scholarly journals Parental perception of physical activity among school children aged 7 years in Montenegro

2020 ◽  
Vol 79 (OCE2) ◽  
Author(s):  
Zorica Đorđević ◽  
Enisa Kujundžić ◽  
Borko Bajić
Keyword(s):  
Public Health ◽  
Physical Activity ◽  
School Children ◽  
Population Group ◽  
Overweight And Obesity ◽  
Free Time ◽  
Activity Level ◽  
Anthropometric Measurement ◽  
Public Health Approach ◽  
Parental Perception

AbstractIntroduction:Globalisation and modern lifestyles are contributing to different public health problems, especially in early age.Objectives:To present the result of family questionnaires regarding the parental perception of physical activity in children and to discuss the importance of findings compared to overweight and obesity rates in this population group.Methodology:In Montenegro Childhood obesity surveillance initiative (COSI) including 7 years old school children was conducted for the first time in 2016 in accordance with WHO protocol. In total 3581 children were examined and 3162 family questionnaires collected. We analyzed a part of the family questionnaires dealing with children free time in correlation with the results of anthropometric measurements.Results:In working days, according to the parents' claims, around 73% of children spend more than an hour playing outside, while at weekends that number is around 95%. Spending free time in front of the screen longer than 4 hours is bigger at weekends comparing to working days 14%:4%. The results of anthropometric measurement show that around 1/5 of boys and girls are overweighed and around over 1/5 of boys and 1/10 are obese.Conclusion:Parental perception of physical activity level among children is one of the key factors that could influence children growth and development into healthy, resilient adults. Public health approach in strengthening this perception is rising awareness of knowledge, attitudes and behavior of parents regarding the connection between physical activity, free time and overweight and obesity rates in their children.

scholarly journals HUBUNGAN ASUPAN ENERGI, STRES KERJA, AKTIFITAS FISIK, DAN DURASI WAKTU TIDUR DENGAN IMT PADA MANAJER MADYA DINAS PEMERINTAH KOTA SURABAYA

2019 ◽  
Vol 3 (1) ◽  
pp. 40
Author(s):  
Annisa Risqi Wulandari ◽  
Dhenok Widari ◽  
Lailatul Muniroh
Keyword(s):  
Physical Activity ◽  
Nutritional Status ◽  
Job Stress ◽  
Energy Intake ◽  
Sleep Duration ◽  
Overweight And Obesity ◽  
Activity Level ◽  
Middle Manager ◽  
Anthropometric Measurement ◽  
Cluster Sampling

Background: Prevalence of overweight and obesity in adult has increased each year in Indonesia. Middle managers were groups at risk for overweight because their job characteristics such as low physical activity and risk of experiencing job stress. Economy support in middle manager was one of supporting factor which affect to higher amount of energy intake. Overweight in adult can affect on their health status and work productivityObjectives: The purpose of this study was to analyze the correlation between energy intake, job stress, physical activity and sleep duration with BMI in middle manager.Methods: This was an observational study with cross sectional design. 49 Middle Manager in Surabaya’s Government Agency were selected using cluster sampling. Nutritional status data were collected using anthropometric measurement, energy intake using SQ-FFQ, job stress using OSI-R questionnaire, physical activity and sleep duration data using activity recall. Data were analyzed by Pearson product moment test.Results: This study showed that most of respondents has normal nutritional status (61.2%), adequate energy intake (47%), moderate level job stress (69.4%), low (46.9%) and moderate (46.9%) physical activity level, and lack of sleep duration (59.2%). There were correlation between energy intake (p=0.001) and sleep duration (p=0.006) with BMI. Job stress (p=0.227) and phyisical activity (p=0.148) had no correlation with BMI.Conclusions: higher energy intake and lower sleep duration would increase BMI.ABSTRAKLatar Belakang: Prevalensi status gizi lebih pada penduduk dewasa semakin meningkat di Indonesia. Manajer madya merupakan kelompok yang berisiko mengalami kegemukan karena jenis pekerjaan kantor yang ringan serta rentan mengalami stres kerja. Dukungan ekonomi juga menjadi salah satu faktor pendukung besarnya asupan energi dibandingkan energi yang dikeluarkan untuk beraktifitas. Masalah gizi lebih pada penduduk dewasa dapat memengaruhi status kesehatan dan produktifitas kerja seseorang.Tujuan: Tujuan penelitian ini adalah untuk menganalisis hubungan antara asupan energi, stres kerja, aktifitas fisik dan durasi waktu tidur dengan Indeks Massa Tubuh (IMT) pada Manajer Madya.Metode: Penelitian ini adalah observasional dengan desain penelitian potong lintang. Sebanyak 49 manajer madya di Dinas Pemerintah Kota Surabaya dipilih menggunakan metode cluster sampling. Pengumpulan data menggunakan pengukuran antropometri untuk IMT, SQ-FFQ untuk asupan energi, kuesioner OSI-R untuk stres kerja serta recall aktifitas fisik untuk data aktifitas fisik dan durasi waktu tidur. Analisis data menggunakan uji korelasi pearson product moment.Hasil: Penelitian menunjukkan bahwa sebagian besar responden memiliki status gizi normal (61,2%), kecukupan energi tergolong baik (47%), stres kerja tingkat sedang (69,4%), aktifitas fisik ringan (46,9%) dan sedang (46,9%) serta durasi tidur yang kurang (59,2%). Terdapat hubungan antara asupan energi (p=0,001) dan durasi waktu tidur (0,006) dengan IMT. Stres kerja (p=0,227) dan aktifitas fisik (p=0,148) tidak berhubungan dengan IMT.Kesimpulan: Semakin tinggi asupan energi dan semakin singkat durasi waktu tidur maka akan semakin tinggi IMT pada manajer madya.

