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es
o
f
th
e
d
is
ea
s
e
[
6
]
.
Sev
er
al
m
ath
em
atica
l m
o
d
els
ev
alu
ated
s
tr
ateg
ies f
o
r
m
a
n
ag
in
g
o
b
esit
y
an
d
p
r
o
p
o
s
ed
ac
tio
n
s
to
p
o
licy
m
ak
e
r
s
o
f
p
u
b
lic
h
ea
lth
to
m
itig
ate
th
e
r
ev
er
s
e
p
atter
n
o
f
o
b
esit
y
[
7
]
.
P
h
y
s
i
c
al
a
ct
i
v
i
t
y
,
d
i
e
t
,
a
n
d
p
h
a
r
m
a
c
e
u
t
i
c
a
l t
r
e
at
m
e
n
t
s
a
r
e
ess
en
t
i
a
l
c
o
m
p
o
n
e
n
ts
o
f
i
m
m
u
n
i
t
y
g
e
n
e
r
a
t
i
o
n
a
g
a
i
n
s
t
s
p
e
ci
f
i
c
d
is
e
as
es
[
8
]
.
T
h
e
s
e
f
a
ct
o
r
s
p
r
o
v
i
d
e
v
al
u
a
b
le
i
n
s
i
g
h
t
s
i
n
t
o
t
h
e
h
u
m
a
n
b
o
d
y
’
s
a
b
i
li
t
y
t
o
c
o
m
b
a
t
i
n
f
e
c
t
i
o
n
s
[
9
]
.
T
h
e
i
n
f
l
u
e
n
c
e
o
f
p
h
y
s
i
c
a
l
e
x
e
r
c
is
e
o
n
t
h
e
i
m
m
u
n
e
s
y
s
t
e
m
o
f
h
u
m
a
n
s
h
as
b
e
e
n
e
x
t
e
n
s
i
v
el
y
s
t
u
d
ie
d
.
I
t
h
a
s
b
e
e
n
s
h
o
w
n
t
h
a
t
e
x
e
r
c
is
e
c
a
n
i
n
f
l
u
e
n
c
e
i
m
m
u
n
i
t
y
a
t
d
if
f
e
r
e
n
t
l
e
v
e
l
s
.
T
h
is
r
e
s
e
a
r
c
h
h
a
s
a
l
s
o
e
x
p
l
o
r
e
d
h
o
w
e
x
e
r
c
i
s
e
c
a
n
c
o
n
t
r
i
b
u
t
e
t
o
t
h
e
p
r
e
v
e
n
t
i
o
n
o
f
p
a
n
d
e
m
i
c
s
t
h
r
o
u
g
h
t
h
e
c
o
n
c
e
p
t
o
f
h
e
r
d
i
m
m
u
n
i
t
y
.
I
n
a
d
d
i
t
i
o
n
,
s
t
u
d
i
e
s
h
a
v
e
a
i
m
e
d
t
o
d
e
t
e
r
m
i
n
e
t
h
e
o
p
t
i
m
a
l
e
x
e
r
ci
s
e
r
e
q
u
i
r
e
m
e
n
t
t
o
m
a
x
i
m
i
z
e
i
m
m
u
n
e
s
y
s
te
m
f
u
n
c
t
i
o
n
[
1
0
]
.
Ad
d
r
ess
in
g
o
v
e
r
weig
h
t
a
n
d
o
b
esit
y
r
eq
u
ir
es
a
c
o
m
p
r
eh
en
s
iv
e
s
tr
ateg
y
in
v
o
lv
in
g
v
a
r
io
u
s
s
tak
eh
o
ld
er
s
s
u
ch
as
d
ec
is
io
n
-
m
ak
e
r
s
,
h
ea
lt
h
ca
r
e
p
r
o
f
ess
io
n
als,
ed
u
ca
to
r
s
,
an
d
th
e
co
m
m
u
n
ity
.
T
h
is
s
tr
ateg
y
aim
s
to
f
o
s
ter
s
u
p
p
o
r
tiv
e
en
v
ir
o
n
m
en
ts
th
at
p
r
o
m
o
te
h
ea
lth
y
h
a
b
its
,
r
aise
p
u
b
lic
awa
r
e
n
ess
,
an
d
e
n
s
u
r
e
eq
u
al
ac
ce
s
s
to
p
r
ev
en
tio
n
an
d
tr
ea
t
m
e
n
t
s
er
v
ices.
