text: Physical activity, genetic, and nutritional considerations in childhood weight managementBAR-OR, ODED (CO-CHAIR); FOREYT, JOHN (CO-CHAIR); BOUCHARD, CLAUDE; BROWNELL, KELLY D.; DIETZ, WILLIAM H.; RAVUSSIN, ERIC; SALBE, ARLINE D.; SCHWENGER, SANDY; ST. JEOR, SACHICO; TORUN, BENJAMINMedicine & Science in Sports & Exercise: January 1998 - Volume 30 - Issue 1 - p 2-10 ACSM Roundtable Discussion Free Abstract Author InformationAuthors Article OutlineOutline Juvenile obesity is a serious, increasingly prevalent problem in technologically developed societies. Almost one-quarter of U.S. children are now obese, a dramatic increase of over 20% in the past decade. It is intriguing that the increase in prevalence has been occurring while overall fat consumption has been declining. Body mass and composition are influenced by genetic factors, but the actual heritability of juvenile obesity is not known. A low physical activity (PA) is characteristic of obese children and adolescents, and it may be one cause of juvenile obesity. There is little evidence, however, that overall energy expenditure is low among the obese. There is a strong association between the prevalence of obesity and the extent of TV viewing. Enhanced PA can reduce body fat and blood pressure and improve lipoprotein profile in obese individuals. Its effect on body composition, however, is slower than with low-calorie diets. The three main dietary approaches are: protein sparing modified fast, balanced hypocaloric diets, and comprehensive behavioral lifestyle programs. To achieve long-standing control of overweight, one should combine changes in eating and activity patterns, using behavior modification techniques. However, the onus is also on society to reduce incentives for a sedentary lifestyle and over-consumption of food. To address the key issues related to childhood weight management, the American College of Sports Medicine convened a Scientific Roundtable in Indianapolis. Children's Exercise & Nutrition Centre, McMaster University, Hamilton, Ontario, CANADA; Departments of Medicine & Psychiatry, Baylor College of Medicine, Houston, TX; Physical Activity Science Laboratory, Universite Laval, Sainte-Foy, Quebec, CANADA; Yale Center for Eating and Weight Disorders, Yale University, New Haven, CT; Department of Pediatrics, Tuft's University, Boston, MA; Clinical Diabetes and Nutrition Section, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Phoenix, AZ; Nutrition Education & Research Program, University of Nevada, Reno, NV; Human Nutrition Unit, Institute of Nutrition of Central America and Panama, Guatemala City, GUATEMALA Abstract HEREDITY AND JUVENILE OBESITY Heritability Level The Risk of Becoming Obese The Single Gene Hypothesis PHYSICAL ACTIVITY AND ENERGY EXPENDITURE IN JUVENILE OBESITY Inactivity and Overweight Energy Expenditure and Overweight MANAGEMENT OF JUVENILE OBESITY Enhanced Physical Activity as an Intervention Diets and Nutritional Considerations Psychological and Social Considerations UNDERNUTRITION, PHYSICAL ACTIVITY, AND PHYSICAL FITNESS Undernutrition and Physical Activity Undernutrition and Physical Fitness POLICY CONSIDERATIONS: PRESENT AND FUTURE Policies Regarding Prevention Public Policy Options The Role of Schools RECOMMENDED QUESTIONS FOR FUTURE RESEARCH REFERENCES Childhood and adolescence obesity (henceforward, juvenile obesity) is a serious, increasingly prevalent problem. Almost one-quarter of children in the United States are currently obese, a dramatic increase of over 20% in the past decade (60). Dietary data from the United States suggest that this increased prevalence occurred despite a decrease in overall fat consumption and little change in calorie intake. It is therefore conceivable that energy expenditure has decreased during that period. Juvenile obesity increases the risk of adult obesity. Forty percent of obese 7-yr-old children and 70% of obese adolescents become obese adults(35,41,54). The obese child is at increased risk for hypertension, hypercholesterolemia, hyperinsulinemia, decreased release of growth hormone, respiratory disorders, and orthopedic problems. The obese child suffers both psychologically and socially. Self-esteem and self-image are often damaged by ridicule and scorn. The prevention and treatment of juvenile obesity through effective weight management are thus of enormous public health importance. Early identification of children at risk, prevention strategies, public policy and public health approaches, and early intervention may be the most effective means of addressing the primary causes of obesity, i.e., poor diet and a lack of physical activity. National objectives for health promotion set forth by Healthy People 2000(63) include seven initiatives which relate directly to improving weight management in children: 1) reduce or maintain the prevalence of overweight in the U.S. at <15%; 2) increase the adoption of sound dietary practices and regular physical activity to 50% of overweight children; 3) increase to 90% the proportion of school lunch and breakfast service and child care food services with menus that are consistent with the Dietary Guidelines for Americans (61); 4) increase to 75% the proportion of schools that provide nutrition education as part of a comprehensive health education program from preschool to 12th grade; 5) increase to 30% those who engage regularly in light to moderate physical activity for at least 30 min·d-1; 6) increase to 75% those children who engage in vigorous physical activity that promotes the development and maintenance of cardiorespiratory fitness three or more days per week for 20 or more minutes per occasion; and 7) reduce to 15% those who engage in no leisure-time physical activity. The major objective of these initiatives is to "increase the span of healthy life" most effectively and efficiently. Unfortunately, few of these goals for the year 2000 will be attained at our current pace. The prevalence of obesity in children is on the rise, less than 50% of children engage in routine physical activity, less than 36% of schools offer physical education classes, sedentary activity has increased (TV watching averaging 24 h·wk-1) and as many as 45% of children snack on high fat, calorie-dense foods at least twice per day(39). This, indeed, is a sad commentary on how the overall health and weight of our children are being directly affected by adverse practices, environmental influences, and lack of educational programming. Likewise, in a recent report (64), the U.S. Surgeon-General states that "the prevalence of vigorous physical activity among young people falls short of the Healthy People 2000 goal of 75%" (p. 192). Nor have these goals been met for light to moderate physical activity (p. 196). The goals set for reduction of inactivity among young people have been "met for adolescents overall, but not for black females or young adults" (p.189). The American College of Sports Medicine (ACSM) convened a Scientific Roundtable with the sponsorship of the National Dairy Council and the Sugar Association. The Roundtable met at the ACSM Center on July 16th and 17th, 1996. Its goals were to examine the roles of heredity, physical activity, and nutrition in juvenile obesity and weight management, and to suggest the most promising strategies for reversing the growing prevalence of obesity in our nation's youth. However, weight control programs should not compromise a person's health. Preoccupation with weight reduction may induce aberrant eating and activity behaviors, which may result in undernutrition. Another aim of the Roundtable was therefore to outline the effects of undernutrition on children's physical activity and fitness. Back to Top | Article Outline HEREDITY AND JUVENILE OBESITY Obesity is a complex multifactorial trait that evolves under the interaction of influences from the social, behavioral, physiological, metabolic, cellular, and molecular domains. Segregation of the genes cannot be easily detected in familial or pedigree studies and whatever the influences of these genes, they are attenuated or exacerbated by nongenetic factors. In addition, it is likely that body fat content is also modulated over one's lifetime by various gene-environment interactions. The outcomes of these interactions may vary among individuals because their sensitivity to environmental exposures or to lifestyles varies because of genetic individuality. Among environmental factors one may include dietary fat, energy intake, level of habitual physical activity, smoking, alcohol intake, and others. Moreover, gene-gene interactions need to be considered, but little research bearing directly on this topic has been reported so far. Back to Top | Article Outline Heritability Level The level of heritability has been considered in a large number of twin, adoption, and family studies. The level of heritability is simply the fraction of the population variation in a trait (e.g., BMI) that can be explained by genetic transmission. Results obtained by a good number of investigators indicate that the heritability level estimates depend on how the study was conducted and on the kinds of relatives upon which they were based. Recent studies incorporating individuals with a wide range of BMI together with information obtained on their parents, siblings, and spouses suggest that the genetic contribution to obesity may be ≈25-40% of the individual differences in body mass or body fat (8). It has been suggested that the heritability level increases from birth to puberty and reaches its maximum at biological maturity. It seems also that the heritability of BMI decreases after middle age. Back to Top | Article Outline The Risk of Becoming Obese A number of studies have reported that obese children frequently had obese parents. In about 30% of the cases, both parents of obese children are obese, with a range in frequency of about 5 to 45%. It has also been estimated that about 25-35% of the cases of obesity occur in families with normal weight parents despite the fact that the risk of becoming obese is higher if one has obese parents. The level of risk (the so-called "R value") for a first-degree relative of an overweight, a moderately obese or a severely obese person in comparison with the population prevalence of the condition reaches about 2 to 3 (1). However, obese children and adolescents who are in the upper decile of the distribution have a much greater risk of being obese as adults (35). Back to Top | Article Outline The Single Gene Hypothesis It is commonly observed that severely or morbidly obese persons are, on the average, about 10-12 BMI units heavier than their parents, brothers, or sisters. Several studies have reported that a single major gene for high body mass was segregating from