Obesity: Responding to the global epidemic.

Abstract

Obesity has reached epidemic proportions in the United States and other developed nations. In the United States, 27% of adults are obese and an additional 34% are overweight. Research in the past decade has shown that genetic influences clearly predispose some individuals to obesity. The marked increase in prevalence, however, appears to be attributable to a toxic environment that implicitly discourages physical activity while explicitly encouraging the consumption of supersized portions of high-fat, high-sugar foods. Management of the obesity epidemic will require a two-pronged approach. First, better treatments, including behavioral, pharmacologic, and surgical interventions, are needed for individuals who are already obese. The second and potentially more promising approach is to prevent the development of obesity by tackling the toxic environment. This will require bold public policy initiatives such as regulating food advertising directed at children. The authors call not for the adoption of a specific policy initiative, but instead propose that policy research, based on viewing obesity as a public health problem, become a central focus of research.Research on obesity has increased exponentially during the past decade and has yielded remarkable discoveries in the regulation of body weight. This same period, however, has witnessed an unparalleled increase in the prevalence of obesity, making it one of our nation's most pressing health problems. This article reviews the epidemiology and complications of obesity and the factors that have contributed to its sharp increase. Consistent with previous reviews, we examine advances in treatment including behavioral, pharmacologic, and surgical interventions (Brownell, 1982;Brownell & Wadden, 1992). Advances in treatment, however, must be complemented in the next decade by innovative public policy designed to prevent the development of obesity. Epidemiology and Complications of ObesityObesity refers to an excess of body fat, which normally accounts for about 25% of weight in women and 18% in men (Bray, 1998). Body fat can be measured by a number of methods but is now usually estimated by the body mass index (BMI), which is calculated as weight in kilograms divided by height in meters squared (i.e., kg/m 2 ; Bray, 1998). (Figure 1 provides for this calculation using pounds and inches.) The BMI is highly correlated with measures of body fat and has replaced the more traditional measure of percentage over ideal weight (VanItallie & Lew, 1992).The World Health Organization (WHO; 1998) has defined obesity as a BMI Ն 30 kg/m 2 , as has the National Institutes of Health/National Heart, Lung, and Blood Institute (NIH/NHLBI; 1998). By this criterion, in 1994 (the last period for which most complete analyses are available), 25% of U. S. women and 20% of men were obese (Flegal, Carroll, Kuczmarski, & Johnson, 1998). An additional 25% and 39%, respectively, were considered overweight, defined as a BMI of 25.0 to 29.9 kg/m 2 . Thus, 55% of adult Americans were either overweight or...

The role of patients' expectations and goals in the behavioral and pharmacological treatment of obesity

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Application of the Theory of Planned Behaviour to weight control in an overweight cohort. Results from a pan-European dietary intervention trial (DiOGenes)

“…The benefits of weight loss and weight loss maintenance have been well documented (Vidal, 2002). However, current approaches to overweight and obesity management have shown limited effectiveness, especially over the long term, with weight loss maintenance presenting a particularly difficult challenge (Elfhag & Rössner, 2005;Garcia Ulen, Huizinga, Beech, & Elasy, 2008;Wadden, Brownell, & Foster, 2002;Wing & Hill, 2001). Better understanding of individuals' behaviours and the differences in behaviours of those who are successful and unsuccessful at weight control will enable development of more targeted treatment options.…”

Physical activity energy expenditure has not declined since the 1980s and matches energy expenditures of wild mammals

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