I
n
th
is
p
ap
er
,
th
e
g
lo
b
al
o
b
esit
y
s
itu
atio
n
will
b
e
ass
e
s
s
ed
an
d
s
o
lu
tio
n
s
f
o
cu
s
in
g
o
n
d
iet
a
n
d
th
e
e
n
v
ir
o
n
m
en
t w
ill b
e
p
r
o
p
o
s
ed
.
2.
M
E
T
H
O
D
T
h
i
s
r
e
s
ea
r
c
h
w
a
s
c
o
n
d
u
c
t
e
d
u
s
i
n
g
p
e
e
r
-
r
e
v
i
e
w
e
d
j
o
u
r
n
a
l
a
r
t
i
c
l
es
t
h
a
t
w
e
r
e
p
u
b
l
i
s
h
e
d
w
it
h
i
n
t
h
e
p
a
s
t
f
i
v
e
y
e
a
r
s
.
T
h
e
e
m
p
h
a
s
i
s
w
as
p
l
a
c
e
d
o
n
f
i
n
d
i
n
g
a
r
t
i
c
l
e
s
t
h
a
t
c
o
n
t
a
i
n
e
d
b
o
t
h
g
l
o
b
a
l
a
n
d
U
n
i
t
e
d
S
t
a
t
es
s
p
e
ci
f
i
c
d
a
t
a
o
n
t
r
e
n
d
s
i
n
o
b
e
s
it
y
.
O
p
e
n
l
y
av
a
i
l
a
b
l
e
d
at
as
e
ts
a
n
d
p
a
ti
e
n
t
h
o
s
p
i
t
a
l
d
a
t
a
w
e
r
e
u
t
i
li
z
e
d
f
o
r
d
a
t
a
a
n
a
l
y
s
is
p
u
r
p
o
s
es
t
o
m
o
d
e
l
t
r
e
n
d
s
o
f
o
b
e
s
it
y
a
n
d
h
e
a
l
t
h
e
f
f
e
c
ts
o
n
a
g
l
o
b
a
l
s
c
a
l
e
.
A
d
d
i
t
i
o
n
a
l
e
c
o
n
o
m
i
c
d
at
a
w
as
u
t
i
l
i
z
e
d
al
s
o
f
o
r
t
h
e
i
m
p
a
c
t
o
f
o
b
e
s
i
t
y
o
n
g
r
o
s
s
d
o
m
e
s
t
ic
p
r
o
d
u
c
t
(
G
D
P
)
u
s
i
n
g
e
co
n
o
m
i
c
d
a
t
a
.
T
o
e
n
s
u
r
e
t
h
e
q
u
a
l
i
t
y
a
n
d
a
c
c
u
r
a
c
y
o
f
s
o
u
r
c
e
s
u
s
e
d
f
o
r
i
n
f
o
r
m
a
t
i
o
n
in
t
h
e
p
a
p
e
r
,
a
l
l
d
a
t
a
w
e
r
e
c
r
o
s
s
-
c
h
e
c
k
e
d
w
i
t
h
m
u
lt
i
p
l
e
r
e
p
u
t
a
b
l
e
s
o
u
r
c
es
.
T
h
e
s
p
e
c
i
f
i
c
t
o
p
i
cs
o
f
i
n
t
e
r
es
t
f
o
r
th
e
r
e
s
e
a
r
c
h
i
n
cl
u
d
e
d
c
a
u
s
es
o
f
o
b
e
s
i
t
y
,
t
r
ac
k
i
n
g
,
a
n
d
a
n
a
l
y
z
in
g
t
h
e
t
r
e
n
d
s
o
f
t
h
e
g
l
o
b
a
l
o
b
e
s
i
t
y
p
r
o
b
l
e
m
,
d
is
e
ase
s
r
e
l
at
e
d
t
o
b
e
i
n
g
o
v
e
r
w
e
i
g
h
t
,
a
n
d
w
a
y
s
t
o
o
v
e
r
c
o
m
e
t
h
e
o
b
es
i
t
y
c
r
i
s
i
s
.
3.
RE
SU
L
T
AND
DI
SCUS
SI
O
N
3
.
1
.
Wha
t
a
re
o
v
er
weig
ht
a
nd
o
bes
it
y
?
E
x
ce
s
s
iv
e
b
o
d
y
weig
h
t
is
a
d
ef
in
in
g
f
ea
tu
r
e
o
f
o
b
esit
y
an
d
o
v
er
weig
h
t.
