Shawshank deconstruction for brooks parole sequence

Brooks parole sequence is particularly evocative and compelling. A variety of techniques is used to shape this particularly emotive and tragic scene. These techniques include the use of camera shots, background music, voice over, lighting and dialogue. Our first impression of â€Å"Brooks parole† sequence is shaped through the use of variety of camera shots. The use of long panning camera shots of Brooks standing still, alone outside Shawshank's gates highlights how frail, small and insignificant he is in the outside world. These camera shots emphasise and gives us the sense of Brooks loss, being alone frightened, scared and anxious. This is further highlighted by the close up camera shots of Brooks in the bus after being released, gripping onto the handle rails. In this camera shot the other passengers on the bus are blurred putting our focus and attention on Brooks, leaving the audience with a great sense of absolute despair, anxiety and loss. The use of this camera technique gives us our last impression of the broken man Brooks had become after leaving Shawshank. The use of these powerful camera techniques used by the director emphasises Brooks feeling of being alone, frightened and anxious. Highlighting further, the impa ct Shawshank has on the individual. The use of background music highlights further Brooks loneliness and despair. The background music is sad, somber and builds in intensity throughout this sequence. The music creates a mood, an atmosphere of loss, shock as we sense Brooks defeat and horror. There is an irony in the fact that Brooks is physically free but emotionally trapped and imprisoned by his sense of solitude and isolation in the outside world, where he should be feeling free. The use of background music leaves us with a strong impression that Brooks freedom will have a tragic end due to him being in a state of despair. In this emotion charged sequence, it is Brooks voice that we hear speaking directly to us, about his thoughts and feelings about his ‘release' from Shawshank. This voice over technique emphasizes Brooks strong sense of not belonging on the outside world. The language used in this voice over is very moving as we feel Brooks pain and desperation to be back in Shawshank. † Send me home, I'm tired of being afraid all the time.† The use of voice over tragically emphasizes just how much Shawshank can take from an individual. Inside Shawshank Brooks had, ‘friends,' ‘family' and ‘position' which made him feel important. This powerful technique highlights that, Shawshank can tragically strip away a man's sense of self. A man becomes dependent on the walls of the institution. â€Å"First you hate them, then you start to get used to them and pretty soon you start depending on them.† Brooks believed that outside of Shawshank he was nothing. This sequence is also shaped through the use of a variety of lighting, which emphasises Brooks feelings of depression and worthlessness and that he can't see himself escaping this dark, unforgiving place. These characteristics are portrayed through the use of dull, dim, dark and shadowy lighting. Ironically, the confinement of Shawshank offered Brooks a security that being on the ‘outside' could not, leaving us to believe that Brooks had become institutionalised. Dialogue is another strong technique used by the director to show a startling contrast in the language used by the guards who farewell Brooks. They shake his hand and wish him ‘good luck'. Their language and their treatment of Brooks contrasts markedly to what we have seen and heard within Shawshank. The cruelty, brutality and taunting are gone. The words and gestures used by the guards highlights the respect they have for Brooks and for us makes his leaving a lot more touching. This evocative and compelling parole sequence is shaped through the use of many techniques, which leads us towards the tragic ending of Brooks at the end of this sequence.

