Canadian clinical practice guidelines on the management and prevention of obesity in adults and children [summary]CMAJ 2007;176(8 suppl): S1-13 This is a summary of the full document, which consists of this summary as well as 26 chapters on specific aspects of obesity prevention and management.The full document can be found at www.cmaj.ca/cgi/content/full/176/8/S1/DC1.O besity is now reaching epidemic proportions in both developed and developing countries and is affecting not only adults but also children and adolescents. Over the last 20 years, obesity has become the most prevalent nutritional problem in the world, eclipsing undernutrition and infectious disease as the most significant contributor to ill health and mortality. It is a key risk factor for many chronic and noncommunicable diseases.In Canada, the prevalence of overweight and obesity has increased over recent decades among both children and adults in all areas of the country. According to the most recent estimates from the 2004 Canadian Community Health Survey, 1 59% of the adult population is overweight (i.e., body mass index [BMI] ≥ 25 kg/m 2 ) and 1 in 4 (23%) is obese (i.e., BMI ≥ 30 kg/m 2 ). The sheer numbers of people who are overweight and obese highlight a pressing public health problem that shows no signs of improving in the near future. What is more alarming is the problem of obesity among children and adolescents in Canada, which is advancing at an even more rapid pace than obesity among adults. In 2004, 1 in 4 (26%) Canadian children and adolescents aged 2-17 years was overweight. The obesity rate has increased dramatically in the last 15 years: from 2% to 10% among boys and from 2% to 9% among girls.1,2 This increase is cause for concern, since there is a tendency for obese children to remain obese as adults. Moreover, obesity-related health problems are now occurring at a much earlier age and continue to progress into adulthood. Given the recent temporal obesity trends among children and youth, the prevalence of obesity among adults will likely continue to increase as the current generation of children enters adulthood.Obesity should no longer be viewed as a cosmetic or body-image issue. There is compelling evidence that overweight people are at increased risk of a variety of health problems, including type 2 diabetes, hypertension, dyslipidemia, coronary artery disease, stroke, osteoarthritis and certain forms of cancers. It has recently been estimated that about 1 in 10 premature deaths among Canadian adults 20-64 years of age is directly attributable to overweight and obesity. In addition to affecting personal health, the increased health risks translate into an increased burden on the health care system. The cost of obesity in Canada has been conservatively estimated to be $2 billion a year or 2.4% of total health care expenditures in 1997.3 Thus, the continuing epidemic of obesity in Canada is exacting a high toll on the health of the population.The cause of obesity is complex and multifactorial. Within the context of environm...

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The adipocyte-derived hormone, leptin, and its receptor, are now known to be integral components of a physiological signalling system that regulates fuel stores and energy balance. Constitutive leptin expression has been demonstrated only in adipose tissue, placenta and stomach. We have used RT-PCR to show that leptin mRNA is selectively transcribed in specific areas of rat brain and pituitary, and in a rat glioblastoma cell line. Using immunocytochemistry we have also shown leptin protein immunoreactivity in the corresponding tissues and cells, and confirmed this by Western blot using two epitope-specific antisera. Leptin mRNA expression in the hypothalamus is suppressed by fasting (48hr), suggesting a role for brain leptin in the central regulation of appetite. These data support the hypothesis that central nervous system derived leptin is a likely ligand for central leptin receptors.

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