Difference between revisions of "Obesity"

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==Childhood obesity==
 
==Childhood obesity==
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* Obesity and extreme obesity among U.S. low-income, preschool-aged children went down for the first time in recent years, according to CDC’s first national study.
 
* Obesity and extreme obesity among U.S. low-income, preschool-aged children went down for the first time in recent years, according to CDC’s first national study.
 
 
   
 
   
 
* From 2003 through 2010, the prevalence of obesity decreased slightly from 15.21% to 14.94%. Similarly, the prevalence of extreme obesity decreased from 2.22% to 2.07%.
 
* From 2003 through 2010, the prevalence of obesity decreased slightly from 15.21% to 14.94%. Similarly, the prevalence of extreme obesity decreased from 2.22% to 2.07%.
  
 
 
* However, from 1998 through 2003, the prevalence of obesity increased from 13.05% to 15.21%, and the prevalence of extreme obesity increased from 1.75% to 2.22%.
 
* However, from 1998 through 2003, the prevalence of obesity increased from 13.05% to 15.21%, and the prevalence of extreme obesity increased from 1.75% to 2.22%.
  
 
 
* Extreme obesity significantly decreased among all racial groups except American Indians/Alaska Natives. The greatest decrease was among 2-year old and Asian/Pacific Islander children.
 
* Extreme obesity significantly decreased among all racial groups except American Indians/Alaska Natives. The greatest decrease was among 2-year old and Asian/Pacific Islander children.
  
 
 
*The data for this study is from the Pediatric Nutrition Surveillance System (PedNSS), which includes almost 50% of preschool children eligible for federally funded maternal and child health and nutrition programs, primarily the WIC Program. The study population included 27.5 million children aged 2 through 4 years from 30 states and the District of Columbia that consistently reported data to PedNSS from 1998 -2010.
 
*The data for this study is from the Pediatric Nutrition Surveillance System (PedNSS), which includes almost 50% of preschool children eligible for federally funded maternal and child health and nutrition programs, primarily the WIC Program. The study population included 27.5 million children aged 2 through 4 years from 30 states and the District of Columbia that consistently reported data to PedNSS from 1998 -2010.
  
   
 
 
== Obesity rates among all children in the United States ==
 
== Obesity rates among all children in the United States ==
 
   
 
   

Revision as of 12:26, 6 February 2014


Obesity is a condition in which the body stores excess energy in the form of fatty tissue of humans and mammals, is increased to a point where it is thought to be a risk factor for certain health conditions or increased mortality.

Contents

How do we get obese?

Excess weight gain that leads to obesity has many causes. Excessive body weight has been shown to correlate with various diseases, particularly metabolic syndrome, cardiovascular disease, diabetes mellitus type 2, sleep apnea, and osteoarthritis. U.S. Dept. of Health and Human Services, National Institutes of Health, 'The Practical Guide: Identification, Evaluation and Treatment of Overweight and Obesity in Adults 5 (2000) PDF. Obesity is both an individual clinical condition and is increasingly viewed as a serious public health problem.

Obesity trends

According to the CDC, up to 70 percent of the population are either overweight or obese. WikiMD brings the latest science and art of treating obesity moderated by a Weight loss doctor

Science and art of losing weight

Secret for losing weight

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Weight loss articles | Body mass index | Obesity | Weight gain | Childhood obesity

Definition

In the clinical setting, obesity is typically evaluated by measuring BMI (Body Mass Index), waist circumference, and evaluating the presence of risk factors and comorbidities. In epidemiological studies BMI alone is used to define obesity.

Body Mass Index

Body mass index is a practical and simple way to measure weight. Although not perfect or without flaws, BMI is a reliable indicator of body fatness for most people except for heavy body builders. It is calculated based on your weight relative to your height.

BMI was developed by the Belgian statistician and anthropometrist Adolphe Quetelet :

  • A BMI less than 18.5 is underweight
  • A BMI of 18.5 - 24.9 is normal weight
  • A BMI of 25.0 - 29.9 is overweight
  • A BMI of 30.0 - 39.9 is obese
  • A BMI of 40.0 or higher is severely (or morbidly) obese

BMI is a simple and widely used method for estimating body fat. BMI as an indicator of a clinical condition is used in conjunction with other clinical assessments. In a clinical setting, physicians take into account race, ethnicity, lean mass (muscularity), age, sex, and other factors which can affect the interpretation of BMI. In epidemiological analyses BMI alone is used as an indicator of prevalence and incidence.