I
t
is
ca
lcu
lated
b
y
d
i
v
id
in
g
th
e
weig
h
t
o
f
th
e
p
er
s
o
n
(
k
g
)
b
y
th
e
s
q
u
ar
e
o
f
h
is
/h
er
h
eig
h
t
(
m
)
.
Ob
esit
y
is
co
m
m
o
n
ly
r
ef
er
r
ed
to
as
h
av
in
g
a
B
MI
o
f
3
0
o
r
h
ig
h
e
r
,
wh
er
ea
s
b
ein
g
o
v
er
weig
h
t
is
g
en
er
ally
ch
ar
ac
ter
ized
b
y
B
MI
r
an
g
in
g
f
r
o
m
2
5
to
2
9
.
9
.
T
h
ese
d
iv
is
io
n
s
ar
e
em
p
l
o
y
ed
to
e
v
alu
ate
th
e
p
o
s
s
ib
ilit
y
o
f
em
er
g
in
g
ass
o
ciate
d
h
ea
lth
is
s
u
es.
T
h
e
em
e
r
g
en
ce
o
f
o
v
er
we
ig
h
t
an
d
o
b
esit
y
is
in
f
lu
en
ce
d
b
y
s
ev
er
al
v
a
r
iab
les.
T
h
ese
in
clu
d
e
in
h
er
ited
tr
aits
,
f
o
o
d
p
r
e
f
er
en
ce
s
,
in
ac
tiv
ity
,
s
ed
en
tar
y
b
eh
a
v
io
r
,
p
s
y
ch
o
lo
g
ical
ch
ar
ac
te
r
is
tics
,
an
d
e
n
v
ir
o
n
m
en
tal
f
ea
tu
r
es.
W
eig
h
t
g
r
o
wth
a
n
d
f
at
ar
e
o
f
ten
th
e
r
esu
lt o
f
a
co
m
p
licated
in
ter
ac
tio
n
o
f
th
ese
f
ac
to
r
s
.
Ob
esit
y
an
d
o
v
e
r
weig
h
t
ca
n
l
ea
d
to
s
er
io
u
s
h
ea
lth
co
n
s
eq
u
en
ce
s
.
I
t
r
aises
th
e
r
is
k
o
f
s
ev
er
al
ch
r
o
n
ic
illn
ess
es,
s
u
ch
as
s
tr
o
k
e,
h
ea
r
t
d
is
ea
s
e,
s
o
m
e
f
o
r
m
s
o
f
ca
n
ce
r
,
ty
p
e
2
d
iab
etes,
an
d
m
u
s
cu
lo
s
k
eleta
l
p
r
o
b
lem
s
.
Ad
d
itio
n
ally
,
i
t
m
ay
r
esu
lt
in
s
o
cial
an
d
p
s
y
ch
o
lo
g
ical
p
r
o
b
lem
s
lik
e
p
r
eju
d
ice,
d
esp
air
,
a
n
d
lo
w
s
elf
-
esteem
.
Ov
er
th
e
r
ec
e
n
t d
ec
ad
es,
t
h
er
e
h
as b
ee
n
a
co
n
s
is
ten
t in
cr
ea
s
e
in
th
e
p
r
ev
alen
ce
o
f
o
v
er
weig
h
t a
n
d
o
b
esit
y
o
n
a
g
lo
b
al
s
ca
le.
Nu
m
e
r
o
u
s
s
o
cio
e
co
n
o
m
ic
tr
e
n
d
s
,
in
cl
u
d
in
g
u
r
b
an
izatio
n
,
g
l
o
b
aliza
tio
n
,
a
n
d
e
atin
g
p
atter
n
s
,
m
ig
h
t
b
e
lin
k
ed
to
t
h
is
ten
d
en
cy
.
Alo
n
g
with
s
ed
en
tar
y
life
s
ty
les,
th
e
av
ailab
ilit
y
o
f
lo
w
-
co
s
t,
p
r
o
c
ess
ed
f
o
o
d
s
wh
ich
co
n
tain
h
ig
h
am
o
u
n
ts
o
f
f
at,
s
u
g
ar
,
a
n
d
s
alt
h
as in
cr
ea
s
ed
o
v
er
weig
h
t a
n
d
o
b
esit
y
r
ates
[
5
]
,
[
6
]
.
3
.
1
.
1
.