Visitor Motivations to Attend Events

Table of contents Introduction1 Food and wine festival2 Sport event3 Music Festival5 Cultural events6 Analysis of motivation8 Common motivation factors8 Unique motivation factors9 Need for organiser9 Conclusion10 Bibliography11 Visitor Motivations to Attend Events Introduction Motivation is the force. Pinder, cited in Gallstedt (2003), defines motivation as ‘‘a set of energetic forces that originate both within as well as beyond an individual’s being to initiate work-related behaviours, and to determine its form, direction, intensity, and duration’’ (Gallstedt, 2003).Mullins (2008) describes motivation as this force which drives any person to show a specific behaviour towards any condition or situation or things. There are mainly two different natures of motivation one is come from person’s internal desire to do action. It is always self-applied and self accomplishment in individual. This kind of motivation is referring to the intrinsic motivat ion (Bratton et. al, 2010). While we discuss about the motivation of event visitor it also fall on this types of motivation visitor attend in the event to fulfil their personal desire.But there are different factors of motivation which fulfil visitors' desire. In the other hand extrinsic motivation works on external level of individuals. Every individual have expectation of external tangible outcomes like financial rewards, bonus, pay increase, profit share, and promotion in their job (Bratton et. al, 2010). The festival and events have extensively increased in number. Along with that its visitor also increased (Lee, 2000). Now a days events and festivals giving economy support to the hosting community or party. It's becoming an important tool for development for the community.Every year festivals and events are popular and visitor travel a long journey to participate. There are different kinds of events and festivals for example Sports, Cultural, Tourism, Music, Religious. Visitors of the events and festivals have their own purpose to attend on it. Each single visitor has motivation to attend on any kinds of events. In other words visitors' motivations to attend events and festivals are different. We can find visitor with different motivation in the same event. There are also some common motivational factors for visitors to attend different kinds of event above mention. e there are some common motivational factor in different kinds of events and different motivation factor in same event. There are some unique motivational factors for some events which we cannot find in other events. Here we are going to discuss about the common motivation factors of different kinds of festivals as Food festival, sport festival music festival and cultural festival and their unique motivation factor in each kinds of festival. Food and wine festival Food and wine festivals have becoming an important part of the special festival. It also an attraction points of tourist.Many touri sts attend food or wine festivals to taste foods and wine. They experience special types of food and wine from these kinds of festivals [ (Hall ; Mitchell, 2001) ]. As it is one of the important tourism activities Food and Wine festivals targeted to the tourist from international and local as well (Chang, 2011), (Chartersa ; Ali-Knightb, 2002). Chang 2011 study on the visitors' motivation to attend a food festival in the Old Town Spring SpringFest which is a regional food festival in Old Town organized every year in March. The town located 20 miles north of Houston, Texas. Old town is a historic 1900's railroad town.He studied the motivation of the visitor in 10,000 populations which is the number of visitors in the festival every year. After study of motivation of visitor from different demography like age, gender, marital status, education, income he came with many motivations factors in food festival. The top five dimensions of motivation and more other motivation factors are fun , to get out in the open air, heard about festival and it sounded like fun, for variety of things to see and do, to have a change from daily routine. He also found more activities which motivates visitors to attend in the festival.These are wine, escape, food, known group socialization, external socialization, art etc. Kwang-Soo, Park Yvette Reisinger Hyun-Jung Kang studied to identify the major factors that motivate visitors in wine and food festival. The objective of this study was to identify the major factors that motivated visitors to attend the South Beach Wine and Food Festival in Miami Beach, Florida, and determine whether these factors varied among the visitors from the United States, Canada, South America, Europe, and Asia. They survey on 475 visitors to South Florida. In this study Forty-four motivational items were analyzed.The top most motivational factors were the desire to taste new wine and food, enjoy the event, enhance social status, escape from routine life, meet new people, spend time with family, and get to know the celebrity chefs and wine experts. Yuan et. al (2004) were also done one research on visitor motivation on wine festival and conclude that most important single reason for visiting festival was wine testing. According to their study, education and learning about wine, meeting the winemaker, socialising and having a day out and entertainment were reasons for their attendance at the festival (Yuan et. l, 2004). From above studies we can understand some important motivational factors of food and wine festivals which are testing food and wine, knowledge about food and wine, socialization, fun, family togetherness, escape, change from daily routine etc. Sport event Sport events help to generate revenue. Sports events represent a major area of event revenue contributing economic benefits to cities and regions. Whilst explain that attendance at sports events is recognised as an important leisure and entertainment activity (Shamir ; Rus kin, 1984).Funk describe that visitors desire to watch sport event occurs within five stages which are need recognition, tension reduction , drive state, want pathway, and goal behaviour. Here this needs illustrates how a need recognised fulfil by seeking way that satisfy the need and received benefit from them (Funk, 2008). John Hall, Barry O’Mahony and Julian Vieceli (2010) study about the motivation of the visitor in sport event . Their study identifies the antecedents of sports event attendance among 460 respondents who were surveyed in Melbourne. Their study was related to the motivational factor for the sport.They combined the motives of visitor in seven different dimensions as entertainment; emotional arousal, back room, true fan, front room, event and social factor there are fun, excitement, the arousal, friend and family. They found that financial and economical condition also influence to the motivation. Price of tickets or perceived value of the sport product are f all into controlled factor which can controlled but the average income of the population and economic condition of the country are fall into uncontrolled factor which cannot controlled by event organiser.There are also some factors which called front room and back room factor. Back room factor are factors amenable to management control that contributes to the overall experience this includes parking, ease of getting a seat and stadium accessibility. Front room factor Facilities or elements of the event experience that are under the control of management. These front room factors relate to factors, which could be said to directly influence the spectator’s enjoyment of the event experience, which include alcohol and smoke free zones. True fan factor Attendees for whom the enjoyment of the game itself is most important.They are interested in the competitive nature of the event, the process the outcomes and the performance of the team or individual that they support. Kevin Filo, Daniel C. Funk and Danny O'Brien investigate motivates of the participants' attachment to a charity sport event. They come with four findings in which first was hobby of charity giving , second was social, reciprocity, self-esteem, need to help others in which they focused more on the charitable cause. Third group of attendants also motivated by the factors of second group but they are less focused on the charitable cause.Fourth finding of the study was the motives for charitable giving make a stronger contribution to attachment for an event with a more prominent charitable cause, while the recreation motives make a stronger contribution to attachment to an event with a less prominent charitable cause. Overall sport events have five to six dimensions of motivation to attract its visitors. Socialization, escape, Event attachment, Family and friends etc. furthermore there are some more motivational factors as true fan, drama, etc which we will discuss later. Music Festival Numbers of musical festival organised every year.According to Bowen, and Daniels (2005) music festivals are unique and special event which attract visitor to hear and view the performance (Bowen ; Daniels, 2005). They had done the research to find more about the motivations for attending a large, multi-day music festival. To find out motivation they conduct interview with visitor on the event site of Celebrate Fairfax, an annual music festival held in Virginia (USA). In the study difference factors of visitor's motivations were analyzed by dividing into three categories as Discovery, Music and Enjoyment.Factors included in these three categories were Increase knowledge of local culture, be with people from community, experience new and different things, recovery from hectic pace, listen to music, special appeal , family and friend togetherness, other non musical attraction, and party and have a fun. From the same study they try to find out whether music matters in musical festival or not? In t he answer of this question authors conclude that music is important to music festival but there are some visitor for them music is not more important.This study suggested that it is better to other non-musical factors in musical festivals. Because musical is no more important for some visitors attend on musical festival. To attract non-musical visitors event need to have some non-musical motivational factors such as socialization, fun and etc. along with musical performance. Gelder and Robinson also agreed with Bowen and Daniels that music festivals need some non-musical experience. When completed the comparative study of visitor motivation for music festival from Glastonbury and V Festival two largest music festivals in UK with 200,000 visitors.They suggested to V Festival, that it needs to include non-musical components on it as socialization, fun, and enjoyment [ (Gelder & robinson, 2009) ]. Formica and Uysal (1996) were analyzed Twenty-three motivation items including them into five different dimensions of motivation as excitement and thrills', socialization', entertainment', event novelty' and family togetherness' while comparing festival motivations of residents and non-residents for Umbria Jazz Festival in Italy.As a result they found socialization factor affect to the residential visitor and non residential visitor are motivated from ‘entertainment' factor (Formica ; Uysal, 1996). Cultural events There are different literatures and researches have done on motivation of visitor for cultural festival. In 1996 Schneider and Backman have done one study on motivation of the cultural festival visitor in Jerash Festival for culture and art festival of Jordan. In the study they tried to find out if the motivation factors are applicable for outside of North America or not?In that study they analyzed twenty three factors of motivation in five different dimensions as family togetherness/ socialization', social/leisure', festival attributes', escape' and eve nt excitement'. The result how that in spite of differences in importance of factors of motivations, the scale developed in United State was also reliable to other parts of the world like Arabic country and South Korea as well (Schneider & Backman, 1996). Formica and Uysal explored the motivation of visitor for ‘Spoleto Festival', a cultural festival in Italy in 1998.In the study they investigated on twenty-three motivation items with six factors as socialization/entertainment, event attraction/excitement', group togetherness', cultural/historical', family togetherness' and &site novelty. In the conclusion of the study they suggest that there are different in motivation between loyal and fair according to their age, income and marital status. (Formica & Uysal, 1998). In 2000 Lee compared the motivation factors of cultural festival between Caucasian and Asian visitors in the Asian setting of the Kyongju World Cultural Expo.In the expo there are performances from 48 different co untries. In his research, he studied on 32 motivation items categorising on seven different dimensions. The seven dimensions which studied by Lee were ‘cultural exploration', family togetherness', ‘escape', ‘novelty', ‘external group socialization', ‘event attractions' and known-group socialization'. From this study Lee found that the motivation level of Caucasian visitors was slightly high then of Asian visitors at Kyongju World Culture Expo. There was high motivation in regarding to cultural exploration and event attractions for both types of visitors.But the factor ‘family togetherness' found little bit weak to motivate in that expo (Lee, 2000). Lee et. al (2004) studied on the festival motivation by nationality and satisfaction. Purpose of the study was to find out the importance of festival market segmentation based on visitor motivation for promotion of event or festival. To study about segmentation of visitor they select the 2000 Kyongju Wo rld Culture Expo organised in Kyongju, South Korea. In the expo over 9000 artists from different countries performed for 87 days between September to November. According to this article More than 1. million visitors visited the expo in 2000. In this study authors identified six motivation dimensions for visitors attending the 2002 World Culture Expo as cultural exploration, family togetherness, novelty, escape, event attractions, and socialization. Among all dimensions cultural exploration found the high portion of motivation in visitors (Lee, Lee, & Wicks, 2004). Analysis of motivation Common motivation factors After reviewing the work of different authors on motivation of events visitor, we can conclude that most of motivation items in every kinds of events are common. e can combine them in five to seven different dimensions as socialization, family togetherness, novelty, escape, event attractions/ Novelty, learn and explore culture and Excitement or thrills (Chang, 2011) (Bowen & Daniels, 2005) (Formica & Uysal, 1996). Socialization: socialization is a desire to interact with a group and its members. There are two types of socialization internal and external socialization. Internal means being with friend or the people already know. External means meeting new people. Family togetherness: this is the desire to enhance family relationship.People motivated by this factor attend event to seek the opportunity to be with family, relatives and friends. At the same time they have desire of doing things together. Escape: Escape from daily routine and the things which we see or do everyday. It is a Desire to have change in usual demands of life, and desire to have some change to minimize the life’s stresses. Learning or exploring cultures – learn about or explore other cultures. Visitors motivated with this factor have a desire to gain knowledge on different kinds of cultural practices and celebrations. Excitement or thrills – desire to do some s timulation things.People excited to do these kinds of activities. Event novelty – this is the desire to do unique and new things. Every this is related to the curiosity of person. Visitor wants to do new and different things and or attending a festival that is unique. Sourse: (Foster & Robinson, 2010) (Bowdin et. al, 2011) Unique motivation factors In spite of common motivation items in every kind of events, there are some unique motivation factors for different events. For example the motivation item ‘food testing' is only applicable for food festival. Visitor may not motivate to attend in cultural expo with this motivation.According to Chang (2011) study more then one third visitor of food and wine festivals motivated with food and wine items. They have a desire to test, purchase, being familiar, increase knowledge about the food and wine (Chang, 2011). Sport event have also unique motivation factor called true fan (Hall, O’Mahony, & Vieceli, 2010). In the word s of Allison 2001, â€Å"True fans stand on terraces, they shout and sing and sometimes fight; they talk of the club as ‘we' or ‘us' and measure their lives in remembered result; they get as much misery as joy from the whole thing† (Allison, 2001, p. 51). For true fan attendees for in the event it is most important. Mostly they are interested in competitive nature of events (Hall, O’Mahony, & Vieceli, 2010). Bowen and Daniels (2005) wrote about the music festival that attract audiences for a variety of reasons but enjoying the artists’ performance is popular motivational factor for music festival or event (Pagg & Patterson, 2010) Motivation: Need to Know by Organiser As a event organiser or manager its important to understand the motives of event visitor.There are different researches, and studies which have suggestions for event managers which make clear why a manager or an organiser need to know motivation in order to organise events or festivals. Manager need to include more activities that not specifically related to the main Purpose of the event. For example Bowen and Daniels study on the topic ‘Does Music Matter? ‘ and come with the result that: music is important to music festival but there are some visitors for them music is not more important.So its better to make festival environment where visitor can socialize, fun and some non-musical experience along with music performance (Bowen & Daniels, 2005). Manager need to understand and offer key motives of events. From above study we find some key motives of visitor to attend events. As an event manager understanding of motivational factor is important to design and serve the product according to visitors desire to receive or being served (Gelder & robinson, 2009). It is important for event manager to Analysis of motivations for festival attendance for market segmentation and effective promotion.Lee suggest manager that for planning events and festival, motivat ion analysis is important to identify different needs and to segment target markets (Lee, 2000). Conclusion After study of motivations for different kinds of events, here we can combine the common motivation items in some dimension as socialization, family togetherness, novelty, escape, event attractions/ Novelty , learn and explore culture and Excitement or thrills. Which we can say the common factors that attract the visitors to attend for every kinds of events. in spite of this common factor there are some unique motivational item for each events or festival.For event organiser it is important to know the about motivation of event visitor. It helps event manager to design the event, serve the visitors and make better understanding between visitors and organisers. Bibliography Allison, L. (2001). Amateurism in sport: an analysis and a defence(Sport in the global society). Great Britain: Routledge. Aswathappa, K. (2007). Human Resource And Personnel Management. New Delhi: Tata McGr aw-Hill Education. Bowdin, G. , Allen, J. , O'Toole, W. , Harris, R. , ; McDonnell, I. (2011). Events Management (3 rd ed. ). Great Britain: Elsevier Ltd.Bowen, H. E. , ; Daniels, M. J. (2005). Does the music matter? Motivations for attending a music festival. Event Management , 9, 155–164. Bratton, J. , Forshaw, C. , Callinan, M. , ; Sawchuk, P. (2010). Work and Organizational Behaviour: Understanding the Workplace. Palgrave Macmillan. Chang, W. (2011). A teste of tourism: Visitors, motivations to attend a food festival . Event Management , 15, 151–161. Chartersa, S. , ; Ali-Knightb, J. (2002). Who is the wine tourist? Tourism Management , 23 (3), 311–319. Filo, K. , Funk, D. C. , ; O'Brien, D. (2011).Examining Motivation for Charity Sport EventParticipation: A Comparison of Recreation-Basedand Charity-Based Motives. Journal of Leisure Research , 43, 491-518. Formica, S. , & Uysal, M. (1996). A market Segmentation of festival visitor: Umbria Jazz Festival in It aly, . Festival Management and Event Tourism , 3 (4), 175-181. Formica, S. , & Uysal, M. (1998). Market Segmentation of an International Cultural-Historical Event in Italy. Journal of Travel Research , 36, 16-24. Foster, K. , & Robinson, P. (2010). A Critical Analysis of the Motivational Factors That Influence EventAttendance in Family Groups. Event Management , 14, 107–125. Funk, D. C. (2008). Consumer Behaviour in Sport and Events:Marketing Action. ElsevierLtd. Gelder, G. , & robinson, P. (2009). A critical comparative study of visitor motivation for attending music festivals: A case study of Glastonbury and V festival. Event Management , 13, 181-196. Gorman, P. (2004). Motivation and emotion. Routledge. Hall, C. , & Mitchell, R. (2001). Special interest tourism: Context and cases. In N. Douglas. N Douglas & R Derrett (Eds. ). Wine and food tourism , 307-329. Hall, J. O’Mahony, B. , & Vieceli, J. (2010). An empirical model of attendance factors at major sporting even ts. International Journal of Hospitality Management , 29, 328–334. HIXSON, E. J. , MCCABE, S. V. , & BROWN, G. (2011). EVENT ATTENDANCE MOTIVATION AND PLACE ATTACHMENT AN EXPLORATORY STUDY OF YOUNG RESIDENTS IN ADELAIDE, SOUTH AUSTRALIA. Event Management , 15, 233-243. Lee, C. -K. (2000). A comparative study of Caucasian and Asian visitors to a Cultural Expo in an Asian setting. Tourism Management , 21, 169-176. Lee, C. -K. , Lee, Y. -K. , & Wicks, B. E. (2004).Segmentation of festival motivation by nationality and satisfaction. Tourism Management , 25, 61-70. Pagg, S. , & Patterson, I. (2010). Rethinking Music Festivals as a Staged Event:Gaining Insights from Understanding VisitorMotivations and the Experiences They Seek. Journal of Convention & Event Tourism , 11, 85–99,. Park, K. -S. , Reisinger, Y. , & Kang, H. -J. (2008). Visitors' Motivation for attending the south beach wine and food festival, Miami Beach Florida. Journal of Travel ; Tourism Marketing , 25 (2), 161-181. Schneider, I. E. , ; Backman, S.J. (1996). Cross-cultural equivalence of festival motivations: a study in Jordan. Festival Management and Event Tourism , 4 (4), 139-144. Shamir, B. , ; Ruskin, H. (1984). Sport Participation vs. Sport Spectatorship: Two Modes of Leisure Behavior. Journal of Leisure research , 16 (1), 9-21. Wamwara-Mbugua, L. W. , ; Cornwell, T. B. (2010). Visitor motivation to attending international festivals . Event Management , 13, 277-286. Wann, D. L. , Grieve, F. G. , Zapalac, R. K. , ; Pease, D. G. (2008). Motivational Profiles of Sport Fansof Different Sports.Sport Marheting Quarterly , 17, 6-19. Won, J. -u. , ; Kitamura, K. (2007). Comparative Analysis of Sport Consumer Motivations between South Korea and Japan. Sport MarHeting Quarterly , 16, 93-105. Working conditions in projects: perceptions of stress and motivation among project team members and project managers2003International Journal of Project Management 21449-455 Yuan, J. (. , Cai, L. A. , M orrison, A. M. , ; Linton, s. (2004). An analysis of wine festival attendees motivations:A synergy of wine, travel and special event. Journal of vacation marketing , 11 (4), 41-58.