scholarly journals Factors Associated with Overweight and Obesity among Reproductive Age Women of Kaski District, Nepal

2020 ◽  
Vol 10 (1) ◽  
pp. 1-7
Author(s):  
Narayan Tripathi ◽  
Arun Kumar Koirala ◽  
Rojana Dhakal
Keyword(s):  
Public Health ◽  
Physical Activity ◽  
Physical Activity Level ◽  
Married Women ◽  
Overweight And Obesity ◽  
Activity Level ◽  
Reproductive Age ◽  
Moderate Physical Activity ◽  
Women Of Reproductive Age ◽  
Factors Associated

Introduction: Overweight and obesity are associated with numerous comorbidities so they are of great public health concern. In Nepal, the proportion of overweight and obese women of reproductive age has been gradually increasing which marks obesity as a serious public health challenge. The study aimed to assess the factors associated with overweight and obesity among reproductive aged women residing in Pokhara metropolitan. Methods: A cross-sectional study was conducted among 278 married women of reproductive age at Pokhara metropolitan, Kaski district, Nepal using probability proportional to size sampling method. Face to face interview was conducted among respondents through pretested questionnaire. Similarly, height and weight were also measured. Based on anthropometric measurements, Body Mass Index was computed and defined according to the World Health Organization criteria. The association between overweight /obesity and the explanatory variables were assessed in bivariate analysis using the Chi-square test and the association was further explored by using multivariate logistic regression. Results: The prevalence of overweight and obesity was 49.6%; with 33.7% of overweight and 15.9 % of obesity. Factors associated with overweight/obesity were age (AOR= 13.85, 95% CI: 5.77-40.80), business as occupation (AOR=7.39, 95%CI: 2.25-14.17), fast food consumption of three or more times a week (AOR=3.42, 95%CI: 1.01-11.63), energy intake above the RDA (AOR=5.45; 95%CI: 2.19-13.55), low or moderate physical activity level (AOR=2.84; 95%CI: 1.18-6.83) and multiparity (AOR=17.80; 95%CI: 4.04-89.06). Conclusions: The study provides evidence that the prevalence of overweight, obesity is remarkably high in married women of reproductive age in Pokhara metropolitan. The study concluded older age, business as occupation, consumption of fast foods for three or more times per week, low or moderate physical activity level, energy intake above the RDA and multiparty had higher odds of being overweight/obesity. On the other hand fruits and vegetables consumption were found to be protective against overweight/obesity.

scholarly journals Program Obesity Zero (POZ) – a community-based intervention to address overweight primary-school children from five Portuguese municipalities

