Obesity
Obesity | |
---|---|
waist circumferences representing optimal, overweight, and obese | |
Specialty | Endocrinology |
Symptoms | Increased fat[1] |
Complications | Cardiovascular diseases, type 2 diabetes, obstructive sleep apnea, certain types of cancer, osteoarthritis, depression[2][3] |
Causes | Excessive consumption of energy-dense foods, sedentary work and lifestyles and lack of physical activity, changes in modes of transportation, urbanization, lack of supportive policies, lack of access to a healthy diet, genetics[1][4] |
Diagnostic method | BMI > 30 kg/m2[1] |
Prevention | Societal changes, changes in the food industry, access to a healthy lifestyle, personal choices[1] |
Treatment | Diet, exercise, medications, surgery[5][6] |
Prognosis | Reduced life expectancy[2] |
Frequency | Over 1 billion / 12.5% (2022)[7] |
Deaths | 2.8 million people per year |
Part of a series on |
Human body weight |
---|
Obesity is a medical condition, sometimes considered a disease,[8][9][10] in which excess body fat has accumulated to such an extent that it can potentially have negative effects on health. People are classified as obese when their body mass index (BMI)—a person's weight divided by the square of the person's height—is over 30 kg/m2; the range 25–30 kg/m2 is defined as overweight.[1] Some East Asian countries use lower values to calculate obesity.[11] Obesity is a major cause of disability and is correlated with various diseases and conditions, particularly cardiovascular diseases, type 2 diabetes, obstructive sleep apnea, certain types of cancer, and osteoarthritis.[2][12][13]
Obesity has individual, socioeconomic, and environmental causes. Some known causes are diet, physical activity,
While a majority of obese individuals at any given time attempt to lose weight and are often successful, maintaining weight loss long-term is rare.
Obesity is a leading preventable cause of death worldwide, with increasing rates in adults and children.[18] In 2022, over 1 billion people were obese worldwide (879 million adults and 159 million children), representing more than a double of adult cases (and four times higher than cases among children) registered in 1990.[19][20] Obesity is more common in women than in men.[1] Today, obesity is stigmatized in most of the world. Conversely, some cultures, past and present, have a favorable view of obesity, seeing it as a symbol of wealth and fertility.[2][21] The World Health Organization, the US, Canada, Japan, Portugal, Germany, the European Parliament and medical societies, e.g. the American Medical Association, classify obesity as a disease. Others, such as the UK, do not.[22][23][24][25]
Classification
Category[26] | BMI (kg/m2) |
---|---|
Underweight | < 18.5 |
Normal weight | 18.5 – 24.9 |
Overweight | 25.0 – 29.9 |
Obese (class I) | 30.0 – 34.9 |
Obese (class II) | 35.0 – 39.9 |
Obese (class III) | ≥ 40.0 |
Obesity is typically defined as a substantial accumulation of
For children, obesity measures take age into consideration along with height and weight. For children aged 5–19, the WHO defines obesity as a BMI two standard deviations above the median for their age (a BMI around 18 for a five-year old; around 30 for a 19-year old).[27][29] For children under five, the WHO defines obesity as a weight three standard deviations above the median for their height.[27]
Some modifications to the WHO definitions have been made by particular organizations.[30] The surgical literature breaks down class II and III or only class III obesity into further categories whose exact values are still disputed.[31]
- Any BMI ≥ 35 or 40 kg/m2 is severe obesity.
- A BMI of ≥ 35 kg/m2 and experiencing obesity-related health conditions or ≥ 40 or 45 kg/m2 is morbid obesity.
- A BMI of ≥ 45 or 50 kg/m2 is super obesity.
As Asian populations develop negative health consequences at a lower BMI than Caucasians, some nations have redefined obesity; Japan has defined obesity as any BMI greater than 25 kg/m2[11] while China uses a BMI of greater than 28 kg/m2.[30]
The preferred obesity metric in scholarly circles is the body fat percentage (BF%) – the ratio of the total weight of person's fat to his or her body weight, and BMI is viewed merely as a way to approximate BF%.[32] Levels in excess of 32% for women and 25% for men are generally considered to indicate obesity.
BMI ignores variations between individuals in amounts of lean body mass, particularly
Effects on health
Obesity increases a person's risk of developing various metabolic diseases,
Mortality
Obesity is one of the leading
Morbidity
Obesity increases the risk of many physical and mental conditions. These comorbidities are most commonly shown in
Complications are either directly caused by obesity or indirectly related through mechanisms sharing a common cause such as a poor diet or a sedentary lifestyle. The strength of the link between obesity and specific conditions varies. One of the strongest is the link with type 2 diabetes. Excess body fat underlies 64% of cases of diabetes in men and 77% of cases in women.[52]: 9
Health consequences fall into two broad categories: those attributable to the effects of increased fat mass (such as
Parts of this article (those related to table below) need to be updated.(March 2022) |
Metrics of health
Newer research has focused on methods of identifying healthier obese people by clinicians, and not treating obese people as a monolithic group.
In 2014, the BioSHaRE–
Less strict | More strict | |
---|---|---|
Blood pressure measured as follows, with no pharmaceutical help | ||
Overall ( mmHg )
|
≤ 140 | ≤ 130 |
Systolic (mmHg)
|
N/A | ≤ 85[clarification needed] |
Diastolic (mmHg)
|
≤ 90 | N/A |
Blood sugar level measured as follows, with no pharmaceutical help | ||
Blood glucose ( mmol/L )
|
≤ 7.0 | ≤ 6.1 |
Triglycerides measured as follows, with no pharmaceutical help
| ||
Fasting (mmol/L) | ≤ 1.7 | |
Non-fasting (mmol/L) | ≤ 2.1 | |
High-density lipoprotein measured as follows, with no pharmaceutical help | ||
Men (mmol/L) | > 1.03 | |
Women (mmol/L) | > 1.3 | |
No diagnosis of any cardiovascular disease |
To come up with these criteria, BioSHaRE controlled for age and tobacco use, researching how both may effect the metabolic syndrome associated with obesity, but not found to exist in the metabolically healthy obese.[86] Other definitions of metabolically healthy obesity exist, including ones based on waist circumference rather than BMI, which is unreliable in certain individuals.[83]
Another identification metric for health in obese people is
Survival paradox
Although the negative health consequences of obesity in the general population are well supported by the available research evidence, health outcomes in certain subgroups seem to be improved at an increased BMI, a phenomenon known as the obesity survival paradox.