Discuss ways in which developmental psychology can inform practice in Essay

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Effective team and performance management - Essay Example Performance management is an integrated and strategic approach to deliver flourishing results in organizations, by the improvement of performance, and by building the capability of individuals and teams. Performance management is important in achieving qualitative performance and superior standards. This project deals with the functions of effective team and performance management, and how they weekly reflects on the group exercise explaining the significant success factors in the growth of a team. It describes its reflections on the experience of practical seminar activities of team and performance management. It also explains group experience from the view of group members imaging their experience. This study evaluates the principles of inter-personal relationship, tries to understand group behaviour and dynamics of organizational behaviour, by analysing the various factors that influence individual behaviour in a team. The study evaluates effective management practice and behaviou ral skills in a team environment, which generate personal as well as organisational performance impact. Regarding effective team and performance management, the study classes include four activities, and they are animal survival reflection exercise, the activity can which adapt learning skills with the level of educational achievements. Other activities are egg flying activity, Belbin’s team role and lost on the moon. These activities study group behaviour and group efforts which help n building an effective team. 2.1) Reflect on what you learned from the group exercise in week one - three (Learning outcomes 3 and 4) It was a great experience that I received during the activities in the class as a team. I enjoyed it a lot. In the group exercise, from week one to week three, I learned about the application of organizational behaviour, and the theories of learning in the context of business. I also learned the factors that influence individual behaviour in a team. In the week o ne activity, I came to know the ways to accomplish assigned work, to respect team members, and how to hold on when the group falls beyond its expectations. The team began to perform well in norming stage. â€Å"Groups can also exert enormous in?uence on individuals through the medium of norms† (International Relations and Group Processes n.d) Each individual began by contributing their best for the improvement of the team. As a result of this, more effort was exerted by the group thereby bringing harmonious relation among the team members. All group members presented themselves at the meeting on time, so that they could closely follow the proceedings of the meeting, and no one was supposed to interrupt the meeting by arriving late at the venue. I, as a team member also learned about how to behave in a meeting, when to present our own opinions, if any; and to encourage silent members in the group to speak out. Decisions were made by the unanimous support of the team members. à ‚   A significant factor of success in the growth of a team, depends on the concept that all players in the team are equal in decision making; and that every team member is valued, and that they that contribute well for the team. All members should be honest in their communication, and should speak frankly without hurting the self-esteem of co-members. The active participation of team members in

Feminist Film Theory Essay Example | Topics and Well Written Essays - 3000 words

Feminist Film Theory - Essay Example He seems angry but could not resist himself from taking a peek inside once again and while he does so, a dog is shown licking his hand, obviously giving an indication of what is going on inside. Looking at the description of the scene it seems to be a part of some porn film. But it is actually is a scene from an award winning film ‘ The Piano’ directed by a female director named Jane Campion . The scene is erotic, it is sexual and it is about sex. Does it involve a woman? Yes. Is a woman in this scene used as a commodity or is she objectified? No. The scene is a brilliant work of art where even though the love scene shot is very intimate and erotic, it does not expose the body of a woman just so that it can create a visual pleasure for men. This scene, and the movie as a whole, is an answer to what Laura Mulvey in her essay, â€Å" Visual Pleasure and Narrative Cinema† had challenged the film makers to achieve. Sex is a part of life. We are born out of sex. So sex can never be denied or eliminated from the cinema. But the challenge was to show sex and woman in such a way that it allows her to maintains her dignity and respect in the society and does not become just an object of visual pleasure. The movie ‘ The Piano’ is an excellent example of how this aim can be achieved. Laura Mulvey is one of the thinkers who had discussed the feminism in cinema with the aid of the psychoanalytical theories of Sigmund Freud. She studied the theories of Freud and have tried to understand how woman has been suppressed and objectified in the world of cinema. She has compared Freud’s theory with the way the audience

Impact of slavery on the lives of african americans during the Essay

Impact of slavery on the lives of african americans during the pre-civil period - Essay Example The history of the African-American in the United States during the pre-civil period (1860) has been shaped by â€Å"slavery† that not only shaped the lives of the African-American people but also the identity of the entire American nation since ‘slavery’ as a socio-political and economic institution Slavery as a legal institution had existed in North America for more than one hundred years before the United States was founded in 1776. But it continued in the South until the 13th Amendment of the US Constitution was passed to abolish slavery in 1865. In the United States, slavery was first practiced in Virginia, one of the former English Colony in 1619. Slavery as Accepted in the US Political Sphere: The Slave Codes Slavery in the US Constitution The Abolitionists often claimed that the US Constitution (before the passing of the 13th Amendment) was â€Å"a slave document created by slave owners† (Berkowitz and Moran). Indeed the truth of the abolitionistsâ €™ claim was first revealed in the â€Å"Notes of Debates in the Federal Convention of 1787† published by James Madison. Madison’s documents show that US democracy during those years was orientated, not by any humanitarian interests, but by the core political interests of both the Northern and Southern States. The Three-fifths Compromise Since slavery was economically profitable in almost all of the southern States and the pro-slavery southern Delegates wanted to be benefited from â€Å"increased representation in the House and the Electoral College†, the southerners wanted the slaves to be counted for enumeration. Meanwhile the northerners partially driven the contra-slavery motive as well as the motive to reduce the southern dominance, wanted to count only the free inhabitants of the states. Thus the Three-Fifths Compromise came into being declaring that three-fifths of the slave population would be counted. The aftermaths of the Three-fifths Compromise we re such that the southern delegates began to dominate the Presidency and the Congress until the defeat of the south in the Civil War. Such dominance of the southerners further allowed them to manipulate the judicial and political power to exploit the African-American labor and thus the conditions of the African-Americans deteriorated. The 1793 Fugitive Slave Act One of the most mentionable events during the Southern Dominance in the Congress is the passing of the â€Å"1793 Fugitive Slave Act†. Since according to this Act any state including contra-slavery northern ones was bound to return a fugitive slave to its owner, slaves lost even their last escape from the inhuman exploitation of the slave-owners. Though the consequent 18o8 Law stopped international slave trade, interstate slave trade within the national territory continued. The effect of the 1808 Law was in favor of the anti-slavery northern states. Though the subsequent Missouri Compromise in 1820 brought the balance of power between the antislavery and pro-slavery factions of the United States, providing the northerners with the opportunity to dominate the House of Representative, slavery continued in the south. Dred Scott Case in 1854 and its Impacts The Dred Scott Case in 1854 can be considered as a milestone in the history of the African-American slavery in the United States. A close analysis of this case render a picture how slavery had shaped the African-Americans’ lives. The final decision of the Dred Scott Case was: since Scott was a black, he was not a citizen and he did not have the right to sue his master in the court. Slavery: Racism, Discrimination and Second Class Status The Scott Case infers that slavery in the United States had shifted its basis from war to color and from indentured servitude to slavery as a constitution supported practice of discriminating and depriving a group of people from their rights in

School and Society- assignment Essay Example | Topics and Well Written Essays - 1500 words

School and Society- assignment - Essay Example e and size of the American society and its level of diversity, education has a broad role to play in addressing vital issues such as the levels of education in the ethnic and underprivileged sections of the society. It is next to impossible to do so without understanding the ramifications of the range of social and administrative measures in the aid of education, adopted by the American society from time to time. Q 1. Describe the perspectives of liberal and vocational education in the development of the comprehensive high schools. Provide examples of how each has helped to shape the role of education in the United States. How do they continue to impact contemporary education? Ans. Considering the rapid changes being unleashed in the 21st century and the basic societal issues, challenges and opportunities that the students have to contend with in an American and a global context, it is important to seriously meditate on the ingredients of the curriculum that will enable the students to lead a positive, productive and meaningful life. Thus it is imperative to expose the students to a wide range of disciplines (U.S. Newswire 1). In that sense, liberal education has played a groundbreaking role in the development of comprehensive high schools in the US. The augmenting need for increasing pragmatism in the 21st century America cannot dilute the importance of traditional liberal education in the schools. However, one cannot underestimate the need for vocational education in schools. Vocational education in tandem with liberal education prepares the individuals to be productive leaders and workers who adhere to a sound ethical background. The signing of the Voc ational Education Act by President Lyndon Johnson gave way to the most comprehensive vocational education program in the history of America. Q2. Compare the major educational recommendations of James B. Conant with those advocated by Mark Van Doren in the article â€Å"Education for All†, assessing their relative

Motivation Letter Essay Example for Free

Motivation Letter Essay Economics, as a field, had always fascinated me right from my school days. As I grew up, I gradually came to appreciate the importance of economics in the modern world. In the university, I was fortunate to have been exposed to many interesting and challenging fields. However, I ultimately chose to major in Accounting, which provides me with fundamental knowledge of many economic-related theories and concepts, as well as familiarity with statistics and data analysis. I also learned the basic tenets of Economics in courses such as Finance, Management, Accounting and Public Finance. Subsequently I enhanced it with CMA Certificate courses right after graduation in 2006 These courses revealed to me the importance of the economic sector in the society, besides that I realized that Economic and Finance professionals have the privileged opportunity of managing assets and analyzing risks to ensure the future success of a company or organization. In 2010 and after having three years experience as Customer Service and Letters of Credits and Guarantees Officer, Business Development Officer at Bank Audi, and One year as Senior Account Officer / Corporate Business Development at Bank of Jordan, I realized the importance of finance and investment, giving the fact that the main decision of any enterprise is where to invest money and how to evaluate investment opportunities. Therefore, I decided to pursue postgraduate studies in investment and finance that would ideally complement my academic knowledge and experience, but unfortunately the current sad situation in my country freezes all my academic chances. So I’m looking to be a part of a respectful program and an opportunity to meet people and economists in one of the world most developed nations. In 5 years, I see myself leading an investment and financial section where I am involved building fruitful international business relations, designing structured financial products and managing well-diversified and effective portfolios by incorporating cutting edge methodologies and sophisticated tools that offer a valuable investment opportunity to the potential investor. Throughout this course I will leverage my existing skills with the knowledge of finance and economics that will help me to achieve my medium-term career goals to manage capital, create portfolios, perform mergers and acquisitions, and ensure future economic stability for corporations, as well as helping financial services industry to make the right financial decisions that will lead to economic stability and high returns. In the long-term, such knowledge, skills and experience will help me assist the Syrian market in designing, implementing and monitoring financial policies, planning and executing the financing initiatives, and interfacing with the financial community and investors.