the parents to their children. However, a few studies did not find support for Mendelian transmission unless age and/or gender variations in the major gene were taken into account. From this small body of data, the trend seems to be for a major recessive gene accounting for about 20-25% of the variance, but with age-associated effects, with a gene frequency of about 0.2-0.3. These results must be viewed with great caution as they are based only on the unmeasured genotype approach and the gene(s) has(have) not been identified yet (8). Back to Top | Article Outline PHYSICAL ACTIVITY AND ENERGY EXPENDITURE IN JUVENILE OBESITY Inactivity and Overweight Interest in the relationship of reduced activity to obesity has been heightened by recent observations which suggest that, despite reductions in dietary fat, the prevalence of obesity in children and adolescents in the United States has continued to increase. Because 30% of the money spent on food is spent on items consumed outside the home, and because the fat and calorie contributions to the total intake of food consumed outside the home remain uncertain, the role of diet in the genesis of obesity cannot be entirely dismissed. Nonetheless, reduced activity remains a prominent potential source of energy imbalance. Although inactivity infers a level of energy expenditure close to resting metabolic rate, inactivity may induce obesity through its association with other behaviors that promote obesity rather than merely through a reduction in energy expenditure. In children(67) and adults (14), the effect of inactivity on the prevalence of obesity appears independent of the effects of more vigorous activity. Television viewing constitutes the most prevalent sedentary behavior among children and adolescents in the United States. As shown over a decade ago(17), and more recently confirmed(34), obesity is directly related to the number of hours spent watching television. Although television viewing is associated with reduced energy expenditure, increased consumption of foods while watching television, and the increased consumption of foods advertised on television, may be as important as reduced activity in the genesis of obesity. These data are consistent with other observations that suggest that sedentary behavior covaries with other behaviors such as smoking, fat consumption, and alcohol consumption (22,37). They also suggest that the effects of inactivity on obesity may be related to the covariance of inactivity with other behaviors rather than the effects of reduced energy expenditure alone. Limited opportunities for outdoor play and interaction may also contribute to inactivity. These factors include: Safety (including traffic) Reduced family size Children being driven to school Urbanization: fenced-in backyards Budget restraints in schools: elimination of physical education classes Limited funding of community (city, county, etc.) programs Liability and insurance issues in schools limit afterhours use of facilities by community Increased technology: computer games Back to Top | Article Outline Energy Expenditure and Overweight Methods to assess energy expenditure in a free-living environment include heart rate monitoring, time-and-motion-techniques (direct observation, activity diaries, or recall interviews) with conversions for the energy cost of specific activities, and doubly labeled water (2H218O, DLW). The DLW method is based on the principle that whereas 2H2 can only leave the body as water, 18O can be eliminated as either water or C18O2(48). A comparison of the disappearance rates of the two isotopes over a 7-d period allows for a determination of CO2 production, which can then be used to calculate total energy expenditure (TEE) over this time period. If a measurement of resting metabolic rate (RMR) is also performed, then an estimate of activity energy expenditure may be obtained by difference (TEE - [RMR + 0.1 × TEE]), while the ratio TEE/RMR has been proposed as an indicator of physical activity level (PAL). Although the DLW method is the most accurate of all methods for determining free-living energy expenditure, it is very expensive. In addition, no information is provided about the specific activities performed nor the behavioral aspects of activity. DLW combined with time-and-motion studies may give a more complete overview of the individual's activity, including the components of daily activity that contribute to obesity and may, thereby, improve our ability to make appropriate recommendations. In adults, both TEE and RMR increase with increasing weight(43,50). RMR is elevated because of increased amounts of fat free mass (the major determinant of RMR); TEE is increased because of the increased cost of weight-bearing activities. Although absolute TEE may be similar, RMR may be lower and activity energy expenditure may be higher in lean than in obese individuals. This indicates an inverse relationship between the amount of physical activity and body size(43). In young children, there is not much information about energy expenditure and risk of obesity. Decreased TEE in children as young as 6-9 months(45) and lower physical activity in preschool aged children (40) are reported to affect later-age obesity. However, conflicting reports show no relationship between TEE at 12 wk and indices of body fatness at 9 months or 2 yr (15). Cross-sectional data from our laboratory show no relationship between physical activity level and percent body fat; nor did we find a significant difference in TEE or activity energy expenditure between lean and obese children(46). Surprisingly, Mohawk children, who have a high prevalence of obesity, are reported to have higher TEE than Caucasian children(33). Data from time-and-motion questionnaires suggest an inverse relationship between time spent in activity and body fat mass(32); however, this observation is not supported by the DLW data. Longitudinal follow-up studies in a large cohort of children may help to clarify these incongruities in the future. In most of the studies of energy expenditure in young children, one consistent observation stands out: children younger than 7 yr appear to expend approximately 20-30% less energy in physical activity(31,46) than the level recommended by the World Health Organization (65). However, the recommendations for children from 1-10 yr of age were based on published intake data from developed countries. A review of the WHO recommendations has recently been undertaken by Torun et al. (57), resulting in the suggestion that habitual physical activity levels be classified as light, moderate, or heavy and that to prevent obesity, energy intakes which support the level of activity be recommended. However, a critical number of calories is necessary to ensure that all other nutrient requirements are met during this period of rapid growth in children. Perhaps targeting physical inactivity(by promoting less television viewing, less use of video games, and less automobile usage), as well as encouraging increased vigorous physical exercise, are reasonable alternatives to ensure good health and prevent obesity in these children (19). Back to Top | Article Outline MANAGEMENT OF JUVENILE OBESITY Enhanced Physical Activity as an Intervention Enhanced physical activity (EPA) is a major component in weight management of obese children and adolescents. Reduction in body fat is only one objective of EPA. Other reported benefits include improved selfesteem, increased aerobic fitness, a decrease in resting blood pressure, and an improved plasma lipoprotein profile (for review see (2)). Another potential benefit which has been documented for adults(49), but not yet for children, is the preservation of fat-free mass when a very-low-calorie diet is implemented. Likewise, training in obese adults can affect fat distribution, decrease insulin resistance, and increase glucose tolerance; but there are no similar data for children. In healthy, nonobese young people EPA has a limited effect on body adiposity (66). Greater efficacy and effectiveness of such programs have been suggested for children and adolescents who are obese(3). There are no data available on the optimal dose of EPA in juvenile obesity. It seems, however, that prolonged programs (e.g., 1 yr or more) are more efficacious than shorter ones (47). Compared with a low-calorie diet, the effect of EPA on body fat and total body mass is considerably slower. The main reason is that the energy equivalent of EPA programs for children seldom exceeds 1-1.2 MJ (250-300 kcal) per activity session, compared with a reduction of 4-5 MJ (1,000-1250 kcal) per 24 h through a low-calorie diet. There are indications, however, that the overall increase in daily energy expenditure exceeds the amount expended in an activity session per se. Likewise, the increase in energy expenditure over a one-month program exceeds the expenditure added by the program itself (6). Poor compliance with and adherence to EPA programs pose a major challenge to the therapist. It seems that the long-term effect of an intervention program is greater when lifestyle physical activities are promoted rather than a regimented exercise prescription (21). Furthermore, a mere reduction in the time spent on sedentary activities can induce a better and more sustainable weight control than does an exercise program(19). Furthermore, attitudes toward vigorous exercise among children reinforced for reductions in sedentary behavior seem more positive than attitudes among children reinforced for EPA(19). Back to Top | Article Outline Diets and Nutritional Considerations Fat reduction phase. Diets used in the treatment of childhood obesity can be divided into three categories: First, very low calorie diets, which comprise a high-protein, low carbohydrate, and low-calorie content. These have been termed "protein sparing modified fast" (PSMF); Second, programs that emphasize balanced hypocaloric diets (BHD); and third, comprehensive, behavioral lifestyle programs that include both nutrition and activity components and set attainable goals for the entire family. A loss of fat-free mass has been shown to occur during diet-induced weight reduction in obese subjects (18), particularly when diet is very low in energy (5). This is of particular concern in children and adolescents, who need to maintain a positive nitrogen balance during growth. It has been suggested (25) that PSMF is a suitable weight loss program for children. It allows for rapid weight loss (as much as L kg·wk-1), and seems to preserve fat-free mass. This is particularly so when exercise is added to the PSMF (24), which may induce an anabolic effect. Unfortunately, most intervention studies on this topic were based on small samples, did not have randomly allocated