Virology & Mycology Infectious Diseases
 
   Publications A-Z
A
»Accounting & Marketing
» Addiction Research & Therapy
» Advanced Chemical Engineering
»Advances in Automobile Engineering
»Advances in Crop Science and Technology
»Advances in Dairy Research
»Advancements in Genetic Engineering
»Advances in Pharmacoepidemiology & Drug Safety
»Advances in Robotics & Automation
»Advanced Techniques in Biology & Medicine
»Advance Research in Meteorological Sciences
»Aeronautics & Aerospace Engineering
»Aging Science
»Agrotechnology
»AIDS & Clinical Research
»Alcoholism and Drug Dependence
»Allergy & Therapy
»Alternative & Integrative Medicine
»Air & Water borne Diseases
»Alzheimers Disease & Parkinsonism
»Analytical & Bioanalytical Techniques
»Anaplastology
»Anatomy & Physiology
»Ancient Diseases & Preventive Remedies
»Andrology-Open Access
»Anesthesia & Clinical Research
»Angiology: Open Access
»Antivirals & Antiretrovirals
»Anthropology
»Applied & Computational Mathematics
»Applied Mechanical Engineering
»Aquaculture Research & Development
» Arabian Journal Business and Management Review
»Architectural Engineering Technology
»Arthritis
»Arts and Social Sciences Journal
» Astrobiology & Outreach
»Astrophysics & Aerospace technology
»Autacoids
»Automatic Control of Physiological State and Function
»Autism-Open Access
  
B
»Bacteriology & Parasitology
»Bioanalysis & Biomedicine
»Bioceramics Development and Applications
»Biochemistry and Analytical Biochemistry
»Biochemistry & Pharmacology: Open Access
»Biochips & Tissue Chips
»Biodiversity & Endangered Species
»Bioenergetics: Open Access
»Bioengineering & Biomedical Science
»Bioequivalence & Bioavailability
»Biosafety & Health Education
»Biofertilizers & Biopesticides
»Biometrics & Biostatistics
»Biomimetics Biomaterials and Tissue Engineering
»Biomolecular Research & Therapeutics
» Biomusical Engineering
»Biochemistry & Physiology: Open Access
»Biological Systems- Open Access
»Biology and Medicine
»Bioprocessing & Biotechniques
»Bioremediation & Biodegradation
»Biosafety
»Biosensors & Bioelectronics
» Biosensors Journal
»Biotechnology & Biomaterials
»Bioterrorism & Biodefense
»Blood Disorders & Transfusion
»Blood & Lymph
»Bone Marrow Research
»Brain Disorders & Therapy
»Business and Economics Journal
»Business and Financial Affairs
  
C
»Cancer Science & Therapy
»Climatology & Weather forecasting
»Carcinogenesis & Mutagenesis
»Cardiovascular Diseases & Diagnosis
»Cardiovascular Pharmacology: Open Access
»Cell & Developmental Biology
»Cell Science & Therapy
»Chemical Engineering & Process Technology
»Chemical Sciences Journal
»Chemotherapy: Open Access
»Child and Adolescent Behavior
»Chromatography & Separation Techniques
»Civil & Environmental Engineering
»Civil & Legal Sciences
»Clinical & Cellular Immunology
»Clinical Case Reports
»Clinical & Experimental Cardiology
»Clinical & Experimental Dermatology Research
»Clinical & Experimental Ophthalmology
»Clinical & Experimental Pathology
»Clinical & Experimental Pharmacology
»Clinical Microbiology: Open Access
»Clinical Pharmacology & Biopharmaceutics
»Clinical Research & Bioethics
»Clinical Research on Foot & Ankle
»Clinical Toxicology
»Clinical Trials
»Clinics in Mother and Child Health
»Cloning & Transgenesis
»Community Medicine & Health Education
»Communication Disorders, Deaf Studies & Hearing Aids
»Computer Science & Systems Biology
» Current Synthetic & Systems Biology
»Cytology & Histology
D
»Data Mining in Genomics & Proteomics
»Defense Management
»Dentistry
»Depression and Anxiety
»Developing Drugs
»Diabetes & Metabolism
»Drug Designing
»Drug Metabolism & Toxicology
  
E
»Earth Science & Climatic Change
»Ecosystem & Ecography
»Endocrinology & Metabolic Syndrome
»Entomology, Ornithology & Herpetology
»Environmental & Analytical Toxicology
»Epidemiology: Open Access
»Emergency Medicine
»Ergonomics
»Electrical & Electronics
»Enzyme Engineering
»Entrepreneurship & Organization Management
  
F
»Family Medicine & Medical Science Research
»Fermentation Technology
»Fertilization: In Vitro - IVF-Worldwide
»Fisheries and Aquaculture Journal
»Fisheries & Livestock Production
»Food Processing & Technology
»Forensic Biomechanics
»Forensic Research
»Forest Research: Open Access
»Fundamentals of Renewable Energy and Applications
»Fungal Genomics & Biology
  
G
»Gastrointestinal & Digestive System
»Genetic Syndromes & Gene Therapy
»Gene Technology
»Generalized Lie Theory and Applications
»Glycobiology
»Glycomics & Lipidomics
»Gynecology& Obstetrics
»General Medicine
»General Practice
»Geography & Natural Disasters
»Geology & Geosciences
»Geophysics & Remote Sensing
»Gerontology & Geriatric Research
»Global Economics
»Global Journal of Technology and Optimization
  
H
»Hair : Therapy & Transplantation
»Hematology & Thromboembolic Diseases
»Health Care : Current Reviews
»Health & Medical Informatics
»Hereditary Genetics
»Homeopathy & Ayurvedic Medicine
»Horticulture
»Hotel & Business Management
»Human Genetics & Embryology
»Hydrology: Current Research
»Hypertension- Open Access
  
I
»Industrial Engineering & Management
»Irrigation and Drainage Systems Engineering
»Infectious Diseases and Therapy
»Information Technology & Software Engineering
»Intellectual Property Rights: Open Access
»Integrative Oncology
»Internal Medicine
»International Journal of Accounting Research
»International Journal of Advanced Innovations, Thoughts & Ideas
»International Journal of Biomedical Data Mining
»International Journal of Economics and Management Science
»International Journal of Sensor Networks and Data Communications
»International Journal of Swarm Intelligence and Evolutionary Computation
»International Journal of waste resources
»International Journal of Genomic Medicine
»International Journal of Physical Medicine & Rehabilitation
»Innovative Energy Policies
»Immunome Research
  
J
»JBR Journal of Interdisciplinary Medicine and Dental Science
»JBR Journal of Clinical Diagnosis and Research
»JBR Journal of Young Scientist
  
