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PubMed2006

Parents often do not recognize overweight in their child, regardless of their socio-demographic background.

To involve parents successfully in the treatment of overweight in their child, they first need to be aware of the problem and its accompanying health risks. Data on 1840 9-11 year olds from the Rotterdam Youth Health Monitor were analysed to investigate whether awareness of parents differs according to socio-demographic characteristics. In the case of overweight children, 50% of the parents do not recognize that their child is overweight. Except for age none of the investigated socio-demographic characteristics, including ethnicity and parental education, was associated with awareness. Parents of obese children show greater awareness than parents of overweight children.

Age Factors↗
PubMed2006

Overweight in children: definitions and interpretation.

Studies in a variety of countries have shown increases in the prevalence of overweight among children in recent years. These increases have given rise to concern about children's health and well-being. The terminology used in these studies varies considerably. However, whatever the terminology used, such studies are generally based on weight [expressed as body mass index (BMI), a measure of weight for height, calculated as weight in kilograms divided by the square of height in meters] and not on body fatness per se. There are many different BMI references that can be used to define childhood overweight or obesity. Children are defined as overweight for population surveillance purposes using a variety of BMI cut points. BMI is a screening tool, not a diagnostic tool. Children with a BMI over these cut points do not necessarily have clinical complications or health risks related to overfatness. More in-depth assessment of individual children is required to ascertain health status. The definitions of overweight generally used are working definitions that are valuable for general public health surveillance, screening and similar purposes.

Adolescent↗
PubMed2006

Sleep in overweight adolescents: shorter sleep, poorer sleep quality, sleepiness, and sleep-disordered breathing.

OBJECTIVE: To document the sleep of overweight adolescents and to explore the degree to which weight-related sleep pathology might account for diminished psychosocial outcome. METHODS: Sixty children aged 10-16.9 from a weight-management clinic were compared to 22 healthy controls using comprehensive actigraphic, polysomnographic, and parent- and self-report questionnaire assessments. RESULTS: Overweight participants averaged more symptoms of sleep-disordered breathing, later sleep onset, shorter sleep time, and more disrupted sleep than controls. Although the groups did not differ in self-reported sleep habits, multiple concerns were reported by parents of overweight participants, including daytime sleepiness, parasomnias, and inadequate sleep. Group differences in academic grades and depressive symptoms were at least partially accounted for by short sleep and daytime sleepiness. CONCLUSIONS: Excessive weight is associated with an increased risk of sleep problems. There is a need for further research in this area and for clinicians who work with overweight children to evaluate their sleep.

Adolescent↗
PubMed2006

Gender, ethnicity, psychosocial factors, and quality of life among severely overweight, treatment-seeking adolescents.

OBJECTIVE: To examine gender and ethnic differences in psychosocial functioning among 100 (78% African American and 59% girls) treatment-seeking overweight 11- to 18-year-old adolescents. Self-esteem was examined as a potential mediator of the association between weight-related teasing and quality of life (QOL). METHODS: Adolescents completed measures evaluating self-esteem, dietary habits, teasing, and QOL. RESULTS: Few racial or gender differences were found. Mean QOL was similar to that reported in another study examining treatment-seeking overweight adolescents and substantially lower than what has been reported for non-treatment-seeking overweight adolescents. Self-esteem partially mediated the association between teasing and QOL. CONCLUSIONS: Severely overweight adolescents of both genders and diverse ethnicities face significant stigmatization and manifest poor overall psychosocial functioning, which is negatively associated with QOL. Furthermore, self-esteem appears to partially mediate the negative relationship between teasing and QOL.

Adolescent↗
PubMed2006

ACOG Committee Opinion No. 351, November 2006: The overweight adolescent: prevention, treatment, and obstetric-gynecologic implications.

The number of overweight adolescents has grown to epidemic proportions in the United States. Adolescent females who are overweight have significant health sequelae. The American College of Obstetricians and Gynecologists recommends that all adolescents be screened annually for overweight by determining weight and stature, calculating a body mass index for age percentile, and asking about body image and eating patterns. Health care providers should promote healthy eating and physical activity to adolescent patients and their parents during routine preventive health care visits. Adolescents with a body mass index greater than or equal to the 95th percentile for age should have an in-depth dietary and health assessment to determine psychosocial morbidity and risk for future cardiovascular disease. Obstetricians-gynecologists are strongly encouraged to provide this assessment. Additional research is needed to determine the most appropriate approach for the successful prevention and treatment of overweight adolescents. Until this research has been completed, it is best to extrapolate an approach from data and studies pertaining to children and adults, while remaining cognizant of the special needs that surround adolescent growth and development. Sound nutritional recommendations and regular physical activity are essential components of prevention and treatment plans.

