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Sistema de Información Científica
Red de Revistas Científicas de América Latina y el Caribe, España y Portugal
Revista Colombiana de Psiquiatría, Suplemento, vol. XXXV / 2006
Nutrition, Physical Activity, Weight Management, and Health
Nutrition, Physical Activity, Weight Management,
and Health
John E. Lewis
Neil Schneiderman
Non-communicable chronic diseases, such as metabolic syndrome, cardiovascular dys-
function, type 2 diabetes, and obesity, make up a large portion of total world-wide
mortality, and are becoming more prevalent in developing countries.
These diseases
have taken on a larger importance, as fertility rates in many developing countries are
still rising and contributing to the overall planetary population.
Chronic diseases are
typically due to poor dietary habits, physical inactivity, and subsequent unhealthy body
However, achieving a healthy weight and then sustaining weight loss
can reduce obesity-related disorders and improve the risk profile for chronic disease.
Weight control through an improved diet style and higher levels of caloric expenditure
can also improve the quality of life for people with diabetes, HIV/AIDS, and mental
health, although the specific recommendations for the disease may vary slightly.
benefits will last for a long time if the modifications are sustained.
Understanding the
effects that various diets and physical activity modes and patterns have on healthy
weight maintenance will ultimately prove beneficial for people who are otherwise at
risk for a variety of chronic diseases.
Key words:
Obesity, chronic disease, diet, exercise.
Nutrición, actividad física, control de peso y salud.
Enfermedades crónicas no transmisibles, tales como síndrome metabólico, disfunción
cardiovascular, diabetes tipo 2 y obesidad, componen una gran proporción de la mor-
talidad mundial y se están volviendo más prevalentes en países en vía de desarrollo.
Estas enfermedades han cobrado importancia debido a que la rata de fertilidad en
muchos países subdesarrollados continúa aumentando, contribuyendo a la población
mundial. Las enfermedades crónicas se deben generalmente a la presencia de hábi-
tos alimenticios deficientes e inactividad física, con una composición corporal poco
saludable como consecuencia. Sin embargo, alcanzar un peso saludable y después
Ph. D. Assistant Professor University of Miami School of Medicine.
Ph. D. James L. Knight Professor of Health Psychology and Professor of Psychiatry, University
of Miami.
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Revista Colombiana de Psiquiatría, Suplemento vol. XXXV / 2006
Lewis J.E., Schneiderman N.
sostener la pérdida de peso puede redu-
cir los trastornos relacionados con la obe-
sidad y mejorar el perfil de riesgo para
enfermedad crónica. El control de peso a
través de un estilo dietario mejorado y
mayores niveles de gasto calórico también
puede mejorar la calidad de vida de per-
sonas con diabetes, VIH/sida y enferme-
dad mental, aunque las recomendaciones
específicas para cada trastorno pueden va-
riar levemente. Estos beneficios serán
duraderos si las modificaciones se man-
tienen. Comprender los efectos que tie-
nen diversas dietas y patrones de activi-
dad física sobre la manutención de un
peso saludable beneficiará a personas que
de otro modo estarían en riesgo de sufrir
una variedad de enfermedades crónicas.
Palabras clave
: obesidad, enfermedad
crónica, dieta, ejercicio.
At the beginning of this century,
non-communicable chronic dis-
eases contributed approximately
60% of the total deaths in the world
and about 46% of the global burden
of disease (1). About half of these
chronic disease deaths are attrib-
utable to cardiovascular disease
(CVD), with many being related to
type 2 diabetes or obesity. The prob-
lem of non-infectious chronic dis-
ease is not limited to the developed
regions of the world, but is becom-
ing a major problem in developing
countries as well (2). Thus, the
labeling of non-communicable dis-
eases by previous generations as
“diseases of affluence” no longer ap-
pears applicable, as these diseases
continue to emerge both in poorer
countries and in the poorer popula-
tion groups of wealthier nations.
This shift in disease pattern is tak-
ing place at an accelerating rate and
is occurring faster in developing
countries than it did in industrial-
ized regions a century ago (3). Be-
cause these chronic diseases for the
most part are related to inadequate
physical inactivity and poor weight
management, we shall focus on
these issues in the present article.