Biochemical and Hormonal Changes in Childhood Obesity

Biochemical and Hormonal Changes in Childhood Obesity The prevalence of chronic or non communicable disease is escalating much more rapidly in developing countries than in industrialized countries. According to World Health Organization (WHO) estimates, by the 2020, non communicable diseases will account for approximately three quarter of all deaths in the developing countries (WHO. Global Strategy for non communicable disease prevention, 1997). In this regard, a potential emerging public health issue for the developing countries may be increasing incidence of childhood obesity with associated complications, which in turn is likely to create public health burden for poorer nations in the near future (Freedman et al, 2001). Lower to middle income nations face the double burden of having both malnourished and over nourished population, with most overweight and obese children being concentrated in urban areas. Rapid urbanization is associated with unhealthy lifestyle or New World Syndrome. In addition, in such communities, childhood obesit y is still considered a sign of healthiness and high social class. There is no universal consensus on a cut off points for defining overweight and obesity in children and adolescents, usually, for clinical practice and epidemiological studies, child overweight and obesity are assessed by means of indicators based on weight and height measurements, such as weight for height measures or body mass index (weight (kg)/height (m2))(WHO. Report series no.847, 1995).The US Centers for Disease Control and Prevention (CDC) defines obese as being at or above 95th percentile of body mass index for age (Kuczmarsk RJ et al, 2000). History of obesity is both interesting and gives details of its progression. Obesity is an age-old health condition. Through out the history of obesity, its reputation varies from appreciation and opposite among cultures and in time. Ancient Egyptians are said to consider obesity as disease. Perhaps the most famous and earliest evidence of obesity is the Venus figurines, Statuettes of an obese female torso that probably had a major role in rituals. Ancient China has also been aware of obesity and dangers that come with it. They always were a believer of prevention as a key to longevity. The Aztecs believed that obesity was supernatural, an affliction of the gods. Hippocrates, the father of medicines was aware of sudden deaths being more common among obese men than lean ones as stated in his writings. In certain cultures and areas where food is scarce and poverty is prevalent, is viewed as symbol of wealth and social status. To date, an African tribe purposely plumps up a bride to pre pare her for child bearing. Before a wedding can be set, a slim bride is pampered to gain weight until she reaches the suitable weight. Through out the history of obesity, the publics view and status of obesity changed considerably in the 1900s. It was regarded as unfashionable by the French designer, Paul Poi ret who designed skin-revealing clothes for women. About the same time, the incidence of obesity began to increase and become wide spread. Later in 1940s, Metropolitan life insurance published a chart of ideal weight for various heights. They also advocated that weight gain parallel to age is unhealthy. The government and medical society become more hands-on with obesity by imitating campaign against it. This was preceded by a study of risk factors for cardiovascular disease revealing obesity in the high ranks. Since then various diets and exercise programs have emerged. In 1996, the Body Mass Index (BMI) was published. This statistical calculation and index determined that a person is obese or not. At this time ,obesity incidence have soared, led by children and adolescent obesity, tripling in just a few short years, greater than any number in the history of obesity. This increase in the incidence of childhood obesity with associated cardiovascular risks, type 2 diabetes mellitus and stroke is supported by a considerable body of evidence. The prevalence of overweight and obesity in childhood and adolescents has been increasing throughout much of the developed and developing world for the past few decades. It has become increasingly clear that excess adiposity in childhood predisposes individual not only to increased risk of adiposity and its sequaele as adults (Freedman et al, 2001), but also to increased risk of multiple chronic diseases in childhood and adolescence (Rosen bloom et al, 1999). Though mechanism not clearly delineated, excess body weight and adiposity is associated with type 2 diabetes mellitus and its complications, cardiovascular disease risk factors, non alcoholic fatty liver disease and asthma in youth. Childhood Obesity 1930 1972 Risk factors for coronary heart disease (CHD) such as hypertension, dyslipidemia, impaired glucose tolerance and vascular abnormalities were present in overweight children. CHD is likely to be increased in overweight children when they become adults as a result of established risk factors. This study investigated whether excess weight in childhood was associated with CHD in adulthood among a very large cohort of persons born in Denmark in 1930 through 1972. They underwent mandatory annual health examination at public or private schools in Copenhagen. Each child was examined by school doctors or nurses and was assigned a health card bearing childs name, date of birth, birth weight reported by parents. 10,235 men and 4,318 women, for whom childhood BMI data were available, received a diagnosis of CHD or died of CHD as adults. The risk of CHD event, a non fatal event, and a fatal event among adults was positively associated with BMI at 7-13 years of age for boys and 10 to 13 years of ag e as girls. The associations were linear for each age and risk increased across the entire BMI distribution. Childhood Obesity 1930 1972 Risk factors for coronary heart disease (CHD) such as hypertension, dyslipidemia, impaired glucose tolerance and vascular abnormalities were present in overweight children. CHD is likely to be increased in overweight children when they become adults as a result of established risk factors. This study investigated whether excess weight in childhood was associated with CHD in adulthood among a very large cohort of persons born in Denmark in 1930 through 1972. They underwent mandatory annual health examination at public or private schools in Copenhagen. Each child was examined by school doctors or nurses and was assigned a health card bearing childs name, date of birth, birth weight reported by parents. 10,235 men and 4,318 women, for whom childhood BMI data were available, received a diagnosis of CHD or died of CHD as adults. The risk of CHD event, a non fatal event, and a fatal event among adults was positively associated with BMI at 7-13 years of age for boys and 10 to 13 years of ag e as girls. The associations were linear for each age and risk increased across the entire BMI distribution. Childhood Obesity and Economic Growth 1930-1983 Childhood obesity was related to the economic growth during the 50 years of economic growth in the industrialized world especially in Denmark. Annual measurements of height and weight were available for all children born between 1930 and 1983 attending primary schools in Copenhagen Municipality. 165,389 boys and 163,609 girls from the age of 7 through 13 years were included in this study. After computerization SBMI (kg/m2) were calculated and the prevalence of overweight and obesity according to international age and gender–specific criteria. Economics growth was indicated by the Gross National Product and the overall consumption per capita, adjusted for inflation. Prevalence of overweight and obesity among Danish children rose in phases, which were not paralleled by trends in economic growth. The microeconomics growth indicators seem inappropriate as proxies for the environmental exposures that have elicited the obesity epidemic. Childhood obesity and television viewing Children spend a substantial portion of their lives watching television (TV). Investigators have hypothesized that TV viewing causes obesity by one or more than three mechanisms: Displacement of physical activity. Increased calorie consumption while watching or caused by the effects of advertising. Reduced resting metabolism. The relationship between TV viewing and obesity has been examined in a relatively large number of cross sectional epidemiological but few longitudinal studies. Many of them have found relatively weak, positive association or mixed results. Many experimental studies have found that reducing TV viewing may help to reduce the risk of obesity. One school based experimental study was designed specifically to test directly the casual relationship between TV viewing behaviors and body fatness. The results of this randomized controlled trial provide evidence that TV viewing is a cause of increased body fatness and that reducing the TV viewing is a promising strategy for preventing childhood obesity (Robinson; 2001). The objective of another study (Utter J et al, 2006), was to explore how time spent watching television (TV) is associated with the dietary behavior of New Zealand children and young adolescents. Total number of participants was 3275 children aged 5-17 years. The findings suggest that longer duration of TV watching (thus more frequent exposure to advertising) influences the frequency of consumption of soft drinks, some sweets and snacks and some fast foods among children and young adolescents. Efforts to control the time spent watching TV may result in better dietary habits and weight control for children and adolescents. Childhood Obesity US- A decade of progress, 1990-1999 Current data suggest that 20% of US children are overweight .An analysis of the secular trends suggest that 20% of US children are overweight, and a clear up ward trend in body weight in children of 0.2 Kg between 1973 and 1994. In addition, childhood obesity is more prevalent among minority sub groups such as African Americans. Obesity that begins early in life persists into adulthood and increases the risk of obesity related conditions later in life. There has been tremendous increase in the number of studies examining the etiology and health effects of obesity in children (Goran MI, 1990-1999).1980 (boys 0.2% girls 0.5%) and 1997 (boys 1.2%, girls 2.0%). Ten years trends of childhood obesity in Israel 1990-2000 Cross sectional data was collected from 13284 second and fifth class school; children between 1990-2000. Prevalence of obesity was determined using Israeli and US reference values. BMI values at 95th percentile increased overtime in all ages and sex categories. Between 1990 and 2000, 95th centile values were increased by 12.7%and 11.8% among second grade boys and girls respectively. Among fifth graders in 2000, 10.7% of boys and 11.1% of girls exceeded the 1990 BMI reference values. The proportion of obese children increased over time using both Israeli and US reference values (Huerta Michael et al, 2008). Netherlands. Overweight, Obesity in 2003: V.1980-97. Data on 90,071 children, aged 4-16 years were routinely collected by 11 Community Heath Services during 2002-2004. International cut -off points for BMI to determine overweight and obesity. On average, 14.5% of boys and 17.5% of the girls were overweight (including obesity), which is a substantial increase since 1980 (boys 3.9% and girls 6.9%) and 1997 (boys 9.7% and girls 13%). Similarly 2.6% of the boys and 3.3% 0f the girls aged 4-16 years were obese, which is much higher than in 1980 (boys 0.2% and girls 0.5%) and 1997 (boys 1.2% and girls 2.0%), (KatjaVan Den Husk, 2007). Obesity trends in US. 2003-2006 Height and weight measurements were obtained from 8164 children and adolescents as apart of the 2003-2004 and 2005-2006 National Health and Nutrition Examination Survey (NHANES). Because no statistically significant differences in the prevalence of high BMI for age were found between the estimates for 2003-2004 and 2005-2006, data for four years were combined to provide more stable estimates for the most recent time period. Over all, in 2003-2006, 11.3% of children and adolescents aged 2 through years were at or above 97th percentile of the 2000 BMI- for- age growth charts, 16.3% were at or above 95th percentile. Prevalence estimates vary by age and by racial/ethnic group. Analysis of the trends in high BMI for age showed no statistically significant trend over the four time periods (1999-2000, 2001-2002, 2003-2004, and 2005-2006) for either boys or girls (Cynthia l.Ogden et al, 2008). 