Adolescent↗
PubMed2006

Impact of body overweight and class I, II and III obesity on the outcome of acute biliary pancreatitis.

OBJECTIVES: Body overweight and obesity have been associated with an increased morbidity in acute pancreatitis, but conflicting results were reported in the literature with regard to the type and frequency of complications. We investigated the occurrence of complications in different classes of overweight in a homogeneous group of patients with gallstone pancreatitis. METHODS: Data were collected prospectively from 250 patients with biliary pancreatitis to allow calculation of the Blamey (Glasgow) and Acute Physiology and Chronic Health Evaluation (APACHE II) scores. According to their body mass index (BMI), the patients were allocated to different categories of body overweight. The outcome for each category was measured by the components of the Atlanta criteria. Secondary end points of the study were the length of hospital stay, the length of stay at the intensive care unit, and the number of abdominal operations. RESULTS: When compared with normal-weight patients (BMI 18.5-24.9), all categories with BMI > or =25 had an increased risk of developing the "severe" form of acute pancreatitis [odds ratio (OR): 3.55, 95% confidence interval (CI): 1.50-8.40]. Patients with class I obesity (BMI 30-34.9) developed significantly more organ failure and local complications (OR: 3.469, 95% CI: 1.15-10.43). Patients with class II and III obesity (BMI 35-49.9) had, in addition to more organ failure and local complications, also more metabolic complications (OR: 7.33, 95% CI: 1.62-33.24) than did their normal-weight counterparts. They needed also more frequently intensive care and had a longer total hospital stay. CONCLUSION: In acute biliary pancreatitis, body overweight and obesity represent a risk of more "severe" disease and the number and type of complications increase in categories of increasing BMI.

Acute Disease↗
PubMed2005

Overweight, thinness, body self-image and eating strategies of 2,121 Italian teenagers.

This study describes the prevalence rate of overweight and thinness in a population of teens living in two different areas of Italy and explores the body self-image perception and unhealthy eating behaviours and strategies to lose weight. A questionnaire was administered to a sample of 2,121 teenage students (1,084 males, 1,037 females). Results showed that teen females and males build and perceive their body images in very different ways. Most of the overall sample perceived their weight as normal, while a relevant 31.6% defined themselves as overweight and another 4.4% as heavily overweight. Analysis based on BMI (calculated through self-referred weight and height) showed that only 9.2% of our sample could be considered overweight and 1.7% obese. Most of female teen students (485 out of 1,037) were trying to lose weight, demonstrating that strategies to lose weight were undertaken also by girls perceiving themselves as normal in relation to body weight. 46.8% girls were using strategies to lose weight compared with 21.9% boys. These strategies included very problematic behaviours like self-induced vomiting (3.3% F vs 1.7% M) and dieting pills (2.8% F vs 1.5% M) undertaken along with more usual thinning strategies like dieting and exercising. Girls were more prone than boys to exercise as a way to lose weight (41% vs 31.7%). This study showed that there is a deep gap between actual weight and perceived body-image and weight. This study is one of the first of this kind in Italy and calls for primary prevention and health education programs aimed at improving teen body-image as a strategy to reduce the eating disorder epidemics spreading among young people.

Adolescent↗
PubMed2006

Stage of exercise and health-related quality of life among overweight and obese adults.

