PHYSICAL ACTIVITY AND OBESITY

432 Pages·2010·10.379 MB·English

by  Bouchard

seCond edition
Physical
Activity
and
Obesity
editors:

Claude Bouchard, Phd
Peter t. Katzmarzyk, Phd
Pennington Biomedical Research Center
Baton Rouge, Louisiana
Human Kinetics
Library of Congress Cataloging-in-Publication Data
Physical activity and obesity / Claude Bouchard, Peter T. Katzmarzyk, editors. -- 2nd ed.
p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-0-7360-7635-7 (hard cover)
ISBN-10: 0-7360-7635-2 (hard cover)
1. Obesity. 2. Exercise--Physiological aspects. I. Bouchard, Claude. II. Katzmarzyk, Peter T., 1968-
[DNLM: 1. Obesity--prevention & control. 2. Exercise--physiology. WD 210 P578 2010]
RC628.P496 2010
616.3’98062--dc22
2009047894
ISBN-10: 0-7360-7635-2 (print)
ISBN-13: 978-0-7360-7635-7 (print)
Copyright © 2010 by Claude Bouchard and Peter T. Katzmarzyk
Copyright © 2000 by Claude Bouchard
All rights reserved. Except for use in a review, the reproduction or utilization of this work in any form or
by any electronic, mechanical, or other means, now known or hereafter invented, including xerography,
photocopying, and recording, and in any information storage and retrieval system, is forbidden without
the written permission of the publisher.
The Web addresses cited in this text were current as of June 2009, unless otherwise noted.
Acquisitions Editor: Michael S. Bahrke, PhD; Managing Editor: Melissa J. Zavala; Assistant Editors: Chris-
tine Bryant Cohen, Casey A. Gentis, and Kathy Bennett; Copyeditor: Joyce Sexton; Indexer: Craig Brown;
Permission Manager: Dalene Reeder; Graphic Designer: Bob Reuther; Graphic Artist: Angela K. Snyder;
Cover Designer: Bob Reuther; Visual Production Assistant: Jason Allen; Art Manager: Kelly Hendren;
Associate Art Manager: Alan L. Wilborn; Illustrator: TwoJay!; Printer: Thomson-Shore, Inc.
Printed in the United States of America 10 9 8 7 6 5 4 3 2 1
The paper in this book is certified under a sustainable forestry program.
Human Kinetics
Web site: www.HumanKinetics.com
United States: Human Kinetics Australia: Human Kinetics
P.O. Box 5076 57A Price Avenue
Champaign, IL 61825-5076 Lower Mitcham, South Australia 5062
800-747-4457 08 8372 0999
e-mail: [email protected] e-mail: [email protected]
Canada: Human Kinetics New Zealand: Human Kinetics
475 Devonshire Road Unit 100 P.O. Box 80
Windsor, ON N8Y 2L5 Torrens Park, South Australia 5062
800-465-7301 (in Canada only) 0800 222 062
e-mail: [email protected] e-mail: [email protected]
Europe: Human Kinetics
107 Bradford Road
Stanningley
Leeds LS28 6AT, United Kingdom
[phone]
e-mail: [email protected]
E4628
Contents
Contributors xv ■  Preface xxi
Part i: definition and Assessment
of Physical Activity and obesity. . . . . . . . . . . . . . . . . . . . 1
1 5
Introduction 2 Assessing the Level
of Physical Activity in Children 22
Claude Bouchard and Peter T. Katzmarzyk
Russell R. Pate
A General Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
Gene–Physical Activity Interaction Effects . . . . . . . . . . . . . .3 Established Measures of Physical Activity . . . . . . . . . . . . .22
Progress Over the Past Decade . . . . . . . . . . . . . . . . . . . . . .4 Emerging Methods in Physical Activity Assessment . . . . .24
Important Differences Between Overweight and Obesity . . .4 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
A Major Challenge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
6
Content of the Book . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Evaluation of the Overweight Patient 26
George A. Bray
2
The Physical Activity and Exercise Continuum 7
Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26
Darren Warburton A Clinical Perspective on Setting Weight Loss Goals . . . . .26
Definition of Health, Physical Activity, and Exercise . . . . . . .7 Clinical Evaluation of the Overweight Patient . . . . . . . . . . .27
The Continuum of Physical Activity Behavior . . . . . . . . . . . .8 Clinical History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27
Estimates and Indices of Physical Activity . . . . . . . . . . . . . .9 Family History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 Physical Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27
Laboratory Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29
3
Assessing the Level of Sedentarism 13
7
Assessment of Obesity in Children 30
Mark S. Tremblay
John H. Himes
Relationship Between Sedentarism and Heal th . . . . . . . . .13
Behavior Compensation . . . . . . . . . . . . . . . . . . . . . . . . . . .14 Definitions and Nomenclature . . . . . . . . . . . . . . . . . . . . . .30