L
»Liver
» Leukemia
» Lovotics
  
M
»Marine Science: Research & Development
»Malaria Chemotherapy, Control & Elimination
»Mass Communication & Journalism
»Material Sciences & Engineering
»Medicinal Chemistry
»Medicinal & Aromatic Plants
»Medical Diagnostic Methods
»Medical Microbiology & Diagnosis
»Medical & Surgical Urology
»Membrane Science & Technology
»Metabolic Syndrome
»Metabolomics:Open Access
»Microbial & Biochemical Technology
»Modern Chemistry & Applications
»Molecular Biology
»Molecular Biomarkers & Diagnosis
»Molecular and Genetic Medicine
»Molecular Imaging & Dynamics
»Molecular Pharmaceutics & Organic Process Research
»Mycobacterial Diseases
N
»Natural Products Chemistry & Research
»Nanomedicine & Biotherapeutic Discovery
»Nanomedicine & Nanotechnology
»Neonatal Biology
»Nephrology & Therapeutics
»Neurology & Neurophysiology
»Neuroinfectious Diseases
»Neurological Disorders
»Novel Physiotherapies
»Nuclear Medicine & Radiation Therapy
»Nutrition & Food Sciences
»Nutritional Disorders & Therapy
»Nursing & Care
  
O
»Obesity & Weight Loss Therapy
»Oceanography-Open Access
»Occupational Medicine & Health Affairs
»OMICS Journal of Radiology
»Osteoporosis and Physical Activity
»Oral Health and Dental Management
»Oral Hygiene & Health
»Organic Chemistry: Current Research
»Orthopedic & Muscular System: Current Research
»Otolaryngology
  
P
»Pain & Relief
»Palliative Care & Medicine
»Pancreatic Disorders & Therapy
»Pediatrics & Therapeutics
»Petroleum & Environmental Biotechnology
»Pharmaceutica Analytica Acta
»Pharmaceutical Regulatory Affairs: Open Access
»Pharmacogenomics & Pharmacoproteomics
»Pharmacovigilance
»Physical Chemistry & Biophysics
»Physical Mathematics
»Plant Pathology & Microbiology
»Plant Biochemistry & Physiology
»Pollution Effects & Control
»political Sciences & public affairs
»Poultry, Fisheries & Wildlife Sciences
»Powder Metallurgy & Mining
»Primatology
»Primary Health Care: Open Access
»Probiotics & Health
» Phylogenetics & Evolutionary Biology
»Proteomics & Bioinformatics
»Phylogenetics & Evolutionary Biology
»Psychology & Psychotherapy
»Psychological Abnormalities in Children
»Pulmonary & Respiratory Medicine
  
R
»Reproductive System & Sexual Disorders
»Research and Development
»Review of Public Adminstration and Management
»Rheumatology: Current Research
»Rice Research: Open Access
  
S
» Single Cell Biology
»Sleep Disorders & Therapy
»Socialomics
»Sociology and Criminology-Open Access
»Sports Medicine & Doping Studies
»Spine
»Stem Cell Research & Therapy
»Steroids & Hormonal Science
»Stock & Forex Trading
»Surgery: Current Research
  
T
»Telecommunications System & Management
»Textile Science & Engineering
»Theoretical and Computational Chemistry:Open Access
»Thermodynamics & Catalysis
»Thyroid Disorders & Therapy
»Tissue Science & Engineering
»Translational Medicine
»Transplantation Technologies & Research
»Transcriptomics: Open Access
»Trauma & Treatment
»Tropical Diseases
»Tropical Medicine and Surgery
»Tourism & Hospitality
  
V
»Vaccines & Vaccination
»Vascular Medicine & surgery
»Veterinary Science & Technology
»Virology & Mycology
»Vitamins & Minerals
»Vortex Science and Technology
  
W
»Women's Health Care
  
Y
»Yoga & Physical Therapy
 
   Browse by Subjects
Clinical
» AIDS & Clinical Research
» Anesthesia & Clinical Research
» Angiology
» Cancer Science & Therapy
» Carcinogenesis & Mutagenesis
» Cell Science & Therapy
» Chemotherapy
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» Clinical & Cellular Immunology
» Clinical Case Reports
» Clinical & Experimental Cardiology
» Clinical & Experimental Dermatology Research
» Clinical & Experimental Ophthalmology
» Clinical & Experimental Pharmacology
» Clinical & Experimental Pathology
» Clinical Microbiology: Open Access
» Clinical Research & Bioethics
» Clinical Research on Foot & Ankle
» Clinical Toxicology
» Clinical Trials
»Clinics in Mother and Child Health
» Communication Disorders, Deaf Studies & Hearing Aids
» Cytology & Histology
» Forensic Research
»Forensic Biomechanics
» Integrative Oncology
»Immunome Research
»JBR Journal of Clinical Diagnosis and Research
» Neurology & Neurophysiology
» Pulmonary & Respiratory Medicine
» Stem Cell Research & Therapy
» Transplantation Technologies & Research
   
Pharmaceutical Sciences
» Advances in Pharmacoepidemiology & Drug Safety
» Alcoholism and Drug Dependence
» Bioanalysis & Biomedicine
» Biochemical Pharmacology
» Bioequivalence & Bioavailability
» Cardiovascular Pharmacology: Open Access
» Clinical Pharmacology & Biopharmaceutics
» Developing Drugs
» Drug Designing
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» Pharmaceutica Analytica Acta
» Pharmaceutical Regulatory Affairs
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Chemistry
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» Theoretical and Computational Chemistry:Open Access
   
Environmental
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» Earth Science & Climatic Change
» Ecosystem & Ecography
» Environmental & Analytical Toxicology
» Fisheries & Livestock Production
»Fundamentals of Renewable Energy and Applications
» Geography & Natural Disasters
» Hydrology: Current Research
»Innovative Energy Policies
»International Journal of waste resources
» Oceanography-Open Access
» Petroleum & Environmental Biotechnology
» Pollution Effects & Control
» Poultry, Fisheries & Wildlife Sciences
   
Omics
» Data Mining in Genomics & Proteomics
»Ergonomics
» Glycomics & Lipidomics
» Health & Medical Informatics
»JBR Journal of Young Scientist
» Metabolomics:Open Access
» OMICS Journal of Radiology
» Pharmacogenomics & Pharmacoproteomics
» Phylogenetics & Evolutionary Biology
» Proteomics & Bioinformatics
» Transcriptomics
   
Life Sciences
» Advanced Techniques in Biology & Medicine
»Advancements in Genetic Engineering
»Advances in Crop Science and Technology
»Advances in Dairy Research
» Aging Science
» Agrotechnology
» Air & Water Borne Diseases
» Antivirals & Antiretrovirals
» Autism-Open Access
» Bacteriology & Parasitology
» Biochemistry & Physiology
» Biochemistry and Analytical Biochemistry
» Bioenergetics
» Bioengineering & Biomedical Science
» Biofertilizers & Biopesticides
» Biological Systems
» Biometrics & Biostatistics
»Biomimetics Biomaterials and Tissue Engineering
» Biomolecular Research & Therapeutics
» Bioremediation & Biodegradation
» Biosafety
» Biosafety & Health Education
» Biosensors & Bioelectronics
» Biosensors Journal
» Biotechnology & Biomaterials
» Bioterrorism & Biodefense
» Cell & Developmental Biology
» Current Synthetic & Systems Biology
» Entomology, Ornithology & Herpetology
» Enzyme Engineering
» Fermentation Technology
» Fertilization: In Vitro - IVF-Worldwide
» Fisheries and Aquaculture Journal
» Forest Research
» Fungal Genomics & Biology
» Gene Technology
» Glycobiology
» Horticulture
» Homeopathy & Ayurvedic Medicine
»International Journal of Swarm Intelligence and Evolutionary Computation
» Marine Science: Research & Development
» Membrane Science & Technology
» Microbial & Biochemical Technology
» Molecular Biology
» Molecular Imaging & Dynamics
» Nanomedicine & Biotherapeutic Discovery
» Nanomedicine & Nanotechnology
» Nutrition & Food Sciences
» Plant Pathology & Microbiology
» Primatology
» Probiotics & Health
» Rice Research: Open Access
» Single Cell Biology
» Sociology and Criminology-Open Access
» Tissue Science & Engineering
» Tropical Diseases
» Veterinary Science & Technology
» Vitamins & Minerals
»Virology & Mycology
   