11-March 2005. Public Release Date: Consensus on Childhood Obesity, Recommends classification as disease A common statement on childhood obesity was published to day in the journal of Chemical Endocrinology and Metabolism (one of the journals of Endocrine Society). The consensus statement reflects the conclusions from an international summit held in Israel last year (2004) and includes a controversial recommendation to classify obesity as a disease. This decision was based upon the available research on the diagnosis, prevalence, causes (including endocrine disorders), risks, prevention and treatment of childhood obesity. Pediatric obesity is now recognized as a major health problem all over the world. Researcher have found that children who are obese have a higher risks adult obesity, which is strongly associated with many serious medical complications that impair quality of life and lead to additional increased risks. The statement also noted the prevalence of overweight/obesity among children 6-11 years (in the US) doubled between the years 1980-2000. By classifying obesity as legiti mate disease, public funding and in user sreimbursement for obesity treatment becomes legalized (consensus on childhood obesity, 2005). Serious health risks will likely to begin to appear in obese children and adolescents as they grow older. These may include diabetes mellitus, metabolic syndrome, hyperandrogenism, heart disease, hypertension, respiratory factors, and sleep disorders. Obese children are also at greater risk of anxiety and depression. It also recommended a number of measures that can be implemented by parents; schools, health providers and government and regulatory agencies to help to prevent the onset of childhood obesity Endocrine Regulation of Energy Metabolism Adipocytokines and Obesity The mechanism underlying obesity was further explained by the discovery of adipocytokines, the role of peripheral thyroid hormones (T4, T3), thyroid stimulating hormone and insulin the regulation of energy metabolism. The levels of some of the adipocytokines were shown to be related to visceral obesity, type 2 diabetes mellitus and coronary artery disease. Plasma levels of all the adipocytokines increase with the obesity except adiponectin (Yuji Matsuzawa et al, 2003). Recent studies point out to the adipose tissue as a highly active organ secreting a range of hormones, Leptin, Adiponectin, and Resistin. They are considered to take part in the regulation of energy metabolism. Leptin, Adiponectin and Resistin are produced by the adipose tissue. Leptin and Adiponectin are insulin sensitizing while Resistin increase the insulin resistance. Leptin The notion that genetic abnormalities contribute to obesity gained important support with the identification of the Ob gene and its protein product in 1994 (Zhangy et al, 1996). The Ob gene termed Leptin from the Greek Leptos, meaning thin, is produced in adipose tissue and is thought to act as an afferent satiety signal in a feed back loop that affects the appetite and satiety centre in the hypothalamus of brain. The ultimate effect of this loop is to regulate body-fat mass. In human, as noted by Considine et al, 1996; caloric restriction reduces leptin concentrations and Ob mRNA levels in adipose tissue, and refeeding increases these levels. One fundamental mechanism of obesity is insensitivity to the action of Leptin, presumably in the hypothalamus. The Leptins primary physiological function is to provide a signal to suppress body fat by decreasing food intake or increasing energy expenditure. Serum leptin concentrations change more during weight loss than during weight gain (Rose nbaum M et al, 1997). Adiponectin Adiponectin or Adipo Q, an adipocyte specific secreted protein with roles in glucose and lipid homeostasis (Insulin stimulates the secretion of adiponectin). Circulating adiponectin concentrations are high 500-30,000 Â µg/l (5-30mg/ml) accounting for 0.01% of total plasma proteins (Berget et al, 2002). Adiponectin was discovered in the mid 1990s by four different groups of researchers (Hu E et al, 1996). Adiponectin has various biological functions including insulin sensitizing (Hotta K et al, 2000), antiatherogenic (Yamauchi T et al, 2003), anti-inflammatory (Ouchi N et al, 2003), antiangiogenic and anti tumor functions (Brakenhielm E et al, 2004). Adiponectin acts through Adiponectin receptors, Adipo R1 and Adipo R2. Adipo R1 is mostly expressed in skeletal muscles and Adipo R2 is abundant in liver. These receptors are also expressed by the pancreatic ß cells (Kharroubi et al, 2003), macrophages and atherosclerotic lesions (Chinetti et al, 2004) as well as in brain (Yamauchi et al, 2003). Circulating Adiponectin levels display diurnal variation with a nocturnal decline and maximum levels in the late morning (Gavrila et al, 2003). Adiponectin is also found in breast milk, which in turn is implicated in childhood obesity prevention (Savino et al, 2008). Among the various adipocytokines, adiponectin, which is an abundant circulating protein (247 amino acids) synthesized purely in adipose tissue, appears to play a very important role in carbohydrates, lipid metabolism and vascular biology. Adiponectin appears to be a major modulator of insulin action and its levels are reduced in type 2 diabetes mellitus, which could contribute to peripheral insulin resistance in this condition. It has significant insulin sensitizing as well as anti inflammatory properties that include suppression of macrophage phagocytosis and TNF-a secretion and blockage of monocytes adhesion to endothelial cells in vitro. Although further investigations are required, Adiponectin administration, as well as regulation of the pathway controlling its production, represents a promising target for managing obesity, hyperlipidemia, insulin resistance, type 2 diabetes mellitus, and vascular inflammation (Manju Chandran et al, 2003). Resistin Human resistin is 108 amino acids prepeptide and is cleaved before its secretion from the Adipose tissue. Resistin circulates in the blood as dimeric protein consisting of 92 amino acids polypeptides that are linked by a disulfide bridge. Holcomb et al, 2000 first described the gene family and its tissue specific distribution. Originally described as lung specific, is also produced by the adipose tissue and peripheral blood monocytes. It is also present in dividing epithelia of the intestine. Resistin increase blood glucose and insulin concentration in the mice and impairs hypoglycemic response to insulin infusion. In addition, anti resistin antibodies decrease blood glucose and insulin sensitivity in obese mice (Ukkalo O, 2002). The physiological role of resistin in human remains controversial. There more resistin protein in obese than lean individuals, with a significant positive correlation between resistin and BMI. BMI is a significant predictor of insulin resistance, but resisti n adjusted for BMI is not. These data demonstrate that resistin protein is present in human adipose tissue and blood and that there is significantly more resistin in serum of obese individuals. Serum resistin is not a significant predictor of insulin resistance in human (Youn et al, 2003, Rear R and Donnelly R, 2004). Tumor Necrosis Factor-a It will be unreasonable not to mention the Tumor Necrosis Factor a and its role in vascular inflammation related to atherosclerosis especially in obesity. It is a cytokine involved in systemic inflammation and is a member of a group of cytokines that stimulate the acute phase reaction. The primary role of TNF is in the regulation of immune cells. TNF is able to induce apoptotic cell death, to induce inflammation and to inhibit tumourgenesis and viral replication. Dysregulation and, in particular, over production of TNF have been implicated in a variety of human diseases, as well as cancer (Locksley et al, 2001). The theory of antitumoural response of the immune system in vivo was recognized by the physician William B in 1968. Dr A Granger reported a cytotoxic factor produced by lymphocytes and named it Lymphotoxin (Kalli WB and Granger GA, 1968). Dr L Loyal old, in 1975 reported another cytotoxic factor produced by macrophages and named it Tumor Necrosis Factor (TNF) (Cars well et al, 1975). Interleukin – 6 (IL-6) Chronic inflammation is linked to endothelial dysfunction, atherosclerosis, and insulin resistance (Fernandez-Real JM and Ricart W, 2003 and Fernandez-Real JM, Ricart W, 2005). Plasma concentrations of proinflammatory cytokines, such as interleukin (IL) 18, IL-6, and tumor necrosis factor (TNF)-a, and of several other inflammatory markers are increased in patients with ischemic heart disease (Fernandez-Real JM and Ricart W, 2003, Ridker PM et al, 2002, Engstrom G et al, 2004, Ridker PM et al, 1997, Pradham AD et al, 2002). Circulating cytokines also are elevated in type 2 diabetes, obesity, and insulin resistance syndrome and play a central role in the pathogenesis of these disorders (Fernandez-Real JM and Ricart W, 2003). IL-6 is a mediator of the inflammatory response, and it is linked to dyslipidemia, type 2 diabetes, and risk of myocardial infarction (Fernandez-Real JM and Ricart W, 2003, Ridker PM et al, 2000, Esteve E et al, 2005, Yudkin JS et al, 2000). IL-6 is secreted by a variety of different cell types, including lymphoid and endothelial cells, fibroblasts, skeletal muscle, and adipose tissue. Circulating IL-6 levels correlate with obesity and insulin resistance and may predict the development of type 2 diabetes mellitus (Yudkin JS et al, 2000, Pradhan AD et al, 2001, Akira S et al, 1993, Mohamed-Ali V et al, 1997). Endothelial dysfunction is regarded as a causal factor in the development of atherosclerosis (Hansson GK, 2005). It is one of the earliest abnormalities that can be detected in people at risk for cardiovascular events, and it is linked to insulin resistance and type 2 diabetes (Steinberg HO and Baron AD, 2002, Natali A et al, 2006). Cytokines have an important role in the endothelial injury induced by inflammation. The vascular endothelium is involved in the inflammatory response to atherosclerosis (Hansson GK, 2005, Steinberg HO and Baron AD, 2002, Natali A et al, 2006, Widlansky ME et al, 2003), and changes in endothelium function could underlie the association between cardiovascular disease and inflammation. Obesity Related Insulin Resistance: Definition and Pathogenesis Insulin resistance is a state in which a given amount of insulin produces a subnormal biological response (Kahn CR, 1978). In particular, it is characterized by a decrease in the ability of insulin to stimulate the use of glucose by muscles and adipose tissue and to suppress hepatic glucose production and output (Matthaei et al, 2000). Furthermore, it accounts a resistance to insulin action on protein and lipid metabolism and on vascular endothelial function and genes expression (Bajaj M and Defronzo RA, 2003). Several defects in the insulin signaling cascade have been implicated in the pathogenesis of insulin resistance, Insulin resistance is believed to have both genetic and environmental factors implicated in its etiology (Matthaei et al, 2000 and Liu et al, 2004). The genetic component seems to be polygenic in nature, and several genes have been suggested as potential candidates (Matthaei et al, 2000). However, several other factors can influence insulin sensitivity, such as obesity, ethnicity, gender, perinatal factors, puberty, sedentary lifestyle and diet (Liu et al, 2004). The Role of Fatty Acids and Adipocytokines Obesity represents the major risk factor for the development of insulin resistance in children and adolescents (Caprio S, 2002), and insulin resistance/hyperinsulinemia is believed to be an important link between obesity and the associated metabolic abnormalities and cardiovascular risk (Weiss R and Kaufman FR, 2008). Approximately, 55% of the variance in insulin sensitivity in children can be explained by total adiposity, after adjusting for other confounders, such as age, gender, ethnicity and pubertal stage (Caprio S, 2002). Obese children have hyperinsulinemia and peripheral insulin resistance with an ~40% lower insulin-stimulated glucose metabolism than non-obese children (Caprio S et al, 19996). Adipose tissue seems to play a key role in the pathogenesis of insulin resistance through several released metabolites, hormones and adipocytokines that can affect different steps in insulin action (Matsuzawa Y, 2005) (Fig. 1). Adipocytes produce non-esterified fatty acids, which inhibit carbohydrate metabolism via substrate competition and impaired intracellular insulin signaling (Matsuzawa Y, 2005, Griffin ME et al 1999 and Randle PJ, 1998). In children, as in adults, several adipocytokines have been related to adiposity indexes as well as to insulin resistance. Adiponectin is one of the most