controls, and failed to prove long-term success. In a study with children, Figuera-Colon et al. (25) compared PSMF diet with a BHD diet. They found that patients on the PSMF diet had a significantly greater weight loss at 10 wk than did the BHD group and that both groups had minimal losses in fat-free mass. However, all the subjects in both groups regained most of their weight at 14.5 months. Indeed, the PSMF regimen should not be considered as a long-term approach. It should be limited to morbid obesity, when a fast reduction of adiposity is indicated, on clinical grounds, over a short period of time. More studies are needed to assess further the effectiveness of the PSMF method regarding the preservation of fat-free mass in children. Epstein et al. (20) observed that behavioral family-based treatments are associated with sustained effects over a 10-yr period. In these treatments overweight children and parents were prescribed a 4.2-5 mJ·24 h-1 (1000-1200 calories··24 h-1) BHD "traffic light" diet. This diet was used to maximize the nutrient density of food. Also included in the treatment is nutrition education for both the children and their families. It is difficult to tease out the efficacy and effectiveness of the 4.2-5 mJ·24 h-1 diet and nutrition education regarding weight loss in Epstein's program because of its combination with behavioral approaches and exercise prescription. It is critical that the composition of all diet formulations to be used in weight management of children include the required nutrients needed to provide for optimal growth as well as health maintenance. Low fat diets are not recommended for children under the age of 2. Dietary recommendations for older children emphasize careful implementation of a low fat diet (not to exceed 30% total energy intake) by the age of 5. Further recommendations include a variety of foods with special emphasis on increasing intake of fruits, vegetables, and grains and an adequate amount of lower fat dairy products, as outlined in the Food Guide Pyramid (62). The quality as well as the quantity of energy consumed should be balanced such that nutrient needs are met. Consumer education is needed about the role of food high in calories and fat (e.g., chips), food high in calories but low in fat (low-fat brownies), and food high in calories but low in nutrients (soft drinks). Weight management should be of life-long concern, beginning in childhood. Emphasis should be placed on total energy balance with the aim of maintaining healthy dietary patterns and choices. Long-term success involves setting realistic lifestyle goals and maintaining appropriate, small changes (deficits of approximately 800 kJ·d-1) which are achievable without compromising nutrient adequacy. A low fat dietary pattern can be achieved through decreasing intake of high-fat foods, fat used in cooking, or that added at the table, and avoiding visible fat whenever possible (trimming meats). A family-based approach should be emphasized. Normalization of eating patterns, with less emphasis on restriction and avoidance, decreases feelings of isolation and resentment, encouraging instead long-term positive eating patterns and enjoyment. In addition to various dietary protocols in treating childhood obesity, there are various ways of providing the information. Group counseling is problem oriented and uses group dynamics to achieve desired outcomes, whereas individual counseling operates on the basis of individually specified problems and individual goals. Certainly, group counseling can reach a larger number of individuals. Research has shown the importance of treating both the child and the parents, with improved outcomes if the child and parents attend group treatment meetings separately (10). Maintenance phase. Weight maintenance programs to prevent further weight gain and to allow children to "grow into their optimal weight" are receiving renewed attention. However, care must be taken to make appropriate nutrition and activity changes for children to achieve their optimal weight and body composition. Energy balance must be carefully maintained and challenges for arriving at the best recommendations for energy intake need further study. Recommendations for energy requirements at various ages, considering both median weight and height, have been established by the National Research Council and range from 450 kJ·kg-1 (2.7 mJ·d-1) for infants to 270kJ·kg-1 (1.3 mJ·d-1) for male adolescents. Although these recommendations have been helpful in determining approximate energy needs, individual variability and activity patterns must be taken into account. Further considerations for growth have included comparisons between expected and observed height and weight changes in 6-month increments. These comparisons can be used to determine whether decreased energy intake is compatible with desired growth patterns. Back to Top | Article Outline Psychological and Social Considerations Psychosocial consequences of obesity in children. The psychological and social consequences of being overweight in a society preoccupied with thinness can be both severe and enduring. Core aspects of psychological functioning such as self-esteem and body image can be affected, mood problems such as depression can occur, social discrimination is common, and long-term negative associations of overweight with college admission, employment opportunities, and income have been documented(29). Efforts at teaching body acceptance at the levels of both individuals and society should be enhanced, and health professionals working with obese children must be sensitive to psychosocial issues. Dieting versus lifestyle changes. The typical response to excess weight is restrictive dieting. As calorie intake falls further from a person's"comfort" level, adherence becomes more difficult and binge eating becomes more likely. Replacing dieting with a focus on healthy eating and reasonable exercise broadens the scope of intervention and prevention beyond weight to the behaviors that affect weight and emphasizes health and well-being rather than physical appearance. Weight preoccupation/body image. Modern culture overstates the degree to which the body can be shaped, molded, and sculpted, and presents highly unrealistic ideals for the perfect body (9). Eating disorders are the end product of this process in some people, but body dissatisfaction is so common that discontent with weight and shape is considered normative (55). The pressure to be thin is felt during childhood, with high rates of body concern and even dieting in children encountered in the third and fourth grades. Those who seek to decrease the prevalence of childhood obesity must be sensitive to the possible negative consequences of producing an even greater emphasis on weight. The need for weight loss in overweight children and adolescents must be balanced against the need to encourage realistic body weight ideals and to minimize dissatisfaction with body image. This can be accomplished to some extent by helping individuals abolish weight and appearance as the center of self-esteem. In addition, children on weight control programs should be tracked for body image issues, self-esteem, and goals. Reasonable weight goals. Because societal ideals for beauty hold out highly unrealistic goals, expectations of both the magnitude and rate of weight loss in both patients and families can often be unreasonable. It is essential that all concerned, including health professionals, have realistic expectations. In adults, this translates into a weight loss of approximately 10% of initial body weight (7). In children, it might mean even smaller losses or maintenance of weight until increased height creates more favorable body proportions. The health benefits of these modest weight changes have been documented, but the challenge is to help patients to attain reasonable goals. The goals people establish for themselves are often, if not always, far in excess of the results to be expected from even the most effective programs. More work is needed to develop programs for acceptance of reasonable goals. Drawing on self-efficacy theory, relapse prevention theory, recent work on body image, and the behavioral principle of shaping, comprehensive efforts must be devised to deal with this important issue. Otherwise, the all-too-common phenomenon of a person despairing over what weight remains to be lost rather than celebrating what has been accomplished will persist. Pathological eating. The problem of binge eating in adults has received considerable attention and is defined as eating what others would consider a large amount of food in a short period of time while feeling that the eating is out of control (23). Little work has been done with children, but interviews with adult binge eaters suggest that binge eating can begin in childhood and adolescence and, for some, precedes dieting and/or even a weight problem. Studies are needed to determine the degree to which binge eating contributes to childhood obesity; the psychological ramifications of binge eating independent of obesity; and whether the treatment of binge eating is necessary in at least some cases of childhood obesity. Back to Top | Article Outline UNDERNUTRITION, PHYSICAL ACTIVITY, AND PHYSICAL FITNESS Undernutrition and Physical Activity There is a biological tendency to maintain energy balance, such that dietary energy intake equates total daily energy expenditure plus tissue accretion for normal growth. When dietary energy becomes a limiting factor, children respond initially by reducing spontaneous physical activity to conserve energy for growth and other biological functions. It is not until the restriction of energy intake becomes more severe that weight gain and growth velocity diminish or stop. In a study under controlled clinical conditions that mimicked the habitual dietary intake of preschool children from low socioeconomic conditions in a developing country (59), a reduction in daily energy intake from 90 to 82 kcal (375 to 345 kJ) per kg body mass produced a proportional decrease in daily energy expenditure without affecting weight gain of 2- to 3.5-yr-old children. When daily intake was further decreased to a population mean of 71 kcal (300 kJ)·kg-1, energy expenditure did not diminish any more but weight gain was markedly reduced. Few studies have compared the physical activity of mildly or moderately malnourished children with better nourished counterparts of the same ethnic, social, and cultural conditions (e.g.,12,30,53,56). All indicate that undernourished children are less active. This is especially evident among toddlers and preschoolers who are not influenced by social conventions nor peer pressure and among older children in environments that