2013 ◽  
Vol 16 (6) ◽  
pp. 1043-1051 ◽  
Author(s):  
Ana Isabel Rito ◽  
Maria Ana Carvalho ◽  
Carlos Ramos ◽  
João Breda
Keyword(s):  
Physical Activity ◽  
Childhood Obesity ◽  
Waist Circumference ◽  
Primary School ◽  
School Children ◽  
Low Income ◽  
Overweight And Obesity ◽  
Activity Level ◽  
Primary School Children ◽  
Nutrition And Physical Activity

AbstractObjectiveResults of the WHO European Childhood Obesity Surveillance Initiative indicated that on average one out of four primary-school children is overweight or obese. Portugal presented one of the highest prevalences of obesity. Childhood obesity prevention and treatment should be a top priority. The aim of the present study was to evaluate the effectiveness of Program Obesity Zero (POZ), a multi-component, community-, family- and school-based childhood obesity intervention.DesignParents and children attended four individual nutrition and physical activity counselling sessions, a one-day healthy cooking workshop and two school extracurricular sessions of nutrition education. Waist circumference, BMI, physical activity level, sedentary behaviours, and nutrition and physical activity knowledge, attitudes and behaviour were assessed at baseline and after 6 months. Diet was assessed using two 24 h recalls, at baseline and at 6 months.SettingFive Portuguese municipalities and local communities.SubjectsTwo hundred and sixty-six overweight children (BMI ≥ 85th percentile) aged 6–10 years, from low-income families in five Portuguese municipalities, were assigned to the intervention.ResultsChildren showed reductions in waist circumference (−2·0 cm; P < 0·0001), mean BMI (−0·7 kg/m2; P < 0·0001) and BMI-for-age percentile (−1·7; P < 0·0001) at 6 months. Overall, children's intake of fruit and vegetables was <400 g/d throughout the intervention. After 6 months, higher fibre consumption and an apparent decrease in sugary soft drinks intake to a quarter of that observed at baseline (mean intake: 198 ml/d at baseline), with improvements in physical activity levels and screen time <2 h/d, were also observed.ConclusionsThe findings suggested that POZ is a promising intervention programme, at municipality level, to tackle childhood overweight and obesity.

scholarly journals Urbanization and greenness in HBSC survey: association with overweight and obesity in adolescents

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
V Bellisario ◽  
R Bono ◽  
G Squillacioti ◽  
M Caputo ◽  
I Gintoli ◽  
...  
Keyword(s):  
Public Health ◽  
Physical Activity ◽  
Risk Factors ◽  
Air Pollution ◽  
Population Density ◽  
Weight Status ◽  
Overweight And Obesity ◽  
Green Spaces ◽  
Children Health ◽  
Public Health Strategies

Abstract Background Childhood obesity is an important public health issue worldwide and includes different risk factors, such as environmental pollutants exposure or physical activity. Neighborhood composition and green spaces availability could contrast obesogenic lifestyles and promote healthy habits, whereas, urbanization and traffic volume exposure are inversely associated with physical activity and worsen effects on childhood health. Methods This project analyzed students involved in the HBSC survey from the Piedmont Region. Data were collected in 2018, following the protocol. All the subjects were georeferenced within buffers around schools. Green-spaces availability was measured by Normalised Difference Vegetation Index (NDVI-satellite images) while urbanization was calculated by population density, traffic intensity (satellite measurements) and air pollution concentration (sampling stations). Results Overall, the sample included 3022 subjects, with amount 50% male/female and 30% for each age group (11-13-15 years old). Concerning weight status, above 14% of the all sample is obese or overweight, with, respectively, 20% among boys and 11% among girls. Preliminary analyses showed an association between weight status and population density (rural vs urbanized areas). Currently, we are analyzing the association with greenness and the other measures of urbanization. Conclusions Our preliminary findings suggest that high urbanization levels impact health implementing weight in children. We are testing the hypothesis that greenness positively influences weight status and reduce negative effects of urbanization and air pollution. The managing of these risk factors must be deepened and corroborated by active preventive Public Health strategies for improving children health. Key messages Urbanization and greenness may influence weight status in children. Public Health strategies must be improved for children health.