AIM: This paper reports a study whose main aim was to understand the correlation between stages of exercise and health-related qualities of life among overweight and obese adults in Taiwan. BACKGROUND: Regular exercise has been shown to improve health-related quality of life in the general population and among patients with chronic diseases. Nevertheless, systematic investigations of the correlation between exercise stages and the health-related quality of life among overweight and obese adults are lacking in Taiwan. METHOD: A cross-section of people from the weight loss clinics of a medical centre in Taipei was recruited to the study. The Chinese version of the Stages of Exercise and the Taiwanese version of Short Form 36 questionnaires were used to collect data from those whose body mass indexes were equal to or >24 kg/m2. The data were collected in 2003. RESULTS: In total, 212 overweight and obese adults participated in the study. The majority were in the preparation (38.2%) or contemplation (31.6%) stages of exercise; relatively few were in the action (14.2%) or maintenance (11.3%) stages, and the smallest number (4.7%) were in the precontemplation stage. Although over 70% of respondents were not in the habit of taking regular exercise, their motivations were very high. For the Short Form 36 scales, the highest scores were for physical functioning (84.5 +/- 17.3), while the lowest were for general health (55.5 +/- 20.9), vitality (59.8 +/- 18.1), and mental health (MH) (66.0 +/- 17.9). Different stages of exercise showed statistically significant differences within the eight domains of Short Form 36 (Wilks = 0.733, P = 0.001); a statistically significant difference was also found for physical functioning (P < or = 0.001), general health (P = 0.003), and vitality (P = 0.005). CONCLUSION: Since stages of exercise are correlated with health-related quality of life among overweight and obese adults, healthcare providers need to understand what stages people are at in order to educate them to achieve a better quality of life and to motivate those who are inactive to do more exercise on a regular basis.

Adult↗
PubMed2006

The prevention of overweight and obesity in children and adolescents: a review of interventions and programmes.

Overweight and obesity are serious, large-scale, global, public health concerns requiring population-based childhood overweight and obesity prevention. The overall objective of this review is to identify aspects of successful childhood overweight prevention programmes. This objective will be met by assessing existing interventions quantitatively as well as qualitatively, identifying efficacy, effectiveness and implementation, and evaluating potential adverse effects of previous studies. This review was limited to school-based studies with a quantitative evaluation using anthropometric outcomes and that intervene on diet or activity-related behaviours. Quantitative and qualitative approaches are used to identify factors related to successful interventions as well as adverse consequences. Sixty-eight per cent of the interventions, or 17 of the 25, were 'effective' based on a statistically significant reduction in body mass index (BMI) or skin-folds for the intervention group. Four interventions were effective by BMI as well as skin-fold measures. Of these, two targeted reductions in television viewing. The remaining two studies targeted direct physical activity intervention through the physical education programme combined with nutrition education. Of the interventions reported here, one was effective in reducing childhood overweight but was also associated with an increase in underweight prevalence. Few other studies reported outcomes for underweight. The majority of overweight/obesity prevention programmes included in this review were effective. Physical education in schools and reducing television viewing are two examples of interventions that have been successful. Because few studies report on underweight prevalence, this review recommends giving more attention to preventing adverse outcomes by reporting the intervention impact on the frequency distribution for both BMI and adiposity measures.

Adolescent↗
PubMed2006

Flow-mediated dilatation in overweight and obese women with polycystic ovary syndrome.

OBJECTIVE: There remains a large degree of disagreement about the association of polycystic ovary syndrome (PCOS) with impaired endothelial dysfunction and cardiovascular disease (CVD) risk. The purpose of this study was to determine whether overweight and obese women with PCOS have impaired endothelial function compared with weight-matched controls without PCOS and whether endothelial function is associated with cardiovascular risk markers and hormonal parameters. DESIGN: Cross-sectional analysis. SETTING: An outpatient trial at the Commonwealth Scientific Industrial Research Organisation Clinical Research Unit. POPULATION: Overweight and obese women with PCOS (n= 12) and weight-matched controls without PCOS (n= 10). METHODS: Endothelial function, cardiovascular risk markers and hormonal parameters were assessed in the patients. MAIN OUTCOME MEASURES: Endothelial function was assessed by flow-mediated dilatation (FMD) of the brachial artery using high-resolution ultrasound. Lipid profile, fasting insulin level, glucose level, insulin resistance, C-reactive protein level, folate level, Vitamin B(12) level and hormonal parameters. RESULTS: Women with PCOS had significantly higher testosterone levels (P < 0.001) and free androgen index (P= 0.006) compared with the controls without PCOS. Both groups were normoinsulinaemic, and there were no significant differences in any of the markers of CVD between women with and without PCOS. Furthermore, FMD was similar in both groups (PCOS 6.1 +/- 1.2% versus control 5.6 +/- 1.0%, P= 0.77). CONCLUSIONS: Compared with a group of weight-matched women with similar metabolic profiles, normoinsulinemic, overweight and obese women with PCOS did not show any greater impairment in endothelial function assessed by FMD. A normoinsulinemic phenotype of PCOS with low metabolic risk factors may reduce the risk of endothelial dysfunction in overweight and obese women with this syndrome. Further studies are required that directly compare FMD in normoinsulinemic and hyperinsulinaemic women with PCOS.

