Health at Every Size

Health at Every Size (HAES) is an idea that "supports people in adopting health habits for the sake of health and well-being (rather than weight control).".[1] It hopes to remove discrimination of obesity and improve standard of living for people who are overweight. HAES believes that traditional restrictive dieting does not result in sustained weight loss for some people,[2] HAES suggests that this method is not always healthful. HAES proposes that health is a result of behaviors that are independent of body weight and submits that societal obsession with thinness does not allow for diversity in body shapes.[3] HAES has recently gained popularity among proponents of the fat acceptance movement as an alternative to weight-loss.[4][5]

Overview

HAES does not pursue the goal of a particular body weight, but rather concentrates on what health benefits and improvements can practically be achieved for individuals. Typically, practicing HAES includes listening to internal body signals and taking care of the body with nutritious varied eating and enjoyable exercise. Scientific studies show a causal link between obesity and increased morbidity.[6] HAES proponents believe that obese people who are unhealthy may be unhealthy not because fat in and of itself is unhealthy, but because years of attempting to lose weight and gaining it back (a process referred to as yo-yo dieting) purportedly causes health issues.[7] Today there are over 8,000 pledges to HAES.

HAES proponents believe that:

  1. In many cases, attempts to diet to lose weight do not lead to sustained weight loss in the long term.[8]
  2. Self-acceptance promotes improved mental health and happiness.[9]

History

The history of Health At Every Size first started in the 1960s as a focus on the changing culture of aesthetics and the repercussions of such a change of fat people. On November 4, 1967, Lew Louderback wrote an article called “More People Should Be Fat!” that appeared in a major national magazine, The Saturday Evening Post.[10] It is one of the earliest, if not the first, critical writings in American media. In the article, Louderback discussed a variety of issues, including:

  1. There are “thin fat people” who suffer physically and emotionally from having dieted to below their natural body weight.
  2. Forced changes in weight are not only likely to be temporary, but also to cause physical and emotional damage.
  3. Dieting seems to unleash destructive emotional forces.
  4. Eating normally, without dieting, allowed Louderback and his wife to relax, feel physically better, and normalize and stabilize their eating and weight.

Bill Fabrey, a young engineer at the time, read the article and contacted Louderback a few months later in 1968. Fabrey helped Louderback research his subsequent book, Fat Power, and Louderback supported Fabrey in founding the National Association to Aid Fat Americans (NAAFA) in 1969, a nonprofit human rights organization. NAAFA would subsequently change its name by the mid-1980s to the National Association to Advance Fat Acceptance.

In 1982, Bob Schwartz wrote Diets Don’t Work, a book that was based on his program of the same name.[11] Schwartz noticed how people who ate unrestricted were not worried about food and weight, and taught what would be later called intuitive eating. Molly Groger wrote a book about her training program, Eating Awareness Training, which also helped people return to intuitive eating. Both Groger and Schwartz however, suggested that by following intuitive eating, people would end up losing weight.

At about the same time, two more books were published; The Dieter’s Dilemma by William Bennett, MD, and Joel Gurin, and Breaking the Diet Habit, by Janet Polivy and C. Peter Herman. Bennett and Gurin posited that nearly all people had set weight points, which regulated each person’s body fat and weight, and that dieting resulted in lowered metabolic rates and rebound weight gain, which made dieting useless. Polivy and Herman discussed the “natural weight” range, which varied by individuals in a species, and recommended intuitive eating -which had not been given a name yet- and accepting one’s natural size, as an alternative to struggling with dieting. They also re-framed dieting as “restrained eating,” wherein one ignored body signals and instead responded to external cues. Linda Bacon is also an important role in this movement today. Linda Bacon is the leader of many HAES workshops and has written four books based on the HAES principles.

Scientific evidence

Proponents claim that evidence from certain scientific studies[12] has provided some rationale for a shift in focus in health management from weight loss to a weight-neutral approach in individuals who have a high risk of type 2 diabetes and/or symptoms of cardiovascular disease.

