Digital Commons Network^™

Grocery Food Taxes And U.S. County Obesity And Diabetes Rates, Lingxiao Wang, Yuqing Zheng, Steven Buck, Diansheng Dong, Harry M. Kaiser

Agricultural Economics Faculty Publications

BACKGROUND: Grocery food taxes represent a stable tax revenue stream for state and municipal government during times of adverse economic shocks such as that observed under the coronavirus disease 2019 (COVID-19) pandemic. Previous research, however, suggests a possible mechanism through which grocery taxes may adversely affect health. Our objectives are to document the spatial and temporal variation in grocery taxes and to empirically examine the statistical relationship between county-level grocery taxes and obesity and diabetes.

METHODS: We collect and assemble a novel national dataset of annual county and state-level grocery taxes from 2009 through 2016. We link this data to …

Vertical Sleeve Gastrectomy Confers Metabolic Improvements By Reducing Intestinal Bile Acids And Lipid Absorption In Mice, Lili Ding, Eryun Zhang, Qiaoling Yang, Lihua Jin, Kyle M Sousa, Bingning Dong, Yangmeng Wang, Jui Tu, Xiaoxiao Ma, Jingyan Tian, Hongli Zhang, Zhipeng Fang, Ana Guan, Yixin Zhang, Zhengtao Wang, David D Moore, Li Yang, Wendong Huang

Faculty, Staff and Students Publications

Vertical sleeve gastrectomy (VSG) is a highly effective bariatric surgery that sustainably treats obesity and type 2 diabetes (T2D). However, the underlying mechanisms governing its metabolic benefits remain unclear. In this study, we have used four different genetically modified mouse lines to understand the link between bile acid circulation and metabolic effects of VSG. Instead of directly activating the nuclear bile acid receptor farnesoid X receptor (Fxr) in the liver or intestine, VSG reduces intestinal levels of bile acids, thereby decreasing fat absorption in the intestine. Given the rising popularity of bariatric surgeries to treat obesity and associated T2D, the …

Macrophage-Derived Thrombospondin 1 Promotes Obesity-Associated Non-Alcoholic Fatty Liver Disease, Taesik Gwag, Raja Gopal Reddy Mooli, Dong Li, Sangderk Lee, Eun Young Lee, Shuxia Wang

Pharmacology and Nutritional Sciences Faculty Publications

Background

Thrombospondin 1 (TSP1) is a multifunctional matricellular protein. We previously showed that TSP1 has an important role in obesity-associated metabolic complications, including inflammation, insulin resistance, cardiovascular, and renal disease. However, its contribution to obesity-associated non-alcoholic fatty liver disease/non-alcoholic steatohepatitis (NAFLD or NASH) remains largely unknown; thus, we aimed to determine its role.

Methods

High-fat diet or AMLN (amylin liver NASH) diet-induced obese and insulin-resistant NAFLD/NASH mouse models were utilised, in addition to tissue-specific Tsp1-knockout mice, to determine the contribution of different cellular sources of obesity-induced TSP1 to NAFLD/NASH development.

Results

Liver TSP1 levels were increased in experimental obese …

Rationale And Design Of The Baylor Infant Twin Study-A Study Assessing Obesity-Related Risk Factors From Infancy, Shabnam R Momin, Mackenzie K Senn, Scott Buckley, Neil R M Buist, Manisha Gandhi, Amy B Hair, Sheryl O Hughes, Kelly R Hodges, William C Lange, Maria A Papaioannou, Mimi Phan, Robert A Waterland, Alexis C Wood

Children’s Nutrition Research Center Staff Publications

Background: Early childhood (0-3 years) is a critical period for obesity prevention, when tendencies in eating behaviors and physical activity are established. Yet, little is understood about how the environment shapes children's genetic predisposition for these behaviors during this time. The Baylor Infant Twin Study (BITS) is a two phase study, initiated to study obesity risk factors from infancy. Data collection has been completed for Phase 1 in which three sub-studies pilot central measures for Phase 2. A novel infant temperament assessment, based on observations made by trained researchers was piloted in Behavior Observation Pilot Protocol (BOPP) study, a new …