common cytokines produced by adipose tissue, with an important insulin sensitizing effect associated with anti-atherogenetic properties (Despres JP, 2006 and Gil-Campos M et al, 2004). Whereas obesity is generally associated with an increased release of metabolites by adipose tissue, levels of Adiponectin are inversely related to adiposity (Matsuzawa Y, 2005). Therefore, reduced levels of this adipocytokine have been implicated in the pathogenesis of insulin resistance and metabolic syndrome (Matsuzawa Y, 2005). Decreased levels of Adiponectin have been detected across tertiles of insulin resistance in children and adolescents (Weiss R et al, 2004), where it is a good predictor of insulin sensitivity, independently of adiposity (Lee S et al, 2006). Adipose tissue also produces tumour necrosis factor-a, an inflammatory factor, which can alter insulin action at different levels in the intracellular pathway (Matsuzawa Y, 2005). Interleukin-6 (IL-6) is ano ther inflammatory cytokine released by adipose tissue and its levels are increased in obesity (Matsuzawa Y, 2005). IL-6 stimulates the hepatic production of C-reactive protein and this can explain the state of inflammation associated with obesity, and could mediate, at least partially, obesity-related insulin resistance (Matsuzawa Y, 2005). Data based mainly on animal studies also suggest that increased levels of resistin, another molecule produced by adipose tissue, could impair insulin sensitivity (Matsuzawa Y, 2005). The close relationship between Leptin levels and insulin resistance in children has also been suggested by the data (Chu NF et al, 2000). Serum levels of retinol-binding protein 4 (RBP4) correlate with insulin resistance in subjects with obesity as well as in those with impaired glucose tolerance (IGT) or type 2 diabetes mellitus, therefore suggesting that it could be useful in assessing insulin resistance and the associated risk for complications (Graham TE et al, 2006). Serum RBP4 is independently related to obesity as well as to components of the metabolic syndrome in normal weight and overweight children (Aeberli I et al, 2007). Diet composition in obese children might be an additional factor promoting and/or worsening insulin resistance. Animal and human studies suggest that a high energy intake as well as a diet rich in fat and carbohydrates and low in fiber could increase the risk of developing insulin resistance (Canete R et al, 2007). The Role of Fat Distribution An altered partitioning of fat between subcutaneous and visceral or ectopic sites has been associated with insulin resistance (Weiss R and Kaufman FR, 2008). Visceral fat has a better correlation with insulin sensitivity than subcutaneous or total body fat (Caprio S et al, 1995), in both obese adults and children. Visceral fat has higher lipolytic activity compared with subcutaneous fat, therefore a greater amount of free fatty acids and glycerol gain entry or carried out to the liver (Matthaei et al, 2000). Visceral fat in girls is directly correlated to the glucose-stimulated insulin levels and inversely correlated with insulin sensitivity and the rate of glucose uptake. No correlation was found between abdominal subcutaneous fat (Caprio S et al, 1995). Ectopic deposition of fat in the liver or muscle can also be responsible for insulin resistance in obese subjects, as the accumulation of fat in these sites impairs insulin signaling, with a reduced glucose uptake in the muscle and a decreased insulin-mediated suppression of hepatic glucose production (Weiss R and Kaufman FR, 2008). Intramyocellular lipid (IMCL) accumulation has been shown as a factor related to decreased insulin sensitivity (Jacob S et al, 1999 and Thamer C et al, 2003). Obese insulin sensitive children and adolescents present lower levels of visceral fat and IMCL when compared with obese insulin resistant children (Weiss R et al, 2005). Accumulation of fat in the liver has also been associated with insulin resistance, independently of adiposity (Kelley DE et al, 2003). It has also been suggested that deposits of fat around blood vessels can produce several cytokines and therefore contribute to the development of insulin resistance, through a so-called vasocrine effect (Yudkin JS et al, 2005). Insulin Resistance and Associated Complications Insulin resistance in obesity is strictly related to the development of hypertension (Marcovecchio ML et al, 2006 and Cruz ML et al, 2002), dyslipidemia (Howard BV and Howard WJ, 1994), impaired glucose tolerance (IGT) (Sinha R et al, 2002), hepatic steatosis (DAdamo E et al, 2008), as well as to the combination of these factors, also known as metabolic syndrome (Eckel RH et al, 2005). Furthermore, insulin resistance is associated with systemic inflammation, endothelial dysfunction, early atherosclerosis and disordered fibrinolysis (Dan Dona P et al, 2002). It is alarming that these metabolic and cardiovascular complications are already found in obese children and adolescents (Dietz WH, 2004). The presence of these alterations in prepubertal children is then particularly worrying, as insulin resistance and related complications might be further exacerbated by the influence of puberty, due to the physiological decrease in insulin sensitivity associated with normal pubertal development (Caprio S et al, 1989). Insulin resistance in childhood can track in adult life (Sinaiko AR et al, 2006). Insulin resistance at the age of 13 years predicts insulin resistance at age 19 years, independently of BMI, and is also associated with cardiovascular risk in adulthood (Sinaiko AR et al, 2006). The fundamental role of insulin resistance in human disease was already recognized in 1988 by Reaven (Reaven GM, 1988) who emphasized its role in the development of a grouping of metabolic abnormalities, which he defined as syndrome X. Later studies strengthened the concept of insulin resistance as a key component of the metabolic syndrome, a cluster of impaired glucose tolerance (IGT), dyslipidemia, hypertension, hyperinsulinemia, associated with an increased risk of type 2 diabetes mellitus and cardiovascular disease (Eckel RH et al, 2005). Insulin resistance represents a serious and common complication of obesity during childhood and adolescence. A timely diagnosis and an appropriated prevention and treatment of obesity and insulin resistance are required in order to reduce the Biochemical and Hormonal Changes in Childhood Obesity Biochemical and Hormonal Changes in Childhood Obesity The prevalence of chronic or non communicable disease is escalating much more rapidly in developing countries than in industrialized countries. According to World Health Organization (WHO) estimates, by the 2020, non communicable diseases will account for approximately three quarter of all deaths in the developing countries (WHO. Global Strategy for non communicable disease prevention, 1997). In this regard, a potential emerging public health issue for the developing countries may be increasing incidence of childhood obesity with associated complications, which in turn is likely to create public health burden for poorer nations in the near future (Freedman et al, 2001). Lower to middle income nations face the double burden of having both malnourished and over nourished population, with most overweight and obese children being concentrated in urban areas. Rapid urbanization is associated with unhealthy lifestyle or New World Syndrome. In addition, in such communities, childhood obesit y is still considered a sign of healthiness and high social class. There is no universal consensus on a cut off points for defining overweight and obesity in children and adolescents, usually, for clinical practice and epidemiological studies, child overweight and obesity are assessed by means of indicators based on weight and height measurements, such as weight for height measures or body mass index (weight (kg)/height (m2))(WHO. Report series no.847, 1995).The US Centers for Disease Control and Prevention (CDC) defines obese as being at or above 95th percentile of body mass index for age (Kuczmarsk RJ et al, 2000). History of obesity is both interesting and gives details of its progression. Obesity is an age-old health condition. Through out the history of obesity, its reputation varies from appreciation and opposite among cultures and in time. Ancient Egyptians are said to consider obesity as disease. Perhaps the most famous and earliest evidence of obesity is the Venus figurines, Statuettes of an obese female torso that probably had a major role in rituals. Ancient China has also been aware of obesity and dangers that come with it. They always were a believer of prevention as a key to longevity. The Aztecs believed that obesity was supernatural, an affliction of the gods. Hippocrates, the father of medicines was aware of sudden deaths being more common among obese men than lean ones as stated in his writings. In certain cultures and areas where food is scarce and poverty is prevalent, is viewed as symbol of wealth and social status. To date, an African tribe purposely plumps up a bride to pre pare her for child bearing. Before a wedding can be set, a slim bride is pampered to gain weight until she reaches the suitable weight. Through out the history of obesity, the publics view and status of obesity changed considerably in the 1900s. It was regarded as unfashionable by the French designer, Paul Poi ret who designed skin-revealing clothes for women. About the same time, the incidence of obesity began to increase and become wide spread. Later in 1940s, Metropolitan life insurance published a chart of ideal weight for various heights. They also advocated that weight gain parallel to age is unhealthy. The government and medical society become more hands-on with obesity by imitating campaign against it. This was preceded by a study of risk factors for cardiovascular disease revealing obesity in the high ranks. Since then various diets and exercise programs have emerged. In 1996, the Body Mass Index (BMI) was published. This statistical calculation and index determined that a person is obese or not. At this time ,obesity incidence have soared, led by children and adolescent obesity, tripling in just a few short years, greater than any number in the history of obesity. This increase in the incidence of childhood obesity with associated cardiovascular risks, type 2 diabetes mellitus and stroke is supported by a considerable body of evidence. The prevalence of overweight and obesity in childhood and adolescents has been increasing throughout much of the developed and developing world for the past few decades. It has become increasingly clear that excess adiposity in childhood predisposes individual not only to increased risk of adiposity and its sequaele as adults (Freedman et al, 2001), but also to increased risk of multiple chronic diseases in childhood and adolescence (Rosen bloom et al, 1999). Though mechanism not clearly delineated, excess body weight and adiposity is associated with type 2 diabetes mellitus and its complications, cardiovascular disease risk factors, non alcoholic fatty liver disease and asthma in youth. Childhood Obesity 1930 1972 Risk factors for coronary heart disease (CHD) such as hypertension, dyslipidemia, impaired glucose tolerance and vascular abnormalities were present in overweight children. CHD is likely to be increased in overweight children when they become adults as a result of established risk factors. This study investigated whether excess weight in childhood was associated with CHD in adulthood among a very large cohort of persons born in Denmark in 1930 through 1972. They underwent mandatory annual health examination at public or private schools in Copenhagen. Each child was examined by school doctors or nurses and was assigned a health card bearing childs name, date of birth, birth weight reported by parents. 10,235 men and 4,318 women, for whom childhood BMI data were available, received a diagnosis of CHD or died of CHD as adults. The risk of CHD event, a non fatal event, and a fatal event among adults was positively associated with BMI at 7-13 years of age for boys and 10 to 13 years of ag e as girls. The associations were linear for each age and risk increased across the entire BMI distribution. Childhood Obesity 1930 1972 Risk factors for coronary heart disease (CHD) such as hypertension, dyslipidemia, impaired glucose tolerance and vascular abnormalities were present in overweight children. CHD is likely to be increased in overweight children when they become adults as a result of established risk factors. This study investigated whether excess weight in childhood was associated with CHD in adulthood among a very large cohort of persons born in Denmark in 1930 through 1972. They underwent mandatory annual health examination at public or private schools in Copenhagen. Each child was examined by school doctors or nurses and was assigned a health card bearing childs name, date of birth, birth weight reported by parents. 