scholarly journals PHYSICAL ACTIVITY LEVEL AND ENERGY EXPENDITURE ASSESSED BY ACCELEROMETRY IN 60Y+ BRAZILIAN SUBJECTS

2019 ◽  
Vol 25 (2) ◽  
pp. 116-120
Author(s):  
Luiz Antonio dos Anjos ◽  
Bruna de Andrade Messias da Silva ◽  
Vivian Wahrlich
Keyword(s):  
Physical Activity ◽  
Energy Expenditure ◽  
Physical Activity Level ◽  
Overweight And Obesity ◽  
Activity Level ◽  
Convenience Sample ◽  
Physical Activity Recommendations ◽  
Physical Activity Programs ◽  
Sedentary Activities ◽  
Activity Recommendations

ABSTRACT Objective: To assess the physical activity level (PAL) and the total daily energy expenditure (EE-TDEE) in a sample of ≥60y subjects from Niterói, Rio de Janeiro, Brazil. Methods: A convenience sample of 88 subjects recruited from recreational physical activity programs wore an accelerometer around the waist for seven consecutive days for at least 10h/day. Minute-by-minute EE was estimated from the counts per minute (CPM) data, and the daily sum yielded the TDEE. PAL (TDEE/BMR) with BMR calculated with the FAO/WHO predictive equation and a population-specific equation. Body composition was assessed by DXA. Results: Mean age (SD) was 69.2 (5.8) years, the prevalence of overweight and obesity was 36.4 and 25.0%, respectively, and excess body fat was 39.8%. The subjects spent 600min/day engaged in sedentary activities (CPM<100). Men engaged in 30min of moderate-to-vigorous physical activity (CPM≥1,952) daily, on average. The subjects were active on 34.5 and 18.0% of the weekdays and weekend days with a 1,400 steps/day difference between these days. TDEE was 1,731.5 (348.7) and 1,356.3 (223.7) kcal/day depending on the BMR prediction equation used. Mean PAL was lower than the maintenance level. Conclusions: The high prevalence of sedentary activities and the low percentage of subjects who met the physical activity recommendations indicate that physical activity programs must be adjusted so that the enrolled subjects can meet the physical activity recommendations, preferably with the activities objectively monitored. Population-specific equations improve the final estimation of TDEE and PAL. Level of Evidence I; Diagnostic studies - Investigating a diagnostic test.

Physical activity and sedentary behaviors associated with overweight and obesity among primary school children in Tanzania: a case-control study

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Renatha Pacific ◽  
Kissa Kulwa ◽  
Haikael D. Martin ◽  
Pammla Petrucka
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
School Children ◽  
Case Control Study ◽  
Case Control ◽  
Overweight And Obesity ◽  
Primary School Children ◽  
Sedentary Behaviors ◽  
Content Type ◽  
Control Study

Purpose This study aims at determining the risk of physical inactivity and sedentary behaviors on overweight and obesity among primary school children aged 10–13 years in Tanzania. Design/methodology/approach A case-control study was conducted from January to March 2020 involving 69 overweight/obese children as cases and 138 normal weight children as controls. Cases were identified as having body mass index-for-age ≥ +1 standard deviation (SD) and controls as those having BMI-for-age range between −2 SD to <+1 SD. A validated questionnaire was used for data collection on daily physical activities and sedentary behavior types, frequency duration and activity score. An independent sample t-test was used to compare means of activity score between cases and controls. Binary logistic regression was used to predict risk factors for overweight/obesity. Findings Risk factors for overweight/obesity were listening to music and/or radio for >2 h/week (OR 2.7, 95% CI 1.2–6.1) and walking for exercise <2 h/week (OR 2.1, 95% confidence interval [CI] 1.1–4.1). On the other hand, rope skipping for >2 h/week (OR 0.14, 95% CI 0.03–0.7) was a protective factor against overweight/obesity. Controls had a significantly higher mean score of being active during lunch breaks compared to cases (p = 0.012). Cases had higher weight, height and percentage body fat than controls (p < 0.001). The home environment provided more avenues for physical activity than the school environment. Originality/value To the best of the authors’ knowledge, this is original research work and the first case-control study to predict physical activity and sedentary behaviors as risk factors for overweight and obesity in Tanzanian school children.

scholarly journals Physical activity and health in Chinese children and adolescents: expert consensus statement (2020)