Intestinal Stem Cell-Derived Enteroids From Morbidly Obese Patients Preserve Obesity-Related Phenotypes: Elevated Glucose Absorption And Gluconeogenesis, Nesrin M Hasan, Kelli F Johnson, Jianyi Yin, Nicholas W Baetz, Lea Fayad, Vadim Sherman, Sarah E Blutt, Mary K Estes, Vivek Kumbhari, Nicholas C Zachos, Olga Kovbasnjuk

Faculty, Staff and Students Publications

OBJECTIVE: The mechanisms behind the efficacy of bariatric surgery (BS) for treating obesity and type 2 diabetes, particularly with respect to the influence of the small bowel, remain poorly understood. In vitro and animal models are suboptimal with respect to their ability to replicate the human intestinal epithelium under conditions induced by obesity. Human enteroids have the potential to accelerate the development of less invasive anti-obesity therapeutics if they can recapitulate the pathophysiology of obesity. Our aim was to determine whether adult stem cell-derived enteroids preserve obesity-characteristic patient-specific abnormalities in carbohydrate absorption and metabolism.

METHODS: We established 24 enteroid lines …

Development Of A Mind Body Program For Obese Knee Osteoarthritis Patients With Comorbid Depression, Cale A. Jacobs, Ryan A. Mace, Jonathan Greenberg, Paula J. Popok, Mira Reichman, Christian Lattermann, Jessica L. Burris, Eric A. Macklin, Ana-Maria Vranceanu

Orthopaedic Surgery and Sports Medicine Faculty Publications

Knee osteoarthritis (OA) is the most common joint disorder in the U.S. and a leading cause of disability. Depression and obesity are highly comorbid among knee OA patients, and the combination of obesity and depression is associated with decreased physical activity, higher pain and disability, and more rapid cartilage degradation. Depression, obesity and OA exacerbate one another and share a common pathophysiology involving systemic inflammation and pro-inflammatory cytokines, reflecting a complex mind-body interaction. Current treatments for knee OA offer little to no benefit over placebo, and do not emphasize mind-body practices or physical activity to target the underlying pathophysiology. Mind-body …

The Sugar Industry Gets Rich And We Get Sick, Mary Katherine A. Schutt, Shannon M. Monnat

Population Health Research Brief Series

This issue brief takes a deep dive into strategies the sugar industry uses to gain profits while making us sick.

Endobariatric Procedures For Obesity: Clinical Indications And Available Options., Hemant Goyal, Jonathan Kopel, Abhilash Perisetti Md, Rupinder Mann, Aman Ali, Benjamin Tharian, Shreyas Saligram, Sumant Inamdar

Other Specialties

Obesity remains a growing public health epidemic that has increased healthcare costs and related comorbidities. Current treatment guidelines encourage a multidisciplinary approach starting from patient selection, interventions, and long-term follow-up to maintain weight loss. However, these conservative interventions are largely ineffective at reducing body weight due to low adherence to the treatment regimen. Recently, endoscopic bariatric therapies have become an attractive alternative to traditional invasive bariatric surgeries due to their improved efficacy, safety, and cost-effectiveness. Endoscopic bariatric therapies include intragastric balloon placement, endoscopic sleeve gastroplasty, gastric bypass revision, and aspiration therapy. These procedures fall into two separate categories depending on …

Risk Factors For Evisceration In Gynecological Oncology Surgeries, Fati̇h Kiliç, Günsu Ki̇myon Cömert, Mehmet Ünsal, İsmet Çi̇ğdem Kiliç, Caner Çakir, Di̇lek Yüksel, Mustafa Alper Karalök, Osman Türkmen, Ahmet Taner Turan

Turkish Journal of Medical Sciences

Background/aim: To investigate the risk factors for evisceration in a gynecological oncology population. The secondary aim was to evaluate the impact of evisceration on survival. Materials and methods: Inclusion criteria consisted of having had an elective surgery performed through a xiphoidopubic incision in our institution and having a gynecological malignancy based on pathology. A total of 198 patients were evaluated, 54 with evisceration and 144 without evisceration. Due to the widely varied prognosis of female genital cancers, the survival was analyzed on a homogenized group, including only 62 patients with primary advanced stage epithelial ovarian-tubal-peritoneal cancer. Results: The preoperative factors …