Methods to Assess Sedentarism . . . . . . . . . . . . . . . . . . . .14 Clinical Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31
Examples of Sedentarism Assessment . . . . . . . . . . . . . . .16 Public Health Applications . . . . . . . . . . . . . . . . . . . . . . . . .31
Implications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17 Research Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . .31
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33
4 Assessing the Level 8 Limitations of Self-Report
of Physical Activity in Adults 18 in Physical Activity and Obesity Research 34
Barbara E. Ainsworth Richard P. Troiano
Movement Construct . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 Methods of Reported Weight Status . . . . . . . . . . . . . . . . .34
Measuring Physical Activity Behaviors . . . . . . . . . . . . . . . .20 Methods of Reported Physical Activity . . . . . . . . . . . . . . . .34
Measuring Energy Expenditure . . . . . . . . . . . . . . . . . . . . .21 Evaluating Agreement Between Self-Reports
and Objective Measures . . . . . . . . . . . . . . . . . . . . . . . .35
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21
Beyond Bias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36
Implications of Reporting Error . . . . . . . . . . . . . . . . . . . . .37
■ iii
Part ii: Prevalence and Cost issues . . . . . . . . . . . . . . . . . . . . .39
9 12
Global Prevalence of Adult Physical Inactivity 40 The Economic Cost of Obesity 53
Wendy J. Brown Peter T. Katzmarzyk
Comparisons From National Population Methods to Estimate Costs . . . . . . . . . . . . . . . . . . . . . . . .53
Surveillance Instruments . . . . . . . . . . . . . . . . . . . . . . .40 Direct Costs of Obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . .54
“International” Surveys for Measuring Indirect Costs of Obesity . . . . . . . . . . . . . . . . . . . . . . . . . .55
Physical (In)Activity . . . . . . . . . . . . . . . . . . . . . . . . . . .41
Lifetime Health Care Costs . . . . . . . . . . . . . . . . . . . . . . . . .56
International Comparisons in Europe . . . . . . . . . . . . . . . . .41
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56
Global Physical Activity . . . . . . . . . . . . . . . . . . . . . . . . . . .42
Minority Populations . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43 13
Global Prevalence of Childhood Obesity 57
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43
Tim Lobstein
10
The Prevalence of Children’s Physical Activity 44 Definitions of Child Overweight and Obesity . . . . . . . . . . .57
Prevalence Levels in Childhood and Adolescence . . . . . . .58
Chris Riddoch
Worldwide Prevalence Levels . . . . . . . . . . . . . . . . . . . . . . .58
Accelerometer Measures of Physical Activity . . . . . . . . . . .44
Secular Trends and Demographic Differences . . . . . . . . . .60
Levels of Physical Activity . . . . . . . . . . . . . . . . . . . . . . . . .45
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60
Future Directions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47 14
The Economic Cost of Physical Inactivity 61
11 Global Prevalence of Adult Obesity 48 Ian Janssen
Direct Versus Indirect Costs . . . . . . . . . . . . . . . . . . . . . . . .61
W. Philip T. James
Population-Level Versus Individual-Level Costs . . . . . . . .62
Secular Increases in Obesity . . . . . . . . . . . . . . . . . . . . . . .48
Currents Costs Versus Lifetime Costs . . . . . . . . . . . . . . . .63
Overall Global Prevalences . . . . . . . . . . . . . . . . . . . . . . . . .50
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64
Regional Differences . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50
Sex Differences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50 15
The Cost-Benefit Relationship of Physical
Age, Period, and Cohort Effects . . . . . . . . . . . . . . . . . . . . .51 Activity Interventions for Obesity 65
Socioeconomic Differences . . . . . . . . . . . . . . . . . . . . . . . .52
Larissa Roux

Cost-Effectiveness Analyses in Obesity . . . . . . . . . . . . . . .65
Determining Cost . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66
Putting It Together in the Real World . . . . . . . . . . . . . . . . .66
Addressing Challenges Through the Project
MOVE Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67
Future Directions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68
iv ■
Part iii: determinants of Physical Activity Levels . . . . . . . . . . .69
16 20
Biological Regulation U.S. Ethnic Differences in Physical Activity
of Physical Activity Level 70 and Sedentary Behavior 85
Catherine M. Kotz Robert L. Newton, Jr.