encourage discretionary physical activity, such as summer camp(53). This decrease in activity can be reversed when nutritional conditions improve, as shown in a study with 2- to 6-yr-old children living in their home environment (56). Just as dietary and lifestyle habits can offset the biological tendency to maintain energy balance, thereby leading to obesity in some children, socioeconomic and cultural demands can override the tendency to compensate limited energy intake with a reduction in physical activity. Compared with boys and girls from industrialized relatively affluent societies, those who come from rural, poor environments where undernutrition is highly prevalent dedicate more time to moderate and heavy physical activities, such as domestic chores and productive work. Furthermore, their overall physical activity level is higher (57). This is not always accompanied by an increase in dietary intake, which partly explains the leanness and short stature of children and adolescents in those societies. Back to Top | Article Outline Undernutrition and Physical Fitness Physical fitness of children is affected by mild or severe undernutrition. A study of preschool children with severe protein-energy malnutrition showed that as nutritional rehabilitation progressed, the regression coefficient of oxygen consumption on heart rate increased, as assessed through weekly tests on a treadmill (56,58). Mild degrees of chronic undernutrition also have a negative effect on fitness. Studies in 6- to 16-yr-old children showed that maximal oxygen consumption was lower in those with marginal undernutrition compared with children with better nutritional conditions (52). These differences disappear when maximal aerobic power is calculated per unit of lean body mass. It seems that while the physiological potential to perform heavy physical work is maintained in children with mild undernutrition, their smaller size limits their absolute maximal aerobic power. In conclusion, undernutrition compromises physical activity and fitness of children from infancy through adolescence. A prolonged reduction in physical activity resulting from sustained low dietary intake may limit a child's social interactions and exploration of his/her surroundings. This, in turn, may contribute to slower cognitive development and suboptimal social performance (56). The smaller body size of children with chronic undernutrition limits their maximal aerobic power. In adults, this has been associated with lower productivity in performing heavy physical work. Thus, the effects of undernutrition on children's physical activity and fitness may have important biological, psychological, social, and economic implications. Back to Top | Article Outline POLICY CONSIDERATIONS: PRESENT AND FUTURE Policies Regarding Prevention Once established, obesity is difficult to treat. While the concept of prevention is appealing, little work has been done on the prevention of obesity in general and of childhood obesity in particular. This lack of attention must be reversed and redressed immediately. The goals of prevention may vary, from promoting no increase in the prevalence of obesity in targeted groups, to reduction of weight and body fat in those at medical risk. There are also many possible methods of prevention. Targeting nutrition education and physical activity in the schools is a logical beginning, particularly in light of the alarming decrease over the past several decades in the number of state and local school boards that mandate physical activity in the schools. A true prevention program, however, should move beyond general nutrition and physical education and must focus on issues specifically related to obesity. Examples might include buffering children against advertisements for poor foods, changing lifestyle patterns, focusing on decreasing sedentary behaviors such as watching television, as well as increasing activity and choosing a diet that is healthy but satisfying. Back to Top | Article Outline Public Policy Options In areas such as smoking and alcohol abuse, professionals have long used policy as a means for affecting public health. Approaches such as smoking bans in public places, regulation of the advertising of cigarettes and alcohol to children, and drunk driving laws are generally accepted and have, to a greater or lesser extent, been evaluated. Despite the potentially powerful impact of similar actions that might affect great segments of the population, there has been virtually no such consideration in the field of obesity. Issues influenced by policy decisions are likely to have substantial impact. Nutrition and exercise programs in the schools are examples, but at a broader level, it is important to consider the effect of policy on the cost and availability of healthy and less-healthy foods, on the content of food advertising, and the availability of exercise facilities around the country. These issues appear to be of central importance in the health and well-being of adults and children alike. There is unprecedented access to high-calorie, high-fat food; the number of fast food restaurants has exploded and factors such as drive-in windows, packaged meals, and"supersize" servings have boosted intake of specific types of foods (4). The average American child sees 10,000 television advertisements for food each year, 95% of these are for fast foods, candy, sweetened cereals, and soft drinks (4). It has been argued that Americans are exposed to a "toxic food environment" and that the outcome is a predictable increase in diet-related diseases, including obesity. Similar arguments can be made for declining physical activity. Several policy measures have been suggested, including subsidizing healthy foods, increasing the price of unhealthy foods, regulating advertising aimed at children, and devoting public funds to build exercise facilities. Since these have not been tested, their impact is uncertain. While it is premature to make specific policy recommendations, it is imperative that policy be studied as a means to determine its role in the genesis of obesity and that policy changes be considered seriously as a means of addressing the growing epidemic of obesity. Mass media efforts can positively facilitate behavior change(13). For example, the "5 a Day-for Better Health" campaign of the National Cancer Institute has positively influenced the consumption of fruits and vegetables. Thus, important attitudinal changes can result from effective use of the media to reshape expectations and definitions of what constitutes desirable eating and activity behaviors. Proactive efforts to promote early and ongoing assessments, implementation of successful interventions and/or prevention strategies, and adoption of healthful behaviors (including healthy eating habits and an active lifestyle) are needed. Thus, to begin, public health efforts should focus on effectively changing the prevailing political, educational, and medical climate. Back to Top | Article Outline The Role of Schools Since 95% of American children, ages 5-17 yr, are enrolled in school, school-based interventions offer important potential. Many children eat one to two meals a day at school and the cafeteria can serve as a laboratory. Social support from teachers and peers can also be generated(44). The Nutrition Education and Training Program(NET)sponsored by USDA (51) is an excellent example. The program encourages: 1) instruction of students; 2) training of school food-service personnel; and 3) the in-service education of teachers and other school staff (57). New federal regulations for school breakfast and lunch programs mandate compliance with the 1995 Dietary Guidelines. Programs should be developed to include school-based assessment for early diagnosis and tracking of weight and weight-related problems. The Comprehensive School Health Program developed by the DHHS and CDC which integrates nutrition, physical education, health education, and psychological and social services beyond the classroom will make an impact. However, for successful weight management to be achieved in children, interventions must be targeted to address special and changing needs, focus on life-long strategies, and be evaluated for effectiveness (36,40). Back to Top | Article Outline RECOMMENDED QUESTIONS FOR FUTURE RESEARCH The following list is not meant to be comprehensive, nor is it in order of priority. It outlines topics that reflect the authors' experience and interests. What is healthy weight in children? Is the effect of inactivity on obesity related to reduced energy expenditure or to the covariance of inactivity with other behaviors that promote obesity? Do other sedentary behaviors have an impact on childhood obesity comparable with the effects of television viewing? Are there certain periods in childhood and adolescence critical to the establishment of active or sedentary behaviors? Are children with low rates of energy expenditure at higher risk of becoming overweight in the future? Is the increased prevalence of obesity among children living in westernized countries the result of decreased physical activity? Is there an optimal dose of enhanced physical activity for the treatment of childhood obesity? Should resistance training be added to high-calorie activities, if one wants to counteract the catabolic effect of very low-calorie diets? What are the characteristics of "good responders" and"poor responders" to a program of enhanced physical activity and dietary modification? Should studies of enhanced physical activity be conducted in isolation from other therapeutic modalities, or should they be included only within multidisciplinary intervention projects? How can school-based programs be more fully utilized as mechanisms for life-long, comprehensive weight management program? What are the optimal and maximal levels of activity recommended for children with chronic mild or moderate undernutrition? Is the obese child destined to become an obese adult? What are the predictors of those cases who track well across decades and those who do not? What are the most important factors influencing children's dietary habits? At what level of obesity should PSMF be implemented? What is the efficacy of dietary programs when administered without enhanced physical activity? What is the optimal approach for promoting prevention of juvenile obesity in the community? Is it more effective to intervene at the level of the environment (e.g., building exercise facilities or bike paths) or the individual (educational efforts)? What is the cost effectiveness of prevention efforts aimed at the general child population versus those aimed at high risk individuals (e.g., children of obese parents)? How can important differences and similarities in weight management strategies for children and adults be best communicated? This Roundtable was made possible through support by the National Dairy Council and the Sugar Association. The authors are indebted to Barbara Campaigne, Ph.D., for her guidance and constructive comments. Address for correspondence: Oded Bar-Or, Children's Exercise & Nutrition Centre, McMaster University, Chedoke Hospital Division, Hamilton, Ontario, L8N 3Z5, Canada. E-mail: email@example.com to Top | Article Outline REFERENCES 1. Allison, D. B., M. S. Faith, and J. S. Nathan. Risch's lambda values for human obesity. Int. J. Obes. 20:990-999, 1996. Cited Here... | PubMed 2. Bar-Or, O. Obesity. In: Sports and Exercise for Children with Chronic Health Conditions. B. Goldberg (Ed.). Champaign, IL: Human Kinetics, 1995, pp.335-353. Cited Here... 3. Bar-Or, O. and T. Baranowski. Physical activity, adiposity and obesity among adolescents. Pediatr. Exerc. Sci. 6:348-360, 1994. Cited Here... | CrossRef 4. Battle, E. K. and K. D. Brownell. Confronting a single tide of eating disorders and obesity: treatment vs. prevention and policy.Addict. Behav. 