Reducing The Obesity Epidemic Globally, Kimberli Pepper

Global Sustainable Development Projects

The consumption of high fructose corn syrup (HFCS) has caused a global obesity epidemic that has several health implications such as type two diabetes, fatty liver disease, kidney failure, oxidative stress, insulin resistance, multiple types of cancer, and pathogenesis of cardiometabolic diseases (Johnson et al., 2013; Malik and Hu, 2015; Romieu et al., 2017; Softic et al., 2016). The prevalence of obesity in the United States was evaluated by the Center for Disease Control (CDC) and reported that USA was at 39.8 percent, which is a significant risk factor for the development of type two diabetes mellitus (T2DM) (Mejia and …

Ifnγ Is A Key Link Between Obesity And Th1-Mediated Autoimmune Diseases, Heekyong R. Bae, Myung-Sook Choi, Suntae Kim, Howard A. Young, M E. Gershwin, Seon Min Jeon, Eun Young Kwon

United States Public Health Resources

Obesity, a characteristic of metabolic syndrome, is also associated with chronic inflammation and the development of autoimmune diseases. However, the relationship between obesity and autoimmune diseases remains to be investigated in depth. Here, we compared hepatic gene expression profiles among high-fat diet (HFD) mice using the primary biliary cholangitis (PBC) mouse model based on the chronic expression of interferon gamma (IFNγ) (ARE-Del-/- mice). The top differentially expressed genes affected by upstream transcriptional regulators IFNγ, LPS, and TNFα displayed an overlap in HFD and ARE-Del-/- mice, indicating that obesity-induced liver inflammation may be dependent on signaling via IFNγ. The top pathways …

Characterization Of Clostridium Cochlearium As A Potential Probiotic For Obesity Management, Paba Edirisuriya

Wayne State University Dissertations

ABSTRACTCHARACTERIZATION OF CLOSTRIDIUM COCHLEARIUM AS A POTENTIAL PROBIOTIC FOR OBESITY MANAGEMENT

ByPABA EDIRISURIYA MAY 2021 Advisor: Dr. Kequan Zhou Major: Nutrition and food science Degree: Doctor of Philosophy Emerging evidence indicates that manipulation of gut microflora is a potential therapeutic approach for managing obesity. Probiotic effects on host weight reduction have repeatedly been revealed through previous studies. Clostridium cochlearium is a butyrate-producing, spore-forming bacteria that have been reported to present in the mammalian gut. Our simulated Invitro digestion model revealed that C. cochlearium could survive in the unfavorable conditions of the human gastrointestinal tract, including low pH (pH2), high bile …

Health Care Provider Program On The Management Of Obesity, Erlinda P. Bhat

Walden Dissertations and Doctoral Studies

Research has shown that educational programs have led to developing the professional skills and behaviors of front-line health care providers who care for overweight or at-risk obese patients. The purpose of this project was to provide an educational program on best practices for weight management to health care providers at a large military clinic. The project question was developed to assess whether the educational program increased the knowledge and confidence of health care providers in the management of obesity. Utilizing Pender's health promotion model, a quasi-experimental study was conducted in which 15 health care providers, including licensed and unlicensed personnel …

The Lived Experience Of Black Women With Weight Loss And Counseling Post Bariatric Surgery, Cynthia Williams

Walden Dissertations and Doctoral Studies

AbstractStudies have shown that bariatric surgery can assist obese individuals to both lose a significant amount of weight rapidly and improve or resolve health comorbidities associated with obesity. This weight loss, however, can be considerably less for the obese Black woman. While reasons for this difference appears multifactorial entailing dietary, genetics, and environmental factors, limited research concerning the lived experiences of obese or formerly obese Black women with weight loss and post bariatric counseling have been conducted. The primary objective of this interpretative phenomenological study was to increase the understanding of the lived experiences of obese or formerly obese Black …

Relationship Between Social Media Screen Time, Sedentariness, And Bmi Among Young Adults, Helen Golod

Walden Dissertations and Doctoral Studies

Obesity has quickly become an epidemic that affects adults and youth not only in the United States, but also increasingly elsewhere in the global community. Research suggests that most children and adolescents spend a significant amount of time indulging in screen-based leisure, especially on social media. Such behavior may also be linked to sedentary lifestyle, which can impact an individual’s body mass index (BMI). There is a lack of understanding concerning how sedentary behavior moderates the relationship between screen time spent on different types of social media and BMI among young adults in the United States. To address this research …