Spontaneous Physical Activity . . . . . . . . . . . . . . . . . . . . . .70 Physical Activity in Adults . . . . . . . . . . . . . . . . . . . . . . . . .85
Physical Activity Regulation . . . . . . . . . . . . . . . . . . . . . . . .70 Sedentary Behavior in Adults . . . . . . . . . . . . . . . . . . . . . . .86
Physical Activity and Body Weight . . . . . . . . . . . . . . . . . . .71 Physical Activity in Children . . . . . . . . . . . . . . . . . . . . . . . .87
Potential Mechanisms . . . . . . . . . . . . . . . . . . . . . . . . . . . .72 Sedentary Behavior in Children . . . . . . . . . . . . . . . . . . . . .87
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .72 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .88
17 Genetics and Physical Activity Level 73 21 Psychological Factors
and Physical Activity Level 89
Tuomo Rankinen
Rod K. Dishman
Evidence From Genetic Epidemiology Studies . . . . . . . . . .73
Evidence From Molecular Studies . . . . . . . . . . . . . . . . . . .74 Moderators and Mediators of Physical Activity . . . . . . . . .89
Future Directions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75 Measurement of Social-Cognitive
Moderators and Mediators . . . . . . . . . . . . . . . . . . . . . .90
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75
Measurement of Physical Activity . . . . . . . . . . . . . . . . . . .91
18 Environments and Choice . . . . . . . . . . . . . . . . . . . . . . . . . .91
Epigenetic or Programming Effects
onPhysical Activity Level 77 Biology and Choice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .91
Multilevel Models of Physical Activity Change . . . . . . . . . .91
Mark H. Vickers Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .92
Evidence From Animal Models and Epidemiology . . . . . . .77
22
Possible Mechanisms . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79 Effects of the Built Environment
Epigenetic Basis for Reduced Physical Activity . . . . . . . . .79 onPhysical Activity Level 93
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80
James F. Sallis
19 Need for Transdisciplinary Collaboration . . . . . . . . . . . . . .93
Socioeconomic Position
and Physical Activity Levels 81 Built Environments and Physical Activity in Adults . . . . . .94
Built Environments and Physical Activity in Youth . . . . . . .95

Lise Gauvin Causal Role of Built Environments . . . . . . . . . . . . . . . . . . .95
Conceptualization and Operationalization of SEP . . . . . . . .81 Strengths and Weaknesses . . . . . . . . . . . . . . . . . . . . . . . .96
Socioeconomic Position and Physical Activity Levels . . . .82 Future Directions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .96
Socioeconomic Position and Physical Activity
Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .83
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .84
■ v
Part iV: Physical Activity and risk of obesity. . . . . . . . . . . . . . .97
23
Sedentary Time and the Risk Energy Expenditure and Physical Activity
of Obesity in Adults 98 in Childhood and Adolescence . . . . . . . . . . . . . . . . . .112
Tracking Physical Activity . . . . . . . . . . . . . . . . . . . . . . . . .112
Ross Andersen
Physical Activity and Adiposity
Obesity and Sedentary Versus Active Choices . . . . . . . . . .98 During Childhood and Adolescence . . . . . . . . . . . . . .112
Associations of Sedentary and Leisure-Time Childhood and Adolescent Activity
Activities With Obesity . . . . . . . . . . . . . . . . . . . . . . . . .99 and Adiposity in Adulthood . . . . . . . . . . . . . . . . . . . . .112
Sedentary Activity and Weight Regain . . . . . . . . . . . . . . . .99 Transition From Adolescence Into Adulthood . . . . . . . . .113
Reducing Sedentary Time to Treat Obesity . . . . . . . . . . .100 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .113
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .100
28
Childhood Obesity and the Risk of Adult Obesity 114
24
Sedentary Time and the Risk
of Obesity in Children 101 François Trudeau
Body Mass Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .114
Steven L. Gortmaker
Effect of Gender . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .115
Television Viewing and Obesity Risk . . . . . . . . . . . . . . . .101
Skinfolds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .116
Effects of TV Viewing on Energy Expenditure
Waist Circumference . . . . . . . . . . . . . . . . . . . . . . . . . . . .116
and Dietary Intake . . . . . . . . . . . . . . . . . . . . . . . . . . . .102
