Introduction of diabetes

Diabetes is a metabolic disorder that is characterized by high blood glucose and either insufficient or ineffective insulin. 5.9% of the population in the United States has diabetes, and diabetes is the seventh leading cause of death in our country. Diabetes is a chronic disease without a cure, however, with proper management and treatment, diabetics can live a normal, healthy lives.

Insulin

Insulin is a hormone secreted by specialized cells in the pancreas in response to (among other things), increased blood glucose concentration. The primary role of insulin is to control the transport of glucose from the bloodstream into the cells. After consuming a meal, insulin enhances the uptake of the energy nutrients (amino acids, glucose, and fatty acids). Insulin helps maintain blood glucose within normal limits and stimulates protein synthesis, glucose synthesis in the liver and muscle, and fat synthesis.

Without insulin, or when insulin is ineffective, glucose regulation falters and the metabolism of energy-yielding nutrients changes. In diabetes, there is too much glucose in the blood. When glucose builds in the blood instead of going into the cells, it can cause two problems:

• Your cells may become starved for energy
• Over time, high glucose blood levels may harm your kidneys, heart, eyes or nerves

There are two main types of diabetes, Type I and Type II, described below.

Type I Diabetes
(a.k.a. Juvenile Onset Diabetes, Insulin-Dependant Diabetes)

Insulin-dependant is caused by damage to the pancreas. The pancreas contains beta cells, which make insulin. With Type I diabetes, the deficiency of insulin is due to a decline in the number of beta cells the pancreas contains. It appears that certain genes make Type I diabetics more susceptible, but a triggering factor (usually a viral infection) sets it off. In most people with Type I diabetes, the immune system makes a mistake, attacking the beta cells and causing them to die. Without the beta cells, you cannot produce insulin. Glucose then builds up in the blood and causes diabetes.

Type I diabetes exhibits the following warning signs:

• Losing weight without trying
• An increased need to urinate
• Increased hunger
• Increased thirst
• Trouble seeing
• Feeling tired and/or
• Going into a coma

For Type I diabetics, treatment usually consists of a healthy diet, exercise, and insulin shots to replace the insulin that your body no longer produces. Most insulin-dependent diabetics test their blood at least four times per day to monitor their blood’s glucose level. This is necessary to keep their blood glucose within certain limits. If blood glucose is not monitored, and if insulin levels are not kept in check, three things may happen:

1. Ketoacidosis – occurs when your blood glucose levels are highly elevated, by either eating too much or taking too little insulin, by stress or illness. In this case, there is too little insulin in the blood. Your body then begins breaking down fat for energy, producing chemicals called ketones. Ketones can make you throw up, have difficulty breathing, cause excessive thirst, cause dry, itchy skin, or even cause coma.

2. Hypoglycemia – occurs when blood glucose levels become too low. It can be cause by taking too much insulin, eating too little, skipping meals, eating at the wrong time, exercising too intensely or for too long, or by drinking alcohol on an empty stomach. If your blood glucose is too low you may feel hungry, confused, tired, shaky or nervous.

3. Complications – elevated glucose levels in the blood over time can hurt your organs. Diabetes can damage kidneys, eyes and nerves, and makes heart and blood vessel disease more likely. Diabetics can defend themselves from complications by keeping their glucose levels under control.

Type II Diabetes
(a.k.a. Adult Onset Diabetes, Non-Insulin-Dependent Diabetes)

Type II diabetes is the most common form of diabetes, with about 90% of diabetes falling into the Type II category. With Type II diabetes, glucose builds up in the blood – not because not enough insulin is present, but probably because cells lose their insulin receptors and become less sensitive to insulin. Type II diabetes usually (though not always) occurs in individuals who are over 40 years of age who are overweight.

Type II diabetes produces mild symptoms, and can be controlled with a healthy diet, exercise and weight loss. Type II diabetics should also monitor their glucose levels to be sure they are maintaining healthy levels. In some cases, weight loss, diet and exercise are not enough to control the glucose levels. In those cases, your physician may control your diabetes by prescribing diabetes pills or insulin shots.