In people with heart failure, those with a BMI between 30.0 and 34.9 had lower mortality than those with a normal weight. This has been attributed to the fact that people often lose weight as they become progressively more ill.[91] Similar findings have been made in other types of heart disease. People with class I obesity and heart disease do not have greater rates of further heart problems than people of normal weight who also have heart disease. In people with greater degrees of obesity, however, the risk of further cardiovascular events is increased.[92][93] Even after cardiac bypass surgery, no increase in mortality is seen in the overweight and obese.[94] One study found that the improved survival could be explained by the more aggressive treatment obese people receive after a cardiac event.[95] Another study found that if one takes into account chronic obstructive pulmonary disease (COPD) in those with PAD, the benefit of obesity no longer exists.[90]
Causes
The "a calorie is a calorie" model of obesity posits a combination of excessive food energy intake and a lack of physical activity as the cause of most cases of obesity.[96] A limited number of cases are due primarily to genetics, medical reasons, or psychiatric illness.[15] In contrast, increasing rates of obesity at a societal level are felt to be due to an easily accessible and palatable diet,[97] increased reliance on cars, and mechanized manufacturing.[98][99]
Some other factors have been proposed as causes towards rising rates of obesity worldwide, including
According to the Endocrine Society, there is "growing evidence suggesting that obesity is a disorder of the energy homeostasis system, rather than simply arising from the passive accumulation of excess weight".[105]
Diet
Excess appetite for palatable, high-calorie food (especially fat, sugar, and certain animal proteins) is seen as the primary factor driving obesity worldwide, likely because of imbalances in neurotransmitters affecting the drive to eat.[107] Dietary energy supply per capita varies markedly between different regions and countries. It has also changed significantly over time.[106] From the early 1970s to the late 1990s the average food energy available per person per day (the amount of food bought) increased in all parts of the world except Eastern Europe. The United States had the highest availability with 3,654 calories (15,290 kJ) per person in 1996.[106] This increased further in 2003 to 3,754 calories (15,710 kJ).[106] During the late 1990s, Europeans had 3,394 calories (14,200 kJ) per person, in the developing areas of Asia there were 2,648 calories (11,080 kJ) per person, and in sub-Saharan Africa people had 2,176 calories (9,100 kJ) per person.[106][108] Total food energy consumption has been found to be related to obesity.[109]
The widespread availability of
As societies become increasingly reliant on energy-dense, big-portions, and fast-food meals, the association between fast-food consumption and obesity becomes more concerning.[120] In the United States, consumption of fast-food meals tripled and food energy intake from these meals quadrupled between 1977 and 1995.[121]
Obese people consistently under-report their food consumption as compared to people of normal weight.[123] This is supported both by tests of people carried out in a calorimeter room[124] and by direct observation.
Sedentary lifestyle
A sedentary lifestyle may play a significant role in obesity.[52]: 10 Worldwide there has been a large shift towards less physically demanding work,[125][126][127] and currently at least 30% of the world's population gets insufficient exercise.[126] This is primarily due to increasing use of mechanized transportation and a greater prevalence of labor-saving technology in the home.[125][126][127] In children, there appear to be declines in levels of physical activity (with particularly strong declines in the amount of walking and physical education), likely due to safety concerns, changes in social interaction (such as fewer relationships with neighborhood children), and inadequate urban design (such as too few public spaces for safe physical activity).[128] World trends in active leisure time physical activity are less clear. The World Health Organization indicates people worldwide are taking up less active recreational pursuits, while research from Finland[129] found an increase and research from the United States found leisure-time physical activity has not changed significantly.[130] Physical activity in children may not be a significant contributor.[131]
In both children and adults, there is an association between television viewing time and the risk of obesity.[132][133][134] Increased media exposure increases the rate of childhood obesity, with rates increasing proportionally to time spent watching television.[135]
Genetics
This section needs to be updated.(July 2021) |
Like many other medical conditions, obesity is the result of an interplay between genetic and environmental factors.[137] Polymorphisms in various genes controlling appetite and metabolism predispose to obesity when sufficient food energy is present. As of 2006, more than 41 of these sites on the human genome have been linked to the development of obesity when a favorable environment is present.[138] People with two copies of the FTO gene (fat mass and obesity associated gene) have been found on average to weigh 3–4 kg more and have a 1.67-fold greater risk of obesity compared with those without the risk allele.[139] The differences in BMI between people that are due to genetics varies depending on the population examined from 6% to 85%.[140]
Obesity is a major feature in several syndromes, such as Prader–Willi syndrome, Bardet–Biedl syndrome, Cohen syndrome, and MOMO syndrome. (The term "non-syndromic obesity" is sometimes used to exclude these conditions.)[141] In people with early-onset severe obesity (defined by an onset before 10 years of age and body mass index over three standard deviations above normal), 7% harbor a single point DNA mutation.[142]
Studies that have focused on inheritance patterns rather than on specific genes have found that 80% of the offspring of two obese parents were also obese, in contrast to less than 10% of the offspring of two parents who were of normal weight.[143] Different people exposed to the same environment have different risks of obesity due to their underlying genetics.[144]
The thrifty gene hypothesis postulates that, due to dietary scarcity during human evolution, people are prone to obesity. Their ability to take advantage of rare periods of abundance by storing energy as fat would be advantageous during times of varying food availability, and individuals with greater adipose reserves would be more likely to survive famine. This tendency to store fat, however, would be maladaptive in societies with stable food supplies.[medical citation needed] This theory has received various criticisms, and other evolutionarily-based theories such as the drifty gene hypothesis and the thrifty phenotype hypothesis have also been proposed.[medical citation needed]
Other illnesses
Certain physical and mental illnesses and the pharmaceutical substances used to treat them can increase risk of obesity. Medical illnesses that increase obesity risk include several rare genetic syndromes (listed above) as well as some congenital or acquired conditions: hypothyroidism, Cushing's syndrome, growth hormone deficiency,[145] and some eating disorders such as binge eating disorder and night eating syndrome.[2] However, obesity is not regarded as a psychiatric disorder, and therefore is not listed in the DSM-IVR as a psychiatric illness.[146] The risk of overweight and obesity is higher in patients with psychiatric disorders than in persons without psychiatric disorders.[147] Obesity and depression influence each other mutually, with obesity increasing the risk of clinical depression, and also depression leading to a higher chance of developing obesity.[3]
Drug-induced obesity
Certain medications may cause weight gain or changes in
Social determinants
While genetic influences are important to understanding obesity, they cannot completely explain the dramatic increase seen within specific countries or globally.