Challenges for Research . . . . . . . . . . . . . . . . . . . . . . . . . .116
Other Sedentary Behaviors and Obesity Risk . . . . . . . . . .102
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .116
Sedentary Time and Physical Activity Levels . . . . . . . . . .102
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .103 29
Physical Activity and Risk
of Obesity in Older Adults 117
25
Physical Activity Level and the Risk
of Obesity in Adults 104 Wendy M. Kohrt
John M. Jakicic Prevalence of Obesity in Older Adults . . . . . . . . . . . . . . .117
Prevalence of Physical Activity in Older Adults . . . . . . . .118
Cross-Sectional Association Between
Does Physical Activity Prevent
Body Weight and Physical Activity . . . . . . . . . . . . . . .104
Fat Accumulation With Aging? . . . . . . . . . . . . . . . . . .118
Physical Activity and Weight Change . . . . . . . . . . . . . . . .105
Does Physical Activity Reduce
Cardiorespiratory Fitness and Weight Change . . . . . . . . .105
Obesity Risk in Older Adults? . . . . . . . . . . . . . . . . . . .119
Sedentary Behavior and Weight Change . . . . . . . . . . . . .105
Independent Effects of Physical Activity
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .106
and Obesity on Physical Function . . . . . . . . . . . . . . . .120
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .120
26 Physical Activity Level and the Risk
of Obesity in Children 107 30
Physical Fitness and Risk of Obesity 121
Margarita S. Treuth
Steven N. Blair
Levels of Physical Activity in Children and Adolescents . . .107
Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .122
Childhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .108
Fitness and Obesity in Children and Adolescents . . . . . . .122
Adolescence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .110
Fitness and Obesity in Adults . . . . . . . . . . . . . . . . . . . . . .124
Future Directions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .110
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .125
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .110
31
The Interaction of Diet
27
Childhood and Adolescent Physical Activity
and Physical Activity on Obesity 126
and Risk of Adult Obesity 111
Tom Baranowski
Robert M. Malina
The Energy Balance Concept . . . . . . . . . . . . . . . . . . . . . .126
Body Mass Index as Influenced
Emerging Questions About Diet and Physical Activity . . . .127
by Growth and Maturation . . . . . . . . . . . . . . . . . . . . .111
Future Directions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .128
Tracking Body Mass Index and Risk
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .128
of Overweight or Obesity . . . . . . . . . . . . . . . . . . . . . . .112
vi ■
Part V: Physical Activity and Biological determinants
of obesity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
32 36
Physical Activity Level Physical Activity Level
and Resting Metabolic Rate 130 and Adipose Tissue Biology 146
Angelo Tremblay Isabelle de Glisezinski
Resting Metabolic Rate in Exercise-Trained Individuals . . .130 Adipocyte Lipolysis Regulation . . . . . . . . . . . . . . . . . . . .146
Acute Effect of Exercise on RMR . . . . . . . . . . . . . . . . . . .130 Lipolysis and Exercise in Obesity . . . . . . . . . . . . . . . . . . .147
A Genotype–Exercise Interaction Effect on RMR . . . . . . .131 Lipolysis and Exercise Training in Obese Persons . . . . . .149
Obesity Treatment and RMR . . . . . . . . . . . . . . . . . . . . . .131 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .150
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .131
37
Physical Activity and Leptin Biology 151
33
Physical Activity
David J. Dyck
and Thermic Effect of Food 132
Importance of Skeletal Muscle
Yves Schutz
and the Potential Role of Leptin . . . . . . . . . . . . . . . . .152
Factors Influencing TEF in Obesity . . . . . . . . . . . . . . . . . .132 Acute Effects of Leptin Regulation of Muscle Fatty
Thermic Effect of Food Combined With Exercise . . . . . . .133 Acid Metabolism and Insulin Sensitivity . . . . . . . . . . .152
Thermic Effect of Food and Exercise Training . . . . . . . . .134 Chronic Effects of Leptin Regulation of Muscle Fatty
Acid Metabolism and Insulin Sensitivity . . . . . . . . . . .153
Exercise, TEF, and Postprandial Substrate Utilization . . . .134
Physical Activity and Leptin . . . . . . . . . . . . . . . . . . . . . . .153
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .135