Engineering
» Advances in Automobile Engineering
» Advances in Robotics & Automation
» Aeronautics & Aerospace Engineering
» Applied & Computational Mathematics
» Applied Mechanical Engineering
» Architectural Engineering Technology
» Astrophysics & Aerospace technology
» Biochips & Tissue Chips
» Bioprocessing & Biotechniques
» Chemical Engineering & Process Technology
» Civil & Environmental Engineering
» Computer Science & Systems Biology
» Electrical & Electronics
» Food Processing & Technology
» Geology and Geosciences
» Geophysics & Remote sensing
»Global Journal of Technology and Optimization
» Industrial Engineering & Management
» Information Technology & Software Engineering
» International Journal of Advance Innovations, Thoughts & Ideas
»International Journal of Sensor Networks and Data Communications
» Irrigation and Drainage Systems Engineering
»Generalized Lie Theory and Applications
» Lovotics
» Material Sciences & Engineering
»Physical Mathematics
» Powder Metallurgy & Mining
» Telecommunications System & Management
» Textile Science & Engineering
»Vortex Science and Technology
   
Medical Sciences
» Addiction Research & Therapy
» Allergy & Therapy
» Alternative & Integrative Medicine
» Alzheimers Disease & Parkinsonism
» Anaplastology
» Anatomy & Physiology
» Ancient Diseases & Preventive Remedies
» Andrology
» Arthritis
» Autacoids
»Automatic Control of Physiological State and Function
» Bioceramics Development and Applications
» Biology and Medicine
» Biomusical Engineering
» Blood & Lymph
» Blood Disorders & Transfusion
» Bone Marrow Research
» Brain Disorders & Therapy
» Cardiovascular Diseases & Diagnosis
» Cloning & Transgenesis
» Community Medicine & Health Education
» Dentistry
» Depression and Anxiety
» Diabetes & Metabolism
» Emergency Medicine
» Endocrinology & Metabolic Syndrome
» Epidemiology: Open Access
» Family Medicine & Medical Science Research
» Gastrointestinal & Digestive System
» General Medicine
» General Practice
» Genetic Syndromes & Gene Therapy
» Gynecology& Obstetrics
» Gerontology & Geriatrics Research
» Hematology & Thromboembolic Diseases
» Hair: Therapy & Transplantation
» Health Care : Current Reviews
» Hereditary Genetics
» Human Genetics & Embryology
» Hypertension-Open Access
» Infectious Diseases & Therapy
» International Journal of Genomic Medicine
» Internal Medicine
»International Journal of Biomedical Data Mining
» International Journal of Physical Medicine & Rehabilitation
»JBR Journal of Interdisciplinary Medicine and Dental Science
» Leukemia
» Liver
»Malaria Chemotherapy, Control & Elimination
» Medical & Surgical Urology
» Medical Diagnostic Methods
» Medical Microbiology & Diagnosis
» Metabolic Syndrome
» Molecular Biomarkers & Diagnosis
» Molecular and Genetic Medicine
» Mycobacterial Diseases
» Neonatal Biology
» Nephrology & Therapeutics
»Neuroinfectious Diseases
» Neurological Disorders
» Novel Physiotherapies
» Nuclear Medicine & Radiation Therapy
» Nursing & Care
» Nutritional Disorders & Therapy
» Obesity & Weight Loss Therapy
» Occupational Medicine & Health Affairs
» Oral Health and Dental Management
» Oral Hygiene & Health
» Orthopedic & Muscular System
» Osteoporosis & Physical Activity
» Otolaryngology
» Pain & Relief
» Palliative Care & Medicine
» Pancreatic Disorders & Therapy
» Pediatrics & Therapeutics
» Primary Health Care
» Psychological Abnormalities in Children
» Psychology & Psychotherapy
» Reproductive System & Sexual Disorders
»Research and Development
» Rheumatology: Current Research
» Sleep Disorders & Therapy
» Spine
» Sports Medicine & Doping Studies
» Steroids & Hormonal Science
» Surgery: Current Research
» Thyroid Disorders & Therapy
» Translational Medicine
» Trauma & Treatment
» Tropical Medicine and Surgery
» Vascular Medicine & surgery
» Women's Health Care
» Yoga & Physical Therapy
 
Management
» Accounting & Marketing
» Arabian Journal Business and Management Review
» Arts and Social Sciences Journal
» Business and Economics Journal
» Business and Financial Affairs
» Civil & Legal Sciences
» Defense Management
» Entrepreneurship & Organization Management
» Global Economics
» Hotel & Business Management
» Intellectual Property Rights: Open Access
»International Journal of Accounting Research
» International Journal of Economics & Management Sciences
» Mass Communication & Journalism
» political Sciences & public affairs
»Review of Public Adminstration and Management
» Socialomics
» Stock & Forex Trading
» Tourism & Hospitality
 