The correlation between
Many explanations have been put forth for associations between BMI and social class. It is thought that in developed countries, the wealthy are able to afford more nutritious food, they are under greater social pressure to remain slim, and have more opportunities along with greater expectations for
Smoking has a significant effect on an individual's weight. Those who quit smoking gain an average of 4.4 kilograms (9.7 lb) for men and 5.0 kilograms (11.0 lb) for women over ten years.[155] However, changing rates of smoking have had little effect on the overall rates of obesity.[156]
In the United States, the number of children a person has is related to their risk of obesity. A woman's risk increases by 7% per child, while a man's risk increases by 4% per child.[157] This could be partly explained by the fact that having dependent children decreases physical activity in Western parents.[158]
In the developing world urbanization is playing a role in increasing rate of obesity. In China overall rates of obesity are below 5%; however, in some cities rates of obesity are greater than 20%.
Gut bacteria
The study of the effect of infectious agents on metabolism is still in its early stages.
An association between
Other factors
Not getting enough sleep is also associated with obesity.[167][168] Whether one causes the other is unclear.[167] Even if short sleep does increase weight gain, it is unclear if this is to a meaningful degree or if increasing sleep would be of benefit.[169]
Some have proposed that chemical compounds called "
Certain aspects of personality are associated with being obese.[170] Loneliness,[171] neuroticism, impulsivity, and sensitivity to reward are more common in people who are obese while conscientiousness and self-control are less common in people who are obese.[170][172] Because most of the studies on this topic are questionnaire-based, it is possible that these findings overestimate the relationships between personality and obesity: people who are obese might be aware of the social stigma of obesity and their questionnaire responses might be biased accordingly.[170] Similarly, the personalities of people who are obese as children might be influenced by obesity stigma, rather than these personality factors acting as risk factors for obesity.[170]
In relation to globalization, it is known that trade liberalization is linked to obesity; research, based on data from 175 countries during 1975-2016, showed that obesity prevalence was positively correlated with trade openness, and the correlation was stronger in developing countries.[173]
Pathophysiology
Two distinct but related processes are considered to be involved in the development of obesity: sustained positive energy balance (energy intake exceeding energy expenditure) and the resetting of the body weight "set point" at an increased value.[174] The second process explains why finding effective obesity treatments has been difficult. While the underlying biology of this process still remains uncertain, research is beginning to clarify the mechanisms.[174]
At a biological level, there are many possible
The arcuate nucleus contains two distinct groups of
Management
The main treatment for obesity consists of
Several hypo-caloric diets are effective.
Health policy
Obesity is a complex public health and policy problem because of its prevalence, costs, and health effects.[193] As such, managing it requires changes in the wider societal context and effort by communities, local authorities, and governments.[185] Public health efforts seek to understand and correct the environmental factors responsible for the increasing prevalence of obesity in the population. Solutions look at changing the factors that cause excess food energy consumption and inhibit physical activity. Efforts include federally reimbursed meal programs in schools, limiting direct junk food marketing to children,[194] and decreasing access to sugar-sweetened beverages in schools.[195] The World Health Organization recommends the taxing of sugary drinks.[196] When constructing urban environments, efforts have been made to increase access to parks and to develop pedestrian routes.[197]
Medical interventions
Medication
Since the introduction of medicines for the management of obesity in the 1930s, many compounds have been tried. Most of them reduce body weight by small amounts, and several of them are no longer marketed for obesity because of their side effects. Out of 25 anti-obesity medications withdrawn from the market between 1964 and 2009, 23 acted by altering the functions of chemical
Five medications beneficial for long-term use are: orlistat, lorcaserin, liraglutide, phentermine–topiramate, and naltrexone–bupropion.[204] They result in weight loss after one year ranged from 3.0 to 6.7 kg (6.6-14.8 lbs) over placebo.[204] Orlistat, liraglutide, and naltrexone–bupropion are available in both the United States and Europe, phentermine–topiramate is available only in the United States.[205] European regulatory authorities rejected lorcaserin and phentermine-topiramate, in part because of associations of heart valve problems with lorcaserin and more general heart and blood vessel problems with phentermine–topiramate.[205] Lorcaserin was available in the United States and then removed from the market in 2020 due to its association with cancer.[206] Orlistat use is associated with high rates of gastrointestinal side effects[207] and concerns have been raised about negative effects on the kidneys.[208] There is no information on how these drugs affect longer-term complications of obesity such as cardiovascular disease or death;[5] however, liraglutide, when used for type 2 diabetes, does reduce cardiovascular events.[209]
In 2019 a systematic review compared the effects on weight of various doses of fluoxetine (60 mg/d, 40 mg/d, 20 mg/d, 10 mg/d) in obese adults.[210] When compared to placebo, all dosages of fluoxetine appeared to contribute to weight loss but lead to increased risk of experiencing side effects such as dizziness, drowsiness, fatigue, insomnia and nausea during period of treatment. However, these conclusions were from low certainty evidence.[210] When comparing, in the same review, the effects of fluoxetine on weight of obese adults, to other anti-obesity agents, omega-3 gel and not receiving a treatment, the authors could not reach conclusive results due to poor quality of evidence.[210]
Among antipsychotic drugs for treating schizophrenia clozapine is the most effective, but it also has the highest risk of causing the metabolic syndrome, of which obesity is the main feature. For people who gain weight because of clozapine, taking metformin may reportedly improve three of the five components of the metabolic syndrome: waist circumference, fasting glucose, and fasting triglycerides.[211]
Surgery
The most effective treatment for obesity is
Epidemiology
Graphs are unavailable due to technical issues. There is more info on Phabricator and on MediaWiki.org. |
See or edit source data.