Child
re
n a
nd
a
do
lesce
nt
o
bes
it
y
I
n
d
u
s
t
r
i
a
l
iz
e
d
a
n
d
d
e
v
e
l
o
p
i
n
g
c
o
u
n
t
r
i
e
s
a
r
e
e
x
p
e
r
i
e
n
c
i
n
g
a
r
i
s
e
i
n
c
h
i
l
d
h
o
o
d
o
b
e
s
i
t
y
r
a
t
e
s
,
a
lb
e
i
t
a
t
v
e
r
y
d
i
f
f
e
r
e
n
t
r
a
t
e
s
a
n
d
i
n
d
i
s
ti
n
c
t
tr
a
j
e
c
t
o
r
i
es
.
I
n
a
d
d
i
t
i
o
n
t
o
1
5
5
m
i
l
l
i
o
n
c
h
il
d
r
e
n
o
f
s
c
h
o
o
l
a
g
e,
n
e
a
r
l
y
2
2
m
i
l
l
i
o
n
c
h
i
l
d
r
e
n
u
n
d
e
r
f
i
v
e
a
r
e
s
i
g
n
i
f
i
c
a
n
t
l
y
o
v
e
r
w
e
i
g
h
t
w
o
r
l
d
w
i
d
e.
A
c
c
o
r
d
i
n
g
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[
1
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.
3
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4
.
Ca
us
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s
u
e.
Ma
z
o
n
et
a
l
.
[
2
8
]
ex
p
lo
r
ed
co
n
n
ec
tio
n
s
b
etwe
e
n
o
b
esit
y
,
n
e
u
r
o
d
eg
en
e
r
ativ
e
d
is
ea
s
es
lik
e
Alzh
eim
er
's
an
d
Par
k
in
s
o
n
'
s
,
an
d
m
etab
o
lic
ch
an
g
es.
T
h
ey
f
o
u
n
d
th
at
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u
tr
itio
n
-
r
elate
d
m
etab
o
lic
d
y
s
f
u
n
ctio
n
s
m
ay
wo
r
s
en
ex
is
tin
g
co
n
d
itio
n
s
an
d
in
itiate
n
e
u
r
o
d
eg
en
e
r
ativ
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illn
ess
es.
Pro
v
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za
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s
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g
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est th
at
ad
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lt o
b
esit
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d
d
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eig
h
ten
th
e
r
is
k
o
f
Alzh
eim
er
'
s
d
is
ea
s
e
[
2
9
]
.
T
h
e
in
cr
ea
s
e
d
r
is
k
s
alig
n
with
Alzh
eim
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b
e
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r
s
b
ef
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clin
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p
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ar
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F
i
g
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r
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1
h
a
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o
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at
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n
n
e
ct
e
d
h
e
a
l
t
h
p
r
o
b
l
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m
s
[
3
0
]
.
3
.
6
.
1
.
Do
wn sy
nd
ro
m
e
Nu
m
er
o
u
s
v
a
r
iab
les,
in
clu
d
i
n
g
a
g
en
etic
p
r
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p
o
s
itio
n
,
r
ed
u
ce
d
p
h
y
s
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ex
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cises
,
h
y
p
o
t
h
y
r
o
id
is
m
,
elev
ated
b
lo
o
d
ch
o
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l,
a
n
d
an
u
n
u
s
u
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iet,
m
ay
in
cr
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s
e
th
e
g
r
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ter
r
is
k
o
f
o
b
es
ity
in
p
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p
le
with
h
y
p
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to
n
ia,
d
o
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s
y
n
d
r
o
m
e,
a
lo
wer
ed
m
etab
o
lic
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ate,
a
h
eig
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ln
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to
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ess
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a
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p
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tial
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tin
g
f
ac
to
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s
.
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ed
u
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itiv
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l
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p
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t
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ca
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co
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tr
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g
to
o
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esit
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I
n
2
0
2
0
,
No
r
d
s
tr
ø
m
et
a
l.
ex
am
in
e
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in
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iv
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d
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tellectu
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t
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f
o
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d
n
o
s
ig
n
if
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t
as
s
o
ciatio
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[
3
1
]
.
Fru
ctu
o
s
o
et
a
l.
f
o
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d
th
at
elev
ated
lev
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in
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lam
m
at
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ar
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alec
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-
3
a
n
d
HSP7
2
ar
e
lin
k
ed
to
o
b
esit
y
[
3
2
]
.