This study of around 3000 Finns over an 18-year period showed that while "weight loss in the obese improves risk factors for cardiovascular diseases and diabetes"[13] there is a small amount of evidence that weight loss from dieting can result in slightly increased mortality in those who are moderately overweight, while those who maintained their weight (but did not gain any additional weight) fared the best.[13][14] The study states, "overall, preventing people, especially children, from becoming overweight in the first place seems crucial, since this work suggests that once weight is gained losing it again may not be good for health."[13] Finally, the study concludes, "This conclusion does not contradict the possible beneficial effects of planned weight loss in obese individuals who have already developed co-morbidities of their obesity, such as type 2 diabetes and symptoms of cardiovascular disease."[13]

Similar conclusions are drawn by other studies where intentional weight loss was found to be associated with slightly increased mortality for healthy weight individuals and the slightly overweight but not the obese, while for those who are obese but otherwise healthy the effect of weight loss is neutral.[12][15][16] This may reflect the loss of subcutaneous fat and beneficial mass from organs and muscle in addition to visceral fat when there is a sudden and dramatic weight loss.[14]

Criticism

Amanda Sainsbury-Salis, an Australian medical researcher, calls for a rethink of the HAES concept,[17] arguing it is not possible to be and remain truly healthy at every size, and suggests that a HAES focus may encourage people to ignore increasing weight, which her research states is easiest to lose soon after gaining. She does, however, note that it is possible to have healthy behaviours that provide health benefits at a wide variety of body sizes.

David L. Katz, a prominent public health professor at Yale, wrote an article in the Huffington Post entitled "Why I Can't Quite Be Okay With 'Okay at Any Size'",[18] which while it does not explicitly name HAES as the topic of the piece, it could easily interpreted as such. While he applauds the principles of anti-obesity bias, his opinion is that a continued focus on being 'okay at any size' (which may be an allusion to HAES) may normalise ill-health and prevent action being taken to reduce the burden of disease that is caused by obesity.

Scientific criticism

Many studies show clear links between mortality and obesity.[19][20][21] In recent years, medical studies have continued to promote healthy living and recently have focussed on the so-called 'healthy obesity' concept. A notable study which was published in the Journal of the American College of Cardiology in 2014 shows that obesity is correlated to higher artery plaque, which means higher risk for heart disease and stroke despite the participant's current lipid profile.[22][23] A recent meta-analysis found elevated risk for all-causes mortality and cardiovascular disease in metabolically-healthy obese patients, estimating the relative risk for these patients vs. metabolically-healthy normal-weight individuals at 1.24. However, this is lower than the relative risks estimated for metabolically-unhealthy obese patients (RR 2.65) and for metabolically-unhealthy non-obese patients (RR 3.14).[24] Another review found that metabolically-healthy obesity "is an important, emerging phenotype with risks somewhere intermediate between healthy, normal weight and unhealthy, obese individuals."[25] One complicating factor is that definitions of metabolically-healthy obesity are not currently standardized across studies.[26]

Studies show that obesity causes a wide variety of health problems.[27] These problems range from congestive heart failure,[28] high blood pressure,[29] deep vein thrombosis and pulmonary embolism,[30] type two diabetes, infertility,[31] birth defects,[32] stroke,[33] dementia,[34] cancer,[35] asthma and chronic obstructive pulmonary disease[36] and erectile dysfunction.[37] Additionally, obesity complicates any operation and can cause significant postoperative wound care problems.[38]

Obesity is associated with cardiovascular diseases including angina and myocardial infarction.[39][40] A 2002 report concluded that 21% of ischemic heart disease is due to obesity[27] while a 2008 European consensus puts the number at 35%.[41]

Having a BMI greater than 30 doubles one's risk of congestive heart failure.[42][43]

More than 85% of those with hypertension have a BMI greater than 25.[43] The risk of hypertension is 5 times higher in the obese as compared to those of normal weight. A definitive link between obesity and hypertension has been found using animal and clinical studies, which have suggested that there are multiple potential mechanisms for obesity-induced hypertension. These mechanisms include the activation of the sympathetic nervous system as well as the activation of the renin–angiotensin-aldosterone system.[44] The association between hypertension and obesity has been also well described in children.[45]

Obesity increases one's risk of venous thromboembolism by 2.3 fold.[46][47]

One of the strongest links between obesity and disease is that with type 2 diabetes. These two conditions are so strongly linked that researchers in the 1970s started calling it “diabesity”.[43] Excess weight is behind 64% of cases of diabetes in men and 77% of cases in women.[48]

Due to its association with insulin resistance, the risk of PCOS increases with adiposity. In the US approximately 60% of patients with PCOS have a BMI greater than 30.[49]

Obesity leads to infertility in both men and women. This is primarily due to excess estrogen interfering with normal ovulation in women[43] and altering spermatogenesis in men.[50] It is believed to cause 6% of primary infertility.[43][51] A review in 2013 came to the result that obesity increases the risk of oligospermia and azoospermia in men, with an of odds ratio 1.3.[52] Being morbidly obese increases the odds ratio to 2.0.[52]