In earlier historical periods obesity was rare and achievable only by a small elite, although already recognised as a problem for health. But as prosperity increased in the
In 1997, the WHO formally recognized obesity as a global epidemic.
The rate of obesity also increases with age at least up to 50 or 60 years old[52]: 5 and severe obesity in the United States, Australia, and Canada is increasing faster than the overall rate of obesity.[31][221][222] The OECD has projected an increase in obesity rates until at least 2030, especially in the United States, Mexico and England with rates reaching 47%, 39% and 35%, respectively.[223]
Once considered a problem only of high-income countries, obesity rates are rising worldwide and affecting both the developed and developing world.[224] These increases have been felt most dramatically in urban settings.[217]
Sex- and gender-based differences also influence the prevalence of obesity. Globally there are more obese women than men, but the numbers differ depending on how obesity is measured.[225][226]
History
Etymology
Obesity is from the
Historical attitudes
Ancient Greek medicine recognizes obesity as a medical disorder and records that the Ancient Egyptians saw it in the same way.[215] Hippocrates wrote that "Corpulence is not only a disease itself, but the harbinger of others".[2] The Indian surgeon Sushruta (6th century BCE) related obesity to diabetes and heart disorders.[230] He recommended physical work to help cure it and its side effects.[230] For most of human history, mankind struggled with food scarcity.[231] Obesity has thus historically been viewed as a sign of wealth and prosperity. It was common among high officials in Ancient East Asian civilizations.[232] In the 17th century, English medical author Tobias Venner is credited with being one of the first to refer to the term as a societal disease in a published English language book.[215][233]
With the onset of the Industrial Revolution, it was realized that the military and economic might of nations were dependent on both the body size and strength of their soldiers and workers.[114] Increasing the average body mass index from what is now considered underweight to what is now the normal range played a significant role in the development of industrialized societies.[114] Height and weight thus both increased through the 19th century in the developed world. During the 20th century, as populations reached their genetic potential for height, weight began increasing much more than height, resulting in obesity.[114] In the 1950s, increasing wealth in the developed world decreased child mortality, but as body weight increased, heart and kidney disease became more common.[114][234] During this time period, insurance companies realized the connection between weight and life expectancy and increased premiums for the obese.[2]
Many cultures throughout history have viewed obesity as the result of a character flaw. The obesus or fat character in Ancient Greek comedy was a glutton and figure of mockery. During Christian times, food was viewed as a gateway to the sins of sloth and lust.[21] In modern Western culture, excess weight is often regarded as unattractive, and obesity is commonly associated with various negative stereotypes. People of all ages can face social stigmatization and may be targeted by bullies or shunned by their peers.[235]
Public perceptions in Western society regarding healthy body weight differ from those regarding the weight that is considered ideal – and both have changed since the beginning of the 20th century. The weight that is viewed as an ideal has become lower since the 1920s. This is illustrated by the fact that the average height of Miss America pageant winners increased by 2% from 1922 to 1999, while their average weight decreased by 12%.[236] On the other hand, people's views concerning healthy weight have changed in the opposite direction. In Britain, the weight at which people considered themselves to be overweight was significantly higher in 2007 than in 1999.[237] These changes are believed to be due to increasing rates of adiposity leading to increased acceptance of extra body fat as being normal.[237]
Obesity is still seen as a sign of wealth and well-being in many parts of Africa. This has become particularly common since the HIV epidemic began.[2]
The arts
The first sculptural representations of the human body 20,000–35,000 years ago depict obese females. Some attribute the
During the
Society and culture
Economic impact
In addition to its health impacts, obesity leads to many problems, including disadvantages in employment[240]: 29 [241] and increased business costs. These effects are felt by all levels of society, from individuals, to corporations, to governments.
In 2005, the medical costs attributable to obesity in the US were an estimated $190.2 billion or 20.6% of all medical expenditures,[242][243][244] while the cost of obesity in Canada was estimated at CA$2 billion in 1997 (2.4% of total health costs).[96] The total annual direct cost of overweight and obesity in Australia in 2005 was A$21 billion. Overweight and obese Australians also received A$35.6 billion in government subsidies.[245] The estimated range for annual expenditures on diet products is $40 billion to $100 billion in the US alone.[246]
The Lancet Commission on Obesity in 2019 called for a global treaty—modelled on the WHO Framework Convention on Tobacco Control—committing countries to address obesity and undernutrition, explicitly excluding the food industry from policy development. They estimate the global cost of obesity $2 trillion a year, about or 2.8% of world GDP.[247]
Obesity prevention programs have been found to reduce the cost of treating obesity-related disease. However, the longer people live, the more medical costs they incur. Researchers, therefore, conclude that reducing obesity may improve the public's health, but it is unlikely to reduce overall health spending.[248] Sin taxes such as a sugary drink tax have been implemented in certain countries globally to curb dietary and consumer habits, and as an effort to offset the economic tolls.