In-Store Marketing Campaign To Promote The Purchase Of Healthy Foods And Beverages At Convenience Stores In Rural Kentucky, Brynnan Nicole Jacobs Dunaway

Theses and Dissertations--Nutrition and Food Systems

The prevalence of obesity is greater in rural communities, and current health promotion interventions have not shown broad positive impacts on dietary patterns in these areas. Focusing community-based efforts on unconventional food retailers is a unique avenue to encourage healthier food choices in rural populations. This study used shelf-wobblers to market healthier snack and beverage items at convenience stores (n=5) in a rural Kentucky county. Selection of healthy snacks and beverages from the store inventory was conducted using the CDC Food Service Guidelines for Federal Facilities calculator. Items were sorted into four categories: meal replacement snacks, high-protein snacks, low-fat carbohydrate …

Preventing Obesity: A Social Ecological Exploration Of Centers For Disease Control Prevention Strategies And Guidance Toward Healthy Eating, Physical Activity, And Communities, Ryan Kelly

Theses and Dissertations

Abstract

Obesity has reached nearly 40% of the adult public in the United States, costing the citizen taxpayer over $200 billion annually in healthcare costs. Those suffering from obesity deal with multiple physical and mental repercussions. Through a content analysis of four Centers for Disease Control (CDC) documents and guided by the conceptual framework of the social ecological model, this research explores the federal approach to preventing obesity. The analysis finds that CDC solutions to obesity involve connecting people to each other and healthier choices, an orientation toward local public administration, and an emphasis on environmental and infrastructure improvements. The …

Time Trends Of Overweight And Obesity Among Schoolchildren In Kuwait Over A 13-Year Period (2007-2019): Repeated Cross-Sectional Study, Abdullah Al-Taiar, Nawal Alqaoud, Ali H. Ziyab, Faheema Alanezi, Monica Subhakaran, Reem Sharaf Alddin, Hueiwang Anna Jeng, Muge Akpinar-Elci

Community & Environmental Health Faculty Publications

Objectives: This study aimed to examine age-specific trends in the prevalence of overweight and obesity in schoolchildren in Kuwait over a 13-year period (2007 to 2019) using the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC) and the International Obesity Taskforce (IOTF) definitions.

Design: Using cross-sectional approach, Kuwait Nutrition Surveillance System (KNSS) objectively measured weight and height of schoolchildren over a 13-year period. Log-binomial regression models were used to examine age-specific trends of obesity and overweight over the study period.

Setting: Public primary, middle, and high schools in all provinces of Kuwait.

Participants: Schoolchildren aged 5-19 …

Adipose Depot-Specific Effects Of 16 Weeks Of Pioglitazone On In Vivo Adipogenesis In Women With Obesity: A Randomised Controlled Trial, Ursula White, Mark D. Fitch, Robbie A. Beyl, Marc K. Hellerstein, Eric Ravussin

Clinical Research Faculty Publications

Aims/hypothesis: In vitro and rodent studies suggest that pioglitazone, a thiazolidinedione, can promote adipogenesis in adipose tissue (AT); however, there is a lack of in vivo studies in humans to support these findings. The objectives of this randomised, placebo-controlled, parallel-arm trial were to test if pioglitazone stimulates in vivo adipogenesis in the subcutaneous adipose tissue depots and if these measures were related to metabolic health outcomes in women with obesity. Methods: Forty-one healthy women with obesity (20 black; 21 white; 29 ± 6 years; BMI 32.0 ± 1.7 kg/m2; 44.0 ± 3.6% body fat) were randomised to consume 30 mg/day …

Leucine And Sildenafil Combination Therapy Reduces Body Weight And Metformin Enhances The Effect At Low Dose: A Randomized Controlled Trial, Candida J. Rebello, Michael B. Zemel, Orville Kolterman, Gilbert Alexander Fleming, Frank L. Greenway

Clinical Research Faculty Publications

Background:This study evaluated the potential of activating the fuel-sensing enzymes Adenine monophosphate (AMP)-activated protein kinase and the deacetylase sirtuin1, to promote weight loss. We tested the efficacy of a fixed dose combination of the amino acid leucine and 2 well-characterized agents with established safety profiles to modulate energy metabolism and facilitate weight loss.Study Question:Will a combination of l-leucine with low-dose metformin and sildenafil produce a novel synergistic interaction that reduces body weight?Study Design:We conducted a 24-week randomized controlled trial evaluating the effect on weight loss of leucine 1.1 g and sildenafil 1.0 mg or 4.0 mg, with and without metformin …