   Conferences
Upcoming Conferences
»2nd International Conference and Exhibition on Pathology, August 05-07, 2013 Las Vegas, USA
»International Conference on Integrative Biology Summit, August 05-07, 2013 Las Vegas, USA
»2nd International Conference on Translational Medicine, August 05-07, 2013 Chicago, USA
»International Conference on Predictive, Preventive and Predictive, Preventive and Personalized Medicine & Molecular Diagnostics, August 05-07, 2013 Chicago, USA
» 2nd International Conference on Biodiversity & Sustainable Energy Development, August 12-14, 2013 Raleigh, USA
» International Conference on Genetic Engineering & Genetically Modified Organisms, August 12-14, 2013 Raleigh, USA
» 4th World Congress on Diabetes & Metabolism, August 14-16, 2013 Chicago, USA
»International Conference on Radiology and Imaging, August 14-16, 2013 Chicago, USA
»2nd International Conference and Exhibition on Orthopedics & Rheumatology, August 19-21, 2013 Las Vegas, USA
»International Conference on Dental & Oral Health, August 19-21, 2013 Las Vegas, USA
»International Conference and Exhibition on Physical Medicine & Rehabilitation, August 19-21, 2013 Las Vegas, USA
»International Conference on Molecular Epidemiology and Evolutionary Genetics, August 21-23, 2013 Miami, USA
»International Conference on Oceanography, August 21-23, 2013 Orlando, USA
»International Conference on Biodefense & Natural Disasters, August 21-23, 2013 Miami, USA
» World Congress on Endocrinology, August 26-28, 2013 Raleigh, USA
»2nd International Conference on Hydrology and Groundwater Expo, August 26-27, 2013 Raleigh, USA
» 2nd International Conference on Tissue Science & Regenerative Medicine, August 26-28, 2013 Raleigh, USA
» International Conference on Omics Studies, September 04-06, 2013 Orlando-FL, USA
»International Symposia on Entomology, September 04-06, 2013 Miami, USA
»2nd International Conference on Surgery and Anesthesia, September 16-18, 2013 Las Vegas, USA
»2nd International Conference on Clinical Microbiology & Microbial Genomics, September 16-18, 2013 Las Vegas, USA
»2nd International Conference and Exhibition on Biowaivers & Biosimilars, September 23-25, 2013 Raleigh, USA
»4th World Congress on Biotechnology, September 23-25, 2013 Raliegh, USA
»International Conference on Hematology & Blood Disorders, September 23-25, 2013 Raliegh, USA
»International Conference on Psychology, Autism and Alzheimer's Disease, September 30-October 01, 2013 San Antonio, USA
»International Conference and Exhibition on Mechanical & Aerospace Engineering, September 30-October 02, 2013 San Antonio, USA
»2nd International Summit on Toxicology, October 07-09, 2013 Las Vegas, USA
»International Conference and Exhibition on Biochemical & Molecular Engineering, October 07-09, 2013 San Antonio, USA
»International Conference and Exhibition on Lasers, Optics & Photonics, October 7-9, 2013 San Antonio, USA
»2nd International Conference and Exhibition on Materials Science & Engineering, October 07-09, 2013 Las Vegas, USA
»2nd International Conference on Forensic Research & Technology, October 07-09, 2013 Las Vegas, USA
»2nd International Conference on Clinical & Cellular Immunology, October 15-17, 2013 Las Vegas, USA
»2nd International Conference on Medicinal Chemistry & Computer Aided Drug Designing, October 15-17, 2013 Las Vegas, USA
»4th International Conference and Exhibition on Analytical & Bioanalytical Techniques, October 15-17, 2013 Las Vegas, USA
»International Conference and Exhibition on Pharmacognosy, Phytochemistry and Natural Products, October 21-23, 2013 Hyderabad, India
» 3rd World Congress on Cancer Science & Therapy, October 21-23, 2013 California, USA
»3rd International Conference on Pharmaceutical Regulatory Affairs, October 21-23, 2013 California, USA
»2nd International Conference and Exhibition on Cell & Gene Therapy, October 23-25, 2013 Orlando, USA
»2nd International Conference and Exhibition on Probiotics & Functional Foods, October 23-25, 2013 Orlando, USA
»International Conference on HIV/AIDS, STDs, & STIs, October 24-25, 2013 Orlando-FL, USA
» International Conference on Fermentation Technology, Bioprocess and Cell Culture, October 28-30, 2013 Kansas City, USA
»2nd International Conference and Exhibition on Food Processing & Technology, October 28-30, 2013 Kansas City, USA
»International Conference on Functional and Comparative Genomics & Pharmacogenomics, November 12-14, 2013 Chicago, USA
»2nd International Conference and Exhibition on Cosmetology & Trichology, November 12-14, 2013 Chicago, USA
»2nd International Summit on GMP, QA & QC, November 12-14, 2013 Chicago, USA
»2nd International Summit on GLP, GCP & Clinical Pharmacology, November 12-14, 2013 Chicago, USA
»2nd International Conference and Exhibition on Pharmacovigilance & Clinical Trials, November 18-19, 2013 San Antonio, USA
»International Summit on Clinical Pharmacy & Dispensing, November 18-20, 2013 San Antonio, USA
»World Congress on Petrochemistry and Chemical Engineering, November 18-20, 2013 San Antonio, USA
»3rd World Congress on Virology, November, 20-22, 2013 Baltimore, USA
»International Congress on Bacteriology and Infectious diseases, November 20-22, 2013 Baltimore, USA
»3rd World Congress on Cell Science & Stem Cell Research, November 20-22, 2013 San Antonio, USA
»2nd International Conference and Exhibition on Obesity & Weight Management, December 02-04, 2013 Las Vegas, USA
»International Conference on Nursing & Emergency Medicine, December 02-04, 2013 Las Vegas, USA
»3rd International Conference on Nanotek & Expo, December 02-04, 2013 Las Vegas, USA
»International Conference and Exhibition on Traditional & Alternative Medicine, December 09-11, 2013 Hyderabad, India
»2nd International Conference on Agricultural & Horticultural Sciences, February 03-05, 2014 Hyderabad, India
Previous Conferences Organized/Co-organized
»2nd International Conference on Nephrology & Therapeutics, July 29-31, 2013 Las Vegas, USA
»3rd International Conference on Vaccines & Vaccination, July 29-31, 2013 Las Vegas, USA
»2nd International Conference on Earth Science & Climate Change, July 22-24, 2013 Las Vegas, USA
»2nd International Conference and Exhibition on Addiction Research & Therapy, July 22-24, 2013 Las Vegas, USA
»International Conference on Animal & Dairy Sciences, July 23-24, 2013 Las Vegas, USA
»3rd International Conference on Proteomics & Bioinformatics, July 15-17, 2013 Philadelphia, USA
»2nd International Conference and Exhibition on Nutritional Science & Therapy, July 15-17, 2013 Philadelphia, USA
»4th International Conference on Biomarkers & Clinical Research, July 15-17, 2013 Philadelphia, USA
»2nd International Conference and Exhibition on Biosensors & Bioelectronics, June 17-19, 2013 Chicago, USA
»2nd International Conference and Exhibition on Neurology & Therapeutics, June 17-19, 2013 Chicago, USA
»2nd International Conference on Gastroenterology & Urology, June 10-12, 2013 Chicago, USA
»2nd International Conference and Exhibition on Biometrics & Biostatistics, June 10-12, 2013 Chicago, USA
»2nd International Conference and Exhibition on Occupational Health & Safety, May 21-22, 2013 Beijing, China
»4th World Congress on Bioavailability & Bioequivalence, May 20-22, 2013 Beijing, China
»3rd International Conference on Clinical & Experimental Ophthalmology, April 15-17, 2013 Chicago, USA
»3rd International Conference on Clinical & Experimental Cardiology, April 15-17, 2013 Chicago, USA
»3rd International Conference on Clinical & Experimental Dermatology, April 15-17, 2013 Chicago, USA
»2ndInternational Conference and Exhibition on Metabolomics & Systems Biology, April 08-10, 2013 Chicago, USA
»3rd International Conference and Exhibition on Pharmaceutics & Novel Drug Delivery Systems, April 08-10, 2013 Chicago, USA
»International Exhibition and Conference on Water Technologies, Environmental Technologies & Renewable Energy, February 13-14, 2013 Mumbai, India
»International Summit on GMP & GCP: USA, Europe, Japan, Asia Pacific December 03-05, 2012 DoubleTree by Hilton Philadelphia Center City, USA
»International Conference on QA, QC and Validation, December 03-05, 2012 DoubleTree by Hilton Philadelphia Center City, USA
»2nd International Conference on Nanotek and Expo, December 03-05, 2012 DoubleTree by Hilton Philadelphia Center City, USA
»International Conference and Exhibition on Obesity and Weight Management, December 03-05, 2012 at DoubleTree by Hilton Philadelphia, USA.
»International conference on Hair Transplantation and Trichology November 26-28, 2012 San Antonio, USA.
»International Conference on Anesthesia & Perioperative Care during November 26-28, 2012 San Antonio, USA.
»International Toxicology Summit & Expo November 26-28, 2012 Hilton San Antonio Airport, USA
»International Conference and Exhibition on Surgery & Transplantation November 26-28, 2012 Hilton San Antonio Airport, USA.
»International Conference and Exhibition on Food Processing and Technology November 22-24, 2012 Hyderabad, India.
»3rd International Conference and Exhibition on Analytical & Bioanalytical Techniques November 22-24, 2012 Hyderabad International Convention Center, India
»2ndInternational Conference and Exhibition on Pharmaceutical Regulatory Affairs November 23-24, 2012 HICC Hyderabad, India
»International Conference and Exhibition on Cosmetology & Cosmetics November 23-24, 2012 HICC Hyderabad, India.
»International Conference on Genetic Syndromes & GeneTherapy November 19-21, 2012 Hilton San Antonio Airport, USA
»Global Biofuels and Bioproducts Summit November 19-21, 2012 San Antonio, USA.
»International Conference and Exhibition on Probiotics-2012, November 19–21, 2012, Hilton San Antonio Airport, USA.
»2nd World Congress on Cell Science and Stem Cell Research, November 12-14, 2012 Hilton San Antonio Airport, USA.
»International Conference on Regenerative and Functional Medicine, November 12-14, 2012 at San Antonio, Texas, USA.
»International Conference on Clinical Microbiology & Microbial Genomics November 12-14, 2012 San Antonio, USA.
» International Confeernce on Pulmonary & Respiratory Medicine October 29 - 31, 2012 Chicago, USA
»International Conference and Exhibition on Computer Aided Drug Design & QSAR October 29-31, 2012, Chicago, USA.
»International Conference on Clinical and Cellular Immunology October 22-24, 2012 Las Vegas, USA.
»International Conference and Expo on Material science and Engineering October 22-24, 2012 DoubleTree by Hilton Chicago-North Shore, USA.
» International Expo and Conference on Analytrix & HPLC October 22-24, 2012 Hilton Northbrook, Chicago, USA.
»International Conference on Forensic Research & Technology October 15 - 17, 2012 DoubleTree by Hilton Chicago - Northshore, USA.
»International Conference and Exhibition on Otolaryngology October 15 - 17, 2012 DoubleTree by Hilton Chicago - Northshore, USA.
»International conference on Biothreats and Biodefense October 15 - 17, 2012 DoubleTree by Hilton Chicago - Northshore, USA.
»International Conference on Tissue Science and Engineering October 1-3, 2012 DoubleTree by Hilton Chicago-North Shore, USA.
»International conference and Exhibition on Pharmacovigilance and Clinical Trials October 1-3, 2012 DoubleTree by Hilton Chicago-North Shore, USA.
»International Conference on Emerging Cell Therapies October 1-3, 2012 DoubleTree by Hilton Chicago-North Shore, USA.
»3rd World Congress on Diabetes & Metabolism which is to be held on September 24-26, 2012 Marriott Convention Center, Hyderabad, India.
»2nd International Conference on Pediatrics & Gynecology September 24-26, 2012, Hyderabad Marriott Hotel & Convention Centre , Hyderabad, India.
»International Conference on Translational medicine-2012, September 17-19, 2012 Holiday Inn San Antonio, Texas, USA.
»3rd World Congress on Biotechnology September 13-15, 2012 HICC, Hyderabad, India
»International Conference on Biodiversity & Sustainable Energy Development September 14-15, 2012 Hyderabad, India.
» International Conference on Agricultural & Horticultural Sciences September 14-15, 2012 Hyderabad International Convention Center, India
» International Conference on Hotel and Business Management September 14-15, 2012 Hyderabad International Convention Center, India
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Research Article Open Access
 