Waist Circumference

Another important measure to know your risk related to excess weight is to know your waist to hip ratio or simply your waist circumference as a big waist circumference is associated with higher risk of developing obesity-related conditions:

  • A man with a waist circumference of 40 inches
  • A woman whose waist circumference is more than 35 inches (lower in Asians)

Excessive abdominal or belly fat increases the risk for developing obesity-related conditions, such as Type 2 Diabetes, high blood cholesterol, high triglycerides, high blood pressure, and coronary artery disease.

Online BMI calculator

Waist circumference

BMI does not take into account differing ratios of adipose to lean tissue; nor does it distinguish between differing forms of adiposity, some of which may correlate more closely with cardiovascular risk. Increasing understanding of the biology of different forms of adipose tissue has shown that visceral fat or central obesity (male-type or apple-type obesity) has a much stronger correlation, particularly with cardiovascular disease, than the BMI alone. ...Learn more on risk of belly fat, or abdominal weight gain

What’s causing your weight gain?

  • Up to 70 percent of the population in the United States deals with being overweight or obese
  • 35 percent of all adults, according to Centers for Disease Control (CDC) are prediabetic and have significant insulin resistance while another 36 percent have some signs of insulin resistance
  • Diabetes has increased by over 500 percent in the last 50 years or so and now affects 8 percent of the population.

Could insulin resistance explain your weight gain?

What really causes your weight gain?

STOP Blaming The Victim For Obesity

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The absolute waist circumference (>102 cm in men and >88 cm in women) or waist-hip ratio (>0.9 for men and >0.85 for women are both used as measures of central obesity.

Body fat measurement

An alternative way to determine obesity is to assess percent body fat. Doctors and scientists generally agree that men with more than 25% body fat and women with more than 30% body fat are obese. However, it is difficult to measure body fat precisely. The most accepted method has been to weigh a person underwater, but underwater weighing is a procedure limited to laboratories with special equipment. Two simpler methods for measuring body fat are the skinfold test, in which a pinch of skin is precisely measured to determine the thickness of the subcutaneous fat layer; or bioelectrical impedance analysis, usually only carried out at specialist clinics.

Gestalt

In practice, in most examples of overweight that may designate risk, both doctor and patient can see "by eye" whether excess fat is a concern. In these cases, BMI thresholds provide simple targets all patients can understand.

Risk factors and comorbidities

The presence of risk factors and diseases associated with obesity are also used to establish a clinical diagnosis. Coronary heart disease, Type II diabetes, and sleep apnea are possible life-threatening risk factors that would indicate clinical treatment of obesity. Smoking, hypertension, age and family history are other risk factors that may indicate treatment Diabetes and heart disease are risk factors used in epidemiological studies of obesity.

Childhood obesity

  • Obesity and extreme obesity among U.S. low-income, preschool-aged children went down for the first time in recent years, according to CDC’s first national study.
  • From 2003 through 2010, the prevalence of obesity decreased slightly from 15.21% to 14.94%. Similarly, the prevalence of extreme obesity decreased from 2.22% to 2.07%.
  • However, from 1998 through 2003, the prevalence of obesity increased from 13.05% to 15.21%, and the prevalence of extreme obesity increased from 1.75% to 2.22%.
  • Extreme obesity significantly decreased among all racial groups except American Indians/Alaska Natives. The greatest decrease was among 2-year old and Asian/Pacific Islander children.
  • The data for this study is from the Pediatric Nutrition Surveillance System (PedNSS), which includes almost 50% of preschool children eligible for federally funded maternal and child health and nutrition programs, primarily the WIC Program. The study population included 27.5 million children aged 2 through 4 years from 30 states and the District of Columbia that consistently reported data to PedNSS from 1998 -2010.

Obesity rates among all children in the United States

  • Approximately 17% (or 12.5 million) of children and adolescents aged 2—19 years are obese.
  • Since 1980, obesity prevalence among children and adolescents has almost tripled.
  • There are significant racial and ethnic disparities in obesity prevalence among U.S. children and adolescents. In 2007—2008, Hispanic boys, aged 2 to 19 years,were significantly more likely to be obese than non-Hispanic white boys, and non-Hispanic black girls were significantly more likely to be obese than non-Hispanic white girls.

