Flegal, K. M., Carroll, M. D., Ogden, C. L., and Johnson, C. L. (2002)., Prevalence and trends in
obesity among U.S. adults, 1999–2000. Journal of the American Medical Association vol.
288 pp. 1723–1727, Data retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12365955
on December 6, 2012
Gortmaker, S. L., Must, A., Sobol, A. M., Peterson, K., Colditz, G. A., and Dietz, W. H. (1996)
Television viewing as a cause of increasing obesity among children in the United States,
1986–1990. Archives of Pediatric and Adolescent Medicine vol. 150 pp. 356–362 , Data
retrieved from http://www.ncbi.nlm.nih.gov/pubmed/8634729 on December 6, 2012
Obesity
8
Latnerm, J. D. and Stunkard, A. J. (2003) Getting worse: The stigmatization of obese children.
Obesity Research vol. 11 no. (3) pp. 452–456, , Data retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/12634444 on December 6, 2012
Must, A. and Strauss, R. S. (1999) Risks and consequences of childhood and adolescent obesity.
International Journal of Obesity and Related Metabolic Disorders vol. 23 no. (Suppl. 2)
pp. S2–S11, Data retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10340798 on
December 6, 2012
National Institutes of Health. (1998). Clinical guidelines on the identification, evaluation, and
treatment of overweight and obesity in adults. Bethesda, MD: Department of Health and
Human Services, National Institutes of Health, National Heart, Lung, and Blood
Institute , Data retrieved from http://www.ncbi.nlm.nih.gov/books/NBK2003/ on
December 6, 2012
Ogden, C. L., Flegal, K. M., Carroll, M. D., and Johnson, C. L. (2002) Prevalence and trends in
overweight among U.S. children and adolescents 1999–2000. Journal of the American
Medical Association vol. 288 pp. 1728–1732 , Data retrieved
http://www.ncbi.nlm.nih.gov/pubmed/12365956 on December 6, 2012
Schwimmer, J. B., Burwinkle, T. M., and Varni, J. W. (2003) Health-related quality of life of
severely obese children and adolescents. Journal of the American Medical Association
vol. 289 no. (14) pp. 1813–1819 , Data retrieved
http://www.ncbi.nlm.nih.gov/pubmed/12684360 on December 6, 2012
Van Baak, M. A., van Mil, E., Astrup, A. V., Finer, N., Van Gaal, L. F., Hilsted, J., and et al.
(2003)Leisure-time activity is an important determinant of long-term weight maintenance
after weight loss in the Sibutramine Trial on Obesity Reduction and Maintenance
Obesity
9
(STORM trial). American Journal of Clinical Nutrition vol. 78 pp. 209–214 , Data
retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12885699 on December 6, 2012
World Health Organization. (2000). Obesity: Preventing and managing the global epidemic:
Report of a WHO consultation (WHO Technical Report Series, No. 894). Geneva: Author
, Data retrieved from www.who.int/nutrition/publications/obesity/WHO_TRS_894/en/ on
December 6, 2012
Prevalence of Obesity in USA
[Name of the Writer]
[Name of the Institution]
Obesity
1
Prevalance of Obesity in USA
Introduction
Obesity has emerged as the most pressing nutritional problem facing the developed
world. This trend has occurred over a relatively short period of time; in the United States, it
appears to have begun in the last quarter of the 20th century. The epidemic in children followed
shortly thereafter. The most recent data (1999–2000) from national surveys in the United States
suggest that almost two thirds of the adult population is overweight, and almost one third is
obese (Flegal et.al, 2002, p. 1724). In children, current estimates (1999–2000) put the prevalence
of overweight at 15%, a threefold increase over the past 30 years (Ogden et.al, 2002, pp. 1729).
Although this epidemic has spared no subgroup of the population and has been documented in
individuals of all ages and racial/ethnic and socioeconomic subgroups, the problem is greatest in
minority populations and among persons living in poverty. Obesity is a global public health
problem, affecting virtually every region of the world with the exception of sub-Saharan Africa.