Obesity is related to many complications in pregnancy including: haemorrhage, infection, increased hospital stays for the mother, and increased NICU requirements for the infant.[53] Obese women have more than twice the rate of C-sections compared to women of normal weight.[54] Obese women also have increased risk of preterm births and low birth weight infants.[55]

Those who are obese during pregnancy have a greater risk of have a child with a number of congenital malformations including: neural tube defects such as anencephaly and spina bifida, cardiovascular anomalies, including septal anomalies, cleft lip and palate, anorectal malformation, limb reduction anomalies, and hydrocephaly.[56]

Ischemic stroke is increased in both men and women who are obese.[43] For women with a BMI greater than 30, the risk of ischemic stroke increases by 1.7 fold,[57] while men with a BMI greater than 30 had a risk of stroke 2.0 times greater.[58]

Those who are obese have a rate of dementia 1.4 times greater than those of normal weight.[59]

Many cancers occur at increased frequency in those who are overweight or obese. A study from the United Kingdom found that approximately 5% of cancer is due to excess weight.[60] These cancers include: [61]

Al high body mass index (BMI) is associated with a higher risk of developing ten common cancers including 41% of uterine cancers and at least 10% of gallbladder, kidney, liver and colon cancers in the UK.[62]

Compared to men with a BMI of 21–23, men with a BMI of 30–35 have 2.3 times more gout, and men with a BMI of greater than 35 have 3.0 times more gout. Weight loss decreases these risks.[63]

Increased rates of arthritis are seen in both weight-bearing and non-weight-bearing joints.[43] Those with a BMI greater than 26.4 had rate of osteoarthritis of the knees 6 times greater than those with a BMI of less than 23.4, well rates of osteoarthritis in the hand was about 1.5 times greater.[64]

Obese individuals are twice to four times more likely to have lower back pain than their normal weight peers.[65]

Urge, stress, and mixed incontinence all occur at higher rates in the obese.[66] The rates are about double that found in the normal weight population.[67] Urinary incontinence improves with weight loss.[68]

Obesity increases one's risk of renal failure by three to four times.[69]