Type II diabetes can cause three types of problems:

1. High Blood Sugar – high glucose levels in the blood are most likely when you’re sick or under a lot of stress. High blood sugar can cause you to have a headache, blurry vision, excessive thirst and an increased need to urinate, and cause dry, itchy skin. Though less of a problem with Type II diabetes, ketones can build up in the blood when Type II diabetics have symptoms of high blood sugar, or when they are sick.
2. Low Blood Sugar – When blood sugar falls to low you may feel tired, shaky, nervous, hungry or confused. It may be caused by taking too much diabetes medicine, eating too little or skipping meals, exercising too intensely or for too long, or from drinking alcohol without eating.
3. Complications – Elevated blood glucose over many years can hurt organs, including the eyes, kidneys, and eyes. It can also make heart and blood vessel disease more likely. The best defense against complications is a careful monitoring of blood glucose, a healthy diet and exercise.

Risks for Diabetes

• Individuals with parents or siblings with diabetes
• People over the age of 45
• People who are overweight
• People who do not exercise regularly
• People with low HDL cholesterol or high triglycerides
• Certain racial and ethnic groups (African Americans, Latinos, Asians and Native Americans)
• Women who had gestational diabetes or who had a baby weighing 9 pounds or more at birth.

Warning Signs of Diabetes

Type I: Frequent urination Unusual thirst Extreme hunger Unusual weight loss Extreme fatigue Irritability

*Type II: Any of the Type I symptoms Frequent infections Blurred vision Cuts/bruises that are slow to heal Tingling/numbness in the hands or feet Recurring skin, gum or bladder infections *individuals with Type II diabetes often have no symptoms

 

Understanding Fat and Cholesterol

Blood Lipid Parameters:

The National Cholesterol Education program recommends that everyone over the age of 20 be tested for cholesterol at least once every 5 years.

The National Cholesterol Education Program
Blood Lipid	Desirable	Borderline	High
Total Cholesterol	< 200 mg/dL	200-239 mg/dL	>= 240 mg/dL
Low-Density Lipoproteins (LDL)	< 130 mg/dL	130-159 mg/dL	>= 160 mg/dL
High-Density Lipoproteins (HDL)	> 35 mg/dL (values >60 mg/dL are considered a negative risk factor)
Triglycerides	< 200 mg/dL

Lipids (Fats) Explained:

Fats, or lipids, can be divided into three general categories: Triglycerides, Phospholipids and Sterols.

• Triglycerides - (fats and oils) This is the main form of fat in the diet. Triglycerides provide us with energy, insulates, cushions and protects internal organs and helps our bodies use carbohydrates and proteins more efficiently. Triglycerides can be further divided into the following categories:
• Saturated fats - Usually solid at room temperature, saturated fats contain the maximum number of hydrogen atoms (saturated with hydrogen). Saturated fats are considered the most detrimental to health.
• Monounsaturated fats - Liquid at room temperature, monounsaturated fats include olive and canola oils. This type of fat tends to lower "bad" LDL cholesterol while leaving the "good" HDL cholesterol unchanged.
• Polyunsaturated fats - Liquid at room temperature, polyunsaturated fats include corn oil, safflower oil and sunflower oil. This type of fat tends to lower both "bad" LDL and "good" HDL cholesterol.
• Hydrogenated fats - This fat results from a process where hydrogen atoms are added back to polyunsaturated or monounsaturated fats to protect against rancidity . This procedure effectively causes hydrogenated fats to become saturated fats. Thus, if a food lists partially hydrogenated oils among its first three ingredients, it usually contains alot of trans-fatty acids and saturated fats.
• Trans-fatty acids - In nature, most unsaturated fats are cis-fatty acids. During hydrogenation, the molecular structure changes from cis- to trans-fatty acids. Trans-fatty acids increase "bad" LDL cholesterol and lower "good" HDL cholesterol, which may increase heart disease risk.
• Essential fatty acids - Essential fatty acids must be supplied by the diet. The body uses essential fatty acids to maintain the structural parts of cell membranes. They are also used as a component in the production of hormone-like substances (eicosanoids) that help regulate blood pressure, clot formation, and maintain the immune response.
• Linoleic Acid - The Omega-6 family. Common sources for these essential fatty acids are vegetable oils and meats. Most individuals can ensure an adequate intake of Omega-6 fatty acids by including grains, seeds, leafy vegetables, and small amounts of vegetable oils and meats in the diet.
• Linolenic Acid - The Omega-3 family. Linolenic acid is a major component of the communicating membranes of the brain, and is active in the eye's retina. It is essential for growth and development. Fish, in particular, is abundant in both Omega-3 and Omega-6 fatty acids.
• Phospholipids - (eg. lecithin) Phospholipids help transport fat-soluble vitamins, hormones and other substances through cell membranes. Because they can dissolve in both water and fat, they act as an emulsifier, helping to keep fats suspended in body fluids and blood. The liver can produce all the body's phospholipids from scratch, therefore it is not an essential nutrient.
• Sterols - Sterols include cholesterol, vitamin D and sex hormones. The are a component of bile, sex hormones (testosterone), adrenal hormones (cortisol) and are a structural component of cell membranes. 9/10 of the body's cholesterol is stored in cells.
  