21:755-765, 1997. 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Fasting with muscular exercise: changes in weight and nitrogen balance (in French).Nouv. Press. Med. 4:875-878, 1975. Cited Here... | PubMed 50. Schulz, L. O. and D. A. Schoeller. A compilation of total daily energy expenditure and body weights in healthy adults. Am. J. Clin. Nutr. 60:676-681, 1994. Cited Here... | PubMed 51. Sims, L. S. and J. Voichick. Our perspective: nutrition education enhances food assistance programs. J. Nutr. Ed. 28:83-85, 1996. Cited Here... 52. Spurr, G. B., M. Barac-Nieto, and J. C. Reina. Growth, maturation, body composition and maximal aerobic power of nutritionally normal and marginally malnourished school-aged Colombian children. In: Human Growth, Physical Fitness and Nutrition. R. J. Shephard and J. Parizkova(Eds.). Med. Sport Sci. 31:41-60, 1991. Cited Here... 53. Spurr, G. B. and J. C. Reina. Influence of dietary intervention on artificially increased activity in marginally undernourished Colombian boys. Eur. J. Clin. Nutr. 42:835-842, 1988. Cited Here... | PubMed 54. Stark, O., E. Atkins, O. H. Wolff, and J. W. B. Douglas. Longitudinal study of obesity in the National Survey of Health and Development. Br. Med. J. 283:13-17, 1981. Cited Here... | PubMed | CrossRef 55. Striegel-Moore, R. H., L. R. Silberstein, and J. Rodin. Toward and understanding of risk factors for bulimia. Am. Psychol. 41:246-263, 1986. Cited Here... | View Full Text | PubMed | CrossRef 56. Torun, B. Short- and long-term effects of low or restricted energy intakes on the activity of infants and children. In:Activity, Energy Expenditure and Energy Requirements of Infants and Children, B. Schurch and N. S. Scrimshaw (Eds.). Lausanne: IDECG, 1990, pp. 335-359. Cited Here... 57. Torun, B., P. S. W. Davies, M. B. E. Livingstone, M. Paolisso, R. Sackett, and G. B. Spurr. Energy requirements and dietary energy recommendations for children and adolescents 1 to 18 years old. Eur. J. Clin. Nutr. 50:S37-S81, 1996. Cited Here... | PubMed 58. Torun, B., Y. Schutz, F. E. Viteri, and R. B. Bradfield. Growth, body composition and heart rate/˙VO2 relationship changes during the nutritional recovery of children with two different physical activity levels. Bibl. Nutr. Dieta 27:55-56, 1979. Cited Here... | PubMed 59. Torun, B. and F. E. Viteri. Energy requirements of preschool children and effects of varying energy intakes on protein metabolism. Food Nutr. Bull., Suppl. 5:229-241, 1981. Cited Here... 60. Troiano, R. P., K. M. Flegal, R. J. Kuczmarski, S. M. Campbell, and JC. Johnson. Overweight prevalence and trends for children and adolescents. Arch. Pediatr. Adolesc. Med. 149:1085-91, 1995. Cited Here... | View Full Text | PubMed | CrossRef 61. U.S. Department of Agriculture, U.S. Department of Health and Human Services. Nutrition and Your Health: Dietary Guidelines for Americans. 4th Ed. Human and Garden Bulletin, No. 232. Washington, D.C. Department of Agriculture, 1995.. Cited Here... 62. U.S. Department of Agriculture. U. S. Department of Agriculture's Food Guide Pyramid. Washington, D.C.: USDA Human Nutrition Information Service, 1992. Cited Here... 63. U. S. Department of Health and Human Services, Public Health Service. Healthy People 2000: Midcourse Review and 1995 Revisions. Maryland: National Center for Health Statistics, 1995. Cited Here... 64. U. S. Department of health and Human Services.Physical Activity and Health: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 1996. Cited Here... 65. WHO (World Health Organization). Energy and Protein Requirements. Report of a joint FAO/WHO/UNU expert consultation. Geneva: World Health Organization, Technical report series 734, 1985. Cited Here... 66. Wilmore, J. H. The C.H. McCloy research lecture: appetite and body composition consequent to physical activity. Res. Q. Exerc. Sport 54:415-425, 1983. Cited Here... | CrossRef 67. Wolf, A. M., S. L. Gortmaker, L. Cheung, et al. Activity, inactivity, and obesity: racial, ethnic, and age differences among schoolgirls. Am. J. Public Health 83:1625-1627, 1993. Cited Here... | PubMed | CrossRef Keywords:BEHAVIOR MODIFICATION; DIET; ENERGY EXPENDITURE; EXERCISE; HEREDITY; OBESITY; PREVENTION; PUBLIC POLICY; TV VIEWING; UNDERNUTRITION ©1998The American College of Sports Medicine


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A Crisis Chapter on Government
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A Crisis Chapter on Government
We are in the midst of one of those awful crises, when vindictiveness, called "civil government," stands nakedly revealed, so that all who have eyes can plainly see this horrible monster. Now's the time to tell the truth—the whole truth—and "shame the devil." Now's the time to strike an effectual blow for real freedom.
Governments are triumphant monopolies of murder, robbery, swindling and all that is atrocious and detestable. Ever since the beginning, they have forced mankind to kill or prepare and hold themselves in readiness to kill each other by the thousands and even millions at a time, and by the cruelest and most destructive means that spite can devise.
All the so-called religions the world has yet "experienced" have solemnly declared that "Almighty God" upholds these governments, all the moralists that have had any practical influence have sanctioned that declaration and all the infidels and political economists have said Amen: some of the infidels most libelously substituting the word "Nature"—their miserably narrow comprehension of it—for "Almighty God."
Whenever one of these governments gets conquered and overthrown by another of them, or by internal revolution, (events that often happen), "Almighty God," the moralists, the infidels, and the political economists turn dead against the fallen government. Whenever rebellionists murder and steal, and devastate so magnificently that the police cannot put them down, they thereby gain "belligerent rights;" their murdering, robbing, &c., &c., &c. thenceforth considered honorable, and enterprising individuals of other nations may honorably join them. But these are not half the inducements that governments hold out to excellence in atrociousness; they punish in the cruelest and most disgraceful manner, all the scoundrels they can catch and convict, who do not attain that excellence; and they plan society so that every man and woman must try their luck at scoundrelism or pay the expenses of those who do.
The fastest of all governments is Demagoguery—swindlingly named "elective" or "free government." The buncomest demagoguery the world has ever seen—a rotted-off branch of the most abominable of monarchies—has just capt the climax: it has spawned an atrociousness far more atrocious than any before, and that cannot be surpassed. One of the principals in a million or so of murders, with robbery and devastation to match, struts flauntingly wherever he pleases, with his insignia, (as do all the principals who are not to proud to stay and associate with their fellow-citizens), and the great general who was pitted against him writes him the politest notes, signing himself "Very *** *****, your obedient servant," while reimprisoning at hammering stone, about a hundred escaped convicts, whose crimes did not average the damage of $20. In demogogueries, the great brigands have to be sated with plunder every year; at furthest, every four years. In monarchies they are only sated once in a life time.
The legislature of a single State in the "Model" Demogoguery perpetrated more and viler corruption in the year of grace "1865," than did the most tyrannical monarchy in the world.
But in spite of the murderers, and robbers, and swindlers, and impostors and quacks that govern mankind, liberty has gained some ground through those only possible liberators, the scientists and artists. It is now manifest destiny that these will finally rule the world, and then freedom with be a reality. It cannot be long before present government runs the length of its tether. Unless it stops in its course, such hells as the people of the United States hope they have just got through the hottest of (March, "1865") will come in such quick succession that no one will be at all provident in guessing "it won't come in my day." The reins of power will then spontaneously fall into the hands of those who will abolish all vindictiveness and constraint; mankind will then be as free as the planets in their orbits; "Heaven" will be realized on earth; the earth itself will be physically changed so as to meet the case, and all through material development; through science and art—the same that has given to us the steamboat and the railroad. The great car of progress speeds on. Noiselessly but surely it will reach its destination. Wealth will then be incomparably more valuable than it now is, thousands of times more plenty, and perfectly secure to its individual owners. Machinery will do all labor that is repulsive, and be owned in shares, by the Universal Mutual Guarantee Co. "The People" will dwell in palaces, splendid as the faith-built "mansions in the skies." All the women will be enchantingly beautiful, all the men faultless, all the children real angels. Love will be free, and universally reciprocal, "virtue" and "vice" obsolete, all constraint banished, everybody completely happy. Between desire and its object, there will intervene only the exertion requisite to impart due pleasurableness to possession. life will last until all clearly imaginable varieties of delight pall on the five senses from repetition. Sickness will be unknown. Death itself will be only a welcome, painless transit to everlasting forgetfulness.
