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WEIGHT MANAGEMENT: OBESITY AND HEALTH INEQUALITIES

Obesity is one of the great unmet health inequalities. Predisposition to obesity is increased by lower socioeconomic status.

Middle-class individuals are far more likely to be interested in healthy nutrition, consume five portions of fruit and vegetables daily and provide healthy food choices for their families than people in lower social classes. They are also more likely to make time for structured formal exercise and to be able to afford a subscription to the local gym or tennis club. They probably have a car and shop at major supermarkets, where good-quality fresh food is available at competitive prices.

People in lower socioeconomic classes are less aware of nutritional health, less likely to have a car (and therefore less likely to shop at a supermarket), can ill-afford local shop prices and might have to rely on public transport to get the weekly shopping. Their children are more likely to go to a school where nutrition is not at the top of an already-overcrowded agenda. They are more likely to buy cheaper, high-fat, high-sugar foods, simply because they can afford them. The local area may be less conducive to safe outdoor play and a greater reliance on TV for home entertainment results in diminished opportunity for physical activity. As a consequence, the prevalence of obesity is higher in this group. Morbidity and disability are more likely, average income is lower, opportunities are fewer and earlier retirement through ill health is more common, and thus the cycle is, to some degree, perpetuated.

Access to help to counter weight gain might also be more difficult for some social groups. Individuals in poorer communities are less likely to be able to afford to self-pay through a commercial weight-loss programme and are less likely to access web-based programmes. Inner-city healthcare providers might be too preoccupied in dealing with more obvious social issues, for example drug abuse and teenage pregnancy, to have the time and resources to fund and deliver weight-management services to those who are in need. Equally, medical practices might be reluctant to offer weight management for fear of opening a 'Pandora's box' of morbidity, and face soaring drug costs once they concede the need for weight management in their patients, who have a higher obesity prevalence to start with.

Although the prevalence of overweight and obesity in men is similar to women, men are less likely to seek advice on weight management from commercial agencies or medical services. Only 1% of clients registering with major weight-loss companies are male, and men account for only 20% of patients attending medical weight-management clinics in both primary and secondary care. This might be because men are less aware of weight as a health issue, or because of a reluctance on the part of men to seek professional advice, but attention must be given to the way in which weight-management services are delivered within the NHS. Weight-management clinics held during work times make it difficult for working men (and women) to attend, and men might feel embarrassed to attend during general medical clinics. The commercial sector has been modeled in a very female-oriented way, with little provision for male preference or needs. Some of the most successful men-oriented weight-management services have been based in barber-shops, at motor-cycle events or are internet based.

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Hoodia gordonii (pronounced HOO-dee-ah) is also called hoodia, xhooba, !khoba, Ghaap, hoodia cactus, and South African desert cactus.Hoodia is a cactus that's causing a stir for its ability to suppress appetite and promote weight loss. 60 Minutes, ABC, and the BBC have all done stories on hoodia. Hoodia is sold in capsule, liquid, or tea form in health food stores and on the Internet. Hoodia gordonii can be found in the semi-deserts of South Africa, Botswana, Namibia, and Angola. Hoodia grows in clumps of green upright stems and is actually a succulent, not a cactus. It takes about 5 years before hoodia's pale purple flowers appear and the cactus can be harvested. Although there are 20 types of hoodia, only the hoodia gordonii variety is believed to contain the natural appetite suppressant.Although hoodia was "discovered" relatively recently, the San Bushmen of the Kalahari desert have been eating it for a very long time. The Bushmen, who live off the land, would cut off part of the hoodia stem and eat it to ward off hunger and thirst during nomadic hunting trips. They also used hoodia for severe abdominal cramps, haemorrhoids, tuberculosis, indigestion, hypertension and diabetes.In 1937, a Dutch anthropologist studying the San Bushmen noted that they used hoodia to suppress appetite. But it wasn't until 1963 when scientists at the Council for Scientific and Industrial Research (CSIR), South Africa's national laboratory, began studying hoodia. Initial results were promising -- lab animals lost weight after taking hoodia.The South African scientists, working with a British company named Phytopharm, isolated the active ingredient in hoodia, a steroidal glycoside, which they named p57. After getting a patent in 1995, they licensed p57 to Phytopharm. Phytopharm has spent more than $20 million on hoodia research.Eventually pharmaceutical giant Pfizer (makers of Viagra) caught wind of hoodia and became interested in developing a hoodia drug. In 1998, Phytopharm sub-licensed the rights to develop p57 to Pfizer for $21 million. Pfizer recently returned the rights to hoodia to Phytopharm, who is now working with Unilever. What you need to know about hoodiaHoodia appears to suppress appetite Much of the buzz about hoodia started after 60 minutes correspondent Leslie Stahl and crew traveled to Africa to try hoodia. They hired a local Bushman to go with them into the desert and track down some hoodia. Stahl ate it, describing it as "cucumbery in texture, but not bad." She lost the desire to eat or drink the entire day. She also didn't experience any immediate side effects, such as indigestion or heart palpitations. Stahl concluded, "I'd have to say it did work."In animal studies, hoodia is believed to reduce caloric intake by 30 to 50 percent. There is one human study showing a reduced intake of about 1000 calories per day. However, I haven't been able to find either study to actually read for myself and am going on secondhand reports.

Information on this site is provided for informational purposes only. It is not meant to substitute for medical advice provided by your physician or other medical professional. You should not use the information contained herein for diagnosing or treating a health problem or disease, or prescribing any medication. You should read carefully all product packaging and labels. If you have or suspect that you have a medical problem, promptly contact your physician or health care provider. Information and statements regarding dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease. *With purchase of 4 bottles.

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