Adult↗
PubMed2006

Overweight in celiac disease: prevalence, clinical characteristics, and effect of a gluten-free diet.

BACKGROUND: It is well established that a minority of celiac patients present with "classic" symptoms due to malabsorption. However, few studies have focussed on the distribution of body mass index (BMI) in celiac populations and its relationship to clinical characteristics, or on its response to treatment. METHODS: We reviewed BMI measurements and other clinical and pathological characteristics from a database of 371 celiac patients diagnosed over a 10-yr period and seen by a single gastroenterologist. To assess response to gluten exclusion, we compared BMI at diagnosis and after 2 yr treatment in patients with serological support for dietary compliance. RESULTS: Mean BMI was 24.6 kg/m2 (range 16.3-43.5). Seventeen patients (5%) were underweight (BMI < 18.5), 211 (57%) were normal, and 143 (39%) were overweight (BMI > or = 25), including 48 (13% of all patients) in the obese range (BMI > or = 30.0). There was a significant association between low BMI and female gender, history of diarrhea, reduced hemoglobin concentration, reduced bone mineral density (BMD), osteoporosis, and higher grades (subtotal/total) of villous atrophy. Of patients compliant with a gluten-free diet, 81% had gained weight after 2 yr, including 82% of initially overweight patients. CONCLUSIONS: Few celiac patients are underweight at diagnosis and a large minority is overweight; these are less likely to present with classical features of diarrhea and reduced hemoglobin. Failed or delayed diagnosis of celiac disease may reflect lack of awareness of this large subgroup. The increase in weight of already overweight patients after dietary gluten exclusion is a potential cause of morbidity, and the gluten-free diet as conventionally prescribed needs to be modified accordingly.

Adult↗
PubMed2006

Moderately overweight and obese patients in general practice: a population based survey.

BACKGROUND: Obesity is a main threat to public health in the Western world and is associated with diseases such as diabetes mellitus and coronary heart diseases. Up to now a minority of research studied the relation between obesity and the use of primary health care. In the Netherlands the general practitioner (GP) is the main primary health care provider. The objective of this article is to evaluate GP consultation and prescription of drugs in moderate and severely overweight (obese) persons in the Netherlands. METHODS: Data were used from a representative survey of morbidity in Dutch general practice in 2001. Our study sample consisted of 8,944 adult respondents (18+ years) who participated in an extensive health interview. Interview data were linked to morbidity and prescription registration data from 95 general practices where respondents were listed. Body mass index (BMI) was calculated using self-reported height and weight. Analyses were controlled for clustering within practices as well as for socio-demographic and life style characteristics. RESULTS: Obesity (BMI > or = 30 kg/m2) was observed in 8.9% of men and 12.4% of women; for moderate overweight (BMI 25-< 30 kg/m2) these percentages were 42.2% and 30.4% respectively. Obese men and women were more likely to consult their GP than persons without overweight. This especially holds for diseases of the endocrine system, the cardiovascular system, the musculoskeletal system, the gastro-intestinal system, and skin problems. Related to this, obese men and women were more likely to receive drugs for the cardiovascular system, the musculoskeletal system, alimentary tract and metabolism (including, for example, antidiabetics), and dermatologicals, but also antibiotics and drugs for the respiratory system. For moderately overweight men and women (BMI 25- < 30 kg/m2) smaller but significant differences were found for diseases of the endocrine system, the cardiovascular system, and the musculoskeletal system. CONCLUSION: Obesity increases the workload of Dutch general practitioners and the use of prescribed medication. The current increase in the prevalence of obesity will further increase the use of health care and related costs. Since a large majority of Dutch persons visit their GP over the course of one year, GPs' potential role in effective prevention strategies cannot be denied.

Adult↗
PubMed2005

Overweight humans are resistant to the weight-reducing effects of melanocortin4-10.