It should be kept in mind, however,
that cigarette smoking and alcohol
abuse also contribute to excess mor-
tality from non-communicable
chronic diseases (4).
Body weight, diet, and level of
physical activity are important de-
terminants of chronic illness, mor-
bidity, and quality of life. The risks
associated with many co-morbid
conditions may be reduced with
modest weight loss. Clinical stud-
ies suggest that minimal, sus-
tained weight loss of 5% to 10% can
reduce or eliminate obesity-related
disorders (5). Weight control meth-
ods often produce short-term suc-
cess, but sustained weight main-
tenance is difficult to reach (6-7).
Weight cycling and relapse of body
weight are common features after
a weight loss intervention. The
maintenance of treatment-induced
weight loss thus remains a signifi-
cant challenge in the management
of obesity (8).
Nutritional therapy emphasiz-
ing mostly low-fat, whole plant foods
11. Nutrition.p65
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Revista Colombiana de Psiquiatría, Suplemento, vol. XXXV / 2006
Nutrition, Physical Activity, Weight Management, and Health
has been successfully utilized to
achieve and maintain weight con-
trol, and can also be beneficial for
normal blood glucose levels, hyper-
tension, hyperlipidemia, dyslipi-
demia, cardiovascular disease risk,
and mental status (9-12). These
benefits have been found to last for
years if the diet style is maintained
A large amount of research
finds that nutrition is one of the
most critical factors for health. The
accumulation of all research to this
point, including animal, laboratory,
clinical, and epidemiological find-
ings, demonstrates compelling evi-
dence for the link between nutri-
tional deficiencies with chronic
disease (15-16). The debate rages
regarding what is considered the
optimal diet style for prevention
and/or reversal of various chronic
diseases and conditions. Particu-
larly for weight loss, high-protein,
low-carbohydrate, Atkins-Style di-
ets have been enormously popular
in the mass media. Understanding
beneficial long-term eating pat-
terns is critical to minimizing the
risk of unhealthy weight gain,
given that the findings for the ben-
efit on CVD death of weight reduc-
tion alone are unclear (17-18). Re-
cent findings examining the
benefits of a very low carbohydrate
diet (19) do not support the belief
that this style of diet is any better
than standard diets for weight loss
and CVD risk, despite other evi-
dence to the contrary (20-21). The
enormous interest in diets promot-
ing high protein and/or low carbo-
hydrate intake is occurring, while
some evidence suggests that eat-
ing a diet high in processed sugars
has followed the similar increasing
curves of obesity and type 2 diabe-
tes (22). Several studies have found
better results in weight loss when
comparing the effect of a free-living,
very low carbohydrate diet to a low-
fat, high-carbohydrate diets over a
period of 6 months (20-21,23-27).
Adequate intake of fruits, veg-
etables, and fiber-rich foods is
known to be beneficial for health
and appears to have protective ef-
fects for such diseases as some can-
cers (15,28-29). However, in some
parts of Latin America, poor access
to clean water may influence the
appropriateness of food choices rec-
ommended on the basis of research
in developed countries. In addition,
some controversies persist regard-
ing the definitive nature of causal
links among nutrition, health, and
disease, the degree of benefits that
can be expected with change, and
optimal quantitative advice (30-31).
The exact role of dietary factors and
nutritional risk in disease is still
being researched, but the evidence
is currently sufficient to warrant a
concerted research effort in promot-
ing healthy eating behavior. The
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Revista Colombiana de Psiquiatría, Suplemento vol. XXXV / 2006
Lewis J.E., Schneiderman N.
potential public health benefit from
improved eating patterns, coupled
with the low risk of adopting guide-
lines for healthy eating, provides a
stronger foundation than ever be-
fore for efforts to understand and
encourage good nutrition among
the general population, patients,
and persons at high risk for disease
Physical Activity
Running parallel to the rising
epidemic of overweight and obesity
is the increasing rate of physical
inactivity. Physical inactivity is
widely recognized as a major threat
to public health (2). Data from São
Paulo, Brazil indicate that 70-80%
of the population are remarkably
inactive (33). A sedentary lifestyle
combined with poor nutrition ac-
counts for an estimated 16% of the
actual causes of death and approxi-
mately 24.4 billion dollars per year
in health care expenditures in the
United States alone (4,34). In con-
trast, a physically active lifestyle
has been associated with health
benefits that include improved con-
trol of hypertension, diabetes, obes-
ity, hyperlipidemia, and reduced
overall morbidity and mortality (35-
38). An objective of Healthy People
2010 is that adults exercise for at
least 30 minutes of moderate physi-
cal activity for most, if not all, days
of the week (39), but more than 60%
of people do not achieve this
amount and are inactive by defini-
tion (38).