Obesity can lead to social stigmatization and disadvantages in employment.[240]: 29 When compared to their normal weight counterparts, obese workers on average have higher rates of absenteeism from work and take more disability leave, thus increasing costs for employers and decreasing productivity.[250] A study examining Duke University employees found that people with a BMI over 40 kg/m2 filed twice as many workers' compensation claims as those whose BMI was 18.5–24.9 kg/m2. They also had more than 12 times as many lost work days. The most common injuries in this group were due to falls and lifting, thus affecting the lower extremities, wrists or hands, and backs.[251] The Alabama State Employees' Insurance Board approved a controversial plan to charge obese workers $25 a month for health insurance that would otherwise be free unless they take steps to lose weight and improve their health. These measures started in January 2010 and apply to those state workers whose BMI exceeds 35 kg/m2 and who fail to make improvements in their health after one year.[252]
Some research shows that obese people are less likely to be hired for a job and are less likely to be promoted.[235] Obese people are also paid less than their non-obese counterparts for an equivalent job; obese women on average make 6% less and obese men make 3% less.[240]: 30
Specific industries, such as the airline, healthcare and food industries, have special concerns. Due to rising rates of obesity, airlines face higher fuel costs and pressures to increase seating width.[253] In 2000, the extra weight of obese passengers cost airlines US$275 million.[254] The healthcare industry has had to invest in special facilities for handling severely obese patients, including special lifting equipment and bariatric ambulances.[255] Costs for restaurants are increased by litigation accusing them of causing obesity.[256] In 2005, the US Congress discussed legislation to prevent civil lawsuits against the food industry in relation to obesity; however, it did not become law.[256]
With the American Medical Association's 2013 classification of obesity as a chronic disease,[24] it is thought that health insurance companies will more likely pay for obesity treatment, counseling and surgery, and the cost of research and development of fat treatment pills or gene therapy treatments should be more affordable if insurers help to subsidize their cost.[257] The AMA classification is not legally binding, however, so health insurers still have the right to reject coverage for a treatment or procedure.[257]
In 2014, The European Court of Justice ruled that morbid obesity is a disability. The Court said that if an employee's obesity prevents them from "full and effective participation of that person in professional life on an equal basis with other workers", then it shall be considered a disability and that firing someone on such grounds is discriminatory.[258]
In low-income countries, obesity can be a signal of wealth. A 2023 experimental study found that obese individuals in Uganda were more likely to access credit.[259]
Size acceptance
The principal goal of the fat acceptance movement is to decrease discrimination against people who are overweight and obese.[261][262] However, some in the movement are also attempting to challenge the established relationship between obesity and negative health outcomes.[263]
A number of organizations exist that promote the acceptance of obesity. They have increased in prominence in the latter half of the 20th century.[264] The US-based National Association to Advance Fat Acceptance (NAAFA) was formed in 1969 and describes itself as a civil rights organization dedicated to ending size discrimination.[265]
The
Industry influence on research
In 2015, the New York Times published an article on the
Reports
Many organizations have published reports pertaining to obesity. In 1998, the first US Federal guidelines were published, titled "Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report".
In 2004, the United Kingdom
The Obesity Policy Action (OPA) framework divides measure into upstream policies, midstream policies, and downstream policies. Upstream policies have to do with changing society, while midstream policies try to alter behaviors believed to contribute to obesity at the individual level, while downstream policies treat currently obese people.[274]
Childhood obesity
The healthy BMI range varies with the age and sex of the child. Obesity in children and adolescents is defined as a BMI greater than the 95th percentile.[275] The reference data that these percentiles are based on is from 1963 to 1994 and thus has not been affected by the recent increases in rates of obesity.[276] Childhood obesity has reached epidemic proportions in the 21st century, with rising rates in both the developed and the developing world. Rates of obesity in Canadian boys have increased from 11% in the 1980s to over 30% in the 1990s, while during this same time period rates increased from 4 to 14% in Brazilian children.[277] In the UK, there were 60% more obese children in 2005 compared to 1989.[278] In the US, the percentage of overweight and obese children increased to 16% in 2008, a 300% increase over the prior 30 years.[279]
As with obesity in adults, many factors contribute to the rising rates of childhood obesity. Changing diet and decreasing physical activity are believed to be the two most important causes for the recent increase in the incidence of child obesity.[280] Advertising of unhealthy foods to children also contributes, as it increases their consumption of the product.[281] Antibiotics in the first 6 months of life have been associated with excess weight at age seven to twelve years of age.[165] Because childhood obesity often persists into adulthood and is associated with numerous chronic illnesses, children who are obese are often tested for hypertension, diabetes, hyperlipidemia, and fatty liver disease.[96]
Treatments used in children are primarily lifestyle interventions and behavioral techniques, although efforts to increase activity in children have had little success.[282] In the United States, medications are not FDA approved for use in this age group.[277] Brief weight management interventions in primary care (e.g. delivered by a physician or nurse practitioner) have only a marginal positive effect in reducing childhood overweight or obesity.[283] Multi-component behaviour change interventions that include changes to dietary and physical activity may reduce BMI in the short term in children aged 6 to 11 years, although the benefits are small and quality of evidence is low.[284]
Other animals
Obesity in pets is common in many countries. In the United States, 23–41% of dogs are overweight, and about 5.1% are obese.[285] The rate of obesity in cats was slightly higher at 6.4%.[285] In Australia, the rate of obesity among dogs in a veterinary setting has been found to be 7.6%.[286] The risk of obesity in dogs is related to whether or not their owners are obese; however, there is no similar correlation between cats and their owners.[287]
See also
- Portal-visceral hypothesis
- Anti-Obesity Day
References
Citations
- ^ a b c d e f g h i "Obesity and overweight Fact sheet N°311". WHO. January 2015. Retrieved 2 February 2016.