New Approach for Obesity Treatment Incorporating Individual Self- Management Education
1Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Ibaraki 305-8574, Japan Sechang OH1*, 2National Institute of Advanced Industrial Science and Technology (AIST), Central 4, 1-1-1 Higashi, Ibaraki 305-8562, Tsukuba, Japan Mijung KIM2, 3Faculty of Health and Sports Science, University of Tsukuba, Tsukuba, Ibaraki 305-8574, Japan Miki ETO3, 1Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Ibaraki 305-8574, Japan Bokun KIM1, 4Dvision of Gastroenterology, University of Tsukuba Hospital, Tsukuba, Ibaraki 305-8575, Japan Junichi Shoda4 and 3Faculty of Health and Sports Science, University of Tsukuba, Tsukuba, Ibaraki 305-8574, Japan Kiyoji Tanaka3
 
Corresponding Author : Sechang OH
University of Tsukuba, 1-1-1 Tennodai
Tsukuba, Ibaraki, 305-8577, Japan
Tel: 81-29-853-3291
Fax: 81-29-853-8365
E-mail: ohsechang@stat.taiiku.tsukuba.ac.jp
 
Received February 23, 2013; Accepted March 01, 2013; Published March 03, 2013
 
Citation: Sechang OH, Mijung KIM, Miki ETO, Bokun KIM, Junichi Shoda, et al. (2013) New Approach for Obesity Treatment Incorporating Individual Self-Management Education. J Obes Wt Loss Ther 3:164. doi: 10.4172/2165-7904.1000164
 
Copyright: © 2013 Sechang OH, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
 
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Abstract
 

Background: Obesity is a global issue, and its prevalence is a major public health concern. To help resolve this obesity epidemic, we propose an education program for positive behavior change. This program incorporates diet and exercise behaviors at the individual level.
Objective: To demonstrate the effects of a new approach for treating obesity by improving individual selfmanagement through investigating, i) behavior modification in the treatment of obesity, ii) the change of obesity states and physical performance capacity, and iii) the risk factors to be diagnosed with metabolic syndrome.
Design: Twenty-four men during the 2011 and thirty-three men during the 2012 intervention contributed to the
current study. Over 12 weeks, a total of 57 subjects participated in individual self-management education program.
Results: For a short-term program, in both the years 2011 and 2012 subjects showed a decrease in daily energy intake (-30.1% and -27.7%) accompanied by an increase in daily energy expenditure (+5.7% and +5.9%), suggesting an ability of individuals to keep obesity under control through behavior therapy. Subjects also showed a marked change in obesity states and physical capacity such as decreased body weight (-12.1% and -13.6%), and higher VO2max (+22.0% and +21.4%). Further, our comprehensive protocol led to a improvement in components for metabolic syndrome; reduction in waist circumference (-10.4% and -11.7%), blood pressure (systolic: -12.9% and -9.8%; diastolic: -14.6% and -9.6%), fasting plasma glucose (-8.6%, -7.6%), and triglyceride (-60.6% and -46.7%) along with an increase in the levels of HDL-C (+16.5% and +10.5%) was seen.
Conclusion: Under our protocol, subjects achieved optimal results for treating obesity during two consecutive years. We recognize that these results are due to an acquired ability like broader perspective and greater acumen about individual obesity management. Therefore, the methods and delivery of our new public approach are useful to the general public.