References

  1. ↑ http://www.haescommunity.org/
  2. ↑ Mann, Traci; Tomiyama, A. Janet,Westling, Erika, Lew, Ann-Marie, Samuels, Barbra, Chatman, Jason (April 2007). "Medicare's search for effective obesity treatments: Diets are not the answer.". American Psychologist 62 (Eating Disorders): 220–233. doi:10.1037/0003-066x.62.3.220.
  3. ↑ Brown, Lora Beth (March–April 2009). "Teaching the "Health At Every Size" Paradigm Benefits Future Fitness and Health Professionals". Journal of Nutrition Education and Behavior 41 (2): 144–145. doi:10.1016/j.jneb.2008.04.358.
  4. ↑ "NAAFA Policy Recommendations". National Association to Advance Fat Acceptance.
  5. ↑ "Activists See Diet Industry as Drain on Money, Self-Esteem". USA Today. Associated Press. August 2, 2004.
  6. ↑ Shields, Margot; Gorber, S. Connor and Tremblay, M. A. (September 2008). "Associations between obesity and morbidity: effects of measurement methods.". Obesity Reviews 9 (5): 501–502. doi:10.1111/j.1467-789x.2008.00496.x.
  7. ↑ "Does sustained weight loss lead to decreased morbidity and mortality?". International Journal of Obesity 23 (S5): S20. 1993. doi:10.1038/sj.ijo.0800982.
  8. ↑ http://www.clinsci.org/cs/124/0231/cs1240231.htm
  9. ↑ Robison, Jon; Kelly Putnam; Laura McKibbin (2007). "Health At Every Size: a compassionate, effective approach for helping individuals with weight-related concerns--Part II". American Association of Occupational Health Nurses 55 (5): 185–192.
  10. ↑ Louderback, Lew (Nov 4, 1967). "More People Should Be Fat". The Saturday Evening Post.
  11. ↑ Bob Schwartz (1996). Diets don't work. Breakthru Pub. ISBN 978-0-942540-16-1.
  12. ↑ 12.0 12.1 Bacon L, Aphramor L. (2011). "Weight science: evaluating the evidence for a paradigm shift". Nutr J 10:9. doi:10.1186/1475-2891-10-9. PMC 3041737. PMID 21261939.
  13. ↑ 13.0 13.1 13.2 13.3 Sørensen TI, Rissanen A, Korkeila M, Kaprio J (2005). "Intention to Lose Weight, Weight Changes, and 18-y Mortality in Overweight Individuals without Co-Morbidities". PLoS Medicine 2 (6; e171). doi:10.1371/journal.pmed.0020171. PMC 1160579. PMID 15971946.
  14. ↑ 14.0 14.1 Kendall Powell (May 31, 2007). "The Two Faces of Fat". Nature 447 (7144): 525–7. doi:10.1038/447525a. PMID 17538594.
  15. ↑ Harrington M, Gibson S, Cottrell RC (2009). "A review and meta-analysis of the effect of weight loss on all-cause mortality risk". Nutr Res Rev. 22 (1): 93–108. doi:10.1017/S0954422409990035. PMID 19555520.
  16. ↑ Ingram DD, Mussolino ME. (2010). "Weight loss from maximum body weight and mortality: the Third National Health and Nutrition Examination Survey Linked Mortality File". Int J Obes 34 (6): 1044–1050. doi:10.1038/ijo.2010.41. PMID 20212495.
  17. ↑ Sainsbury, Amanda (2014 Mar 18). "Call for an urgent rethink of the ‘health at every size’ concept". J Eat Disord 2 (8). doi:10.1186/2050-2974-2-8. Retrieved 2015-04-29. Check date values in: |date= (help)
  18. ↑ Katz, David. "Why I Can't Quite Be Okay With 'Okay at Any Size'". Huffington Post. Retrieved 29 April 2015.
  19. ↑ Samaras TT, Storms LH (1992). "Impact of height and weight on life span.". Bull World Health Organ 70 (2): 259–67. PMC 2393304. PMID 1600586.
  20. ↑ "Negative health effects of obesity". Michigan State University. Michigan State University Board of Trustees. 2014.
  21. ↑ Schwimmer JB, Burwinkle TM, Varni JW (2003). "Health-related quality of life of severely obese children and adolescents.". JAMA 289 (14): 1813–9. doi:10.1001/jama.289.14.1813. PMID 12684360.
  22. ↑ "Is Healthy Obesity a Myth?". nlm.nih.gov. 30 April 2014. Retrieved 31 May 2014.
  23. ↑ "Dispelling the myth of 'healthy obesity'". British Heart Foundation. 1 May 2014. Retrieved 31 May 2014.
  24. ↑ Kramer, CK; Zinman, B; Retnakaran, R (Dec 3, 2013). "Are metabolically healthy overweight and obesity benign conditions?: A systematic review and meta-analysis.". Ann Intern Med 11 (159): 758–69. doi:10.7326/0003-4819-159-11-201312030-00008. PMID 24297192.