Discussion
Identification
The World Health Organization (2000) defines obesity as a condition of abnormal or
excess accumulation of adipose tissue (body fat) to an extent that an individual's health may be
impaired. Because the precise measurement of adipose tissue requires invasive laboratory
measures, in the population context, a simpler measure on which to base an obesity definition is
required. Although imperfect, the Body Mass Index (BMI), defined as weight in kilograms
divided by height in meters squared, has been adopted by consensus in the United States by the
Obesity
2
National Institutes of Health (1998) and the Centers; for Disease Control and Prevention (CDC)
and internationally by WHO (2000). Consensus definitions of overweight and obesity have been
set at 25 (overweight) and 30 (obesity), with severity classes of obesity defined as follows:
overweight, 25.0 to 29.9; Class I obesity, 30.0 to 34.9; Class II obesity, 35.0 to 39.9; and Class
III obesity, 40.0+. The WHO (2000) terminology differs slightly, but the cutoff points are the
same.
In growing children, in whom weight and height are both changing (and at different
rates), the definition of obesity is inherently more complicated. Although no universally agreed
on standard exists for assessing overweight and obesity in children and adolescents, there is a
growing consensus that BMI should be adopted as an indirect measure of adiposity for children
and adolescents, as well (Barlow & Dietz, 1998, pp. 223). Because BMI varies substantially by
age and gender during childhood and adolescence, the specific BMI cutoffs used to classify
obesity must be gender- and age-specific and must be referenced against a standard. In the
United States, the standard used is the CDC Revised Growth Reference (Barlow & Dietz, 1998,
pp. 228). Internationally, several standards (Cole et.al, 1995, pp. 27; Ogden et al., 2002, pp.
1728), including one based on a pooled international sample (Cole et.al, 2000, pp. 1241), are also
in use.
Several periods in development have been proposed as critical periods in the
development of persistent obesity and its comorbid consequences. These include the prenatal
period (when intrauterine exposures may influence adiposity), early childhood, and adolescence.
Some evidence suggests that breast-feeding may protect against later obesity. Likelihood of
persistence in adulthood of obesity from childhood is related both to age at onset and severity.
Obesity
3
Sequelae
Childhood obesity has a number of immediate, intermediate, and long-term health
consequences (Must & Strauss, 1999, pp. S3). These include classic cardiovascular risk factors,
such as high blood pressure, abnormal blood lipid levels, and impaired glucose tolerance.
Respiratory conditions include sleep-disordered breathing. In addition, early menarche and
menstrual abnormalities are linked to overweight. Of particular concern is the emergence of type
2 diabetes, once considered an adult-onset disease, as a disease of childhood. The psychological
impact may represent one of the most damaging effects of obesity given that stigmatization and
social isolation may result in lower self-esteem and depression. In a recently replicated classic
study, children were asked to rank order a series of drawings of children with various handicaps
(crutches, wheelchair, missing a hand, facial disfigurement, obesity) based on which child they
would “like best” (Latnerm & Stunkard, 2003, p. 456). The obese child was ranked last
irrespective of the ranking child's sex, race, socioeconomic status, living environment, and own
disability. According to Schwimmer et.al, (2003), “ratings of quality of life for children with
obesity were similar to those of children undergoing chemotherapy for cancer” (p. 1814).
Although obesity in adulthood that has been present from childhood may carry an
additional burden due to increased severity, much adult obesity arises through adult weight gain.
The health consequences of obesity present in adulthood are enormous, both in magnitude and
impact on quality of life. In developing its clinical guidelines, the NIH report identified an
extensive list of health conditions for which obesity increased risk. These include hypertension,
type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea
and respiratory problems, many cancers, and depression. The number of deaths per year in the
United States attributable to obesity has been estimated at about 300,000.