All this is clearly preconceived, and therefore must necessarily take place. For thought is not absolute, but relative. the impossible, self-evidently cannot be conceived, even prospectively. Mentality does not transcend materiality, but functionally depends on it, objectively and subjectively. Perfection—"Heaven"—is preconceived even by common intellectual faculties; though mistakenly, in toto, as to method. Perfection, therefore, will, self-evidently, be realized. Nature—all which to or in man exists—is not, fixedly, a mere half and half of good and evil. Nature is "God" and will prove all-sufficient.
Hark ye, my fellow-citizens of the United States. You seem wholly intent on having another patch up of old government schemes and devices. That patch up won't last fifty years; then, or probably much sooner, you'll have a civil war a great deal worse than the present one; t will be felt both North and South. Do you think it was the enslavement of the Negro that caused this war? Pshaw! It was the enslavement of human nature that has caused all the war that has ever taken place! And human nature can't be conquered; she is backed up, slowly but surely, by Almighty Power, by the force of all cognizable existence, marshalled by ART.
1. How much deeper in war debt has the detestable Monarchy of England run in a thousand years than the "Model Republic" has in less than a century? Professor Lewis says our war debt is not over $3,000,000,000; be he don't reckon the state, county, city and even village war debt.
2. Wouldn't it be perfectly true to call every "election" a Game of Caucus and Ballot Box—a Grand Raffle for the Public Treasury—a Stupendous Swindle? Are not the People mere cards of the politicians in playing that game? Do they any more than decide for this or that spoil distributor, between whom the odds is merely the difference between tweedledum and tweedledee?
3. If the State Capitol at Albany and the State Prison at Sing Sing had changed inmates in "1865," wouldn't a great act of justice have been done? and wouldn't the "dear people" have gained immensely thereby? and might not this question have been fairly raised with respect to the incumbents of the Federal Capitol any time since the commencement of Andrew Jackson's administration?
4. Were the "angels" who sang "peace on earth and good will to men" "heavenly angels" or "masked imps of hell," judging the tree by its fruit?
5. How much more honorable is war (except war absolutely necessary in defense of most important rights) than assassination? How much more honorable is it to compel, or entice (generally by lying and intoxication) peaceful men to kill each other, and to bombard and starve women and children by the thousands, than to creep, ever so stealthily, behind your single enemy and stab only him in the back? What's the difference between cowardice and the difference between our treatment of secessionists and State prisoners?
We are education and habituated to consider the most cruel and cowardly assassination as "honorable war!" and to submit to the most expensive and abominable oppression that can be imposed, because that oppression is magically surrounded with a make-believe of freedom.
Disdainful of Monarchies, the Great Republic sycophantically apes their religion, their law, their moralism. She even emulates their cowardice, in knuckling to generals, in crime, whilst savagely torturing and hanging comparative nothing as [?] in crime. Abolish this horrid injustice; take the lead in delivering mankind from the religious, political, and moral "Hell" in which they have always been tormented, and be the glory of the nations, whilst earth and man endure. By "whorawing" and calling ourselves a great people, and all that sort of thing, over such gross injustice, we are but preparing a volcano more dreadful than the one that has just spent its worst fury. Right is mighty and will prevail.
The distinction that is made between scoundrels under the law and scoundrels over the law; between "criminals" and officer [?] "warriors," slaps justice full in the face, and kicks right, and honor, and mercy, and truth, clean out of court, and stinks most abominably of cowardice.
Let us pardon ALL scoundrels, beginning with the hen-roost robbers, and proceeding thence to pardon the Secessionists of every grade, and then even those scoundrels at the very bottom of the pit of scoundrelism—the UTTERLY CORRUPT, LOBBY ANOINTED LEGISLATORS. Then, let us have a new order of things; a REALLY
ARTICLE I.—All constraint shall be abolished; every man, moan and child shall be fully developed or perfected, and be so situated as to do exactly as they please.
ARTICLE II.—Congress shall make an appropriation sufficient to rear every child born in the United States, in the best manner that MATERIAL SCIENCE AND ART can devise, and similarly provide for the mothers, during their lying in.
ARTICLE III.—Supernaturalism: all that pretends to go beyond or exceed the powers or laws of nature, is henceforth and forever excluded from the domain of government.
There, Fellow Citizens, that's just what's got to be done, and there will only be worse and worse "Hell to pay" till it is done. Till just this is done, mankind will be worse and worse tormented by the religious, political, and moral quacks, who screen themselves behind "Divine Providence" and teach and habituate us to worship a personification of their own unsurpassable foolishness and villainy, as "Almighty God."
"I accept this war as the providence of God," says Hardee, Secesh General and D. D., as reported by the N.Y. Herald. Nearly all the Union Generals and D. D.s agree with Saint Hardee on this tremendous point. But just think of it; just try to think that any real "God" couldn't or wouldn't do what "He" wanted to do except by means of big guns and little guns and put punchers and brain splitters, and Libby prison horrors, and Shoddy, and bounty jumpers, and widows and orphans made by the hundred thousand, and a million or so of murders, including that of President Lincoln, and more than five billion dollars other damage. Why, men can do such things in that way, and the foolishest and wickedest men have done just exactly that. What's the use of "Him"?
If the theology of General Saint Hardee and his brother theologians in the States north of Dixie be true, isn't it the rankest blasphemy to offer those big rewards for Jeff Davis & Co., and call them murderers and fugitives from justice? Haven't they, up to the time of their hegira, acted under the "providence of God"? What if Jeff and his colleagues should offer to surrender, and turn State's evidence against their principal, on condition of being let off? What would Secretary Stanton, General Hardee, and our other civil and military doctors of divinity do in such a case? In "God's" name, what could they do?
There! I've spoken the bold truth, and I'll bet it will "shame the devil" and a good many of his imps; that "devil," the only "devil" that ever was or can be--ignorance; alias Mystery; alias Foolishness; he is one of the two great Omnipresents who live on balderdash and have their thrones in the realm of nonsense; and his imps, all of them who instigate any harm worth noticing, are the parsons, politicians, and moralists. These miserable wretches are chargeable with all the woe mankind have ever endured. I wouldn't have a thousand billionth part of their guilt resting on me, for all the gold in the universe.
Calvin Blanchard, A Crisis Chapter on Government (New York: Calvin Blanchard, 1865.).

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On Disruptions!!
No business conversation today is complete without someone talking about either being disrupted, or of disruptions in the ecosystem.
A good video to watch is this Keynote from Tony Seba, which talks of demise of some Industries which we would not think possible – namely the Automobile as we know, Electricity Utility as we consume today and some others. What would they be replaced with? None other than our Silicon Valley! See for yourself
Not being an in-depth researcher or author and futurologist like Tony, I cannot present spell binding data on disruption, but I will attempt to list some mega-trends and disruptions that is shaping the future Information Technology (or IT) Services Industry. Of course Tony's predictions above will shake up the IT Services industry no less, in that some of the target customers and Business Verticals itself will not survive!
Here are these, in no particular order, I penned as they came to my mind.
- Everything connected to everything – also called as IOT (Internet of Things) or Internet of Everything. Every 'thing' will have an IP address and be always online. Reams are still being written on this, of trillions of 'things' talking to the internet
- Everything will have to be Secured – a corollary from above megatrend. With so many (trillions) things online and open, Cyber Security will be one of the biggest concerns, and business opportunity!
- 5G – higher throughputs, higher bandwidths, higher data compressions (Hopefully I will be able to connect to the 'WhateverG' network at my home in Noida, as of now I cannot get 3G or 4G signals!)
- Algorithm Economies and Algorithm Organisations will Rule. Google, Facebook are what I call the Algorithm Companies. They employ people, yes, but their business is based on Algorithms
- The 'Geek' shall inherit the earth? Finally.
- Video and Images will rule – we will stop calling, we will always video-call. Selfies and Perfect Profile Pictures will drive behavior, not to say of dressing
- A strong positive domino effect on the apparel and grooming industry – with all the selfies we would want to be seen in something 'new' everyday
- Possible new businesses - Apparel (dresses) as a Service. Wear a new dress every day, delivered in the morning, intuitively selected by an AI system based on your mood, your schedule, health and other 'vital' signals analysed as you sleep!