Obesity rates among all children in the United States

Approximately 17% (or 12.5 million) of children and adolescents aged 2—19 years are obese. Since 1980, obesity prevalence among children and adolescents has almost tripled. There are significant racial and ethnic disparities in obesity prevalence among U.S. children and adolescents. In 2007—2008, Hispanic boys, aged 2 to 19 years

Causes of weight gain

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When food energy intake exceeds energy expenditure, fat cells (and to a lesser extent muscle and liver cells) throughout the body take in the energy and store it as fat. In its simplest conception, therefore, obesity is only made possible when the lifetime energy intake exceeds lifetime energy expenditure by more than it does for individuals of "normal weight".

In all individuals, the excess energy utilized to generate fat reserves is minute relative to the total number of calories consumed. This means that very fine perturbations in the energy balance can lead to large fluctuations in weight over time. To illustrate, an obese 40 year old who carries 100 lb of adipose tissue has only consumed about 25 more calories per day than he has burned on average - or the equivalent of an apple every three days. In comparison a very lean 40-year-old who carries only 15 lb of body fat will have exceeded his daily energy expenditure by about four calories a day - the equivalent of an apple every 18 days.

Factors that have been suggested to contribute to the development of obesity include:

As with many medical conditions, the caloric imbalance that results in obesity often develops from a combination of genetic and environmental factors. Polymorphisms in various genes controlling appetite, metabolism, and adipokine release predispose to obesity, but the condition requires availability of sufficient calories, and possibly other factors, to develop fully. Various genetic abnormalities that predispose to obesity have been identified (such as Prader-Willi syndrome and leptin receptor mutations), but known single-locus mutations have been found in only about 5% of obese individuals. While it is thought that a large proportion of the causative genes are still to be identified, much obesity is likely the result of interactions between multiple genes, and non-genetic factors are likely also important.

Some eating disorders are associated with obesity, especially binge eating disorder (BED). As the name indicates, patients with this disorder are prone to overeat, often in binges. A proposed mechanism is that the eating serves to reduce anxiety, and some parallels with substance abuse can be drawn. An important additional factor is that BED patients often lack the ability to recognize hunger and satiety, something that is normally learned in childhood. Learning theory suggests that early childhood conceptions may lead to an association between food and a calm mental state.


What went wrong with our diet?

Instead of blaming the victim for obesity, or yourself for obesity, it is important to understand what drives the weight gain, such as insulin resistance that affects up to 71 percent of the entire population out of which 35 percent already have metabolic syndrome.

Confusing choices

With over 20,000 books written on this topic with so much misleading information, let a trained practicing weight loss physician, Dr Prab R. Tumpati,MD educate you on the true science and art of obesity medicine.

Why the food pyramid failed?

The now withdrawn and failed food guide pyramid was a disaster as it advocated a low fat, but glycemic diet that leads to increased risk of insulin resistance which in turn causes weight gain.

Metabolic starvation in the obese

Most people that gain weight are not on a mission to gain weight intentionally. It is the paradoxical metabolic starvation that happens in the obese due to insulin resistance with a compensatory increase in the anabolic hormone called insulin that drives weight gain, hunger and metabolic starvation leading to food cravings, and weight gain!

3 things wrong with our diet | How insulin resistance causes weight gain? | Causes of weight gain | Skin tags and insulin resistance | Sugar rush and crash | How to lose weight? | Weight loss information

Ted Talks: Why blaming the obese is blaming the victim?

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Evolutionary aspects

Although there is no definitive explanation for the recent increase of obesity, the thrifty gene hypothesis provides some understanding of this phenomenon, and suggests why certain populations and individuals may be more prone to obesity than others. In times when food was scarce, the ability to take advantage of rare periods of abundance and use such abundance by storing energy efficiently was undoubtedly an evolutionary advantage. Individuals with greater adipose reserves were more likely to survive famine. This tendency to store fat is likely maladaptive in a society with adequate and stable food supplies. Although many people likely have a genetic propensity towards obesity, in most cases this propensity requires the modern environment with increased caloric availability and decreased requirements for physical labor in order to be expressed fully.