2020 ◽  
Vol 54 (22) ◽  
pp. 1321-1331
Author(s):  
Peijie Chen ◽  
Dengfeng Wang ◽  
Hongbing Shen ◽  
Lijuan Yu ◽  
Qian Gao ◽  
...  
Keyword(s):  
Public Health ◽  
Physical Activity ◽  
Children And Adolescents ◽  
Consensus Statement ◽  
Overweight And Obesity ◽  
Chinese Children ◽  
Health Concern ◽  
Future Research ◽  
Activity Promotion ◽  
Chinese Children And Adolescents

China is experiencing significant public health challenges related to social and demographic transitions and lifestyle transformations following unprecedented economic reforms four decades ago. Of particular public health concern is the fourfold increase in overweight and obesity rates in the nation’s youth population, coupled with the low prevalence of adolescents meeting recommended levels of physical activity. Improving the overall health of China’s more than 170 million children and adolescents has become a national priority. However, advancing nationwide health initiatives and physical activity promotion in this population has been hampered by the lack of a population-specific and culturally relevant consensus on recommendations for achieving these ends. To address this deficiency and inform policies to achieve Healthy China 2030 goals, a panel of Chinese experts, complemented by international professionals, developed this consensus statement. The consensus was achieved through an iterative process that began with a literature search from electronic databases; in-depth reviews, conducted by a steering committee, of the resulting articles; and panel group evaluations and discussions in the form of email correspondence, conference calls and written communications. Ultimately, the panel agreed on 10 major themes with strong scientific evidence that, in children and adolescents aged 6–17, participating in moderate to vigorous physical activities led to multiple positive health outcomes. Our consensus statement also (1) highlights major challenges in promoting physical activity, (2) identifies future research that addresses current knowledge gaps, and (3) provides recommendations for teachers, education experts, parents and policymakers for promoting physical activity among Chinese school-aged children and adolescents. This consensus statement aligns with international efforts to develop global physical activity guidelines to promote physical activity and health and prevent lifestyle-related diseases in children and adolescents. More importantly, it provides a foundation for developing culturally appropriate and effective physical activity interventions, health promotion strategies and policy initiatives to improve the health of Chinese children and adolescents.

scholarly journals Exercise for the Management of Diabetes Mellitus: A Review of the Evidence

2013 ◽  
Vol 3 (2) ◽  
pp. 99-108
Author(s):  
Md. Shahjamal Khan
Keyword(s):  
Public Health ◽  
Physical Activity ◽  
Diabetes Mellitus ◽  
Aerobic Exercise ◽  
Public Health Problem ◽  
Moderate Intensity ◽  
Public Health Approach ◽  
Diabetic Patients ◽  
Published Evidence ◽  
Exercise Programmes

Diabetes mellitus is a public health problem in both developed and developing countries and has increased alarmingly, giving the disease the dimension of an epidemic. The aetiology of diabetes is multifactorial involving genetic, environmental, and behavioural origins. Exercise is an important part for the management of diabetes mellitus. Regularly planned exercise reduces insulin resistance, improves glucose tolerance, improves lipid profile and increases cardiovascular and cardiopulmonary function. This article critically reviews the more relevant evidence on the interrelationships between exercise and diabetes mellitus. This study included bibliography research from both the review and the research literatures on exercise in diabetes mellitus. From this review it appears that the effects of aerobic exercise are well established, and interventions with more vigorous aerobic exercise programmes resulted in greater reductions in HbA1c, greater increase in oxygen consumption and greater increase in insulin sensitivity. Considering the available evidence, it appears that resistance training could be an effective intervention to help glycaemic control, especially considering that the effects of this form of intervention are comparable with what is reported with aerobic exercise. It is well established that physical activity produces general and specific health benefits for diabetic patients. The basic principles of an effective exercise programme are the intensity, duration and frequency of exercise in an appropriate environment. Usually, moderate-intensity and long-duration exercise programmes are considered most suitable for diabetic patients. As it is supported by published evidence, encouragement to adopt increased physical activity and reduction of sedentary behaviour is a successful public health approach for diabetes mellitus prevention and management. Journal of Enam Medical College; Vol 3 No 2 July 2013; Page 99-108 DOI: http://dx.doi.org/10.3329/jemc.v3i2.16133

How Many Steps Are Enough? Dose–Response Curves for Pedometer Steps and Multiple Health Markers in a Community-Based Sample of Older Australians