  Cholesterol - The liver manufacturers about 800-1500 mg. of cholesterol per day, which contributes much more to total body cholesterol than does diet. The liver can also make cholesterol from carbohydrates, proteins or fat. Only animal foods contain cholesterol. Excess cholesterol harms the body when it forms deposits on artery walls, leading to atherosclerosis and heart disease. Cholesterol can be further divided into HDLs and LDLs:

·         Low-Density Lipoproteins (LDL) - Considered "bad" cholesterol. It is produced in the liver and circulates through the body, transporting fat to the muscles, heart, fat stores and other tissues.

·         High-Density Lipoproteins (HDL) - Considered "good" cholesterol. It is produced by the liver to carry cholesterol and phospholipids from the cells back to the liver for recycling and/or excretion. Because HDLs represent cholesterol removal from arteries and blood to the liver for breakdown and disposal, it is considered "good" cholesterol. Therefore, high levels of HDL cholesterol is considered a negative risk factor for heart disease.

Approximate Cholesterol Amounts in Foods:

Food	mg/chol
Grains, vegetables, fruits	0
Whole Milk, 1 cup	30-35
Nonfat Milk, 1 cup	5-10
Cheese, 1 ounce	25-30
Butter, 1 tablespoon	10
Beef, chicken, or pork, 3 ounces	70-85
Liver, 3 ounces	410
Egg yolk	213
Egg white	0
Shrimp, 3 ounces	165
Fish, lobster, clams, 3 ounces	50-60

The table above shows the approximate amounts of cholesterol that can be found in common foods.

Note that current research indicates that food cholesterol does not appear to increase blood cholesterol as dramatically as does saturated fats. So while it is wise to watch your cholesterol intake, be sure to decrease your consumption of saturated fats as well.

How you can improve your Cholesterol Levels

• Reduce or maintain a desirable weight
• Exercise. Aerobic exercise four days per week for 30 minutes or more can increase the level of ("good") HDL cholesterol in your body
• Choose monounsaturated or polyunsaturated fats in small amounts in place of saturated fats
• Avoid saturated fats.
• Eat fish once or twice per week
• Avoid hydrogenated or trans-fatty acids
• Reduce consumption of high-cholesterol foods
• Consume more soluble fiber
• Graze. Eating 5 or more meals per day keeps insulin concentrations low and slows down the liver's synthesis of cholesterol

Note

16.7 Million People Around the Globe Die From Heart Disease Each Year

This year, more than 32 million people across the world will suffer a heart attack or stroke, and about 12.5 million of those incidents are fatal.2 Blood cholesterol levels have a lot to do with a person抯 risk of getting heart disease. In fact, the higher the blood cholesterol level, the greater the risk for developing heart disease.

Regular tracking of cholesterol and triglycerides is important for many reasons.

• Testing your numbers over time helps you make informed decisions.
• Checking your numbers gives you peace of mind. Why wait and worry?
• Tracking your levels lets you know if your heart health regimen is working.

 

Australia's mental health

by Dr Norman Swan

A national health survey has found a significant number of Australians have mental health issues.

24 08 2009

The psychological wellbeing of Australians has become a lot clearer thanks to the second national mental health survey. The Australian Bureau of Statistics doorknocked thousands of households asking questions about common mental health problems.
They found that one in two of us will have anxiety, depression, or a problem with drug and alcohol abuse in our lifetimes. About one in five people surveyed had had a mental disorder in the last 12 months; and one in four of those had had more than one – losing about nine days of useful functioning every month.
Yet surprisingly few people were being treated. Largely because they felt they didn't need any help or, wrongly, they felt there was no help available. This included people who were suicidal.
It was also found that people with physical illnesses were more likely to have anxiety, depression or problems abusing alcohol and other drugs.
Since this survey was done the Government has provided more access to evidence-based psychological treatments so more people are receiving help. But these deep-seated beliefs that nothing that can be done are a problem, as is the stigma which still exists to people identifying themselves as psychologically unwell.
So it's important that doctors, friends and families recognise when someone has a mental illness and offer assistance, but it's also important to recognize that there may be more than one thing going on at the same time, a physical illness with anxiety and depression, or a drug and alcohol problem with illness with anxiety and depression and they all need to be treated so the person can become well again.

