The rapid increase in the prevalence of overweight and obesity in the U.S. represents a major health problem. Obesity is a worldwide epidemic, and after tobacco use, obesity is the second-leading preventable cause of death in the U.S.1 Obesity is the result of sustained positive-energy balance, and the current obesity epidemic is the result of interactions between genes and the environment (i.e., diet and exercise habits), as well as metabolic, social, behavioral, and psychological factors. Obesity has been associated with three conditions that are characterized by resistance to insulin-mediated glucose disposal: coronary heart disease, type 2 diabetes, and hypertension.23 It has been estimated that approximately 25 percent of the U.S. population has three or more of the following abnormalities: excess body weight, high triglyceride or low HDL cholesterol concentration, hypertension, or impaired fasting glucose.4
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