  25. ↑ Roberson, Lara L; Aneni, Ehimen C; Maziak, Wasim; Agatston, Arthur; Feldman, Theodore; Rouseff, Maribeth; Tran, Thinh; Blaha, Michael J; Santos, Raul D; Sposito, Andrei; Al-Mallah, Mouaz H; Blankstein, Ron; Budoff, Matthew J; Nasir, Khurram (Jan 8, 2014). "Beyond BMI: The "Metabolically healthy obese" phenotype & its association with clinical/subclinical cardiovascular disease and all-cause mortality -- a systematic review". BMC Public Health 14 (14): 14. doi:10.1186/1471-2458-14-14. PMC 3890499. PMID 24400816. Retrieved 29 July 2014.
  26. ↑ Blüher, S; Schwarz, P (Jun 19, 2014). "Metabolically healthy obesity from childhood to adulthood — Does weight status alone matter?". Metabolism 14. doi:10.1016/j.metabol.2014.06.009. PMID 25038727.
  27. ↑ 27.0 27.1 "www.who.int" (PDF). WHO. Retrieved February 22, 2009.
  28. ↑ "Obesity and the risk of heart failure".
  29. ↑ "Obesity".
  30. ↑ "Obesity and thrombosis".
  31. ↑ "Impact of male obesity on infertility: a critical review of the current literature".
  32. ↑ "Maternal Overweight and Obesity and the Risk of Congenital Anomalies".
  33. ↑ "Body Mass Index and the Risk of Stroke in Men".
  34. ↑ "Obesity and central obesity as risk factors for incident dementia and its subtypes: a systematic review and meta-analysis".
  35. ↑ "Overweight, Obesity, and Mortality from Cancer in a Prospectively Studied Cohort of U.S. Adults".
  36. ↑ "The effect of obesity on chronic respiratory diseases: pathophysiology and therapeutic strategies".
  37. ↑ "Effect of Lifestyle Changes on Erectile Dysfunction in Obese Men".
  38. ↑ http://www.thedailybeast.com/articles/2015/03/21/what-your-doctor-won-t-tell-you-about-surgery.html. Missing or empty |title= (help)
  39. ↑ Poirier P, Giles TD, Bray GA et al. (May 2006). "Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss". Arterioscler. Thromb. Vasc. Biol. 26 (5): 968–76. doi:10.1161/01.ATV.0000216787.85457.f3. PMID 16627822.
  40. ↑ Yusuf S, Hawken S, Ounpuu S et al. (2004). "Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study". Lancet 364 (9438): 937–52. doi:10.1016/S0140-6736(04)17018-9. PMID 15364185.
  41. ↑ Tsigos C, Hainer V, Basdevant A et al. (2008). "Management of obesity in adults: European clinical practice guidelines". Obes Facts 1 (2): 106–16. doi:10.1159/000126822. PMID 20054170. as PDF
  42. ↑ Kenchaiah S, Evans JC, Levy D et al. (August 2002). "Obesity and the risk of heart failure". N. Engl. J. Med. 347 (5): 305–13. doi:10.1056/NEJMoa020245. PMID 12151467.
  43. ↑ 43.0 43.1 43.2 43.3 43.4 43.5 43.6 Haslam DW, James WP (October 2005). "Obesity". Lancet 366 (9492): 1197–209. doi:10.1016/S0140-6736(05)67483-1. PMID 16198769.
  44. ↑ Rahmouni K, Correia ML, Haynes WG, Mark AL (January 2005). "Obesity-associated hypertension: new insights into mechanisms". Hypertension 45 (1): 9–14. doi:10.1161/01.HYP.0000151325.83008.b4. PMID 15583075.
  45. ↑ Chiolero A, Bovet P, Paradis G, Paccaud F (March 2007). "Has blood pressure increased in children in response to the obesity epidemic?". Pediatrics 119 (3): 544–53. doi:10.1542/peds.2006-2136. PMID 17332208.
  46. ↑ Ageno W, Becattini C, Brighton T, Selby R, Kamphuisen PW (January 2008). "Cardiovascular risk factors and venous thromboembolism: a meta-analysis". Circulation 117 (1): 93–102. doi:10.1161/CIRCULATIONAHA.107.709204. PMID 18086925.
  47. ↑ Darvall KA, Sam RC, Silverman SH, Bradbury AW, Adam DJ (February 2007). "Obesity and thrombosis". Eur J Vasc Endovasc Surg 33 (2): 223–33. doi:10.1016/j.ejvs.2006.10.006. PMID 17185009.
  48. ↑ Peter G. Kopelman, Ian D. Caterson, Michael J. Stock, William H. Dietz (2005). Clinical obesity in adults and children: In Adults and Children. Blackwell. p. 493. ISBN 1-4051-1672-2.
  49. ↑ Azziz R, Sanchez LA, Knochenhauer ES et al. (February 2004). "Androgen excess in women: experience with over 1000 consecutive patients". J. Clin. Endocrinol. Metab. 89 (2): 453–62. doi:10.1210/jc.2003-031122. PMID 14764747.
  50. ↑ Hammoud AO, Gibson M, Peterson CM, Meikle AW, Carrell DT (October 2008). "Impact of male obesity on infertility: a critical review of the current literature". Fertil. Steril. 90 (4): 897–904. doi:10.1016/j.fertnstert.2008.08.026. PMID 18929048.
  51. ↑ Arendas K, Qiu Q, Gruslin A (June 2008). "Obesity in pregnancy: pre-conceptional to postpartum consequences". J Obstet Gynaecol Can 30 (6): 477–88. PMID 18611299.