Several studies have shown
that people who are more physically
active are less likely to gain weight
over time than those who are not
(40-43). Others found that most peo-
ple are gaining weight due to con-
suming less than 100 excess calo-
ries/day (44). Therefore, increasing
physical activity by 100 calories/
day could theoretically prevent
weight gain in most people, which
averages out to 2,000 additional
steps each day (44). Although this
is a possible approach to prevent-
ing weight gain, the amount of
physical activity that would be re-
quired for substantial weight loss is
not feasible for many people. Fur-
thermore, the National Weight Con-
trol Registry (NWCR), a database of
almost 5,000 successful weight loss
maintainers, shows that 90% of
their participants report losing
weight with both food restriction
and physical activity (45).
Subjects in the NWCR who have
succeeded in long-term weight loss
maintenance report expending
2,800 calories/week in physical ac-
tivity (45). More than 90% are main-
taining their weight loss with high
levels of regular physical activity.
The amount of physical activity re-
ported by the NWCR participants is
positively correlated with the
amount of weight they are main-
taining. A decrease in physical ac-
tivity in this group has been shown
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Nutrition, Physical Activity, Weight Management, and Health
to be a predictor of weight gain over
time (46). Another study found that
obese subjects who had previously
lost weight and engaged in at least
200 minutes/week of physical ac-
tivity were less likely to regain the
lost weight than those participants
who engaged in not as much physi-
cal activity (47). Some argue that
using inexpensive, electronic
pedometers and providing physical
activity goals in steps per day is ef-
fective in increasing physical activ-
ity over the short run (48). However,
combining dietary modification with
increased physical activity will pro-
duce the best results.
During the past twenty years,
the developed world and cities
within developing countries have
fallen to a pervasive health epi-
demic: obesity. Approximately 1.7
billion people are now obese, its
prevalence is rising in most coun-
tries, and dramatically increasing
among children and adolescents
(49). The incidence of overweight
(defined as a body mass index [BMI]
between 25 and 30 kg/m
) and
obesity (defined as a BMI > 30 kg/
) among adults is at an all time
high and continuing to rise (50,51).
More people are now overweight or
obese than people who smoke, live
in poverty, or drink heavily. Over-
weight/obesity has become such an
epidemic that it is now listed as one
of the leading health indicators in
Healthy People 2010 (39) and obes-
ity in the United States is second
only to tobacco use as a public
health threat. Obesity as a single
causative factor now stands to ac-
tually negatively impact life expect-
ancy rates, which have risen for
the last 200 years (52). Obese indi-
viduals and even persons with mild
to moderate overweight have in-
creased risk for multiple condi-
tions, many of which are associated
with a relatively high rate of mor-
bidity and mortality, such as type 2
diabetes, cardiovascular disease,
endometrial, postmenopausal
breast, kidney, and colon cancer,
musculoskeletal disorders, sleep
apnea, and gallbladder disease
(5,7,51,53-56). For example, type 2
diabetes is directly related to body
weight (57).
The number of overweight and
obese persons is also emerging as
a major financial drain, resulting
in more than $70 billion a year in
public health expenditures in the
United States (58). Obesity also con-
tributes to higher health care ex-
penditures than either smoking or
alcohol use (59). Overweight and
obesity cost taxpayers $117 billion
per year in direct health care costs
and indirect costs, such as lost
wages (60). One study found that
obese adults (18 to 65 years of age)
have 36% higher than average an-
nual medical expenditures com-
pared to those of normal weight (59).
11. Nutrition.p65
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Lewis J.E., Schneiderman N.
Malnutrition and Obesity: A
Double Burden of Disease in
Developing Countries
Almost 30% of the people on our
planet suffer from malnutrition (61).