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .154
34
Physical Activity
38
and Substrate Oxidation 136 Physical Activity Level
and Hypothalamic Peptides 155
Steven R. Smith
Christopher D. Morrison
Metabolic Inflexibility in Obesity
and Type 2 Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . .136 Hypothalamic Regulation of Energy Balance . . . . . . . . . .155
Reduced Capacity for Fat Oxidation? . . . . . . . . . . . . . . . . 136 Hypothalamic Regulation of Physical Activity:
General Considerations . . . . . . . . . . . . . . . . . . . . . . . .156
Is Inflexibility “Preprogrammed” Into Muscle Cells? . . . .137
Regulation of Physical Activity
Importance of Physical Activity
by Hypothalamic Neuropeptides . . . . . . . . . . . . . . . . .156
in Glucose and Fat Oxidation . . . . . . . . . . . . . . . . . . . .137
Effect of Physical Activity on the Hypothalamus . . . . . . .157
Intramyocellular Lipid Droplets
as a Fuel Source During Exercise . . . . . . . . . . . . . . . .138 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .158

Intramyocellular Lipid Droplets
39
as a Buffer Against “Lipotoxicity”? . . . . . . . . . . . . . . . 140 Physical Activity Level and Gut Peptides 159
Fat Oxidation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .140
Stephen C. Woods
Intensity and Duration of Exercise
Needed to Improve Metabolic Flexibility . . . . . . . . . . .140 Gastrointestinal Peptides . . . . . . . . . . . . . . . . . . . . . . . . .160
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .141 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .161
35 Physical Activity and Sympathetic 40 Physical Activity Level
Nervous System Activity 142 and Thyroid Hormones 162
Ian A. Macdonald Anthony C. Hackney
Exercise and the Sympathoadrenal System . . . . . . . . . . .143 Regulation and Physiologic Function . . . . . . . . . . . . . . . .162
Physical Activity and the Sympathoadrenal System . . . . .144 Physical Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .145 Lipid Metabolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .164
Obesity and Exercise . . . . . . . . . . . . . . . . . . . . . . . . . . . .165
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .165
■ vii
41 44
Physical Activity Level and the Genetics of Obesity 178
Hypothalamic-Pituitary-Adrenal Axis 166
Ruth J.F. Loos
Denis Richard
Evidence for a Genetic Contribution to Obesity . . . . . . . .178
The HPA Axis and Stress . . . . . . . . . . . . . . . . . . . . . . . . .166 Mendelian Disorders and Single-Gene Disorders . . . . . . .179
The HPA Axis, Exercise, and Exercise Training . . . . . . . . .167 Genes for Common Obesity . . . . . . . . . . . . . . . . . . . . . . .179
The HPA Axis, Energy Homeostasis, and Obesity . . . . . .169 Future Directions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .182
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .169 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .182
42 Physical Activity Level 45 Epigenetic Effects on Obesity 183
and Skeletal Muscle Biology 170
Peter W. Nathanielsz
David A. Hood
Altered Regulation of Appetite and Physical Activity . . . .184
Myofibrillar Isoforms . . . . . . . . . . . . . . . . . . . . . . . . . . . .171
General Mechanisms of Epigenetic Modification
Calcium-Handling Kinetics . . . . . . . . . . . . . . . . . . . . . . . .172 of Gene Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . .185
Energy Provision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .172 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .186
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .173
43
Postexercise Energy Expenditure 174
Elisabet Børsheim
Methodological Considerations . . . . . . . . . . . . . . . . . . . .174
Aerobic Exercise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .175
Supramaximal Exercise . . . . . . . . . . . . . . . . . . . . . . . . . .175
Resistance Exercise . . . . . . . . . . . . . . . . . . . . . . . . . . . . .175
Mechanisms Underlying EPOC . . . . . . . . . . . . . . . . . . . . .176
Effect of Subject Characteristics . . . . . . . . . . . . . . . . . . . .176
Effect of Diet Composition . . . . . . . . . . . . . . . . . . . . . . . .177
Implications for Total Energy Expenditure and Obesity . . . .177
Part Vi: Physical Activity, Behavioral, and environmental
determinants of obesity . . . . . . . . . . . . . . . . . . . . . . . 187
46 47
Physical Activity Level, Sleep, and Obesity 188 Physical Activity Level and Occupational Work 192

Shawn D. Youngstedt David R. Bassett, Jr.