 
Keywords
 
Obesity; Self-management ability; Dietary and exercise intervention; Public health; New obesity approach
 
Introduction
 
Prevalence of obesity (body mass index; BMI, over 25 kg/m2 defined) in Japan [1] is over 30% in adult men between the age of 20- 60 years. Over the past 15 years, this rate has risen by approximately 20% [2]. Figure 1 shows such a trend in comparison with that of the United States (BMI over 30 kg/m2 defined) [3]. Such an increase in obesity, especially in middle-aged men, elevates the risk of mortality and morbidity, which is a major public health concern in Japan [4]. Clinically, it has been well established that obesity is an underlying factor for several chronic diseases including Cardiovascular Disease (CVD), hypertension, cancer, stroke, and type 2 diabetes [5]. Moreover, obesity and its comorbid conditions are associated with negative health consequences, including low physical capacity and psychological distress, as well as other impacts such as social stigma and high socioeconomic cost [6-9]. Hence, obesity should be recognized as a serious disease, and actively prevented and treated [10,11].
 
Obesity is the result of various deteriorated physiological systems that lead to an imbalance between energy intake and expenditure [12]. Hence, any factor that increases energy intake or decreases energy expenditure by even a small amount will trigger obesity in the long term. Hereditary effects cannot be ignored in individual predisposition to obesity [13]. However, prevalence of obesity at present indicates that environmental factors must underlie the obesity epidemic. Thus, obesity management ultimately associates with eating less and being more physically active. Though this action sounds easy, such a simplistic approach is extremely hard to follow and control. In particular, maintaining the decreased weight-loss goal is much more difficult; there is almost always a regain in weight of about 40% within the first year following treatment and the rest within three years [14]. In addition, it is necessary to cautiously apply a weight-loss program, because repeated trial and failure add further adverse effects such as physical and psychological damage. Hence, it is necessary to reconsider the fundamental reasons and to concentrate on seeking new options for efficient obesity management, especially at the societal level. We hypothesize that the reason is due to an absence of individual selfmanagement ability-related diet and exercise behaviors.
 
Although an increasing number of clinical researchers have been aggressively working to find optimal ways of preventing and treating obesity, including dieting, exercising, behavioral treatments, pharmacotherapy, and surgery [15-18], recent evidence suggests that although sometimes effective, the benefits of these approaches are uncertain and controversial. Treatment is not effective for the most seriously obese, and the majority of these people struggle in vain to lose weight, tending to blame themselves for relapses [19]. One reason for these problems may be that general anti-obesity approaches mostly rely on prescribed methods for isolated factors rather than a more holistic approach [9,17]. The highly prescriptive regimes on which these approaches depend are difficult for obese individuals to integrate into their existing lifestyle. Also, to resolve such problems in effectively implementing this type of program, one-on-one assistance from obesity-related specialists (e.g., doctors, dietitians, counselors, physical trainers, psychologists, and behaviorists) can make such approaches costly and time consuming, rendering them potentially unsustainable at the societal level [20]. Thus, such approaches are expected to be neither effective nor permanent without individual awakening. In recent years we have seen the availability of numerous therapies and approaches for obesity management. But, it is often difficult and confusing for an obese individual to choose the appropriate strategy or exclude an inappropriate strategy [20]. We do not at all wish to imply that the numerous recommended treatment guidelines for obese individuals [17,21-23] are of no help, but rather would like to state that sometimes the contents are too difficult or too rigid to be selected by the individual. Hence, it is our belief that obese individuals might need a professional to counsel, advise, and explain basic knowledge regarding obesity until they acquire the ability to self-manage; i.e., capable of choosing an appropriate program for their own particular health condition, to manage their plan, and to overcome associated barriers.
 
Based on these considerations, in this study we strived to advance a previously established support program, consisting of dietary restriction and exercise, to a new conative program that includes goal setting, lifestyle skills teaching, and health checking. The program is meant to recognize various individual states, and at the same time help participants formulate their own regime out of their own volition. The purpose of this study, therefore, was to demonstrate the impact of our new obesity treatment incorporating individual self-management education. We did this by i) estimating behavior modification in the treatment of obesity, ii) evaluating the change of obesity states and physical capacity, and iii) investigating the reduction in risk factors related to metabolic syndrome. In all, we present a new public health approach for obesity.
 
Materials and Methods
 
Clinical study design
 
Figure 2 presents a simple workflow of enrollment to the program and contents of the class. The study was performed from June through October, 2011 and 2012 at the University of Tsukuba, Japan. Obese adult men (BMI between 25 and 35 kg/m2), were recruited from Ibaraki prefecture (Kanto region of Japan). A total of 67 men (years 2011:28 men, and 2012: 39 men) were recruited through advertisements in a local newspaper, fliers, and a public broadcast on local cable TV. For 12 weeks, the 67 participants received a dietary and exercise education program including goal setting, lifestyle skills teaching, and health checks, aimed at improving individual self-management ability. For substantial analysis, we excluded 10 men (years 2011: 4 men and 2012: 6 men) because of drop out, low attendance (<30%) and deficit of data during the intervention. Consequently, of the initial 67 participants, data from 57 subjects from the two years (2011 and 2012) of study were analyzed and are presented in the current study. The study was approved by the Institutional Review Board at the University of Tsukuba, and all study participants agreed to the study with written informed consent.
 
Key program features
 
Dietary education program: Subjects were provided with a dietary education program through 12 weekly lectures. The program consisted of dietary lectures and small interactive group sessions on individual self-management. During the 12 lectures, subjects mainly learned methods for calculating dietary calories by weighing food, were given information about a nutritionally balanced diet, and planned a dietary program on their own. Our job was to help them adjust to the program through continuous and repetitive training. For self-monitoring, participants kept food diaries including several daily reports, e.g. personal goal setting, body weight change, and physical and mental conditions. Skilled dieticians offered comments on subjects’ food diaries and provided one-on-one dietary behavioral counseling after each lecture. Though we did not strictly demand subjects to follow said guidelines, we recommended guidelines for proper consumption and energy balance. Small interactive group sessions were added to encourage all participants to modify their own dietary behaviour. Subjects were encouraged to share their experiences and ideas for obesity treatment.
 
Exercise education program: In an exercise education class, carried out under the supervision of skilled professional trainers, subjects did aerobic exercise with the following regimen. i) 15-20 min warm-up session, which included stretching, ii) 40-60 min walking and/or jogging session, and iii) 15-20 min cool-down session that included resistance training using body weight (Figure 2). This class was conducted for 90 min per day three times a week for 12 weeks. By taking part in the above program, subjects learned about exercise, such as the right way of walking or how to prevent injury during exercise and how to increase exercise intensity, time, and frequency according to their physical condition. The trainers also explained basic training methods e.g., stretching, resistance training, and how the training can affect their bodies. Progressively with each session, subjects were given fewer direct instructions as to the intensity and time of the given exercise. Instead, it was emphasized that subjects control, as best as possible, the amount of exercise appropriate for their health condition. Short-range telemetry (Polar RS400, Kempele, Finland) was made available during the exercise program to encourage participants to monitor their cardiovascular exercise intensity.
 