T
h
is
s
u
g
g
ested
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at
elev
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ip
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s
e
tis
s
u
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lev
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in
f
lam
m
ati
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ar
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tr
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in
d
iv
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d
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s
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n
d
r
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e
[
3
2
]
,
[
3
3
]
.
3
.
6
.
2
.
M
o
s
t
o
bes
e
co
un
t
ries a
ro
un
d t
he
wo
rld
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t
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t
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y
,
B
M
I
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r
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h
h
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h
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0
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(
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I
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I
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Fig
u
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1
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T
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)
in
in
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ials
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ials
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izes,
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ir
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1
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4
f
o
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th
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elatio
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ip
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e
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a
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is
s
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es
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ass
o
ciate
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as
well.
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m
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th
a
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3
6
,
0
0
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C
an
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,
f
o
u
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1
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4
6
o
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etw
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life
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s
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ar
ticip
a
n
ts
b
u
t n
o
t in
m
ale
p
ar
ticip
a
n
ts
[
3
5
]
,
[
3
6
]
.
3
.
7
.
1
.
O
bes
it
y
,
depress
io
n,
a
nd
a
s
s
o
cia
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ed
m
o
o
d dis
o
rder
s
Dev
elo
p
m
en
t
o
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co
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ar
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ter
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is
k
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tes
d
ep
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ich
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with
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t th
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illn
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[
3
7
]
.
Fu
r
th
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m
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e,
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r
e
was a
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ab
le
co
r
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d
a
n
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e
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waist cir
cu
m
f
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ce
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Ad
o
lescen
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ep
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ess
io
n
m
a
y
b
e
ca
u
s
ed
b
y
o
b
esit
y
[
3
4
]
.
Acc
o
r
d
in
g
to
th
e
Natio
n
al
L
o
n
g
itu
d
in
al
Stu
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f
Ad
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lescen
t
Hea
lth
(
ADD
Hea
lth
)
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o
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ly
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lt
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o
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k
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in
th
e
f
u
tu
r
e,
b
u
t
o
n
l
y
am
o
n
g
g
ir
ls
[
3
8
]
.
Of
th
e
g
r
o
u
p
,
7
%
e
x
p
er
ien
ce
d
s
ig
n
if
ican
t
d
ep
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io
n
in
ea
r
l
y
teen
ag
e
y
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r
s
th
at
is
(
ag
es
1
1
,
1
3
,
an
d
1
5
)
a
n
d
2
7
%
in
late
teen
ag
e
y
ea
r
s
(
1
8
an
d
2
1
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r
s
o
ld
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.
T
h
e
1
2
%
o
f
r
esear
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p
ar
ticip
an
ts
wer
e
o
b
ese
at
ag
e
2
6
.
A
b
id
ir
ec
tio
n
al
ass
o
ciatio
n
was
d
is
co
v
er
ed
:
s
ad
n
ess
r
aised
th
e
c
h
an
ce
o
f
o
b
esit
y
b
y
5
8
%,
wh
il
e
o
b
esit
y
in
cr
ea
s
ed
th
e
r
is
k
o
f
d
ep
r
ess
io
n
b
y
5
5
%
[
3
9
]
.
3
.
7
.
2
.
Va
ria
t
io
ns
by
ra
ce
a
nd
et
hn
icit
y
in m
ent
a
l hea
lt
h a
nd
o
b
esity
O
b
e
s
it
y
'
s
i
m
p
a
c
t
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n
m
e
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t
a
l
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ll
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b
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.
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t
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F
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x
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m
p
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X
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a
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A
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[
4
0
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r
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[
4
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esit
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lth
cr
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is
th
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in
d
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o
f
all
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ac
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o
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m
eth
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d
s
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tili
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to
tack
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d
u
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tio
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teg
r
atin
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n
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t
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itio
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e
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to
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tio
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ch
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ate
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cu
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la
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o
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teac
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tu
d
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ts
th
e
s
ig
n
i
f
ican
ce
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win
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ea
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im
p
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r
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co
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les,
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w
h
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Su
ch
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e
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s
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ci
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en
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'
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C
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o
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R
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r
r
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ated
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d
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ical
ac
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ity
d
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s
.
-
Pro
m
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h
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E
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f
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ab
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a
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tial
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in
c
o
m
b
atin
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R
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im
p
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u
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itiativ
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ag
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p
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d
d
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ities
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well
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b
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f
in
d
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id
u
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[
4
5
]
.