Epidemiologic Association of Sleep Duration Historical Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . .192
With Obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .188 Recent Time Trends in Modern
Potential Mechanisms . . . . . . . . . . . . . . . . . . . . . . . . . . .189 Industrialized Civilizations . . . . . . . . . . . . . . . . . . . . . .192
Long Sleep and Obesity . . . . . . . . . . . . . . . . . . . . . . . . . .190 Relationships Between Occupational
Influence of Exercise on Sleep Physical Activity and Obesity . . . . . . . . . . . . . . . . . . .193
and Implications for Obesity . . . . . . . . . . . . . . . . . . . .190 How Jobs Influence Caloric Expenditure . . . . . . . . . . . . .193
Future Directions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .190 Worksite Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . .194
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .194
48
Physical Activity Level
and Mode of Transportation 195
Catrine Tudor-Locke
Active Transportation . . . . . . . . . . . . . . . . . . . . . . . . . . . .196
Passive Transportation . . . . . . . . . . . . . . . . . . . . . . . . . . .197
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .197
viii ■
49 51
Effects of the Built Environment on Obesity 199 Physical Activity Level and Dietary Intake 210
Neville Owen Conrad P. Earnest
Associations of the Built Environment With Obesity . . . .199 What Is Compensation? . . . . . . . . . . . . . . . . . . . . . . . . . .210
Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .200 Does Dieting Mean a License to Eat? . . . . . . . . . . . . . . . .211
Significance of Sedentary Behaviors . . . . . . . . . . . . . . . .201 Does Exercise Volume Matter? . . . . . . . . . . . . . . . . . . . . .211
A Better Understanding . . . . . . . . . . . . . . . . . . . . . . . . . .201 Refining Energy Balance . . . . . . . . . . . . . . . . . . . . . . . . . .212
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .202 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .213
50
Socioeconomic Status and Obesity 203
Youfa Wang
Global Perspectives on Adults . . . . . . . . . . . . . . . . . . . . .203
Both Sexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .206
Socioeconomic Status and Weight Change
in Adults From Developed Countries . . . . . . . . . . . . . .206
A Global Perspective of Children
in Developed Countries . . . . . . . . . . . . . . . . . . . . . . . .207
Recent Findings in the United States . . . . . . . . . . . . . . . .207
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .209
Part Vii: Physical Activity in the Prevention
and treatment of obesity . . . . . . . . . . . . . . . . . . . . . . 215
52 54
Physical Activity in the Prevention Weight Loss Induced
of Weight Gain 216 by Physical Activity Versus Diet 223
Mikael Fogelholm Joseph E. Donnelly
Secular Trends in Physical Activity and Obesity . . . . . . . .216 Negative Energy Balance for Weight Loss . . . . . . . . . . . .223
Prospective Studies on Physical Activity Energy Gap Caused by Energy Restriction
and Weight Change . . . . . . . . . . . . . . . . . . . . . . . . . . .216 or Physical Activity . . . . . . . . . . . . . . . . . . . . . . . . . . .224
Reasons for Conflicting Results . . . . . . . . . . . . . . . . . . . .217 Energy Gap Caused by Energy Restriction
The Public Health Message . . . . . . . . . . . . . . . . . . . . . . .218 and Physical Activity . . . . . . . . . . . . . . . . . . . . . . . . . .224
Energy Restriction Plus Physical Activity

53 and Fat Mass Loss . . . . . . . . . . . . . . . . . . . . . . . . . . .224
Physical Activity for Weight Loss 219
Resistance Training and Weight Loss . . . . . . . . . . . . . . . .224
Robert Ross Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .225
Physical Activity, Weight Loss,
55
and Obesity Reduction . . . . . . . . . . . . . . . . . . . . . . . .219 Role of Physical Activity