2014 ◽  
Vol 11 (3) ◽  
pp. 509-518 ◽  
Author(s):  
Ben Ewald ◽  
John Attia ◽  
Patrick McElduff
Keyword(s):  
Public Health ◽  
Physical Activity ◽  
Older Adults ◽  
Dose Response ◽  
Activity Level ◽  
Response Curves ◽  
Markers Of Inflammation ◽  
Health Target ◽  
Steps Per Day ◽  
Dose Response Curves

Background:Although an overall public health target of 10,000 steps per day has been advocated, the dose–response relationship for each health benefit of physical activity may differ.Methods:A representative community sample of 2458 Australian residents aged 55–85 wore a pedometer for a week in 2005–2007 and completed a health assessment. Age-standardized steps per day were compared with multiple markers of health using locally weighted regression to produce smoothed dose–response curves and then to select the steps per day matching 60% or 80% of the range in each health marker.Results:There is a linear relationship between activity level and markers of inflammation throughout the range of steps per day; this is also true for BMI in women and high density lipoprotein in men. For other markers, including waist:hip ratio, fasting glucose, depression, and SF-36 scores, the benefit of physical activity is mostly in the lower half of the distribution.Conclusions:Older adults have no plateau in the curve for some health outcomes, even beyond 12,000 steps per day. For other markers, however, there is a threshold effect, indicating that most of the benefit is achieved by 8000 steps per day, supporting this as a suitable public health target for older adults.

scholarly journals Diet and physical activity as determinants of weight gain, overweight and obesity: The WCRF/AICR evidence and policy implications

2020 ◽  
Vol 79 (OCE2) ◽  
Author(s):  
Isobel Bandurek ◽  
Emily Almond ◽  
Susannah Brown ◽  
Giota Mitrou ◽  
Ifigeneia Bourgiezi ◽  
...  
Keyword(s):  
Public Health ◽  
Physical Activity ◽  
Health Policy ◽  
Weight Gain ◽  
Public Health Policy ◽  
Screen Time ◽  
Overweight And Obesity ◽  
Evidence Based ◽  
Diet And Physical Activity ◽  
Adults And Children

AbstractIntroductionGlobally, over 1.97 billion adults and 338 million children and adolescents are living with overweight and obesity, increasing the risk of numerous co-morbidities, including at least 12 cancers(1). WCRF/AICR conducted a literature review of diet and physical activity as determinants of weight gain, overweight and obesity in adults and children. We also introduce a novel evidence-based policy framework for promoting physical activity, and linked database, currently in development as part of the EU-funded CO-CREATE project on child and adolescent obesity prevention.Materials and MethodsEvidence on diet and physical activity as determinants and risk of weight gain, overweight and obesity was systematically extracted from existing reviews and a systematic search for recent meta-analyses, then collated and analysed. The WCRF Continuous Update Project Expert Panel drew conclusions about which exposures influence risk of weight gain, overweight and obesity, using pre-defined criteria that included evidence of biological plausibility.ResultsThe Panel identified strong evidence that several diet and physical activity related exposures influence the risk of weight gain, overweight and obesity in adults and children (see table 1). Separate conclusions were drawn for adults and children in relation to screen time, considered a marker of sedentary time.However, the Panel noted that as exposures tend to cluster, physiologically interact and share common biological mechanisms, they should not be regarded as absolutely ‘singular'but an integrated concept of interrelated exposures within a pattern of lifestyle. Table 1.Risk of weight gain, overweight and obesitySTRONG EVIDENCEDECREASES RISKINCREASES RISKCONVINCINGWalkingScreen time (children)Sugar sweetened drinksPROBABLEAerobic physical activityFoods containing dietary fibre‘Mediterranean type’ dietary patternHaving been breastfedScreen time (adults)‘Fast foods’‘Western type’ dietFor full list of footnotes, see Energy Balance and Body Fatness report(1).DiscussionHealthy dietary patterns help prevent excess weight gain. Achieving such patterns requires attention to the broader economic, environmental and social factors that influence and constrain people's behaviour. The findings of this report support the need for evidence-based public health policy to help create health-enabling environments, particularly for children and adolescents. The WCRF International MOVING framework(2) presents a package of policies to promote physical activity, which alongside wider public health policy can help address the multiple drivers of overweight and obesity.

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