CONTEXT: By enhancing energy expenditure and suppressing appetite, melanocortin peptides derived from proopiomelanocortin play a primary role in the hypothalamic regulation of body weight. In a recent study in normal-weight adults, the 6-wk intranasal administration of the MSH/ACTH(4-10) core fragment of proopiomelanocortin resulted in a distinct reduction of body weight and body fat, accompanied by significant decreases in leptin and insulin plasma concentrations. OBJECTIVE: The present study aimed to generalize this finding to overweight patients. DESIGN, SUBJECTS, AND INTERVENTION: MSH/ACTH(4-10) (0.5 mg) and placebo were intranasally administered once in the morning and once in the evening over a period of 12 wk in 23 overweight men (body mass index, mean +/- sem: 29.72 +/- 0.43 kg/m(2)). RESULTS: MSH/ACTH(4-10) did not induce any significant reduction in body weight, body fat, and plasma levels of insulin and leptin as compared with the effects of placebo. Melanocortin treatment was accompanied by reduced cortisol concentrations. CONCLUSIONS: We conclude that contrasting with normal-weight humans, overweight subjects are not susceptible to the effects of melanocortin administration on hypothalamic weight regulatory systems. In overweight subjects, a decreased sensitivity to ACTH/MSH peptides may derive from alterations at the level of the melanocortin receptor or at subsequent steps in the processing of the body fat signal.

Administration, Intranasal↗
PubMed2006

Association of acylated and nonacylated ghrelin with insulin sensitivity in overweight and obese postmenopausal women.

OBJECTIVE: Ghrelin [acylated (AG) and nonacylated (NAG)] has been shown to play a pivotal role in the regulation of food intake and insulin sensitivity. It is presently unclear whether variation in insulin sensitivity is related to AG and NAG levels in obese individuals. To address this issue, we determined whether insulin-sensitive overweight or obese (ISO) and insulin-resistant overweight or obese (IRO) individuals display different total ghrelin (TotG), AG, and NAG profiles during a euglycemic/hyperinsulinemic clamp (EHC). DESIGN: Eighty-nine nondiabetic overweight and obese postmenopausal women underwent EHC to evaluate insulin sensitivity. Body composition and blood lipid profiles were assessed. Subjects within the highest tertile of insulin sensitivity were described as ISO (n = 31), whereas those within the lowest tertile of insulin sensitivity were considered as IRO (n = 29). Plasma TotG, AG, and NAG profiles were assessed by RIA at 0, 60, 160, 170, and 180 min during the EHC. RESULTS: TotG and NAG levels were significantly decreased for ISO and IRO individuals during the EHC, whereas only ISO subjects displayed a significant reduction of AG concentrations (P < 0.05). AG area under the curve value and the ratio of AG/NAG (fasting and area under the curve) were significantly decreased in ISO individuals. Furthermore, maximal reduction of TotG and AG concentrations was greater in ISO compared with IRO individuals (P < 0.05). Insulin sensitivity was significantly correlated with maximal reduction of TotG (r = 0.36; P < 0.01) and AG (r = 0.36; P < 0.05) concentrations. CONCLUSION: The dysregulation of ghrelin secretion profiles during EHC is associated with insulin resistance. AG may contribute to the variation of insulin sensitivity in overweight or obese postmenopausal women.

Acylation↗
PubMed2006

Changing prevalences of overweight and obesity in primary school children--a glimmer of hope?

BACKGROUND: The current epidemic of childhood obesity is a growing public health concern. Estimates of the prevalence of obesity are necessary so that secular trends can be monitored and the need for preventative measures assessed. AIMS: To establish the prevalences of overweight and obesity in Aberdeen primary schoolchildren and to investigate how children have been changing with respect to body fatness during their primary school years. METHODS: Retrospective study of two cohorts of school entrants, using height and weight data from school nurse records. RESULTS: Data were collected on 1018 children. The prevalence of overweight among children in primary year 1 decreased from 28.7% in 1997/98 to 21.5% in 2001/02 (P<0.01). The mean BMI SD score also significantly decreased in boys from 0.51 in 1997/98 to 0.32 in 2001/02. For the 1997/98 school entrants, the prevalences of overweight and obesity did not change between school entry and the end of primary school. The mean BMI SD score decreased significantly during primary school in boys but not in girls. CONCLUSION: Although childhood overweight and obesity remain major public health concerns, we report a slight improvement in measures of obesity over time, particularly in boys.

Body Mass Index↗
PubMed2006

Prevalence of overweight among deaf children.

