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INTRODUCTION
Obesity and overweight are increasingly viewed as serious health risks because of their growing prevalence in the population. According to Flegal, Carroll, Ogden and Johnson (4) it is estimated that at least 60% of adults in the US are classified as overweight, and that 30% of US adults meet the criteria for obesity. The health risks associated with overweight and obesity continue to be discovered, and are now estimated to impose $100 billion dollars in health care costs annually (19). Studies have shown that the percentage of the population in these categories has increased over the past 20 years, even as there has been increased awareness and focused efforts on improving health status (1). The strength of association between overweight and obesity and many other disease states continues to increase. Co-morbidities associated with obesity and overweight include hypertension (3), elevated cholesterol and poor lipid profiles (1, 9, 15), type II diabetes (2, 11), cardiovascular disease (14, 18), and cancer (6, 7, 11, 18). Overweight and obesity in children has grown at a more rapid rate (20), which can be anticipated to create an even greater financial burden as health care costs for treating these co-morbidities are accumulated over a greater portion of the lifespan.
The Centers for Medicare and Medicaid Services recently (July, 2004) made the decision to remove language from their policies that stated that obesity was not a disease. This change begins the CMS review process to determine Medicare coverage of obesity treatments, signaling that concerns regarding this crisis have now reached a policy level. Thus, it is important to develop and implement programs that help prevent and treat obesity.
The National Heart, Lung, and Blood Institute (NHLBI) (12) conducted an exhaustive review of the current knowledge on obesity, its risks, and its management. The resulting document, The Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report summarizes their findings and establishes evidence-based protocols for addressing obesity. The role of physical activity is identified in contributing to modest weight loss, decreasing abdominal fat, and assisting in weight maintenance. Strong evidence was found to support the benefits of increased physical activity when combined with a reduced calorie diet. The Clinical Guidelines on the Identification, Evaluation,...