-
Ob
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af
f
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g
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n
cy
Pre
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y
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ce
s
s
i
s
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p
ac
ted
b
y
o
b
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as
well.
Ob
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m
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s
ar
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m
o
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lik
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to
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r
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ater
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r
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is
e
in
ce
s
ar
ea
n
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ec
tio
n
b
ir
th
s
[
4
6
]
.
Ag
e
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s
tan
d
ar
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ized
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r
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f
o
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ld
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r
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Un
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States
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ater
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E
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0
[
1
4
]
.
I
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th
e
UK,
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e
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6
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o
1
5
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6
% (
1
9
8
9
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d
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0
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7
)
[
4
7
]
.
-
Mo
th
er
s
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s
ab
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t e
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len
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n
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h
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lth
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is
in
e
W
h
e
n
as
k
e
d
wh
at
t
h
e
y
t
h
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g
h
t
was
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o
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,
m
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m
s
h
ig
h
li
g
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te
d
f
r
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i
ts
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e
g
et
a
b
les
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d
it
em
s
ty
p
ic
all
y
p
r
e
p
ar
ed
a
t
h
o
m
e.
M
o
s
t
m
o
m
s
b
el
ie
v
e
d
f
o
o
d
c
o
o
k
e
d
i
n
t
h
e
h
o
u
s
e
was
s
a
f
e
r
th
a
n
f
o
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d
p
r
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p
a
r
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d
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.
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ich
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is
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c
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r
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p
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ais
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b
y
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e
v
e
r
a
l m
o
m
s
as d
e
lect
a
b
le
o
r
v
al
u
a
b
l
e.
A
f
e
w
m
o
th
e
r
s
d
is
c
u
s
s
e
d
th
e
im
p
o
r
t
an
ce
o
f
h
a
v
i
n
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d
d
ie
t
an
d
h
o
w
t
o
g
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a
b
a
la
n
c
ed
o
n
e
.
So
m
e
m
o
m
s
o
f
ch
il
d
r
en
atte
n
d
i
n
g
m
e
d
i
u
m
-
an
d
l
o
w
-
t
u
i
ti
o
n
s
c
h
o
o
ls
b
eli
ev
e
d
t
h
a
t
f
ast
f
o
o
d
ite
m
s
l
ik
e
s
h
aw
ar
m
as
(
v
e
g
e
ta
b
les
a
n
d
m
ea
t
wr
ap
p
e
d
in
f
l
at
b
r
ea
d
)
an
d
b
u
r
g
er
s
w
er
e
h
e
alt
h
y
f
o
r
t
h
eir
k
i
d
s
,
b
u
t
i
f
c
o
o
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a
t
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3
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-
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4
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[
4
9
]
.
T
ab
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7
s
h
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m
m
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if
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ab
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.
Gu
id
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l Fed
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f
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lo
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Ob
s
tetr
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FIG
O)
co
m
m
ittee
[
5
0
]
P
h
a
se
G
u
i
d
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l
i
n
e
s
Pre
-
p
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g
n
a
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c
y
1
.
W
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sh
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f
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p
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t
w
o
me
n
.
P
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n
a
n
c
y
1
.
A
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B
M
I
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T
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n
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.
2
.
P
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w
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s
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t
h
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v
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d
v
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mi
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me
n
t
s.
3
.
O
b
e
s
e
w
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m
e
n
sh
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u
l
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k
n
o
w
t
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e
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a
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t
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x
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a
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v
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b
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T
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f
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c
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l
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n
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.
4
.
M
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d
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t
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t
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o
n
s
sh
o
u
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a
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l
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d
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f
i
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mu
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sc
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p
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f
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a
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a
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a
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me
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t
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f
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b
e
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p
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n
a
n
t
w
o
me
n
.
P
o
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p
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1
.
A
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.
2
.
A
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3
.
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4
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t.
-
I
n
cr
ea
s
in
g
p
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y
s
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ac
tiv
ity
Pro
m
o
tin
g
a
n
ac
tiv
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life
s
ty
le
is
v
ital
in
co
m
b
atin
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esit
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v
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m
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ts
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d
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p
lace
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ical
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ay
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way
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m
b
at
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u
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p
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m
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g
ac
tiv
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tr
an
s
p
o
r
tatio
n
;
ii)
in
co
r
p
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r
atin
g
p
h
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s
ical
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in
to
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aily
r
o
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; a
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d
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p
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w
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d
i
e
ts
[
5
1
]
.
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