Association Between The Consumption Of Breakfast And The Recommendation Of Physical Activity And The Nutritional Status In Children, Eduardo Rossato De Victo, Gerson Ferrari, Dirceu Solé, Carlos André Miranda Pires, Timóteo Leandro Araújo, Peter T. Katzmarzyk, Victor Keihan Rodrigues Matsudo

Population and Public Health Science Faculty Publications

The scope of this article is to associate breakfast consumption (BC) with moderate to vi-gorous physical activity (MVPA) intensity and the nutritional status of children aged 9-11. The sample consisted of 432 children from São Caetano do Sul participating in the International Study of Childhood Obesity Lifestyle and the Environment. Data were collected between 2012 and 2013. The weekly BC was obtained using the self-reported method. To measure MVPA, children used ac-celerometers and were classified into two groups (< 60 versus ≥60 min/day). The nutritional status was presented by body mass index (BMI). Logistic regression models were used, adjusted for gender, age, race, parental educational level and eating score. The mean BC was 5.25 (CI95%: 5.1-5.4) days/week and the MVPA was 59.29 (CI95%: 57.3-61.7) min/day. In the total sample, 55.8% of the children did not perform ≥60 min/day of MVPA and 50.2% were overweight or obese. The daily BC was not associated with MVPA, however, it reduced the odds of children being overweight or obese (OR: 0.51; CI95%: 0.34-0.76; p=0.001). Daily BC reduced the odds of excess weight or obesity in children, though it did not increase the chances of children meeting the recommendations of MVPA. Public policies should encourage daily BC to prevent excess weight or obesity.

Digital Tools To Support Family-Based Weight Management For Children: Mixed Methods Pilot And Feasibility Study, Amanda E. Staiano, Jenelle R. Shanley, Holly Kihm, Keely R. Hawkins, Shannon Self-Brown, Christoph Höchsmann, Melissa C. Osborne, Monique M. Leblanc, John W. Apolzan, Corby K. Martin

Clinical Research Faculty Publications

Background: Family-based behavioral therapy is an efficacious approach to deliver weight management counseling to children and their parents. However, most families do not have access to in-person, evidence-based treatment. We previously developed and tested DRIVE (Developing Relationships that Include Values of Eating and Exercise), a home-based parent training program to maintain body weight among children at risk for obesity, with the intent to eventually disseminate it nationally alongside SafeCare, a parent support program that focuses on parent-child interactions. Currently the DRIVE program has only been tested independently of SafeCare. This study created the “mHealth DRIVE” program by further adapting DRIVE …

Understanding Parent/Child Experiences Affecting Obesogenic Behavior In Children, Jean Gaffney

Walden Dissertations and Doctoral Studies

Families living in an inequitable food environment are impacted by limited access to healthier foods inventory. Habitual consumption of foods lacking adequate nutritional value increasingly contributes to the heightened prevalence of obesity and premature death from non-communicable chronic diseases such as diabetes and heart disease. This basic qualitative analysis examined factors that impact parental decisions in food choices among obese and overweight children. The study explores the level of understanding held by low-income parents/caregivers as it relates to basic nutritional knowledge. Bandura’s Social Cognitive Theory framed the study. A purposeful sample of eight parents/caregiver between the age of 18-50, parenting …

A Weight-Loss Intervention Augmented By A Wearable Device In Rural Older Adults With Obesity: A Feasibility Study, John A. Batsis, Curtis L. Petersen, Matthew L. Clark, Summer B. Cook, Francisco Lopez-Jimenez, Rima I. Al-Nimer, Dawna Pidgeon, David Kotz, Todd A. Mackenzie, Stephen J. Bartels

Dartmouth Scholarship

Background

Older persons with obesity aged 65+ residing in rural areas have reduced access to weight management programs due to geographic isolation. The ability to integrate technology into health promotion interventions shows a potential to reach this underserved population. Methods

A 12-week pilot in 28 older rural adults with obesity (body mass index [BMI] ≥ 30 kg/m2) was conducted at a community aging center. The intervention consisted of individualized, weekly dietitian visits focusing on behavior therapy and caloric restriction with twice weekly physical therapist-led group strengthening training classes in a community-based aging center. All participants were provided a Fitbit Flex …