Neurobiological mechanisms

Flier summarizes the many possible pathophysiological mechanisms involved in the development and maintenance of obesity. This field of research had been almost unapproached until leptin was discovered in 1994. Since this discovery, many other hormonal mechanisms have been elucidated that participate in the regulation of appetite and food intake, storage patterns of adipose tissue, development of insulin resistance. Since leptin's discovery, ghrelin, orexin, PYY 3-36, cholecystokinin, adiponectin, and many other mediators have been studied. The adipokines are mediators produced by adipose tissue; their action is thought to modify many obesity-related diseases.

Leptin and ghrelin are considered to be complementary in their influence on appetite, with ghrelin produced by the stomach modulating short-term appetitive control (i.e. to eat when the stomach is empty and to stop when the stomach is stretched). Leptin is produced by adipose tissue to signal fat storage reserves in the body, and mediates long-term appetitive controls (i.e. to eat more when fat storages are low and less when fat storages are high). Although administration of leptin may be effective in a small subset of obese individuals who are leptin-deficient, many more obese individuals are thought to be leptin-resistant, and this resistance has been implicated in obesity in some people, is thought to explain in part why administration of leptin has not been shown to be effective in suppressing appetite in most obese subjects.

Neuroscientific approaches hinge on the action of the aforementioned mediators on the hypothalamus, the part of the brain that is thought to process signals related to metabolic state and energy storage and to shift the energy balance in either a positive or negative direction, primarily by acting on appetite and energy expenditure. Lesion studies in the 1940s and 1950s identified two regions of the hypothalamus — the lateral hypothalamus (LH) and ventromedial hypothalamus (VMH) — as the brain's hunger and satiety centers, respectively. Specific lesions to a mouse's LH suppressed its appetite while damaging the VMH caused overeating.

Studies of the distribution of the leptin receptor in the mid-1990s cast doubt upon this dual center theory of hunger and satiety. Leptin's effect on the arcuate nucleus melanocortin system is now considered central to the regulation of feeding and metabolism.

What went wrong with our diet?

Instead of blaming the victim for obesity, or yourself for obesity, it is important to understand what drives the weight gain, such as insulin resistance that affects up to 71 percent of the entire population out of which 35 percent already have metabolic syndrome.

Confusing choices

With over 20,000 books written on this topic with so much misleading information, let a trained practicing weight loss physician, Dr Prab R. Tumpati,MD educate you on the true science and art of obesity medicine.

Why the food pyramid failed?

The now withdrawn and failed food guide pyramid was a disaster as it advocated a low fat, but glycemic diet that leads to increased risk of insulin resistance which in turn causes weight gain.

Metabolic starvation in the obese

Most people that gain weight are not on a mission to gain weight intentionally. It is the paradoxical metabolic starvation that happens in the obese due to insulin resistance with a compensatory increase in the anabolic hormone called insulin that drives weight gain, hunger and metabolic starvation leading to food cravings, and weight gain!

3 things wrong with our diet | How insulin resistance causes weight gain? | Causes of weight gain | Skin tags and insulin resistance | Sugar rush and crash | How to lose weight? | Weight loss information

Ted Talks: Why blaming the obese is blaming the victim?

52 weeks of weight loss and wellness videos

Poverty link

Some obesity co-factors are resistant to the theory that the "epidemic" is a new phenomenon. In particular, a class co-factor consistently appears across many studies. Comparing net worth with BMI scores, a 2004 study found obese American subjects approximately half as wealthy as thin ones. When income differentials were factored out, the inequity persisted — thin subjects were inheriting more wealth than fat ones. Another study finds women who married into higher status predictably thinner than women who married into lower status.

Health Consequences of Obesity

Obesity increases the risk of over 50 health conditions, including, but not limited to the following:

In fact, losing weight has many preventive benefits that up to 90 percent of diabetes, 80 percent of cardiovascular diseases and 60% of cancers could be prevented with weight loss and other lifestyle interventions according research.

Cost of Obesity

In 2008, overall medical care costs related to obesity for U.S. adults were estimated to be as high as $147 billion. People who were obese had medical costs that were $1,429 higher than the cost for people of normal body weight. Obesity also has been linked with reduced worker productivity and chronic absence from work. Obesity also comes at a steep individual cost as one study from George Washington University found that the average annual cost of obesity can as high as $4,879 for a woman, $2,646 for a man!