Among children under 5 years of
age in the developing world, some
60% of all deaths are related to this
condition (1). Concurrently, an epi-
demic of obesity, with its attendant
co-morbidities of diabetes, stroke,
and CVD, has also affected develop-
ing as well as industrialized coun-
tries (2). This is associated with a
high prevalence of obesity begin-
ning in youth in developing coun-
tries and regions as diverse as In-
dia, Nigeria, Latin America, and the
Caribbean (62). Thus, beginning
with malnutrition in early child-
hood, nutritional transitions may
occur leading to relatively cheap
high energy density diets that are
basically inadequate.
The good news about economic
development is that it leads to an
increased food supply and a de-
crease in dietary deficiencies as
has occurred in much of Latin
America. The bad news is that
some of the shifts that have oc-
curred in food availability have led
to higher energy density diets with
increases in saturated fat and
sugar as well as reduced fresh fruit
and vegetable intake (63). Unfortu-
nately, these dietary changes have
occurred in conjunction with other
unhealthy lifestyle changes includ-
ing reduced physical activity at
work and leisure (64). Thus, people
within particular developing coun-
tries may concomitantly suffer from
food shortages, nutrient inadequa-
cies, and obesity, all leading to an
increase in chronic diseases (2).
Metabolic Syndrome, Type 2
Diabetes, and Cardiovascular
The worldwide increase in the
prevalence of obesity in the past two
decades has been accompanied by
two major medical developments
that have important consequences
for the future prevalence of CVD.
One of these has been the current
worldwide epidemic of type 2 diabe-
tes (65). The second development
has been the recognition that obes-
ity is associated with the cluster-
ing of a group of CVD risk factors
that has been termed the metabolic
syndrome (66).
Risk factors that comprise the
metabolic syndrome include, but
are not limited to, central obesity,
high blood pressure, glucose intol-
erance, elevated triglycerides, low
levels of high density lipoprotein
(HDL) cholesterol, fibrinolysis, and
insulin resistance (67-68).
nostic guidelines for metabolic syn-
drome have been provided by the
World Health Organization (68) and
the National Cholesterol Education
Program (NCEP) in the United
States (67) among others. Recently,
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Nutrition, Physical Activity, Weight Management, and Health
using a hierarchical structure
analysis, Shen et al. showed that
four factors, obesity, insulin resist-
ance, dyslipidemia, and hyperten-
sion, were all significantly associ-
ated with a common metabolic
syndrome factor across gender and
ethnic groups (69). To the extent
that the insulin resistance factor
was made up of fasting insulin and
fasting glucose, this finding of an
insulin resistance factor, helping to
define metabolic syndrome, lends
support to the WHO working defini-
tion, which specifies either glucose
intolerance or insulin resistance
as a prerequisite condition. Both
type 2 diabetes and impaired glu-
cose tolerance have previously
been closely associated with the
syndrome. Clustering of the syn-
drome components predicts both
the development of manifest diabe-
tes and CVD (70-71).
The relationship between psy-
chosocial factors and metabolic syn-
drome is not well understood, but
the Third National Health and Nu-
trition Examination Study in the
United States found that women
with a history of a major depressive
episode were twice as likely to have
the metabolic syndrome compared
with those without a history of de-
pression (72).
Type 2 diabetes accounts for the
vast majority of diabetes cases
worldwide and for more than 90%
of cases in the United States (73).
It develops when the production of
insulin by the pancreas is insuffi-
cient to overcome the underlying
abnormality of increased resist-
ance to its action. In its early stage,
type 2 diabetes is characterized by
an overproduction of insulin
(hyperinsulinemia). As the disease
progresses, the insulin level falls,
as the insulin producing cells of the
pancreas begin to fail. Complica-
tions of untreated type 2 diabetes
include: blindness, kidney failure,
foot ulcerations that may lead to
amputation, and increased risk of
infections, stroke, and CVD. Accord-
ing to WHO, the criterion for diabe-
tes is a fasting plasma glucose con-
centration = 126mg/dL (68).
In the year 2000, approximately
150 million people worldwide had
type 2 diabetes and this figure is
expected to double by 2025 (74).