  52. ↑ 52.0 52.1 Sermondade, N.; Faure, C.; Fezeu, L. et al. (2012). "BMI in relation to sperm count: An updated systematic review and collaborative meta-analysis". Human Reproduction Update 19 (3): 221–231. doi:10.1093/humupd/dms050. PMC 3621293. PMID 23242914.
  53. ↑ Heslehurst N, Simpson H, Ells LJ et al. (November 2008). "The impact of maternal BMI status on pregnancy outcomes with immediate short-term obstetric resource implications: a meta-analysis". Obes Rev 9 (6): 635–83. doi:10.1111/j.1467-789X.2008.00511.x. PMID 18673307.
  54. ↑ Poobalan AS, Aucott LS, Gurung T, Smith WC, Bhattacharya S (January 2009). "Obesity as an independent risk factor for elective and emergency caesarean delivery in nulliparous women--systematic review and meta-analysis of cohort studies". Obes Rev 10 (1): 28–35. doi:10.1111/j.1467-789X.2008.00537.x. PMID 19021871.
  55. ↑ McDonald SD, Han Z, Mulla S, Beyene J (2010). "Overweight and obesity in mothers and risk of preterm birth and low birth weight infants: systematic review and meta-analyses". BMJ 341: c3428. doi:10.1136/bmj.c3428. PMC 2907482. PMID 20647282.
  56. ↑ Stothard KJ, Tennant PW, Bell R, Rankin J (February 2009). "Maternal overweight and obesity and the risk of congenital anomalies: a systematic review and meta-analysis". JAMA 301 (6): 636–50. doi:10.1001/jama.2009.113. PMID 19211471.
  57. ↑ Kurth T, Gaziano JM, Rexrode KM et al. (April 2005). "Prospective study of body mass index and risk of stroke in apparently healthy women". Circulation 111 (15): 1992–8. doi:10.1161/01.CIR.0000161822.83163.B6. PMID 15837954.
  58. ↑ Kurth T, Gaziano JM, Berger K et al. (2002). "Body mass index and the risk of stroke in men". Arch. Intern. Med. 162 (22): 2557–62. doi:10.1001/archinte.162.22.2557. PMID 12456227.
  59. ↑ Beydoun MA, Beydoun HA, Wang Y (May 2008). "Obesity and central obesity as risk factors for incident dementia and its subtypes: A systematic review and meta-analysis". Obes Rev 9 (3): 204–18. doi:10.1111/j.1467-789X.2008.00473.x. PMID 18331422.
  60. ↑ Reeves GK, Pirie K, Beral V, Green J, Spencer E, Bull D (December 2007). "Cancer incidence and mortality in relation to body mass index in the Million Women Study: cohort study". BMJ 335 (7630): 1134. doi:10.1136/bmj.39367.495995.AE. PMC 2099519. PMID 17986716.
  61. ↑ Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ (April 2003). "Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults". N. Engl. J. Med. 348 (17): 1625–38. doi:10.1056/NEJMoa021423. PMID 12711737.
  62. ↑ Lyford, Joanna (August 2014). "Rising obesity levels in UK could result in 4,000 extra cancer cases each year". The Pharmaceutical Journal.
  63. ↑ Choi HK, Atkinson K, Karlson EW, Curhan G (April 2005). "Obesity, weight change, hypertension, diuretic use, and risk of gout in men: the health professionals follow-up study". Arch. Intern. Med. 165 (7): 742–8. doi:10.1001/archinte.165.7.742. PMID 15824292.
  64. ↑ Hart DJ, Spector TD (February 1993). "The relationship of obesity, fat distribution and osteoarthritis in women in the general population: the Chingford Study". J. Rheumatol. 20 (2): 331–5. PMID 8474072.
  65. ↑ Molenaar EA, Numans ME, van Ameijden EJ, Grobbee DE (November 2008). "[Considerable comorbidity in overweight adults: results from the Utrecht Health Project]". Ned Tijdschr Geneeskd (in Dutch; Flemish) 152 (45): 2457–63. PMID 19051798.
  66. ↑ Hunskaar S (2008). "A systematic review of overweight and obesity as risk factors and targets for clinical intervention for urinary incontinence in women". Neurourol. Urodyn. 27 (8): 749–57. doi:10.1002/nau.20635. PMID 18951445.
  67. ↑ Bart S, Ciangura C, Thibault F et al. (September 2008). "[Stress urinary incontinence and obesity]". Prog. Urol. (in French) 18 (8): 493–8. doi:10.1016/j.purol.2008.04.015. PMID 18760738.
  68. ↑ Subak LL, Wing R, West DS et al. (January 2009). "Weight loss to treat urinary incontinence in overweight and obese women". N. Engl. J. Med. 360 (5): 481–90. doi:10.1056/NEJMoa0806375. PMC 2877497. PMID 19179316.
  69. ↑ Ejerblad E, Fored CM, Lindblad P, Fryzek J, McLaughlin JK, Nyrén O (2006). "Obesity and risk for chronic renal failure". J. Am. Soc. Nephrol. 17 (6): 1695–702. doi:10.1681/ASN.2005060638. PMID 16641153.

Further reading