Complications

Obesity, especially central obesity (male-type or waist-predominant obesity), is an important risk factor for the "metabolic syndrome" ("syndrome X"), the clustering of a number of diseases and risk factors that heavily predispose for cardiovascular disease. These are diabetes mellitus type 2, high blood pressure, high blood cholesterol, and triglyceride levels (combined hyperlipidemia). An inflammatory state is present, which — together with the above — has been implicated in the high prevalence of atherosclerosis (fatty lumps in the arterial wall), and a prothrombotic state may further worsen cardiovascular risk.

Apart from the metabolic syndrome, obesity is also correlated (in population studies) with a variety of other complications. For many of these complaints, it has not been clearly established to what extent they are caused directly by obesity itself, or have some other cause (such as limited exercise) that causes obesity as well. Most confidence in a direct cause is given to the mechanical complications in the following list, compiled by the American Medical Association for general physicians:

While being severely obese has many health ramifications, those who are somewhat overweight face little increased mortality or morbidity. Some studies suggest that the somewhat "overweight" tend to live longer than those at their "ideal" weight [1]. This may in part be attributable to lower mortality rates in diseases where death is either caused or contributed to by significant weight loss due to the greater risk of being underweight experienced by those in the ideal category. Another factor which may confound mortality data is smoking, since obese individuals are less likely to smoke. Osteoporosis is known to occur less in slightly overweight people.

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Sleep disorders and weigh gain?

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Therapy

The mainstay of treatment for obesity is an energy-limited diet and increased exercise. In studies, diet and exercise programs have consistently produced an average weight loss of approximately 8% of total body mass on average (excluding study drop-outs). While not all dieters will be satisfied with this outcome, studies have shown that a loss of as little as 5% of body mass can create enormous health benefits.

A more intractable therapeutic problem appears to be weight loss maintenance. Of dieters who manage to lose 10% or more of their body mass in studies, 80-95% will regain that weight within two to five years. It appears that the homeostatic mechanisms regulating body weight are very robust (see leptin, for example), and vigorously defend against weight loss. Much important research is now being devoted to determining what factors can improve the currently dismal weight loss maintenance rates.

Recent scientific research has cast some doubt over whether or not dieting actually improves health, with some studies indicating that dieting may in fact be more detrimental than remaining overweight.

In a clinical practice guideline by the American College of Physicians, the following five recommendations are made:

  1. People with a BMI of over 30 should be counseled on diet, exercise and other relevant behavioral interventions, and set a realistic goal for weight loss.
  2. If these goals are not achieved, pharmacotherapy can be offered. The patient needs to be informed of the possibility of side-effects and the unavailability of long-term safety and efficacy data.
  3. Drug therapy may consist of sibutramine, orlistat, phentermine, diethylpropion, fluoxetine, and bupropion. For more severe cases of obesity, stronger drugs such as amphetamine and methamphetamine may be used on a selective basis. Evidence is not sufficient to recommend sertraline, topiramate, or zonisamide.
  4. In patients with BMI > 40 who fail to achieve their weight loss goals (with or without medication) and who develop obesity-related complications, referral for bariatric surgery may be indicated. The patient needs to be aware of the potential complications.
  5. Those requiring bariatric surgery should be referred to high-volume referral centers, as the evidence suggests that surgeons who frequently perform these procedures have fewer complications.

Much research focuses on new drugs to combat obesity, which is seen as the biggest health problem facing developed countries. Nutritionists and many doctors feel that these research funds would be better devoted to advice on good nutrition, healthy eating, and promoting a more active lifestyle.

Medication most commonly prescribed for diet/exercise-resistant obesity is orlistat (Xenical®, which reduces intestinal fat absorption by inhibiting pancreatic lipase) and sibutramine (Reductil®, Meridia®, an anorectic). In the presence of diabetes mellitus, there is evidence that the anti-diabetic drug metformin (Glucophage®) can assist in weight loss — rather than sulfonylurea derivatives and insulin, which often lead to further weight gain. The thiazolidinediones (rosiglitazone or pioglitazone) can cause slight weight gain, but decrease the "pathologic" form of abdominal fat, and are therefore often used in obese diabetics.