The study examined the prevalence of overweight cases in a sample of 151 deaf children aged 6-11 years. Participants were deaf students attending six elementary schools, both regular and special, in four states. Body mass index (BMI) was calculated using height and weight, plotted on the Center for Disease Control and Prevention (CDC) U.S. BMI-for-age growth charts, then compared to national values for same age and gender (CDC, 2006a, 2006b; National Center for Health Statistics, 2005). The results indicated that the prevalence of overweight deaf children aged 6-11 years was above the national percentage for same age and gender. A larger percentage of boys was overweight (24.7%) than girls (20.4%). After age 8 years, girls showed a consistent decrease in BMI with increasing age, a trend not demonstrated by boys. As a group, deaf children demonstrate a higher prevalence of overweight than national averages.

Age Factors↗
PubMed2005

High prevalence of overweight among pediatric users of community health centers.

OBJECTIVE: With the increasing prevalence of pediatric obesity, it is important to identify high-risk populations of children to direct limited resources for prevention and treatment to those who are most vulnerable. The objectives of this study were to determine the prevalence of overweight in children who are clients of community health centers in medically underserved areas of the Health Resources and Service Administration regions II and III (Mid-Atlantic and Puerto Rico), compare this prevalence to nationally representative data, and contrast prevalence data between geographic areas and racial/ethnic groups. METHODS: The charts from a representative sample of 2474 children using 30 community health centers in 2001 were abstracted to collect clinically measured weight and height. Overweight was defined as a body mass index of > or =95th percentile of a reference population. To generate an unbiased estimate of overweight, multiple imputations were used for missing data. These data were compared with the 1999-2002 National Health and Nutrition Examination Survey. RESULTS: The prevalence of overweight was elevated in this sample of children aged 2 to 5 years (21.8%; 95% confidence interval [CI]: 19.1-24.8) and 6 to 11 years (23.8%; 95% CI: 16.9-27.7) compared with the 1999-2002 National Health and Nutrition Examination Survey (10.3% and 15.8%, respectively). No significant differences in prevalence were observed between Asian American (18.2%; 95% CI: 11.2-28.3), Hispanic (24.6%; 95% CI: 21.3-28.2), non-Hispanic black (25.6%; 95% CI: 20.8-30.9), and non-Hispanic white (22.8%; 95% CI: 19.0-27.0) children. Furthermore, no differences in prevalence were observed between children using community health centers in continental urban (23.7%; 95% CI: 20.6-27.2), suburban (24.0%; 95% CI: 20.0-28.5), or rural (22.9%; 95% CI: 19.3-26.9) areas. CONCLUSIONS: The present study identified a population of children at particularly high risk for obesity based on the type of health care delivery system they use regardless of race/ethnicity or geographic characteristics. Because community health centers are experienced in prevention and serve >4.7 million children in the United States, they may be a particularly promising point of access and setting for pediatric obesity prevention.

Child↗
PubMed2006

Improvement in risk factors for metabolic syndrome and insulin resistance in overweight youth who are treated with lifestyle intervention.

OBJECTIVE: To evaluate the prevalence of risk factors that are associated with the metabolic syndrome and insulin resistance in overweight youth and to determine the effect of a short-term, family-centered, lifestyle intervention on various associated anthropometric and metabolic measures. METHODS: Overweight youth who were between 8 and 16 years of age participated in a 12-week, family-centered, lifestyle intervention program. Anthropometric and metabolic measures were assessed before the program in all participants (n = 109) and after the program in a subset of the participants (n = 43). RESULTS: At baseline, 49.5% of youth had multiple risk factors associated with the metabolic syndrome, based on a modified definition of the National Cholesterol Education Program, and 10% had impaired fasting glucose and/or impaired glucose tolerance. Measures of insulin resistance correlated significantly with the risk factors of the metabolic syndrome. Forty-three youth had pre- and postintervention evaluations that showed statistically significant improvements in body mass index, systolic blood pressure, lipids (total, low-density lipoprotein cholesterol, and triglycerides), postprandial glucose, and leptin levels. CONCLUSION: Overweight youth have multiple risk factors associated with the metabolic syndrome. A 12-week lifestyle program may have a positive effect on reducing risk factors for the metabolic syndrome and insulin resistance in overweight youth.

Adolescent↗