- ^ S2CID 208791491.
- ^ PMID 20194822.
- ^ PMID 25825681.
- ^ PMID 24231879.
- ^ PMID 25105982.
- PMID 38432237.
- PMID 33882682.
- ^ CDC (21 March 2022). "Causes and Consequences of Childhood Obesity". Centers for Disease Control and Prevention. Retrieved 18 August 2022.
- ^ "Policy Finder". American Medical Association (AMA). Retrieved 18 August 2022.
- ^ S2CID 19963495.
- ^ "Obesity - Symptoms and causes". Mayo Clinic. Retrieved 30 November 2021.
- ^ PMID 30177480.
- PMID 32707119.
- ^ PMID 18173389.
- PMID 25429313.
- S2CID 10220216.
- ISBN 978-0-12-397753-3.
- PMID 38432237.
- ^ "One in eight people are now living with obesity". www.who.int. Retrieved 1 March 2024.
- ^ PMID 18230908.
- ^ "The implications of defining obesity as a disease: a report from the Association for the Study of Obesity 2021 annual conference - eClinicalMedicine".
- ^ PMID 24222017.
- ^ a b Pollack A (18 June 2013). "A.M.A. Recognizes Obesity as a Disease". The New York Times. Archived from the original on 24 June 2013.
- ^ Weinstock M (21 June 2013). "The Facts About Obesity". H&HN. American Hospital Association. Archived from the original on 9 September 2013. Retrieved 24 June 2013.
- ^ The SuRF Report 2 (PDF). The Surveillance of Risk Factors Report Series (SuRF). World Health Organization. 2005. p. 22.
- ^ a b c d "Obesity and overweight". World Health Organization. 9 June 2021. Retrieved 16 March 2022.
- ^ "Defining Adult Overweight and Obesity". U.S. Centers for Disease Control and Prevention. 7 June 2021. Retrieved 16 March 2022.
- ^ "BMI-for-age (5–19 years)". World Health Organization. Retrieved 16 March 2022.
- ^ PMID 12046553.
- ^ PMID 17399752.
- PMID 9246834.
- ^ "Regular Exercise: How It Can Boost Your Health".
- ^ "NFL Players Not at Increased Heart Risk: Study finds they showed no more signs of cardiovascular trouble than general male population".
- ^ .
- ^ S2CID 71146382.
- ^ PMID 19299006.
- S2CID 7205587.
- S2CID 14589790.
- PMID 10546692.
- PMID 27146380.
- ^ PMID 27423262.
- PMID 10511607.
- S2CID 23967973.
- PMID 23511854.
- S2CID 15637224.
- ^ "Obesity". www.who.int. Retrieved 9 September 2022.
- S2CID 8120329.
- S2CID 7453798.
- ^ "Obesity linked to long Covid-19, RAK hospital study finds". Khaleej Times. 12 August 2021. Retrieved 12 August 2021.
- PMID 34197283.
- ^ ISBN 978-1-4051-1672-5.
- ^ PMID 15181027.
- PMID 17498510.
- PMID 16823477.
- S2CID 260320617.
- PMID 24269108.
- S2CID 115876581.
- PMID 17185009.
- ^ PMID 17504714.
- PMID 16799182.
- ^ PMID 18611299.
- ^ S2CID 26275773.
- PMID 18028045.
- S2CID 23729708.
- PMID 18335412.
- PMID 18331422.
- S2CID 17285706.
- PMID 19901245.
- PMID 21080117.
- ^ PMID 16636330.
- PMID 33634150.
- S2CID 38095938.
- PMID 18426630.
- PMID 19051798.
- PMID 24713832.
- S2CID 20378183.
- PMID 16641153.
- PMID 16093964.
- S2CID 36775257.
- PMID 23974763.
- ^ PMID 32128581.
- ^ PMID 31524630.
- S2CID 3996442.
- PMID 24484869.
- ^ Stolk R (26 November 2013). "The Healthy Obese Project (HOP)" (PDF). BioSHaRE Newsletter (4): 2. Archived from the original (PDF) on 23 October 2015. Retrieved 11 April 2022.
- PMID 29504574.
- S2CID 29584669.
- ^ S2CID 37354831.
- ^ PMID 12825847.
- PMID 16996880.
- S2CID 23306195.
- S2CID 25332291.
- S2CID 205524756.
- PMID 16824844.
- ^ PMID 17420481.
- PMID 14684391.
- PMID 10968581.)
{{cite journal}}
: CS1 maint: DOI inactive as of January 2024 (link - S2CID 19894128.
- ^ Masand PS. "Weight gain associated with psychotropic drugs". Expert opinion on pharmacotherapy. 2000;1:377–389.
- ^ Baum, Charles L. "The effects of cigarette costs on BMI and obesity." Health Economics 18.1 (2009): 3-19. APA
- S2CID 221794897.
- S2CID 342831.
- ^ McAllister, Emily J et al. "Ten putative contributors to the obesity epidemic". Critical reviews in food science and nutrition vol. 49,10 (2009): 868-913. doi:10.1080/10408390903372599
- PMID 28898979.
- ^ a b c d e f "EarthTrends: Nutrition: Calorie supply per capita". World Resources Institute. Archived from the original on 11 June 2011. Retrieved 18 October 2009.
- PMID 26549651.
- ^ "USDA: frsept99b". United States Department of Agriculture. Archived from the original on 3 June 2010. Retrieved 10 January 2009.
- ^ "Diet composition and obesity among Canadian adults". Statistics Canada.
- ^ National Control for Health Statistics. "Nutrition For Everyone". Centers for Disease Control and Prevention. Retrieved 9 July 2008.
- PMID 18312812.
- PMID 12365955.
- PMID 14762332.
- ^ PMID 17569676.
- PMID 21696306.
- PMID 16895873.
- S2CID 28672221.
- PMID 20693348.
- S2CID 809587.
