Obesity

With society's ever increasing price tag of education, public schools have gone to great lengths to cut costs from the unessential activities during and after school hours. First it was the obvious luxury of music programs and art classes; however, with the desperate need for teachers, athletic programs have felt the grunt of this expedition. Now, more than ever, youths in our communities are battling serious problems. Not only are sports and organized athletic programs vital to physical development, but also mental growth and offer children structure and goals. Unfortunately, many schools have to cut back or even eliminate sports/athletic programs due to lack of funding.

As the cost of athletic programs increase, many states are forced to pass the fees along directly to students. According to national statistics, there is a 25% to 30% reduction in participation when fees are implemented. Consequently, many of the students who benefit most from athletic programs cannot afford to participate.

School funding cannot be solely to blame for the decrease in physical activity in the education environment. With the increased emphasis on the need to achieve academic aptitude, children as well as their adult parents see athletics as an extra, or something that can be done when and if homework is completed. Not to say that this is not commendable, but evidence supports the fact that athletic programs have the ability to turn at-risk youth in positive directions. Sports programs promote healthy social and physical development while offering positive alternatives to high risk behavior.

Reduced physical activity represents one of the most significant changes in lifestyle that has been observed during the twentieth century. Our sedentary lifestyle and the reduced energy requirements of the majority of our jobs has been a source of comfort in a business world where efficiency and productivity are sought. The impact of the transition from a traditional to a modern lifestyle on daily energy needs can be estimated by various means. By using the doubly labeled water technique and indirect calorimetry, Singh et al. (1) showed that the energy cost of living at the peak labor season was as high as 2.35_resting metabolic rate (RMR) in Gambian women. When this value is compared to results usually obtained in women living in industrialized countries, 1.4 to 1.8_RMR (2,3), it can be estimated that for a given body weight, a modern lifestyle may have reduced the energy cost of living by as much as 1 to 4 MJ/day. Accordingly, a recent analysis by Prentice and Jebb (4) has emphasized the contribution of sedentariness to the increased prevalence of overweight in the United Kingdom. Despite these observations, the contribution of exercise to the prevention and treatment of obesity is still perceived as trivial by many health professionals. The perception of many of them was recently well summarized by Garrow (5) who stated that exercise is a remarkably ineffective means of achieving weight loss in obese people, mainly because their exercise tolerance is so low that the level of physical activity that they can sustain makes a negligible contribution to total energy expenditure. When one looks at the currently available literature, it is difficult to disagree with this statement. Indeed, numerous studies have demonstrated that when exercise is used alone to treat obesity, body weight loss is generally small (6). In addition, the further weight loss generated by adding an exercise program to a reduced-calorie diet is also often small if not insignificant (7). Traditionally, the study of the impact of exercise on body weight control has focused on its energy cost and on the hope that the body energy loss will be equivalent to the cumulative energy cost of exercise sessions. In practical terms, this means for instance that if a physical activity program induces an excess of energy expenditure of 2000 kcal/week, a similar energy deficit should be expected in the active obese individual. Recent experimental data show that such a view is not realistic since it does not take into account the compensations in other components of energy balance which may either attenuate or amplify the impact of exercise on body energy stores. It thus appears preferable to consider exercise as a stimulus affecting regulatory processes, which can ultimately affect all the components of energy balance instead of only focusing on its energy cost. The objective of this chapter is to summarize recent developments in knowledge pertaining to the effects of exercise on energy balance. Clinical implications of these notions are also addressed.

With the passing decades, a person's work role is a major social identity for most adults, with almost all men and the majority of women participating in the labor force in most contemporary postindustrial societies. No longer is work and home lives considered separate entities, today, they are one in the same. Many aspects of employment are relevant to body weight and obesity (1). Employment provides financial resources through income, and also access and opportunities for using health care services. Many jobs include health benefits and risks, some related to body weight such as involvement in healthy levels of physical activity or the stress of working varying schedules in 'shift work' (2). An important aspect of employment is that working

usually imposes an organized structure on people's lives and provides a social world that is different from the family and household social network. Despite the potential relevance of work to patterns of body weight, relatively little explicit attention has focused on patterns of work and weight. However, employment information is reported in studies of other aspects of weight. Some studies in postindustrial societies find that women who are not employed are more likely to be obese than their counterparts who participate in the labor force (3). Unemployed men have been reported to be underweight (4). Fuller analysis of employment and employment transitions such as entering the workforce, changing jobs, and retiring need to be conducted to understand their role in body weight and obesity. Overall, even though the majority of adults in developed societies are employed outside the home, there is a dearth of information about how employment influences obesity. Mechanisms for activity level and caloric intake from employment are not well worked out, so employment and obesity deserves additional research attention in the future.

Occupation

Occupation is the type of work that a person performs in a society. The occupations are diverse, and can be classified on many dimensions relevant to body weight. While occupation has not been a focus in most of the weight literature, differences in