10,235 men and 4,318 women, for whom childhood BMI data were available, received a diagnosis of CHD or died of CHD as adults. The risk of CHD event, a non fatal event, and a fatal event among adults was positively associated with BMI at 7-13 years of age for boys and 10 to 13 years of ag e as girls. The associations were linear for each age and risk increased across the entire BMI distribution. Childhood Obesity and Economic Growth 1930-1983 Childhood obesity was related to the economic growth during the 50 years of economic growth in the industrialized world especially in Denmark. Annual measurements of height and weight were available for all children born between 1930 and 1983 attending primary schools in Copenhagen Municipality. 165,389 boys and 163,609 girls from the age of 7 through 13 years were included in this study. After computerization SBMI (kg/m2) were calculated and the prevalence of overweight and obesity according to international age and gender–specific criteria. Economics growth was indicated by the Gross National Product and the overall consumption per capita, adjusted for inflation. Prevalence of overweight and obesity among Danish children rose in phases, which were not paralleled by trends in economic growth. The microeconomics growth indicators seem inappropriate as proxies for the environmental exposures that have elicited the obesity epidemic. Childhood obesity and television viewing Children spend a substantial portion of their lives watching television (TV). Investigators have hypothesized that TV viewing causes obesity by one or more than three mechanisms: Displacement of physical activity. Increased calorie consumption while watching or caused by the effects of advertising. Reduced resting metabolism. The relationship between TV viewing and obesity has been examined in a relatively large number of cross sectional epidemiological but few longitudinal studies. Many of them have found relatively weak, positive association or mixed results. Many experimental studies have found that reducing TV viewing may help to reduce the risk of obesity. One school based experimental study was designed specifically to test directly the casual relationship between TV viewing behaviors and body fatness. The results of this randomized controlled trial provide evidence that TV viewing is a cause of increased body fatness and that reducing the TV viewing is a promising strategy for preventing childhood obesity (Robinson; 2001). The objective of another study (Utter J et al, 2006), was to explore how time spent watching television (TV) is associated with the dietary behavior of New Zealand children and young adolescents. Total number of participants was 3275 children aged 5-17 years. The findings suggest that longer duration of TV watching (thus more frequent exposure to advertising) influences the frequency of consumption of soft drinks, some sweets and snacks and some fast foods among children and young adolescents. Efforts to control the time spent watching TV may result in better dietary habits and weight control for children and adolescents. Childhood Obesity US- A decade of progress, 1990-1999 Current data suggest that 20% of US children are overweight .An analysis of the secular trends suggest that 20% of US children are overweight, and a clear up ward trend in body weight in children of 0.2 Kg between 1973 and 1994. In addition, childhood obesity is more prevalent among minority sub groups such as African Americans. Obesity that begins early in life persists into adulthood and increases the risk of obesity related conditions later in life. There has been tremendous increase in the number of studies examining the etiology and health effects of obesity in children (Goran MI, 1990-1999).1980 (boys 0.2% girls 0.5%) and 1997 (boys 1.2%, girls 2.0%). Ten years trends of childhood obesity in Israel 1990-2000 Cross sectional data was collected from 13284 second and fifth class school; children between 1990-2000. Prevalence of obesity was determined using Israeli and US reference values. BMI values at 95th percentile increased overtime in all ages and sex categories. Between 1990 and 2000, 95th centile values were increased by 12.7%and 11.8% among second grade boys and girls respectively. Among fifth graders in 2000, 10.7% of boys and 11.1% of girls exceeded the 1990 BMI reference values. The proportion of obese children increased over time using both Israeli and US reference values (Huerta Michael et al, 2008). Netherlands. Overweight, Obesity in 2003: V.1980-97. Data on 90,071 children, aged 4-16 years were routinely collected by 11 Community Heath Services during 2002-2004. International cut -off points for BMI to determine overweight and obesity. On average, 14.5% of boys and 17.5% of the girls were overweight (including obesity), which is a substantial increase since 1980 (boys 3.9% and girls 6.9%) and 1997 (boys 9.7% and girls 13%). Similarly 2.6% of the boys and 3.3% 0f the girls aged 4-16 years were obese, which is much higher than in 1980 (boys 0.2% and girls 0.5%) and 1997 (boys 1.2% and girls 2.0%), (KatjaVan Den Husk, 2007). Obesity trends in US. 2003-2006 Height and weight measurements were obtained from 8164 children and adolescents as apart of the 2003-2004 and 2005-2006 National Health and Nutrition Examination Survey (NHANES). Because no statistically significant differences in the prevalence of high BMI for age were found between the estimates for 2003-2004 and 2005-2006, data for four years were combined to provide more stable estimates for the most recent time period. Over all, in 2003-2006, 11.3% of children and adolescents aged 2 through years were at or above 97th percentile of the 2000 BMI- for- age growth charts, 16.3% were at or above 95th percentile. Prevalence estimates vary by age and by racial/ethnic group. Analysis of the trends in high BMI for age showed no statistically significant trend over the four time periods (1999-2000, 2001-2002, 2003-2004, and 2005-2006) for either boys or girls (Cynthia l.Ogden et al, 2008). 11-March 2005. Public Release Date: Consensus on Childhood Obesity, Recommends classification as disease A common statement on childhood obesity was published to day in the journal of Chemical Endocrinology and Metabolism (one of the journals of Endocrine Society). The consensus statement reflects the conclusions from an international summit held in Israel last year (2004) and includes a controversial recommendation to classify obesity as a disease. This decision was based upon the available research on the diagnosis, prevalence, causes (including endocrine disorders), risks, prevention and treatment of childhood obesity. Pediatric obesity is now recognized as a major health problem all over the world. Researcher have found that children who are obese have a higher risks adult obesity, which is strongly associated with many serious medical complications that impair quality of life and lead to additional increased risks. The statement also noted the prevalence of overweight/obesity among children 6-11 years (in the US) doubled between the years 1980-2000. By classifying obesity as legiti mate disease, public funding and in user sreimbursement for obesity treatment becomes legalized (consensus on childhood obesity, 2005). Serious health risks will likely to begin to appear in obese children and adolescents as they grow older. These may include diabetes mellitus, metabolic syndrome, hyperandrogenism, heart disease, hypertension, respiratory factors, and sleep disorders. Obese children are also at greater risk of anxiety and depression. It also recommended a number of measures that can be implemented by parents; schools, health providers and government and regulatory agencies to help to prevent the onset of childhood obesity Endocrine Regulation of Energy Metabolism Adipocytokines and Obesity The mechanism underlying obesity was further explained by the discovery of adipocytokines, the role of peripheral thyroid hormones (T4, T3), thyroid stimulating hormone and insulin the regulation of energy metabolism. The levels of some of the adipocytokines were shown to be related to visceral obesity, type 2 diabetes mellitus and coronary artery disease. Plasma levels of all the adipocytokines increase with the obesity except adiponectin (Yuji Matsuzawa et al, 2003). Recent studies point out to the adipose tissue as a highly active organ secreting a range of hormones, Leptin, Adiponectin, and Resistin. They are considered to take part in the regulation of energy metabolism. Leptin, Adiponectin and Resistin are produced by the adipose tissue. Leptin and Adiponectin are insulin sensitizing while Resistin increase the insulin resistance. Leptin The notion that genetic abnormalities contribute to obesity gained important support with the identification of the Ob gene and its protein product in 1994 (Zhangy et al, 1996). The Ob gene termed Leptin from the Greek Leptos, meaning thin, is produced in adipose tissue and is thought to act as an afferent satiety signal in a feed back loop that affects the appetite and satiety centre in the hypothalamus of brain. The ultimate effect of this loop is to regulate body-fat mass. In human, as noted by Considine et al, 1996; caloric restriction reduces leptin concentrations and Ob mRNA levels in adipose tissue, and refeeding increases these levels. One fundamental mechanism of obesity is insensitivity to the action of Leptin, presumably in the hypothalamus. The Leptins primary physiological function is to provide a signal to suppress body fat by decreasing food intake or increasing energy expenditure. Serum leptin concentrations change more during weight loss than during weight gain (Rose nbaum M et al, 1997). Adiponectin Adiponectin or Adipo Q, an adipocyte specific secreted protein with roles in glucose and lipid homeostasis (Insulin stimulates the secretion of adiponectin). Circulating adiponectin concentrations are high 500-30,000 Â µg/l (5-30mg/ml) accounting for 0.01% of total plasma proteins (Berget et al, 2002). Adiponectin was discovered in the mid 1990s by four different groups of researchers (Hu E et al, 1996). Adiponectin has various biological functions including insulin sensitizing (Hotta K et al, 2000), antiatherogenic (Yamauchi T et al, 2003), anti-inflammatory (Ouchi N et al, 2003), antiangiogenic and anti tumor functions (Brakenhielm E et al, 2004). Adiponectin acts through Adiponectin receptors, Adipo R1 and Adipo R2. Adipo R1 is mostly expressed in skeletal muscles and Adipo R2 is abundant in liver. These receptors are also expressed by the pancreatic ß cells (Kharroubi et al, 2003), macrophages and atherosclerotic lesions (Chinetti et al, 2004) as well as in brain (Yamauchi et al, 2003). Circulating Adiponectin levels display diurnal variation with a nocturnal decline and maximum levels in the late morning (Gavrila et al, 2003). Adiponectin is also found in breast milk, which in turn is implicated in childhood obesity prevention (Savino et al, 2008). Among the various adipocytokines, adiponectin, which is an abundant circulating protein (247 amino acids) synthesized purely in adipose tissue, appears to play a very important role in carbohydrates, lipid metabolism and vascular biology. Adiponectin appears to be a major modulator of insulin action and its levels are reduced in type 2 diabetes mellitus, which could contribute to peripheral insulin resistance in this condition. It has significant insulin sensitizing as well as anti inflammatory properties that include suppression of macrophage phagocytosis and TNF-a secretion and blockage of monocytes adhesion to endothelial cells in vitro. Although further investigations are required, Adiponectin administration, as well as regulation of the pathway controlling its production, represents a promising target for managing obesity, hyperlipidemia, insulin resistance, type 2 diabetes mellitus, and vascular inflammation (Manju Chandran et al, 2003). Resistin Human resistin is 108 amino acids prepeptide and is cleaved before its secretion from the Adipose tissue. Resistin circulates in the blood as dimeric protein consisting of 92 amino acids polypeptides that are linked by a disulfide bridge. Holcomb et al, 2000 first described the gene family and its tissue specific distribution. Originally described as lung specific, is also produced by the adipose tissue and peripheral blood monocytes. It is also present in dividing epithelia of the intestine. Resistin increase blood glucose and insulin