Obesity reviews : an official journal of the International Association for the Study of Obesity
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Obstructive sleep apnea-hypopnea syndrome involves recurring episodes of total obstruction (apnea) or partial obstruction (hypopnea) of airways during sleep. Obstructive sleep apnea-hypopnea syndrome affects mainly obese individuals and it is defined by an apnea-hypopnea index of five or more episodes per hour associated with daytime somnolence. In addition to anatomical factors and neuromuscular and genetic factors, sleep disorders are also involved in the pathogenesis of sleep apnea. ⋯ Sleep apnea treatment includes obesity treatment, use of equipment such as continuous positive airway pressure, drug therapy and surgical procedures in selected patients. Currently, there is no specific drug therapy available with proven efficacy for the treatment of obstructive sleep apnea-hypopnea syndrome. Body-weight reduction results in improvement of sleep apnea, and obesity treatment must be emphasized, including lifestyle changes, anti-obesity drugs and bariatric surgery.
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The literature on pulmonary gas exchange at rest, during exercise, and with weight loss in the morbidly obese (body mass index or BMI > or = 40 kg m(-2)) is reviewed. Forty-one studies were found (768 subjects weighted mean = 40 years old, BMI = 48 kg m(-2)). The alveolar-to-arterial oxygen partial pressure difference (AaDO2) was large at rest in upright subjects at sea level (23, range 5-38 mmHg) while the arterial pressure of oxygen (PaO2) was low (81, range 50-95 mmHg). ⋯ Weight loss of 45 kg (BMI = -13 kg m(-2)) over 18 months is associated with an improvement in PaO2 (by 10 mmHg, range 1-23 mmHg), a reduction in AaDO2 (by 8 mmHg, range -3 to -16 mmHg), and PaCO2 (by -3 mmHg, range 3 to -14 mmHg) at rest. Every 5-6 kg reduction in weight increases PaO2 by 1 and reduces AaDO2 by 1 mmHg, respectively. Morbidly obese women have better gas exchange at rest compared with morbidly obese men which is likely due to lower waist-to-hip ratios in women than from differences in weight or BMI.
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Taking a food supply chain approach, this paper examines the regulation of food marketing and nutrition labelling as strategies to help combat obesity in China in an era of rapid agro-food industry growth. China is the largest food producer and consumer in the world. Since the early 1980s, the agro-food industry has undergone phenomenal expansion throughout the food supply chain, from agricultural production to trade, agro-food processing to food retailing, and from food service to advertising and promotion. ⋯ Government legislation and guidance, as well as self-regulation and voluntary initiatives, are needed to reduce children's exposure to food advertising and promotion, and increase the effectiveness of nutrition labelling. Policies on food marketing and nutrition labelling should be adapted to the China context, and accompanied by further action throughout the food supply chain. Given China's unique characteristics and position in the world today, there is an opportunity for the government and the agro-food industry to lead the world by creating a balanced, health promoting model of complementary legislation and industry action.