Additional advice and information
 
During the study periods, subjects were not firmly restricted to our program, but were allowed to incorporate their previous regimen into our program, and were given detailed advice on how to do so. In addition, at three times-baseline, 4 weeks, and 12 weeks-subjects underwent medical and physical check-ups and received detailed information on their health condition, explained by a medical doctor and professional trainers (Figure 2). With this information, we expected subjects to perform a self-evaluation of their health condition, and based on the evaluation, individuals were expected to control and manage their progress. Moreover, skilled staff members responded to participants’ for counseling on issues related to physical problems, psychological distress, and medical and social situations.
 
Energy intake and expenditure analyses
 
After receiving detailed instructions and under the supervision of a dietician, subjects completed a 3-day food record for Total Energy Intake (TEI) assessments at baseline and at week 12. A professional dietician used the food-intake records to estimate daily energy intake and macronutrient composition using commercially available software (Excel Eiyo-kun; Kenpakusya, Tokyo, Japan). Total Energy Expenditure (TEE) and steps per day were measured by a single-axis pedometer (Lifecorder; Suzuken Co. Ltd., Nagoya, Japan). The pedometer was firmly attached to the subject’s clothing during all activity hours except while bathing and sleeping, beginning two weeks prior to the intervention period, and throughout the entire 12 week program. Detailed descriptions of the accelerometer have been previously published by Kumahara et al. [24].
 
Anthropometric, MRI, DEXA, and ultrasound analyses
 
We measured body weight to within 0.1 kg with the participants dressed in a light gown using a digital electronic scale (TBF-551; Tanita, Tokyo, Japan), and standing height to within 0.1 cm with a wall-mounted stadiometer (YG-200; Yagami, Nagoya, Japan). Fat mass and lean body mass were measured by using dual energy x-ray absorptiometry (DEXA; QDR 4500, Hologic Inc., Bedford, MA). The data were used to calculate percentage body fat. Abdominal fat area was determined by magnetic resonance imaging (MRI; Erlangen, Germany, 3.0-Tesla system, Achieva R3.2, Philips, Netherlands) in which the Total Abdominal Fat Area (TAFA), Subcutaneous Abdominal Fat Area (SAFA), and Visceral Abdominal Fat Area (VAFA) were evaluated at the level of the umbilicus. Waist Circumference (WC) was measured to within 0.1 cm using a glass fiber tape at the umbilicus level. Hepatic steatosis was also performed by a clinical gastroenterologist using an ultrasound system (Nemyo MX; Toshiba medical systems, Tokyo, Japan) with a 3.5-5.0 MHz curved array transducer.
 
Metabolic parameters analyses
 
Maximal oxygen uptake (VO2max test) for 57 subjects was performed under the supervision of a medical doctor and a physical trainer using a graded direct cycling ergometer (Monark, model 828E, Stockholm, Sweden) at baseline and at week 12. Following a 2-min warm-up period at 30 watts (W), workload was increased every 1 minute by 15 W intervals until volitional exhaustion. Ventilations and gas exchanges were evaluated using an indirect calorimeter (Oxycon, Mijnhardt, Breda, The Netherlands and Minato Medical Science, Tokyo, Japan), and heart rate (HR) was assessed using an electrocardiograph (Dyna Scope, Fukudadenshi, Tokyo, Japan). Systolic and diastolic blood pressure (SBP and DBP) were measured on the right arm using a mercury sphygmomanometer. Also, to calculate physical fitness age, participants performed tests (side step, one-leg stance with eyes closed, trunk flexion, trunk extension, vertical jump and grip strength) to measure balance, agility, flexibility, muscle strength and endurance. Using these parameters, physical age was calculated as per Lee et al. [25]
 
Biochemical analysis of blood
 
Blood samples were collected by inserting a butterfly needle into the median cubital vein following no exercise for 48 hours and a fast status for 12 hours, at baseline and at week 12. The collected blood was separated into serum and plasma from the clot by centrifugation (2000 g for 15 min, 4°C) and stored at -80°C until analyzed. Levels of Triglycerides (TG) and high density lipoprotein-cholesterol (HDL-C) were analyzed enzymatically. Fasting Plasma Glucose (FPG) level was analyzed by the enzymatic colorimetric method.
 
Surrogate parameters
 
Surrogate markers were calculated as follows: Physical age was determined according to the equation of Lee et al. [25]. We used the definition for metabolic syndrome proposed by the National Cholesterol Education Program-Adult Treatment Panel III from 2001, which was revised in 2005. It is based on the fulfillment of any three of five risk factors. The criterion for waist circumference in this study (≥ 85 cm) is that used by the Japan Society for the Study of Obesity. The five risk factors are i) waist circumference equal to or greater than 85 cm, ii) triglycerides equal to or greater than 150 mg/dL, iii) HDL-C less than 40 mg/dL, iv) blood pressure equal to or greater than 130/85 mmHg, and v) fasting glucose equal to or greater than 100 mg/dL [26].
 
Statistical analysis
 
Statistical analysis was performed by using SPSS Statistics for Windows, version 20.0 (IBM Inc., Armonk, NY, USA). Descriptive parameters show the mean, standard deviation or proportion (%). In case of categorical variables, the chi-square test was used. To compare intra-group changes over time (at the baseline and 12th week), all dependent variables were analyzed using one-way repeated measures ANOVA. The threshold for significance was denoted at p<0.05.
 
Results
 
Data from a total of 57 subjects, 24 of whom participated during the 2011 intervention and 33 during the 2012 intervention, were analyzed, presented, and discussed in the present study.
 
Energy intake and expenditure parameters
 
Table 1 presents the parameters estimating behavior modification. According to the three-day food records, all subjects showed a significant decrease in TEI, fat, and carbohydrate intake per day. However, for the protein intake per day data, a significant (p<0.05) decrease from baseline to week 12 was seen in the 2012 subjects, but the decrease was not as significant for subjects in 2011. The TEE and steps per day parameters showed significant increase at week 12.
 
Obesity states
 
The parameters evaluating change of obesity states are presented in table 2a. Body weight was significantly decreased at week 12. In addition, 12 weeks of lifestyle improvement promoted by education on exercise and diet resulted in significant reductions in TAFA, VAFA, and SAFA as assessed by MRI, and in percentage body fat as determined by DEXA. Ultrasound analysis also revealed that the number of obese subject with liver steatosis significantly decreased.
 
Physical performance capacity
 
Table 2b presents the parameters for physical performance capacity. The data show significant improvement in VO2max, physical age, and resting heart rate suggesting that physical performance capacity increased during the 12 weeks of education.
 