For Reference

Title: Australian and New Zealand Journal of Psychiatry
Author: Henderson S et al. State of the nation's mental health 2007.
URL: http://www.informahealthcare.com/loi/anp
2009;43:591-593
Title: Australian and New Zealand Journal of Psychiatry
Author: Johnston AK et al. Suicidal thoughts and behaviours among Australian adults: findings from the 2007 National Survey of Mental Health and Wellbeing.
URL: http://www.informahealthcare.com/loi/anp
2009;43:635-643
Title: Australian and New Zealand Journal of Psychiatry
Author: Whiteford H, Groves A Policy implications of the 2007 Australian National survey of Mental Health and Wellbeing.
URL: http://www.informahealthcare.com/loi/anp
2009;43:644-651
Title: Australian and New Zealand Journal of Psychiatry
Author: Teesson M et al. Comorbidity in Australia: findings of the 2007 National Survey of Mental Health and Wellbeing.
URL: http://www.informahealthcare.com/loi/anp
2009;43:606-614
Title: Australian and New Zealand Journal of Psychiatry
Author: Meadows Gn, Burgess PM Perceived need for mental health care: findings from the 2007 Australian Survey of Mental Health and Wellbeing.
URL: http://www.informahealthcare.com/loi/anp
2009;43:624-634
Title: Australian and New Zealand Journal of Psychiatry
Author: Burgess PM et al. Service use for mental health problems: findings from the 2007 National Survey of Mental Health and Wellbeing.
URL: http://www.informahealthcare.com/loi/anp
2009;43:615-623
Title: Australian and New Zealand Journal of Psychiatry
Author: Slade T et al. 2007 National Survey of Mental Health and Wellbeing: methods and key findings.
URL: http://www.informahealthcare.com/loi/anp
2009;43:594-605

Migraine research

Migraine is a common disorder affecting a large number of people worldwide. Researchers at the UCLA Department of Neurology have extensively researched this condition with the aim of bringing new therapies to people suffering from migraine.

http://www.abc.net.au/radionational/programs/healthreport/migraine-research/4039834

Cosmetic Acupuncture: Solution for Ageless, Clear Skin?