- S2CID 25820487.
- ^ Lin BH, Guthrie J, Frazao E (1999). "Nutrient contribution of food away from home". In Frazão E (ed.). Agriculture Information Bulletin No. 750: America's Eating Habits: Changes and Consequences. Washington, DC: US Department of Agriculture, Economic Research Service. pp. 213–39. Archived from the original on 8 July 2012.
- ^ Pollan M (22 April 2007). "You Are What You Grow". The New York Times. Retrieved 28 April 2021.
- ISBN 978-1-4051-1672-5.
- ^ Schieszer J. Metabolism alone doesn't explain how thin people stay thin. The Medical Post.
- ^ a b "Obesity and overweight". World Health Organization. Archived from the original on 18 December 2008. Retrieved 10 January 2009.
- ^ a b c "WHO | Physical Inactivity: A Global Public Health Problem". World Health Organization. Archived from the original on 13 February 2014. Retrieved 22 February 2009.
- ^ S2CID 31964889.
- ^ PMID 17387258.
- PMID 17875578.
- PMID 15760296.
- PMID 21383837.
- PMID 8634729.
- S2CID 26129544.
- PMID 2053671.
- ^ Emanuel EJ (2008). "Media + Child and Adolescent Health: A Systematic Review" (PDF). Common Sense Media. Retrieved 6 April 2009.
- ^ Jones M. "Case Study: Cataplexy and SOREMPs Without Excessive Daytime Sleepiness in Prader Willi Syndrome. Is This the Beginning of Narcolepsy in a Five Year Old?". European Society of Sleep Technologists. Archived from the original on 13 April 2009. Retrieved 6 April 2009.
- PMID 28910990.
- S2CID 6052584.
- S2CID 23487924.
- PMID 17566051.
- S2CID 10870369.
- PMID 17122358.
- ISBN 978-0-312-42785-6.
- S2CID 10870369.
However, it is also clear that genetics greatly influences this situation, giving individuals in the same 'obesogenic' environment significantly different risks of becoming obese.
- S2CID 25725625.
- PMID 14726719.
- ^ Chiles C, van Wattum PJ (2010). "Psychiatric aspects of the obesity crisis". Psychiatr Times. 27 (4): 47–51.
- S2CID 37456911.
- PMID 2648443.
- ^ PMID 17478442.
- ^ ISBN 978-1-84614-039-6.
- S2CID 264194973.
- S2CID 23665421.
- PMID 12917508.
- PMID 7565970.
- PMID 18400700.
- PMID 15006281.
- PMID 17919713.
- ^ "Obesity and Overweight" (PDF). World Health Organization. Retrieved 22 February 2009.
- S2CID 12470420.
- S2CID 207474312.
- ^ PMID 11238776.
- PMID 18380992.
- ^ "Antibiotics: repeated treatments before the age of two could be a factor in obesity". Prescrire International. 2018. Retrieved 2 July 2018.
- ^ PMID 25488483.
- PMID 16790384.
- ^ PMID 18517032.
- PMID 29401314.
- S2CID 23948346.
- ^ S2CID 46500679.
- S2CID 24974378.
- PMID 23176713.
- PMID 31399309.
- ^ PMID 28898979.
- ^ S2CID 6010027.
- S2CID 4359725.
- ISBN 978-0-7216-3256-8.
- ^ a b US Department of Health and Human Services. (2017). "2015–2020 Dietary Guidelines for Americans - health.gov". health.gov. Skyhorse Publishing Inc. Retrieved 30 September 2019.
- PMID 30879355.
- ^ PMID 16389240.
- PMID 9550162.
- PMID 17413092.
- PMID 24355667.
- ^ PMID 30625301.
- ^ PMID 30326502.
- PMID 28696389.
- ^ S2CID 45507530. Retrieved 17 June 2016.
- PMID 25182101.
- PMID 25007189.
- PMID 16002825.
- PMID 22596383.
- S2CID 262280720.
- ISBN 978-0-16-051005-2.
- ^ Barnes B (18 July 2007). "Limiting Ads of Junk Food to Children". The New York Times. Retrieved 24 July 2008.
- ^ "Fewer Sugary Drinks Key to Weight Loss". U.S. Department of Health and Human Services. Archived from the original on 16 November 2012. Retrieved 18 October 2009.
- ^ "WHO urges global action to curtail consumption and health impacts of sugary drinks". WHO. Retrieved 13 October 2016.
- PMID 17169714.
- PMID 31046212.
- ^ a b "How can local authorities reduce obesity? Insights from NIHR research". NIHR Evidence (Plain English summary). National Institute for Health and Care Research. 19 May 2022.
- PMID 29482264.
- PMID 35446606.
- ISSN 0261-3077. Retrieved 23 April 2023.
- PMID 27894343.
- ^ S2CID 20407626.
- ^ S2CID 46738622.
- ^ "Belviq, Belviq XR (lorcaserin) by Eisai: Drug Safety Communication – FDA Requests Withdrawal of Weight-Loss Drug". FDA. 13 February 2020. Retrieved 18 February 2020.
- PMID 18006966.
- ^ Wood S. "Diet Drug Orlistat Linked to Kidney, Pancreas Injuries". Medscape. Medscape News. Retrieved 26 April 2011.
- S2CID 208610508.
- ^ PMID 31613390.
- PMID 27304831.
- ^ PMID 24352617.
- PMID 32813948.
- S2CID 20533869.
- ^ S2CID 43866948.
- S2CID 4928218.
- ^ a b "Obesity and overweight". World Health Organization. Retrieved 8 April 2009.
- ^ FAO, IFAD, UNICEF, WFP and WHO. 2017.The State of Food Security and Nutrition in the World 2017. Building resilience for peace and food security. Rome, FAO
- PMID 29155689.
- ^ World Health Organization (2000). Obesity: preventing and managing the global epidemic (Report). World Health Organization. pp. 1–2. Retrieved 1 February 2014.