- Everything as a service – remember the famous quote, 'don't buy anything – rent your shoes if you can'. It was prophetic in nature!
- Establishment of Consciousness as a mainstream science
- Work anywhere, anytime, for anyone
- Crowd Everything – Crowd-Consulting, Crowdsourcing, Crowd-financing, Crowd-Learning
- IT Services Industry as we know will not exist, so far as Resourcing and Employees go. A large proportion of the work will be in Crowdsourcing models, farmed out as modules to independent developers.
- IT Services companies will be more of thin layer of Aggregators, Integrators and Architecture Definers, as against armies of code developers and system maintainers. Much like manufacturing in the past – the 'Programming Supply Chain' will rapidly evolve to a set of smaller, far more economical, sub-system providers and Individuals. Check what platforms like Maven or Upwork and many similar are already providing.
- End of Full Time Employment and Job Security as we know it. Read the points above. This will happen in all Sectors
- Concept of work and management. All teams will be Virtual – people will have to be re-trained to lead a new team every week, or everyday probably! You could be leading a team of ten nationalities, collaborating across time-zones one week and be an individual contributor the next.
- Blurring of lines between Products and Services
- Data will be the new Fuel
- 'Brand' as a concept will die. Consumers will have no Brand Loyalty, they will flit from product to product on a daily basis.
- Differentiation will last for a day - 'Brands' will have to prove their worth or establish differentiation on a daily basis
- Think of the Impact on Advertising Industry
- Products Customised to an Individual – remember the good old darzi (Tailor) in India, when the concept of 'ready-made' clothes was non-existent! Now take that custom tailor, accelerate the turnaround time to end product by 100, accessible online, anywhere anytime, home delivered, and you have a new economic model!
- Concept to Product Cycle, or Lab to Retail Shelf cycle will be Days, maybe Hours! It will be driven by consumer need, events, and availability of technologies like 3-D printing
- Environment and Sustainability will drive product and services adoption – the paradox of an increasingly aware, even though highly consumer and materialistic generation combined with a very high sense of responsibility towards the Environment. This generation will force corporations to be more 'Socially Responsible'. They will shun products that are known to kill our planet or 'exploit' human resources
- Availability of information and transparency will force the above change
- New Industries will emerge more rapidly, ones that we cannot yet conceptualise (did we think 'knowledge Search' would be a hundreds of billions of dollar business)
- Discontinuities and disruptions appear more frequently, and have a higher impact
- Concept of physical 'cash', probably of 'wealth' will be replaced – see Block-chain and Bitcoin
- A more 'Urban World' than ever before. This will force 'pockets' or islands of 'rural' within the urban jungles, from a way-of-life perspective
- Resurgence of Values, Self-discovery and Spirituality
There would be many more disruptions, mega trends than what I have listed above. Do let me know your thoughts.


text:
|by Bernadette Mayer
to bewilder the ever-present ladybugs
& turn supermarkets into galaxies
there's a snowdrop coming up 2/1/09
it's good to know there's hope for spring
darwin never knew
how silly sexually we'd be
it's the only flower you might have trouble
getting to; maybe I'm so old I wont be able
to reach any flowers this year, even daisies
will be beyond me: "I'm so close to that queen
anne's lace but I can't reach it!" there's always
the special queen anne's lace hotline for seniors
your corkscrew penis wont fit
my vagina corkscrewing the other way
the weather man's afraid to say rain
today's prediction was "dryish"
but it was raining, is raining & will be
raining, the mosquitoes've become lethal
& huge, there's flooding everywhere, trees
fall down, we should be building an ark
waiting for max, alyssa & marie, having started way too
early, I'm bored & it isn't raining, I miss the rain when
it's not here now that I've gotten used to it. melissa
& mike are visiting too & today, after we eat gnocchi
with artichokes, everybody but max adjourns to the NYC.
here & there across the sunny field
is a sign of autumn, the water's deep & cold
for august, it's the green corn moon, the grain
moon, where did I go wrong, almost harvest?
now it's wet & cold, where do I go?
max photographed barn wood on old route 20
I write to kill time (erik satie)
eeny meeny miny moe, are you a towhee?
A - avocet
B - blue jay
C - chickadee, cardinal
D - warbler (dendroica)
E - egret
F - finch
G - rose breasted grosbeak
H - blue heron
I - ibis, icterid (blackbird)
J - junco
K - kestrel
L - loon
M - merganser
N - nuthatch
O - owl, osprey
P - pelican
Q - quail
R - red winged blackbird (icterid), robin, roadrunner
S - siskin
T - tanager, turkey
U - underwood typewriter
V - vulture
W - woodpecker (pileated), wren
Y - yellow finch
Z - zinger
our power
our poor pourer
our impoverishment
went out the hungry door
all sentient beings see the sun
and/or feel it, it weighs a ton
poor on odd days, rich on even
but on the days of the month
that are prime numbers, we get
a little bit the way we're not
today, poor as church mice
we hie to the Hannaford's
spend fifty-eight dollars & seventy-three cents
for a week's worth of food, the eggs
& cigarettes got with a credit card
soon we'll be free-vores &
dumpster-dive & glean
when in the course of human events
I summon up remembrance of the walk we took
I see nothing, I don't see, maybe I was blind
or so enraptured by the sights of the creeks
- how many things can you keep in mind
at once? - I said I didn't see those creeks
but I did except I cant remember anything
now I've both lied & lost this sunny memory
so recently stored away in a manger
no crib for a bed, the little lord pathway
- "I wonder if I should drink coffee" -
now I remember less than nothing, what
does that mean? - I feel so attabled I might
be the someone else I threatened my sister with
being & nothingness
is a yellow, red, orange, black & green
word. I got sardines at the dollar store
where everything except sardines is more
than a dollar, for sixty cents, as they should be
my father used to take sardine sandwiches to work
perhaps therefore, I love sardines. when people
used to talk about the subway, they'd say:
we were packed like sardines which send a message:
small, cheap, tightly packed, anchovies for the poor
or you too can be both colorful & inexpensive as
a really snappy, tiny bright blue convertible
in which you can enjoy the good things about
feeling like a sardine but maybe you'd rather
be a striped bass or be a manatee with me
or a grand whale, forgetful of nothing even
being so big, the ocean's CEO, you'll take home
a giant amount of cash when the ocean goes bust
so you can share it even with the downtrodden
sardines who get packed in cans in Thailand
& shipped to the family dollar store for Bernadette
day is night is different
from saying night is day
today is like a night, tonight
might seem as long as a day, it's
raining lions & mastodons, the creek
never floods in july or hasn't but
it might be turning over a new leaf
next day more rain, all night, rain
it's beginning to seem too weird
pain at the pump's been replaced by rain
just to distract you like the inside
of a fallen trumpet flower to a blue jay
when's it gonna not rain?
I cant do without food
money's green as grass
neither grows on trees
but I'll trade you blades for cash
I need to get bill a snow globe
of the statue of liberty, we've got plenty
of tree trunks here, ones with leaves
but no manufactured items except
t.v.s, cars, earth movers & chain saws
sinks, stoves & refrigerators
bill's got a generator & a snow-blower
I have an electric typewriter
& a huge inflated bee on top of the t.v.
everybody has more money than me
the tulips are planted by the water pump
phil and hector went to the creek
I didn't go cause it's still too icy
I've been burned by my last attempt
today a fifty degree day in February
last night I dreamt anne gave me 100 $100 bills
she had some extras. sun, no, yes, maybe
on their return they walk to the footprints
still in the snow without apparent difficulty
and, guess what? the sun comes out
but not for long; the snow's shrunk as feebly
as the sun shines. let's hope tonight's rain
washes the snow away so walk I can
the ice got worse, now what?
yellow & green pie with chemicals
out the somber window that shows
hibernating trees, the water pump, the road
nothing falling from the gray sky yet
the room I'm in's too clean, the fire's failed
I'm doing the French fries on top of the stove
the mail's failed to come, the turkey had no liver
but it may work to write this poem unless
it gets stuck like a car by the creek
the creeks are over the top, be wary
of them, of getting mail from a bank
& a flyer from the family dollar store
in which everything is more than a dollar
except sardines, I don't even have a bank
account but I saw a rainbow in the woods once
when the sun got low enough to shine
under the earth's cloud caps, I thought
that's not a bad deal on dish detergent
|< Prev
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|more poetry:


text:
Which engine mounts should I buy for a Yanmar 2gm 20 diesel serial# 23669
We have a P.Y.I engine mount available, part number 244671. The Bushings Inc part you are going to want is the DF-2205-2 (part number 86662).Thank you.