Obesity
4
Risk Factors
In all persons, child or adult, obesity arises due to energy imbalance: When energy intake
exceeds energy expenditure, most of the excess calories are stored as adipose tissue. To give rise
to obesity, energy imbalance must occur over a long period of time and likely reflects a
combination of factors. Individual behaviors, environmental factors, and heredity, singly and in
combination, contribute to the development of obesity. The rapidity with which the obesity
epidemic emerged rules out simple genetic explanations. The current environment in the United
States has been characterized as obesogenic, meaning that it promotes high energy intakes and
low energy expenditures—the energy imbalance that gives rise to weight gain. Modern
industrialized societies provide abundant, relatively inexpensive food; modern life is organized
to reduce energy expenditure at work and at home, through technology and urbanization. For a
species that evolved to store fat in times of plenty in order to survive in leaner times, many
individuals are genetically susceptible to gain weight in the current environment.
Excessive energy intake is a primary risk factor for the development of childhood and
adult obesity, although the specific aspects of intake responsible are controversial. Dietary
factors, such as diet composition, energy density, fat intake, fruit and vegetable consumption,
snacks, sugar-rich foods, and soft drinks, have all been identified in association with obesity.
Increased consumption of fruits and vegetables can help reduce the intake of dietary fat and
calories because they are naturally low in fat and energy density compared with other foods.
Despite current recommendations that individuals over the age of 2 years consume 2 to 4
servings of fruits and 3 to 5 servings of vegetables daily, children and adolescents eat an average
of only 3.6 servings of fruits and vegetables per day, and fried potatoes account for a large
proportion of those servings. A number of other dietary variables, including soft drinks,
Obesity
5
snacking, portion sizes, and infant feeding have also been linked to childhood obesity. Studies
suggest that the increased consumption of sugar-sweetened soft drinks, snack foods (which are
often high in fat or/and sugar), and large-sized portions of foods have contributed to the increase
in energy intakes.
Physical Activity
Reduced physical activity may be the most important factor in explaining the increase of
obesity over the past two decades. Physical activity among U.S. youth is in decline, with nearly
half of young people aged 12 to 21 reporting that they do not engage in vigorous physical
activity regularly and one fourth reporting no vigorous physical activity. Whereas leisure time
physical activity has increased in men and remained constant in women over the past four
decades in the United States, activity associated with work and home life has declined over the
same period. Sedentary behavior and “inactivity,” such as watching television and playing
video/computer games, also are contributory factors. Gortmaker et al. (1996) reported an
adjusted-odds ratio (OR) for obesity of 8.3 for adolescents who watched TV more than 5 hours
per day compared with those who watched 0 to 2 hours (Gortmaker 1996, p. 4) . Compelling
evidence comes from intervention studies, which show that reducing TV viewing time can help
prevent childhood obesity. Adults in a trial of maintenance following weight loss sustained their
losses best when physical activity was high and television viewing was low (van Baak et.al,
2003, pp. 210). TV watching may promote obesity by reducing physical activity, lowering
metabolic rate, and increasing energy intake. The latter may occur due to the fact that TV
viewing may be associated with snacking and may moderate eating habits generally through
greater exposure to advertising of foods high in added sugars and fat or by conveying mixed
Obesity
6
messages about lifestyle and health in the content of advertisements. TV viewing is a major
source of inactivity among Americans. Screen time, a summary measure of time spent viewing
television and videos and engaged in computer-based activity, represents the largest proportion
of nonsleep, nonschool time for youth.
Conclusion
Obesity has emerged as the major nutritional problem facing the pediatric and adult
populations worldwide. The etiology of obesity is multifactorial and includes individual risk
factors, genetic influences, and environmental effectors. The severity of the problem, in terms of
immediate and long-term health consequences to physical and psychological health, suggests it is
a problem that will dominate the public health agenda in the 21st century.