concentration in the mice and impairs hypoglycemic response to insulin infusion. In addition, anti resistin antibodies decrease blood glucose and insulin sensitivity in obese mice (Ukkalo O, 2002). The physiological role of resistin in human remains controversial. There more resistin protein in obese than lean individuals, with a significant positive correlation between resistin and BMI. BMI is a significant predictor of insulin resistance, but resisti n adjusted for BMI is not. These data demonstrate that resistin protein is present in human adipose tissue and blood and that there is significantly more resistin in serum of obese individuals. Serum resistin is not a significant predictor of insulin resistance in human (Youn et al, 2003, Rear R and Donnelly R, 2004). Tumor Necrosis Factor-a It will be unreasonable not to mention the Tumor Necrosis Factor a and its role in vascular inflammation related to atherosclerosis especially in obesity. It is a cytokine involved in systemic inflammation and is a member of a group of cytokines that stimulate the acute phase reaction. The primary role of TNF is in the regulation of immune cells. TNF is able to induce apoptotic cell death, to induce inflammation and to inhibit tumourgenesis and viral replication. Dysregulation and, in particular, over production of TNF have been implicated in a variety of human diseases, as well as cancer (Locksley et al, 2001). The theory of antitumoural response of the immune system in vivo was recognized by the physician William B in 1968. Dr A Granger reported a cytotoxic factor produced by lymphocytes and named it Lymphotoxin (Kalli WB and Granger GA, 1968). Dr L Loyal old, in 1975 reported another cytotoxic factor produced by macrophages and named it Tumor Necrosis Factor (TNF) (Cars well et al, 1975). Interleukin – 6 (IL-6) Chronic inflammation is linked to endothelial dysfunction, atherosclerosis, and insulin resistance (Fernandez-Real JM and Ricart W, 2003 and Fernandez-Real JM, Ricart W, 2005). Plasma concentrations of proinflammatory cytokines, such as interleukin (IL) 18, IL-6, and tumor necrosis factor (TNF)-a, and of several other inflammatory markers are increased in patients with ischemic heart disease (Fernandez-Real JM and Ricart W, 2003, Ridker PM et al, 2002, Engstrom G et al, 2004, Ridker PM et al, 1997, Pradham AD et al, 2002). Circulating cytokines also are elevated in type 2 diabetes, obesity, and insulin resistance syndrome and play a central role in the pathogenesis of these disorders (Fernandez-Real JM and Ricart W, 2003). IL-6 is a mediator of the inflammatory response, and it is linked to dyslipidemia, type 2 diabetes, and risk of myocardial infarction (Fernandez-Real JM and Ricart W, 2003, Ridker PM et al, 2000, Esteve E et al, 2005, Yudkin JS et al, 2000). IL-6 is secreted by a variety of different cell types, including lymphoid and endothelial cells, fibroblasts, skeletal muscle, and adipose tissue. Circulating IL-6 levels correlate with obesity and insulin resistance and may predict the development of type 2 diabetes mellitus (Yudkin JS et al, 2000, Pradhan AD et al, 2001, Akira S et al, 1993, Mohamed-Ali V et al, 1997). Endothelial dysfunction is regarded as a causal factor in the development of atherosclerosis (Hansson GK, 2005). It is one of the earliest abnormalities that can be detected in people at risk for cardiovascular events, and it is linked to insulin resistance and type 2 diabetes (Steinberg HO and Baron AD, 2002, Natali A et al, 2006). Cytokines have an important role in the endothelial injury induced by inflammation. The vascular endothelium is involved in the inflammatory response to atherosclerosis (Hansson GK, 2005, Steinberg HO and Baron AD, 2002, Natali A et al, 2006, Widlansky ME et al, 2003), and changes in endothelium function could underlie the association between cardiovascular disease and inflammation. Obesity Related Insulin Resistance: Definition and Pathogenesis Insulin resistance is a state in which a given amount of insulin produces a subnormal biological response (Kahn CR, 1978). In particular, it is characterized by a decrease in the ability of insulin to stimulate the use of glucose by muscles and adipose tissue and to suppress hepatic glucose production and output (Matthaei et al, 2000). Furthermore, it accounts a resistance to insulin action on protein and lipid metabolism and on vascular endothelial function and genes expression (Bajaj M and Defronzo RA, 2003). Several defects in the insulin signaling cascade have been implicated in the pathogenesis of insulin resistance, Insulin resistance is believed to have both genetic and environmental factors implicated in its etiology (Matthaei et al, 2000 and Liu et al, 2004). The genetic component seems to be polygenic in nature, and several genes have been suggested as potential candidates (Matthaei et al, 2000). However, several other factors can influence insulin sensitivity, such as obesity, ethnicity, gender, perinatal factors, puberty, sedentary lifestyle and diet (Liu et al, 2004). The Role of Fatty Acids and Adipocytokines Obesity represents the major risk factor for the development of insulin resistance in children and adolescents (Caprio S, 2002), and insulin resistance/hyperinsulinemia is believed to be an important link between obesity and the associated metabolic abnormalities and cardiovascular risk (Weiss R and Kaufman FR, 2008). Approximately, 55% of the variance in insulin sensitivity in children can be explained by total adiposity, after adjusting for other confounders, such as age, gender, ethnicity and pubertal stage (Caprio S, 2002). Obese children have hyperinsulinemia and peripheral insulin resistance with an ~40% lower insulin-stimulated glucose metabolism than non-obese children (Caprio S et al, 19996). Adipose tissue seems to play a key role in the pathogenesis of insulin resistance through several released metabolites, hormones and adipocytokines that can affect different steps in insulin action (Matsuzawa Y, 2005) (Fig. 1). Adipocytes produce non-esterified fatty acids, which inhibit carbohydrate metabolism via substrate competition and impaired intracellular insulin signaling (Matsuzawa Y, 2005, Griffin ME et al 1999 and Randle PJ, 1998). In children, as in adults, several adipocytokines have been related to adiposity indexes as well as to insulin resistance. Adiponectin is one of the most common cytokines produced by adipose tissue, with an important insulin sensitizing effect associated with anti-atherogenetic properties (Despres JP, 2006 and Gil-Campos M et al, 2004). Whereas obesity is generally associated with an increased release of metabolites by adipose tissue, levels of Adiponectin are inversely related to adiposity (Matsuzawa Y, 2005). Therefore, reduced levels of this adipocytokine have been implicated in the pathogenesis of insulin resistance and metabolic syndrome (Matsuzawa Y, 2005). Decreased levels of Adiponectin have been detected across tertiles of insulin resistance in children and adolescents (Weiss R et al, 2004), where it is a good predictor of insulin sensitivity, independently of adiposity (Lee S et al, 2006). Adipose tissue also produces tumour necrosis factor-a, an inflammatory factor, which can alter insulin action at different levels in the intracellular pathway (Matsuzawa Y, 2005). Interleukin-6 (IL-6) is ano ther inflammatory cytokine released by adipose tissue and its levels are increased in obesity (Matsuzawa Y, 2005). IL-6 stimulates the hepatic production of C-reactive protein and this can explain the state of inflammation associated with obesity, and could mediate, at least partially, obesity-related insulin resistance (Matsuzawa Y, 2005). Data based mainly on animal studies also suggest that increased levels of resistin, another molecule produced by adipose tissue, could impair insulin sensitivity (Matsuzawa Y, 2005). The close relationship between Leptin levels and insulin resistance in children has also been suggested by the data (Chu NF et al, 2000). Serum levels of retinol-binding protein 4 (RBP4) correlate with insulin resistance in subjects with obesity as well as in those with impaired glucose tolerance (IGT) or type 2 diabetes mellitus, therefore suggesting that it could be useful in assessing insulin resistance and the associated risk for complications (Graham TE et al, 2006). Serum RBP4 is independently related to obesity as well as to components of the metabolic syndrome in normal weight and overweight children (Aeberli I et al, 2007). Diet composition in obese children might be an additional factor promoting and/or worsening insulin resistance. Animal and human studies suggest that a high energy intake as well as a diet rich in fat and carbohydrates and low in fiber could increase the risk of developing insulin resistance (Canete R et al, 2007). The Role of Fat Distribution An altered partitioning of fat between subcutaneous and visceral or ectopic sites has been associated with insulin resistance (Weiss R and Kaufman FR, 2008). Visceral fat has a better correlation with insulin sensitivity than subcutaneous or total body fat (Caprio S et al, 1995), in both obese adults and children. Visceral fat has higher lipolytic activity compared with subcutaneous fat, therefore a greater amount of free fatty acids and glycerol gain entry or carried out to the liver (Matthaei et al, 2000). Visceral fat in girls is directly correlated to the glucose-stimulated insulin levels and inversely correlated with insulin sensitivity and the rate of glucose uptake. No correlation was found between abdominal subcutaneous fat (Caprio S et al, 1995). Ectopic deposition of fat in the liver or muscle can also be responsible for insulin resistance in obese subjects, as the accumulation of fat in these sites impairs insulin signaling, with a reduced glucose uptake in the muscle and a decreased insulin-mediated suppression of hepatic glucose production (Weiss R and Kaufman FR, 2008). Intramyocellular lipid (IMCL) accumulation has been shown as a factor related to decreased insulin sensitivity (Jacob S et al, 1999 and Thamer C et al, 2003). Obese insulin sensitive children and adolescents present lower levels of visceral fat and IMCL when compared with obese insulin resistant children (Weiss R et al, 2005). Accumulation of fat in the liver has also been associated with insulin resistance, independently of adiposity (Kelley DE et al, 2003). It has also been suggested that deposits of fat around blood vessels can produce several cytokines and therefore contribute to the development of insulin resistance, through a so-called vasocrine effect (Yudkin JS et al, 2005). Insulin Resistance and Associated Complications Insulin resistance in obesity is strictly related to the development of hypertension (Marcovecchio ML et al, 2006 and Cruz ML et al, 2002), dyslipidemia (Howard BV and Howard WJ, 1994), impaired glucose tolerance (IGT) (Sinha R et al, 2002), hepatic steatosis (DAdamo E et al, 2008), as well as to the combination of these factors, also known as metabolic syndrome (Eckel RH et al, 2005). Furthermore, insulin resistance is associated with systemic inflammation, endothelial dysfunction, early atherosclerosis and disordered fibrinolysis (Dan Dona P et al, 2002). It is alarming that these metabolic and cardiovascular complications are already found in obese children and adolescents (Dietz WH, 2004). The presence of these alterations in prepubertal children is then particularly worrying, as insulin resistance and related complications might be further exacerbated by the influence of puberty, due to the physiological decrease in insulin sensitivity associated with normal pubertal development (Caprio S et al, 1989). Insulin resistance in childhood can track in adult life (Sinaiko AR et al, 2006). Insulin resistance at the age of 13 years predicts insulin resistance at age 19 years, independently of BMI, and is also associated with cardiovascular risk in adulthood (Sinaiko AR et al, 2006). The fundamental role of insulin resistance in human disease was already recognized in 1988 by Reaven (Reaven GM, 1988) who emphasized its role in the development of a grouping of metabolic abnormalities, which he defined as syndrome X. Later studies strengthened the concept of insulin resistance as a key component of the metabolic syndrome, a cluster of impaired glucose tolerance (IGT), dyslipidemia, hypertension, hyperinsulinemia, associated with an increased risk of type 2 diabetes mellitus and cardiovascular disease (Eckel RH et al, 2005). Insulin resistance represents a serious and common complication of obesity during childhood and adolescence. A timely diagnosis and an appropriated prevention and treatment of obesity and insulin resistance are required in order to reduce the