Feasibility Of Acceptance-Based Health Coaching Targeting Food Cravings In Pregnancy, Lauren Blau

Legacy Theses & Dissertations (2009 - 2024)

Excess gestational weight gain (GWG) is the leading high-risk condition in pregnancy in the United States and associated with a variety of poor delivery and health outcomes for the mother and infant. The majority of interventions addressing diet and physical activity in pregnancy have at best small effects on weight gain and pregnancy health outcomes. Past studies on weight loss in non-pregnant samples have demonstrated the utility of addressing psychological factors to modify eating behaviors. Currently, there is a lack of research to evaluate the efficacy of targeting psychological factors to improve cognitive and affective coping skills when attempting to …

The Probiotic Effect Of Clostridium Cochlearium Is Associated With Significant Change In Short-Chain Fatty Acid Metabolism And Gut Microbiota, Qing Ai

Wayne State University Dissertations

The prevalence of obesity is rising steadily across the world, which increases the risk of many metabolic diseases and life-threatening illnesses. A specific strain, Clostridium cochlearium (C. cochlearium), reported as a butyrate producer, could have potential probiotic effects against obesity. The objective of this study was to evaluate the effects of dietary supplementation of C. cochlearium on a high-fat diet-induced obese (DIO) mouse model. The 16S rRNA sequencing of mice gut microbiome was performed at the end of the experimental period to identify the changes in gut microbial composition, investigate possible functional genes, and elucidate potential mechanisms. Thirty-six C57BL/6 6-8 …

Three Essays On Grocery Sales Taxes, Lingxiao Wang

Theses and Dissertations--Agricultural Economics

Grocery sales taxes represent a stable tax revenue stream for state and municipal government, but there is rare empirical evidence suggesting grocery taxes may adversely affect health. In addition, the how governments set grocery sales taxes is still unclear. Therefore, based on a novel national dataset of annual county and state-level grocery taxes from 2009 through 2016, the following three essays in the dissertation investigate the health impacts of grocery sales taxes and the causes of grocery sales taxes in a framework of tax competition.

In the first essay, we document the spatial and temporal variation in grocery taxes and …

Combating The High Prevalence Of Obesity Among Egyptian Households: A Pilot Study: Port-Said Households/ مكافحة السمنة في المجتمع المصري: دراسة تجريبية في بورسعيد, Asmaa Sedky, Marwa Gaber, Noha Magdy, Shaimaa El Safoury

Papers, Posters, and Presentations

Obesity is a major public health issue in Egypt and its repercussions are not only limited to the health dimension but also extend to affecting the productive capacity of the citizens. This adversely affects the overall fundamentals of the Egyptian economy. Moreover, there is a current political interest in promoting the health and well-being of the citizens which is reflected in the recent 100 Million Seha massive campaign that measured the weight and height of millions of Egyptians.

By applying the decision-making rule which has to do adhere to the equity, administrative, and political criteria, we recommend adjusting the Egyptian …

Human Regulatory T Cells Control Inflammation From Effector T Cells In Prediabetes, Rui Liu

Theses and Dissertations--Pharmacy

Type 2 diabetes (T2D) is a chronic low-grade inflammatory disease. A T cell cytokine profile (Th17) from PBMCs can distinguish obese T2D from obese non-diabetes subjects. Individual T cell subsets interact with each other and the diverse subsets jointly determine overall inflammation. Cellular metabolism drives cytokine production of CD4⁺ T cells, and therefore contributes to inflammation in T2D. However, specific changes in metabolism and function of CD4⁺ T cells during the progression from lean healthy to obese and diabetic stages in people have not been clarified.

We hypothesize that human regulatory T cells (Treg) impact metabolism of effector …

Politics Of The Obesity Epidemic, Jacob Lyle

CMC Senior Theses

American society has long been obsessed with the issue of obesity. The turn of the 20th century broadly marked the beginning of America's current collective understanding of obesity. Throughout the century, the salience of the issue waxed and waned due to various factors. Around 2000, obesity became a major political issue. Media coverage of the issue exploded, and it became a hot topic for political debate. This paper looks to conduct a complete reckoning of the obesity epidemic that includes contextualizing the economic, cultural, and political factors that have shaped the issue throughout the 20th and 21st centuries.