Obesity
7
References
Barlow, S. E. and Dietz, W. H. (1998) Obesity evaluation and treatment: Expert committee
recommendations. Pediatrics vol. 102 pp. 222–228, Data retrieved from
http://pediatrics.aappublications.org/content/102/3/e29.full on December 6, 2012
Cole, T. J., Bellizzi, M. C., Flegal, K. M., and Dietz, W. H. (2000) Establishing a standard
definition for child overweight and obesity worldwide: International survey. British
Medical Journal vol. 320 pp. 1240–1243, Data retrieved from
http://www.bmj.com/highwire/filestream/350165/field_highwire_article_pdf_abri/0 on
December 6, 2012
Cole, T. J., Freeman, J. V., and Preece, M. A. (1995) Body mass index reference curves for the
U.K., 1990. Archives of Disease in Childhood vol. 73 pp. 25–29, Data retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1511150/ on December 6, 2012
Flegal, K. M., Carroll, M. D., Ogden, C. L., and Johnson, C. L. (2002)., Prevalence and trends in
obesity among U.S. adults, 1999–2000. Journal of the American Medical Association vol.
288 pp. 1723–1727, Data retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12365955
on December 6, 2012
Gortmaker, S. L., Must, A., Sobol, A. M., Peterson, K., Colditz, G. A., and Dietz, W. H. (1996)
Television viewing as a cause of increasing obesity among children in the United States,
1986–1990. Archives of Pediatric and Adolescent Medicine vol. 150 pp. 356–362 , Data
retrieved from http://www.ncbi.nlm.nih.gov/pubmed/8634729 on December 6, 2012
Obesity
8
Latnerm, J. D. and Stunkard, A. J. (2003) Getting worse: The stigmatization of obese children.
Obesity Research vol. 11 no. (3) pp. 452–456, , Data retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/12634444 on December 6, 2012
Must, A. and Strauss, R. S. (1999) Risks and consequences of childhood and adolescent obesity.
International Journal of Obesity and Related Metabolic Disorders vol. 23 no. (Suppl. 2)
pp. S2–S11, Data retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10340798 on
December 6, 2012
National Institutes of Health. (1998). Clinical guidelines on the identification, evaluation, and
treatment of overweight and obesity in adults. Bethesda, MD: Department of Health and
Human Services, National Institutes of Health, National Heart, Lung, and Blood
Institute , Data retrieved from http://www.ncbi.nlm.nih.gov/books/NBK2003/ on
December 6, 2012
Ogden, C. L., Flegal, K. M., Carroll, M. D., and Johnson, C. L. (2002) Prevalence and trends in
overweight among U.S. children and adolescents 1999–2000. Journal of the American
Medical Association vol. 288 pp. 1728–1732 , Data retrieved
http://www.ncbi.nlm.nih.gov/pubmed/12365956 on December 6, 2012
Schwimmer, J. B., Burwinkle, T. M., and Varni, J. W. (2003) Health-related quality of life of
severely obese children and adolescents. Journal of the American Medical Association
vol. 289 no. (14) pp. 1813–1819 , Data retrieved
http://www.ncbi.nlm.nih.gov/pubmed/12684360 on December 6, 2012
Van Baak, M. A., van Mil, E., Astrup, A. V., Finer, N., Van Gaal, L. F., Hilsted, J., and et al.
(2003)Leisure-time activity is an important determinant of long-term weight maintenance
after weight loss in the Sibutramine Trial on Obesity Reduction and Maintenance
Obesity
9
(STORM trial). American Journal of Clinical Nutrition vol. 78 pp. 209–214 , Data
retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12885699 on December 6, 2012
World Health Organization. (2000). Obesity: Preventing and managing the global epidemic:
Report of a WHO consultation (WHO Technical Report Series, No. 894). Geneva: Author
, Data retrieved from www.who.int/nutrition/publications/obesity/WHO_TRS_894/en/ on
December 6, 2012