While type 2 diabetes is the fourth
or fifth leading cause of mortality
in most developed countries, it is
also reaching epidemic proportions
in many developing countries (75).
It is expected that in the near fu-
ture the majority of cases of type 2
diabetes will occur in these devel-
oping countries with India and
China having more cases than any
other country in the world (76). Peo-
ple with diabetes are more likely to
die from a heart attack and are
more likely than those without dia-
betes to have a second event (77).
Patients with diabetes, who have
never had a myocardial infarction,
have as high a risk of heart attack
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Lewis J.E., Schneiderman N.
as non-diabetics who have already
had a myocardial infarction (78).
Lifestyle Intervention for
Prevention of Type 2 Diabetes
and Cardiovascular Disease
Current evidence suggests that
moderate weight reduction (5-10%)
may reduce major risk factors for
type 2 diabetes and CVD including
obesity, elevated blood glucose, in-
sulin resistance, dyslipidemia, fibri-
nolysis, inflammation, and high
blood pressure (79-82). Both the
NCEP (67) and the WHO Expert Panel
(83) have stressed the importance of
lifestyle modification (including ca-
loric restriction, improved nutrition,
and physical activity) in the preven-
tion of type 2 diabetes and CVD.
The largest and most compre-
hensive study of the effect of life-
style intervention in subjects at
risk for type 2 diabetes was reported
by the Diabetes Prevention Pro-
gram (84). This trial randomly as-
signed 3234 non-diabetic persons
with elevated fasting and post-load
plasma glucose concentrations to
placebo, metformin, or a lifestyle
modification program. The goals
were for participants to have 7%
weight loss and 150 minutes of
physical activity per week. Average
follow-up was 2.8 years. The lifestyle
intervention significantly reduced
the incidence of type 2 diabetes by
58% and metformin by 31% as com-
pared with placebo. The lifestyle
intervention was significantly
more effective than metformin. In
a similar trial carried out in Fin-
land, Tuomilehto et al. randomly
assigned 522 middle-aged, over-
weight men and women with im-
paired glucose tolerance to either
an intervention or a control group
(85). Each subject in the interven-
tion group received individualized
counseling aimed at reducing
weight and intake of total fat and
saturated fat, and increasing in-
take of fiber and physical activity.
Mean duration of follow-up was 3.2
years. During the trial the risk of
diabetes was significantly reduced
by 58%. The reduction in the inci-
dence of diabetes was directly as-
sociated with changes in lifestyle.
Both the DPP (84) and the Finish
diabetes prevention trial (85)
showed lifestyle changes that lasted
several years and are thus an ex-
cellent model for such interven-
tions. The Look AHEAD NIH trial
now is assessing the long-term ef-
fects of such a program in terms of
morbidity and mortality in type 2
diabetics (86).
With the increased survival
rate of people with HIV infection,
primarily due to the use of anti-
retroviral medications, the co-mor-
bid prevalence and impact of disabil-
ity in this population has also risen.
As in the general population, exer-
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Nutrition, Physical Activity, Weight Management, and Health
cise is a primary management
strategy used to ameliorate impair-
ments (problems with body function
as a significant loss, such as pain
or weakness), activity limitations
(difficulties an individual may have,
such as inability to engage in mod-
erate exertion), and participation
restrictions (problems, such as in-
ability to work) in victims of HIV/
AIDS (87). Exercise can be used to
address unwanted increases in
weight and body fat related to meta-
bolic syndrome as a consequence
of the use of highly active anti-
retroviral treatment (HAART) and
from HIV infection itself (88).
Regular exercise has been
found to slow down the progression
of HIV and increase the CD4 cell
count. The results of one study
showed that HIV patients exercising
3-4 times per week were less likely
to develop AIDS than those only car-
rying out daily exercise (89), reveal-
ing a need to slightly limit the
amount of physical activity for peo-
ple with HIV compared to other
populations, where the WHO recom-
mends one hour of moderate exer-
cise per day for the prevention of
chronic disease (90). Other improve-
ments due to exercise include mus-
cle strength and flexibility, cardiop-
ulmonary fitness, and decreases in
depression, anxiety, and anger (91-
94). Progressive resistance exercise
or a combination of progressive re-
sistance exercise and aerobic exer-
cise at least three times a week for
at least four weeks appears to be safe
and may lead to clinically important
changes in body weight and compo-
sition for adults living with HIV/
AIDS who are medically stable in
immunological and virological sta-
tus (95-96). These studies indicate
that moderate levels of physical ac-
tivity are safe and beneficial in the
short term for individuals infected
with HIV.