by   Janet Forgrieve

Two years ago, Sheila Schmidt’s face was at that awkward age when fine lines begin creeping in to meet the blemishes and breakouts she still woke up to once in a while. At 34, she opted for cosmetic acupuncture, also called facial rejuvenation, to minimize future wrinkles and clear up her occasional acne.
“I would never do Botox; I think there’s just something fundamentally wrong with injecting yourself with those things,” she says. “I have super-sensitive skin, so chemical peels are also out.”
While the procedure works to help patients of any age look younger and fresher, women Schmidt’s age can delay the onset of wrinkles before they start and also beat blemishes while keeping skin tone fresh and even, says Denver practitioner Martha Lucas. Patients should also be in good general health and report any medical issues before undergoing the procedure.
“The greatest candidates are women in their mid 30s, because it can slow down or diminish wrinkling,” Lucas says. “But who you’re also going to see are women in their late 40s and mid 50s, who have some lines and wrinkles, and we can help them too.”
What Is Cosmetic Acupuncture?
Using acupuncture needles on specific points on the face to enhance beauty and preserve a youthful appearance has been done for centuries in China and other Asian countries, but it’s just started to become popular in the United States in the past decade or so, practitioners say.
Cosmetic acupuncture is done in the same fashion as acupuncture done for general health and specific conditions, with the goal of creating collagen just under the skin to help fill in wrinkles and plump skin, similar to the results of Botox, Restylane or plastic surgery, Lucas says. Like traditional acupuncture, the cosmetic version also aims to balance the body’s energy and create a sense of well-being.
Increasingly, patients are opting for needles over the knife, says Lucas, who has been performing the procedure for eight years and teaches the Mei Zen method – literally translated as “beautiful person” – to other practitioners whose patients are increasingly asking for it.
“When I teach classes, I ask why they’ve come, and 70 percent are saying it’s because their patients are asking for it,” she says.
Benefits Of Cosmetic Acupuncture
Lauren Mathews performs the procedure at The Element Center in Denver, and says her patients find it a great alternative to Botox because it works to improve the look of the entire face and not just certain spots, and it also appeals to many who balk at having foreign substances injected into their faces.
“It fills in wrinkles and increases the collagen production in areas that need it, like frown lines, smile lines and smoker’s lines around the mouth,” Mathews says. “In addition, the color and texture of the skin brightens and smoothes and sagging gets lifted in a natural way. It’s not like a surgical facelift because it’s not that drastic.”
While most patients seek out the procedure to improve their looks and erase some of the toll time takes on all our faces, they find an added bonus in the increased sense of well-being that comes along with acupuncture, Lucas says.
“It addresses the person’s overall health, whereas a lot of the Western techniques are just about the face.”
Pins, Needles Or The Knife: How Does Cosmetic Acupuncture Compare to Other Procedures?
While most information surrounding the effectiveness of the procedure is anecdotal, one 1996 study published in the International Journal of Acupuncture said that, of 300 patients surveyed, 90 percent said they saw a lessening of lines, clearer skin tone and subtle tightening.
Since patients don’t take chemicals into their body or undergo anesthesia and surgery, there’s little if any controversy over the safety of the procedure. The worst that patients experience may be some pain during the treatment, and patients and practitioners alike say the biggest drawback is the time commitment. “It takes some time, because collagen takes some time to be permanent and there are still people who want to get an injection on their lunch break and be done with it,” Lucas says.
Sessions take up to 90 minutes each, which means the 10-session initial treatment recommended by the American Cosmetic Acupuncture Association requires a commitment of about three hours per week for five weeks. The course costs between $1,000 and $1,500, after which patients are encouraged to continue monthly maintenance sessions at about $125 to $150 a pop.
Keeping up is key, says Schmidt, whose busy life and new job kept her from making regular follow-up appointments until recently. A maintenance session a few weeks ago helped erase her recently acquired stress and smooth out new fine lines she says, encouraging her to make the time for regular appointments in the future.
The procedure may be more or less costly than other options, depending on how much work patients want. Botox injections, which are made of botulinum toxin, temporarily remove wrinkles and lines on the face, can cost between $300 and $1,000 depending on how many areas of the face are injected, and are made to be repeated every six months, according to the Ethical Cosmetic Surgery Association. Finding a qualified doctor to administer Botox is key, as improperly done injections can result in temporary eyelid drooping and weakness in the facial muscles.
Restylane, another temporary fix sold as a facial filler made of an acid that’s naturally occurring in the body, works to smooth wrinkles in the nose and mouth area and can cost between $500 and several thousand dollars per treatment, depending on the size of the area to be covered, according to the Ethical Cosmetic Surgery Association. Injections are quick, done during office visits, and results last about six months in most people, the association says. Side effects can include bruising, redness and itching, and patients with allergies may not be good candidates for Restylane.
Chemical peels, designed to even out the skin tone and remove some types of scars and precancerous growths, vary widely, with mild peels starting at $150 and going all the way up to $6,500 for a deep chemical peel. Chemical peels must be repeated periodically to maintain the effects. A peel to a small part of the face can be over in 15 minutes, while a deep, full-face procedure can take a couple of hours, according to the American Society of Plastic Surgeons. When done by a qualified dermatologist, peels are generally safe, although there is always some risk of infection and scarring, the society says, and skin may be red and flaky for several days after the procedure.
Facelifts, which require general anesthesia and two to four weeks of recovery time, average somewhere between $10,000 and $20,000 including anesthesia and facility fees, according to the Consumer Guide to Plastic Surgery. Because it’s surgery with a general anesthesia, the procedure can take several hours and include at least one night in the hospital. While facelifts offer the most drastic changes, they carry all the risks of major surgery and the longest recovery time of the procedures listed here.