- PMID 24351678.
- ^ Tjepkema M (6 July 2005). "Measured Obesity–Adult obesity in Canada: Measured height and weight". Nutrition: Findings from the Canadian Community Health Survey. Ottawa, Ontario: Statistics Canada.
- ^ "Obesity Update 2017" (PDF). Organisation for Economic Co-operation and Development. Retrieved 6 October 2018.
- PMID 20054170. Archived from the original(PDF) on 26 April 2012.
- PMID 24857516.
- . Retrieved 7 December 2022.
- ^ "Online Etymology Dictionary: Obesity". Douglas Harper. Retrieved 31 December 2008.
- ^ "Obesity, n". Oxford English Dictionary 2008. Archived from the original on 11 January 2008. Retrieved 21 March 2009.
- PMID 14578257.
- ^ a b "History of Medicine: Sushruta – the Clinician – Teacher par Excellence" (PDF). Dwivedi, Girish & Dwivedi, Shridhar. 2007. Archived from the original (PDF) on 10 October 2008. Retrieved 19 September 2008.
- ISBN 978-1-58829-721-1.
- ISBN 978-1-4129-5238-5.
- ISBN 978-0-8032-2183-3.
tobias venner obesity.
- PMID 12976585.
- ^ PMID 11743063.
- PMID 10735392.
- ^ PMID 18617488.
- ISBN 978-0-14-026144-8.
- S2CID 246984311.
- ^ ISBN 978-1-4051-1672-5.
- PMID 19249259.
- S2CID 6717295.
- PMID 14527256.
- ^ "Obesity and overweight: Economic consequences". Centers for Disease Control and Prevention. 22 May 2007. Retrieved 5 September 2007.
- S2CID 1588787.
- ^ Cummings L (5 February 2003). "The diet business: Banking on failure". BBC News. Retrieved 25 February 2009.
- ^ "Public health experts call for global food treaty". Financial Times. 27 January 2019. Retrieved 7 March 2019.
- PMID 18254654.
- doi:10.12968/ijtr.2007.14.7.23858. Archived from the originalon 8 October 2011.
- S2CID 20420379.
- PMID 17452538.
- ^ "Alabama "Obesity Penalty" Stirs Debate". Don Fernandez. Retrieved 5 April 2009.
- ^ DiCarlo L (24 October 2002). "Why Airlines Can't Cut The Fat". Forbes.com. Retrieved 23 July 2008.
- PMID 15450642.
- ^ Cox L (2 July 2009). "Who Should Pay for Obese Health Care?". ABC News. Retrieved 6 August 2012.
- ^ a b "109th U.S. Congress (2005–2006) H.R. 554: 109th U.S. Congress (2005–2006) H.R. 554: Personal Responsibility in Food Consumption Act of 2005". GovTrack.us. Archived from the original on 1 November 2008. Retrieved 24 July 2008.
- ^ a b Basulto D (20 June 2013). "A changing battlefield in the fight against fat". The Washington Post. Archived from the original on 2 September 2014. Retrieved 20 June 2013.
- ^ "Obesity can be deemed a disability at work – EU court". Reuters. 18 December 2014. Retrieved 18 December 2014.
- S2CID 244396815.
- stuttgarter-nachrichten.de(in German). Retrieved 25 March 2023.
- ^ "What is NAAFA". National Association to Advance Fat Acceptance. Archived from the original on 12 March 2009. Retrieved 17 February 2009.
- ^ "ISAA Mission Statement". International Size Acceptance Association. Retrieved 17 February 2009.
- ^ SSRN 1316106.
- PMID 10340803.
- ^ National Association to Advance Fat Acceptance (2008). "We come in all sizes". NAAFA. Archived from the original on 26 December 2018. Retrieved 29 July 2008.
- ^ "International Size Acceptance Association – ISAA". International Size Acceptance Association. Retrieved 13 January 2009.
- ^ O'Connor A (9 August 2015). "Coca-Cola Funds Scientists Who Shift Blame for Obesity Away From Bad Diets". The New York Times.
- S2CID 29815670.
- ISBN 978-1-58808-002-8.
- ISBN 978-1-86016-200-8.
- ISBN 978-0-215-01737-6. Retrieved 17 December 2007.
- National Health Services(NHS). 2006. Retrieved 8 April 2009.
- ISBN 978-1-85717-562-2.
- S2CID 30908778.
- Center for disease control and prevention. Retrieved 6 April 2009.
- PMID 11382664.
- ^ S2CID 5992031.
- S2CID 31102802.
- S2CID 144317779.
- PMID 16306494.
- PMID 30576057.
- PMID 23044984.
- S2CID 26039769.
- PMID 28639319.
- ^ a b Lund EM (2006). "Prevalence and Risk Factors for Obesity in Adult Dogs from Private US Veterinary Practices" (PDF). Intern J Appl Res Vet Med. 4 (2): 177–86.
- S2CID 36725298.
- PMID 19545467.
Further reading
- "Obesity 2015". The Lancet. 2015.
Series from the Lancet journals
- Jebb S, Wells J (2005). "Measuring body composition in adults and children". In Kopelman PG, Caterson ID, Stock MJ, Dietz WH (eds.). Clinical obesity in adults and children: In Adults and Children. Blackwell Publishing. pp. 12–28. ISBN 978-1-4051-1672-5.
- ISBN 978-1-58808-002-8.
- "Obesity: guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children" (PDF). National Health Services(NHS). 2006. Retrieved 8 April 2009.
- World Health Organization (WHO) (2000). Technical report series 894: Obesity: Preventing and managing the global epidemic (PDF). Geneva: World Health Organization. ISBN 978-92-4-120894-9. Archived from the original(PDF) on 1 May 2015. Retrieved 10 May 2006.
External links
- Quotations related to Obesity at Wikiquote
- WHO fact sheet on obesity and overweight