While the benefits of exercise
for the person with HIV are rela-
tively straightforward, the nutri-
tional recommendations have
changed from before HAART until
now. Malnutrition, low serum levels
of micronutrients, chronic dia-
rrhea, anorexia, malabsorption,
impaired nutrient storage, in-
creased energy demands, and al-
tered metabolism were common in
persons with AIDS prior to HAART
and are still common in resource-
limited countries (97). Studies con-
ducted before the widespread use of
HAART suggested that HIV infection
is also associated with a proathero-
genic lipid profile characterized by
an increase in triglyceride levels,
a decrease in HDL cholesterol le-
vels, and the presence of small,
dense LDL particles (98-100). While
the use of multivitamin or single
micronutrient supplementation
has been modest at best (101), the
use of HAART is leading to new
questions about the importance of
micronutrients for persons with
HIV. Even though macronutrient
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Lewis J.E., Schneiderman N.
deficiencies are uncommon and
less severe in developed countries
today, HAART and HIV itself are
having a profound affect on
oxidative stress, lipodystrophy, and
metabolic syndrome (97). In par-
ticular, the use of protease inhibi-
tors (PI) has had further deleteri-
ous effects on metabolic risk
factors. Specifically, the initiation
of PI-based HAART is associated
with the development of insulin
resistance in 25% to 62% and the
development of overt new-onset dia-
betes mellitus in 6% to 7% (88,102-
103) in persons with HIV. Increases
in LDL cholesterol and triglyceride
levels following HAART have also
been observed (104-105). Thus, in
addition to recommending exercise
to decrease visceral fat and improve
lipid profiles, nutritional interven-
tion for persons with HIV/AIDS on
HAART should focus on high fiber,
foods with a low glycemic index, low
saturated fat and processed sugars,
and high intake of fresh and natu-
ral fruits and vegetables.
Mental Health
Approximately one-quarter of all
adults are suffering from a diagnos-
able mental disease (106), including
depressive and other mood disor-
ders. Nearly half (45%) of those with
any mental disorder meet criteria
for two or more disorders with se-
verity strongly related to co-morbid-
ity (106). Major Depressive Disorder
(MDD) is the leading cause of dis-
ability for persons between the ages
of 15 and 44 (107). Almost 15 mil-
lion adults over 18 years of age are
affected by MDD (106) and it is more
prevalent in women than in men
(108). Depressive disorders often co-
occur with anxiety disorders and
substance abuse (109). Almost half
of lost employment productivity is
due to MDD at $44 billion per year
(110). The WHO’s Global Burden of
Disease Study looked at disability-
adjusted life years, which measure
lost years of healthy life regardless
of whether the years were lost to
premature death or disability for
various diseases (111). Disability
caused by MDD ranks second to CVD
in the magnitude of disease burden
in the developed world.
Several studies have investi-
gated the effects of nutrients and/
or specific components of the typi-
cal diet and their impact on depres-
sion. In a study of healthy college
students, moderate and heavy cof-
fee drinkers scored higher on a de-
pression scale than did low users
(112). In addition, the intake of caf-
feine has been linked with the de-
gree of mental illness in psychiat-
ric patients: the higher the intake,
the more severe the depression
(113). Excess intake of refined sugar
from sweet foods can also aggravate
depression. The combination of caf-
feine and refined sugar is likely
even worse for depression than ei-
ther substance consumed alone. In
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Nutrition, Physical Activity, Weight Management, and Health
one study, restricting sugar and caf-
feine in people with depression has
been reported to elevate mood (114).
Low levels of folic acid have been
noted in depressed patients (115).