Risk factors for metabolic syndrome
 
The risk factors related to metabolic syndrome examined in this study for each subject from baseline to 12 weeks is shown in table 3. After 12 week program, significant reduction in parameters including WC, SBP, DBP, FPG, and TG were seen, while, significant increase in HDL-C was seen. The number of components for metabolic syndrome according to diagnostic criteria in Japan [26] revealed significant decrease under our protocol.
 
Discussion
 
One of the most urgent tasks for public health in the 21st century is conquering the epidemic of obesity [27]. Despite numerous attempts worldwide to address obesity through prevention and treatment, there is no letup in its rapid global increase. The problem does not seem to go away simply-it is even more difficult to combat, since its causes have become so intertwined in social, environmental, and governmental aspects. Currently, there is no common agreement on the specific causes of obesity [11]; integration of psychological, physical, medical, social, and economical factors [9] for reversing obesity is beyond the capacity of untrained individuals. Therefore, in order to achieve concrete results in counteracting obesity, multifaceted approaches at the individual level will be necessary. In this direction, we believe that a positive behavior change via acquiring individual self-management ability will be critical to reverse the rising tide of obesity. In particular, individuals incorporating diet and exercise programs will be able to successfully and efficiently achieve their goal. In this study, we promote an intervention study that adopts a new conative program consisting of dietary and exercise education, and incorporating individual selfmanagement. During the 12-week education period, we focused on offering knowledge to encourage behavior change regarding diet and exercise, without demanding subjects to follow a strict regimen specified by the program. With our systemic protocol, subjects were able to control their dietary and exercise behavior, and subsequently showed considerable improvement in their obesity states and reduction of risk factors for metabolic syndrome during the two consecutive years. We recognize that these optimal results are obtained through abilities acquired during this program, such as a broader perspective and improved acumen about obesity management. Our new approach showed effectiveness and methodical convenience for the public. In fact, it may be not surprising that the subjects achieved better results during the program, since they had lacked an understanding about the optimal approach for prevention and management of obesity. We also noted that although our program obtained extraordinary results, it did not bring out remarkably different outcomes as compared to those of other intervention studies. Nonetheless the results obtained in this study are of value, since after acquiring basic and essential knowledge about diet and exercise, including the need for behavior modification, during a short period of education subjects achieved optimal results of their own volition.
 
Difference between previous programs and our current program
 
This study was predicated on the observation that previous dietary restriction and imprudent exercise to counter obesity are difficult goals to sustain for the general population. Our systemic protocol is intended to implement an established program based on dietary and exercise guidelines that were already in place, and to further apply individual self-management education.
 
Health authorities have provided theoretical and practical guidance to present clearly and compendiously facts and figures of the obesity epidemic [17,21-23]. However, such high level of information may be more likely to confuse rather than help people. We reasoned that obese individuals have to spend considerable time and effort to select, interpret, and apply the appropriate strategy suited to their needs. Also, it is necessary to promote such an approach to the general public. A society level strategy needs to be simple and inexpensive to be effective [20]. This is an important consideration where the ultimate goal is to conquer the epidemic of obesity.
 
Our approach was applied to the public through practical education designed to help participants acquire the self-management techniques needed to obtain a conative health behavior change. There are four main goals for obesity management ability: the first is maintenance of a high level of physical activity, safely; the second is the spontaneous intake of a low-energy balanced diet; the third is active monitoring and evaluation of obesity and health condition; and the last is the acquisition of various basic information to understand guidelines and gain a clear distinction of the appropriate strategy for an individual’s circumstances. We believe that this ability contributes to improved selfconfidence and self-respect, subsequently leading to the achievement of successful results.
 
Current program benefits individual self-management ability
 
Although obesity-related new technology development offers the potential for a more effective treatment, it is of little help without a fundamental modification in lifestyle. As most obesity issues originate from impaired lifestyle, treatment of obesity needs to preferentially account for lifestyle behavior modification combining diet and exercise [28]. Without a doubt, exercise is an essential part of life for maintaining good health and mind. Strong evidence is accumulating for the therapeutic benefits of exercise, which is being increasingly advocated by leading health authorities [29]. Despite this, obese people have problems of fear of injury, and low self-efficacy in respect to a novel or unfamiliar exercise mode or increased exercise. It is mostly from low self-esteem that obese individuals tend to avoid exercise [30]. Thus, in order to avoid such physical and psychological injuries, individuals need a steady plan and management technique. In our approach, subjects attended a 12-week exercise education program for two consecutive years. We recommended subjects an exercise, which can be done with few restrictions, such as walking and jogging, and demonstrated basic training method such as stretching and resistance training using their bodies. The subjects were free to determine the type, intensity, and duration of exercise based on their own judgment, and skilled exercise trainers helped them by giving professional advice.
 
In addition to exercise, correct dietary intake is essential in counteracting obesity. A growing number of studies emphasize the importance of the reduction of energy intake for weight reduction [31,32]. However, improving dietary intake means maintaining energy balance, not just targeting a reduction of energy intake. Many researchers warn of risks such as unbalanced energy intake and excessive reduction of energy, and also report the difficulty of maintaining the dietary status [33,34]. Here, we focused on conveying basic and essential knowledge related to dietary modification with energy balance to subjects via sessions of lectures and practice. Through this approach, we expected subjects to acquire an ability to control various obstacles related to dietary behavior specific to their own conditions. Based on these two methods, our program obtained good results.
 
Conclusion and Future Prospects
 
The overall results from our new public approach show that improving individual self-management ability through the current protocol significantly reduced dietary intake and increased physical activity. Such results are very meaningful because of the proactive approach demonstrated by individual participants. For example, table 2a showed significant improvement in obesity conditions, especially -12.9% weight reductions. A recent review has reported that weight reduction of 5%-10% of the initial body weight is recommended for alleviating obesity-related metabolic abnormalities [35]. Subjects achieved in excess of this criterion via our program during the short 12- week term. Acquiring individual Self-management ability, with greaterthan- recommended beneficial effects, also led to significant reduction of risk factors for metabolic syndrome (Table 3). These are related to the pathology of obesity-related diseases such as hypertension, dyslipidmia, type-2 diabetes, and consequently, CVD. An improvement in these components may be helpful in reducing these diseases. Based on the obtained data, the methods and delivery of our new public approach are acceptable. Our study demonstrated individual Self-management ability and deduced its beneficial results. This leads us to report our program as having high potential for obesity management as a new practical approach for public health.
 
Nevertheless, our study is only a small step forward in tackling the obesity epidemic, and there are limitations to be overcome. It should be noted that we did not conduct follow-up research to check the maintenance and progress of the accomplishment achieved with individual self-management ability. It is likely that some subjects were highly dependent on that support and supervision and had not developed the skills and routines necessary to continue to succeed independently. In the current study, although we could not evaluate these possibilities, it is important to establish and prepare for future challenges.
 
Conflict of Interest
 
The authors declare that they have no competing interests
 
Acknowledgements
 
We are grateful to Dr. Rina So and Takehiko Tsujimoto (Graduate School of Comprehensive Human Sciences) of the University of Tsukuba, for their help with a part of the intervention trials. We also greatly appreciate Professor Randeep Rakwal (Graduate School of Life and Environmental Sciences) of the University of Tsukuba for a critical reading of the manuscript and constructive comments therein.
 
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