Need repair or replacement of starting motor. Now 25 years old, built by Hitachi Ltd part S114-303
We do have a replacement Starter Motor available for that engine.
I am from Romania and I am interesting buy 4 injectors for yamaha 150hp from 2006,nr from original injector is CDH275,7320857.
You will need a Yamaha dealer for that part.
I had impeller installed by a mechanic. Now the pump is dripping salt water. The mechanic claims due to over heating of the engine a new pump has to be installed. I thinking he may have caused the leak when installing the impeller. This is a 2007 ynmar with very low hours. Thanks
If the pump ran without water for a long period of time it could get hot enough to destroy the seal. The leak could also be coming from the gasket if not installed correctly.
I am trying to locate a small diesel fuel tank suitable for an inboard 8hp Yanmar marine diesel (I believe a YSE8), either an original tank new or second hand or similar style tank that I can fit in the space available. Can you assist with either a tank or advice as to where I might find one?
Not being sure what size tank you are looking for, try this Selection of Fuel Tanks. For an original tank, you will need to contact the dealer.


text:
For hospitals attempting to fill ever growing vacancies, they are additionally going through growing challenges associated with escalating competitors from different healthcare institutions for the available workforce as well as fundamental modifications in hospital care. Check out the information sections and tales beneath for analysis, opinions and projections of how wearable health expertise can be utilized to patient care. See Appendix A for a glossary of key phrases associated with RF wireless know-how and wi-fi medical devices which have been adapted from the IEC 60050-161 International Electrotechnical Vocabulary (IEV) and different sources. Incumbent customers of the selected and adjacent bands, if any, and how they'll influence a medical machine's operation. From the global perspective, one of the exciting prospects for the medical functions of DNA technology is within the subject of communicable disease. One of the main limitations to progress in these fields is the relative isolation of the social sciences and well being care economics from the mainstreams of medical research and apply. Medical info and file technicians usually have at least an affiliate's diploma.
The thrilling part about this advancement is that stem-cell enhanced fats cells can be utilized in so many different environments, and the accepted makes use of of this expertise will solely develop as extra benefits are uncovered. In addition, computers are also used for a number of forms of medical examinations and procedures.
The prevailing evidence suggests no recognized medical worth for any of these in contrast with cheaper options. Without a serious attempt to unravel these difficulties, the potential of contemporary biomedical sciences appears sure to easily widen the hole in health care between North and South. If this stage of result shouldn't be achieved, candidates might be transferred to the Bachelor of Computer Science and Technology degree program with full credit score for units of research already completed. Contour threads have really been used in numerous different medical procedures, however have solely recently grow to be available within the beauty industry. Future specialization opportunities are also accessible for experienced medical radiologic technologists with technical excellence in areas similar to angiography, mammography, management and educating.
Medtronic, the world's largest standalone medical gadgets manufacturer, also anchored its excessive worth-added manufacturing of cardiac gadgets and lead in Singapore. Now, new know-how has enabled the study of population science to revolutionize the medical area.
Better integration of these fields will probably be a major problem for universities and national and international health care businesses. By far the most dramatic and useful software of the infrared digital camera is within the area of drugs. In healthcare, speech recognition technology can be utilized within the front finish as well as in the again end. It is basically an enhanced medical coding system that features over 14,000 totally different codes globally, as well as further subcategories. The guides have been developed with substantial enter from people and organisations within the NHS, the medical technologies industry, academia, patient and carer organisations and the Department of Health. Students may select initiatives provided by workers or propose their own analysis tasks. This follows from the actual fact to utilize pointers and ethics wanted in medical subject.


text:
I don't normally do 'wordless' posts ('chance would be a fine thing', as DH would probably say, ho ho). But today DH and I are out to dinner and a rock concert (yeehaw!) with my sweetie friend Rasmus and Magtens Korridorer. Pre-Flylady I would be running out the door, shouting instructions to the baby-sitter, frantically looking for my 'evening' handbag, telephone half-charged, DH and the taxidriver waiting impatiently for me. Changed days. Lookey here - two (count 'em) coats - and I've still an hour to go! ;)
Have a great Saturday night! :)


text:
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text:
Asian shares inched lower on Thursday, taking their cues from an overnight drop in U.S. and European equities on renewed concerns about global growth, which also weighed on commodities.
The MSCI's broadest index of Asia-Pacific shares outside Japan was down 0.3 percent, with Australian shares falling 0.4 percent, hit by sinking copper prices which deepened concerns about demand for Australia's raw materials.
South Korean shares opened down 0.4 percent.
"Cyclical large-caps are losing steam as the rate of economic recovery appears slowing in major countries such as the U.S. and China, while first-quarter earnings forecasts continue to be revised down," said Chang Jae-ho, an analyst at Daishin Securities.
Both the Standard & Poor's 500 Index and the Nasdaq Composite Index closed down more than 1 percent on Wednesday after disappointing corporate earnings reports.
Apple Inc fell below $400 a share for the first time since late 2011 after a poor revenue forecast from key supplier Cirrus Logic while shares of Intel Corp, the world's largest semiconductor maker, initially fell after it forecast a sharp decline in its current-quarter revenue and trimmed its 2013 capital spending plans.
European shares fell to a 2013 low.
Japan's Nikkei average opened down 0.8 percent.
Commodities also fell on Wednesday, with copper, seen as a gauge for manufacturing and China-related growth, shedding over 3 percent. A 10.3 percent decline in European car sales over March weighed on copper prices as an indicator of slumping demand for metals.
Oil prices tumbled for a sixth straight session on Wednesday, with Brent crude futures falling below $98 per barrel for the first time since July as rising U.S. fuel supplies added to overall concern about global oil demand.
U.S. crude futures fell 0.5 percent to $86.29 a barrel early on Thursday, just above a four-month low of $86.06 hit earlier in the week.
In addition to growth worries, the euro zone faces renewed risk of political uncertainty as Italy's divided parliament begins voting for a new state president on Thursday, a crucial step towards resolving the stalemate since the inconclusive election in February and to carry on with fiscal reforms.
The euro steadied around $1.3032, above Wednesday's one-week low of $1.3001.
The euro fell 1.1 percent on Wednesday for its biggest daily decline against the dollar since June, weakened by talk of a euro zone interest rate cut. The dollar also drew support from signs of economic weakness in Britain and Canada.
The dollar inched down 0.2 percent against the yen at 97.89 yen after touching a low of 95.67 yen on Tuesday, while the euro fell 0.3 percent to 127.54 yen, still above Tuesday's low of 125 yen.
Data from Japan's ministry of finance showed on Thursday that buying of Japanese equities last week by foreign investors hit a record high since the ministry began collecting the numbers in 2005, reaffirming the positive view on Japan and its strong push to beat deep-rooted deflation.
The capital flows data also confirmed Japanese investors have yet to actively seek returns from overseas assets despite falling domestic yields, with Japanese investors last week selling 332 billion yen of foreign bonds.
Traders will watch the impending Group of 20 meeting in Washington for any critical remarks over the yen's continued weak trend.
Gold, which on Monday triggered the wide market sell-off and led the liquidation of assets across the board after weaker-than-expected Chinese and U.S. economic reports stoked growth concerns, remained vulnerable.
Spot gold was down 0.2 percent at $1,373.51 an ounce early on Thursday, still some $100 below Friday's close. Bullion touched its lowest in more than two years of $1,321.35 on Tuesday.


text:
The Science District is one of the major areas of Castlevania City in Castlevania: Lords of Shadow 2. This part of the modern city is devoted to housing laboratories of scientific and technological research.
Fast travel here can be done with the Map Room or Wolf Altar.
Location indexEdit
Item DataEdit
|Item Data: Science District
|Name - Game
|Type / Users
|Attributes / Consume
|Statistics / Sell
|First Obtained During Bioquimek Mission
|On the exact spot of this memorial, what are known as the Chronicles of the Ancient Light were discovered 500 years ago. These apocryphal texts detail the horrific experiences of those who managed to escape from the claws of Dracula. Most of them lost their mind and parts of their bodies too, devoured by ghouls, vampires and harpies. These survivors soon died of the most awful infections and deliriums. However, a few miraculously managed to return safe and sound. Thanks to them, maps of the inside of the castle and precise tales of the horrors that took place inside were pieced together. It was the great Roland de Ronceval, Paladin of God, who made military use of those maps, gaining knowledge of the castle that, in hindsight, was crucial to defeating the Prince of Darkness.
| City Memorial
| Find: Science District
First Obtained: Bioquimek Corporation
See alsoEdit
- Bioquimek Corporation - The first mission where this area is accessible.
- Bernhard's Wing - Location that is accessible from this location.
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