In studies of depressed patients,
15% to 38% have been shown to be
deficient in serum or red blood cell
folic acid (116-118). Depression is
the most common symptom of a folic
acid deficiency. Other symptoms of
folic acid deficiency are: fatigue,
apathy, and dementia. Inositol is a
B vitamin required for the activity
of several important neurotransmit-
ters, including serotonin. De-
pressed people often have low levels
of inositol. In one clinical study, sub-
jects were given 12 grams of inosi-
tol per day and the results showed
that they had therapeutic results
similar to common antidepressant
drugs, but with no unwanted side
effects (119). Additional research
has also confirmed the value of in-
ositol for treating depression (120).
The results of a number of clinical
studies suggest that S-adenosyl-L-
methionine may be a useful natu-
ral antidepressants (121).
While the use of these various
nutrients may be beneficial, a more
holistic approach to nutritional
modification in depressed patients
has not been investigated. Nutri-
tional therapy emphasizing mostly
low-fat, whole-plant foods, while
avoiding simple sugars and chemi-
cal additives or preservatives, has
been successfully utilized in other
diseases and can also be beneficial
for weight control, hypertension,
hyperlipidemia, dyslipidemia, CVD
risk, and mental status (9-12). Ad-
ditionally, these benefits have been
found to last for years if the diet style
is maintained (13-14). However,
randomized clinical trials are
needed to establish efficacy and ef-
Research has shown that regu-
lar exercise can improve mood in
cases of mild to moderate depres-
sion (122). One study reported the
relative risk of depression was 27
percent lower for people playing
three or more hours of sport a week
compared with those playing no
sport at all (123). Another study
compared the effects of exercise
and drug therapy in treating de-
pression in older people (124). The
156 depressed men and women
were divided into three groups.
Over 16 weeks, one group took
antidepressants, the second group
undertook an aerobic exercise pro-
gram, and the third group used both
medications and exercise. The re-
sults indicated that after 6 months
those patients who continued to
exercise were much less likely to
experience a return of their de-
pression than were the other pa-
tients. Only 8 percent of patients
in the exercise group had their de-
pression return, while 38 percent
of the drug-only group and 31 per-
cent of the exercise-plus-drug
group relapsed. Other important
11. Nutrition.p65
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Lewis J.E., Schneiderman N.
findings included that the more
one exercised, the less likely one
would see their depressive symp-
toms return and for each 50-
minute increment of exercise, an
accompanying 50 percent reduc-
tion in relapse risk was found.
Another study sought to exam-
ine the exercise-depression link
by splitting a group of people suf-
fering with MDD into two groups.
One group exercised aerobically for
one hour, three times a week for
nine weeks while maintaining a
course of psychotherapy and medi-
cation, and the other group contin-
ued with psychotherapy and medi-
cation only. The study showed
significantly larger reduction
scores in depression in the exer-
cising group compared with the
therapy and medication group
(125). The effects of aerobic exer-
cise have been contrasted against
relaxation training on depressed
individuals. Depression scores
were reduced by both methods, al-
though exercise provided greater
reductions in depressive scores
(126). Exercise benefits have been
demonstrated in people who are
not clinically depressed, but who
present some depressive symp-
toms (127-128). Another study com-
pared aerobic exercise, including
jogging and cycling, to non-aerobic
circuit exercise on a multi-gym.
The study found both methods of
exercise to produce significant re-
ductions in depressive scores (129).
Although medications are
available to treat overweight, and
surgery is available for obesity, com-
plex medical regimens are costly to
apply over a typical lifetime, have
untoward side effects, and patients
may fail to achieve the treatment
goals required to lose and/or main-
tain excess fat and weight. Also,
standard conventional medical
treatment involving medications or
surgery has not been proven to un-
equivocally cure or reverse the ef-
fects of obesity. Potentially modifi-
able environmental factors, including
poor dietary choices and failing to
engage in regular exercise, are
known to be primary contributors
to overweight and obesity and re-
lated problems including high blood
pressure, CVD, stroke, diabetes,
certain types of cancer, arthritis,
and breathing problems. Given the
enormous public health cost of
obesity, focusing on healthy eating
and a moderate and consistent ex-
ercise program should be the basis
of any attempt to achieve weight
loss and subsequent control (16).
The true impact of the public health
costs of obesity can only be under-
stood within the context of both
mental and physical health.
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