Physical Activity Without Weight Loss in Pharmacological Weight Loss 226
and Obesity Reduction . . . . . . . . . . . . . . . . . . . . . . . .221
Frank L. Greenway
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .222
Lack of Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .226
Potential Role of Exercise . . . . . . . . . . . . . . . . . . . . . . . . .227
Future Directions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .228
■ ix
56 61
Role of Physical Activity Physical Activity and Weight Control
in Surgical Weight Loss 229 During Pregnancy 249
Paul E. O’Brien Michelle F. Mottola
Current Types of Weight Loss Surgery . . . . . . . . . . . . . .229 Healthy Lifestyle Approach for Weight Control . . . . . . . .250
Rationale for Exercise in Bariatric Surgery . . . . . . . . . . . .229 Activity Recommendations . . . . . . . . . . . . . . . . . . . . . . . .250
Does Exercise Make a Difference? . . . . . . . . . . . . . . . . . .230 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .252
Recommendations for Exercise Programs
in Bariatric Surgical Patients . . . . . . . . . . . . . . . . . . . .231 62 Physical Activity and Postpartum Weight Loss 253
Future Directions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .232
Cheryl Lovelady
57
Physical Activity and Depot-Specific Fat Loss 233 Exercise Effects in Lactation . . . . . . . . . . . . . . . . . . . . . . .253
Other Physical Activity Interventions . . . . . . . . . . . . . . . .254
Victor Katch
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .254
Subject Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .233
Measurement Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . .234 63 Physical Activity and Birth Weight 256
Body Areas Studied and Exercise Mode . . . . . . . . . . . . . .234
Johan G. Eriksson
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .236
Maternal Physical Activity During Pregnancy
58 Physical Activity, Visceral Fat, and Offspring Birth Size . . . . . . . . . . . . . . . . . . . . . . .256
and Ectopic Fat Deposition 237 Developmental Origins of Health and Disease . . . . . . . . .256
Birth Size and Exercise . . . . . . . . . . . . . . . . . . . . . . . . . . .256
Bret Goodpaster
Protective Effect of Exercise
Effects of Physical Activity Among Individuals Born Small . . . . . . . . . . . . . . . . . .257
on Visceral Abdominal Fat . . . . . . . . . . . . . . . . . . . . . .237 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .257
Effects of Physical Activity
on Intra- and Extramyocellular Lipids . . . . . . . . . . . . .237 64
Physical Activity and Body Composition
Physical Activity and Intrahepatic Fat . . . . . . . . . . . . . . . .238 in Children 259
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .238
Bernard Gutin
59
Physical Activity, Weight Loss, Body Mass Index as an Indicator
and Maintenance of Lean Mass 240 of Intervention Effectiveness . . . . . . . . . . . . . . . . . . . .259
Positive Energy Balance as a Cause
Steven B. Heymsfield
for Pediatric Obesity . . . . . . . . . . . . . . . . . . . . . . . . . .260
Body Composition and Energy Expenditure Effects . . . . .240 Experimental Trials of Physical Activity
Low-Calorie Diet Effects . . . . . . . . . . . . . . . . . . . . . . . . . .241 and Body Composition . . . . . . . . . . . . . . . . . . . . . . . .261
Combined Activity and Low-Calorie Diet Effe cts . . . . . . .241 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .262
Experimental Observations . . . . . . . . . . . . . . . . . . . . . . . .242
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .244
60
Physical Activity
for Weight Loss Maintenance 245
Rena R. Wing
Relationship Between Activity
and Weight Loss Maintenance . . . . . . . . . . . . . . . . . .245
Amount of Physical Activity to Prescribe . . . . . . . . . . . . .246
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .247
x ■