Finding The Right Acupuncurist

When shopping for a practitioner, first find a board-certified acupuncturist who is licensed in your state, then shop around until you find one who can answer all your questions and also fill you in on their patient success stories.
Lucas and Mathews say patients come to them in a couple of ways. A segment of their patients are already using their more traditional acupuncture services and, at some point, choose the additional procedures. Others hear about cosmetic acupuncture, typically from friends who have tried it. Once they’re patients, many eventually try the treatment for aches, pains or emotional issues as well.
To find a qualified practitioner in your area, try the referral page of the American Cosmetic Acupuncture Association.
Afterglow
While cosmetic acupuncture patients shouldn’t expect the immediate, dramatic results they might see with other treatments, they do report seeing some changes rather quickly.
Teresa Williams turns 42 this year and has been using Mathews’ acupuncture services for health issues, including pain from carpal tunnel syndrome and discomfort from occasional bronchitis and headaches, for about two years. Recently, she began cosmetic acupuncture as well. One morning after her second session she was putting on eye shadow and noticed she suddenly had a bit more lid to cover, she says.
“My face is definitely tighter, and I just got all excited this morning about putting makeup on,” she says.

Overweight and Obesity in Australia

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Adults

For the first time since 1995 the 2007-08 National Health Survey (NHS) has measured the height, weight, hip and waist circumference of respondents aged 5 years or more.

Results from this survey reveal that in 2007-08, 61.4% of the Australian population are either overweight or obese¹.

• 42.1% of adult males and 30.9% of adult females were classified as overweight (Body Mass Index between 25.0 and 30.0 kg/m2).
• 25.6% of males and 24% of females were classified as obese (Body Mass Index > 30.0 kg/m2).

The Australian Government is currently planning the implementation of an ongoing data collection to measure nutrition, physical activity, physical measurement and chronic disease risk factor data in the Australian population. The first survey will be undertaken as part of the Australian Health Survey which is due to commence in March 2011.

Older Australians

In 2007-08¹, 39.9% of males between the ages of 55-64, 45.1% of males between the ages of 65-74 and 52.8% of males aged 75 years and over, were classified as overweight while 35%, 33.9% and 21.5% respectively, were classified as obese.

For females, 34.6% between the ages of 55-64, 42% between the ages of 65-74 and 31.8% aged 75 years and over, were classified as overweight, while 33.4%, 29.4% and 25.1 % respectively, were classified as obese.

For more information on the 2007-08 National Health Survey visit the Australian Bureau of Statistics website at: http://www.abs.gov.au/

Children and Adolescents

For children and adolescents, the 2007-08 National Health Survey results indicate that 24.9% of children aged 5 – 17 years are overweight or obese.
25.8% of boys and 24.0% of girls are either overweight or obese.

These results are similar to the 2007 Australian National Children’s Nutrition and Physical Activity Survey (the Children’s Survey) released in October 2008. The Children’s survey measured food intake, physical activity participation and physical measurements in a sample of 4,487 children aged 2-16 years from across Australia.

For more information on the Children’s Survey visit the Department of Health and Ageing website at: www.health.gov.au/nutritionmonitoring

Health consequences of overweight and obesity
For adults, the health problems and consequences of obesity are many and varied, including musculo-skeletal problems, cardiovascular disease, some cancers, sleep apnoea, type 2 diabetes, and hypertension to name a few² Many of these health problems are preventable though a healthy and active lifestyle. In particular, regular physical activity reduces cardiovascular risk in its own right and also improves levels of cardiovascular risk factors such as overweight, high blood pressure, and Type 2 diabetes³.

With respect to children, the most important long term consequence of childhood obesity is its persistence into adulthood. Once a child is overweight or obese it is unlikely that they will spontaneously revert to a healthy weight, predisposing them to the health concerns listed above for adults. Obese children and adolescents also suffer from an increase in medical conditions. For example, the prevalence of Type 2 diabetes is increasing in children and adolescents. Other problems associated with excess weight in children and adolescence includes the development of sleep apnoea, heat intolerance, breathlessness on exertion, tiredness and flat feet. Some research suggests that obese children (particularly older girls) also tend to exhibit decreased self-esteem and a significant proportion of children use unhealthy dietary practices for weight control⁴.

¹Australian Bureau of Statistics 2008, National Health Survey 2007-08, Cat 4364.0.
²World Health Organization 2000, Obesity: Preventing and Managing the Global Epidemic, WHO Technical Report Series 894.
³Australian Institute of Health and Welfare 2008, Australia’s health 2008, Cat No. AUS99.
⁴National Health and Medical Research Council 2003, Clinical Practice Guidelines for the Management of Overweight and Obesity in Children and Adolescents.