Although bariatric surgery is being used sometimes to combat obesity, there are many non-surgical weight loss options for losing weight. The most common weight loss surgery in Europe and Australia is the adjustable gastric band where a silicone ring is placed around the top of the stomach to help restrict the amount of food eaten in a sitting. This surgery has been FDA approved in the United States since 2001 but has been being used in other parts of the world since the early 1990s. It is considered the safest and least invasive of the available weight loss surgeries such as Roux-en-Y gastric bypass surgery (RNY), biliopancreatic diversion, and stomach stapling (also known as "vertical banded gastroplasty", VBG). Unlike those more invasive techniques the band surgery does not cut into or reroute any of the digestive tract and is completely reversible. Removing the implant returns the stomach to its pre-surgical norm. All of these surgeries can be done laparoscopically. The more invasive of the surgeries usually bypass or remove some portion of the patient's intestines which causes malabsorption and dumping.

All of these surgeries come with risk to the patient. For instance a recent study by the U.S. Department of Health and Human Service showed a 40% complication rate within 180 days of bariatric surgery. Moreover these surgeries do not guarantee either successful weight loss or reduced morbidity and mortality. Patients are also required to to make lifelong changes to their diet if they are to keep the lost weight off in the long term. Therefore, as with any major surgery, patients needs to carefully evalute the long term ramifications of their choice.

Cultural and social significance

Etymology

Obesity is the nominal form of obese which comes from the Latin obēsus, which means "stout, fat, or plump." Ēsus is the past participle of edere (to eat), with ob added to it. In Classical Latin, this verb is seen only in past participial form. Its first attested usage in English was in 1651, in Noah Biggs's Matæotechnia Medicinæ Praxeos

Culture and obesity

In several human cultures, obesity is associated with physical attractiveness, strength, and fertility. Some of the earliest known cultural artifacts, known as Venus figurines, are pocket-sized statuettes representing an obese female figure. Although their cultural significance is unrecorded, their widespread use throughout pre-historic Mediterranean and European cultures suggests a central role for the obese female form in magical rituals, and suggests cultural approval of (and perhaps reverence for) this body form. This is most likely due to their ability to easily bear children and survive famine.

In contrast, in modern Western culture, a more slender body shape is more typically considered desirable. "Thinness" is often considered more important for women than men.

Obesity was occasionally considered a symbol of wealth and social status in cultures prone to food shortages or famine. Well into the early modern period in European cultures, it often served this role. But as food security was realised, it came to serve more as a visible signifier of "lust for life", appetite, and immersion in the realm of the erotic. This was especially the case in the visual arts, such as the paintings of Rubens (15771640), whose regular use of the full female figures gives us the description Rubenesque for plumpness. Obesity can also be seen as a symbol within a system of prestige. "The kind of food, the quantity, and the manner in which it is served are among the important criteria of social class. In most tribal societies, even those with a highly stratified social system, everyone - royalty and the commoners - ate the same kind of food, and if there was famine everyone was hungry. With the ever increasing diversity of foods, food has become not only a matter of social status, but also a mark of one's personality and taste."

Not all contemporary cultures disapprove of obesity, although the Western preference for thinness is increasingly being exported worldwide as part of the process of globalization. Few cultures have escaped the "Westernization" of body shape preference, though cultures which are traditionally more approving (to varying degrees), include some African, Arabic, Indian, and Pacific Island cultures. Especially in the past decades, obesity has come to be seen more as a medical condition. There is also a small but vocal fat acceptance movement that seeks to challenge weight-based discrimination.

Popular culture

Various stereotypes of obese people have found their way into expressions of popular culture. A common stereotype is the obese character who has a warm and dependable personality, but equally common is the obese vicious bully. Gluttony and obesity are commonly depicted together in works of fiction. In cartoons, obesity is often used to comedic effect, with fat cartoon characters having to squeeze through narrow spaces, frequently getting stuck or even exploding.

It can be argued that depiction in popular culture adds to and maintains commonly perceived stereotypes, in turn harming self esteem of obese people. A charge of discrimination on the basis of appearance could be leveled against these depictions.

On the other hand, obesity is often associated with positive characteristics such as good humor (the stereotype of the jolly fat man like Santa Claus), and some people are more sexually attracted to obese people than to slender people (see chubby culture, fat admirer).

Public health and policy

The prevalence of overweight and obesity in the United States makes obesity a leading public health problem. From 1980 to 2002, obesity prevalence has doubled in adults and overweight prevalence has has tripled in children and adolescents. From 2003-2004, "children and adolescents aged 2 to 19 years, 17.1% were overweight...and 32.2% of adults aged 20 years or older were obese.” The prevalence in the United States continues to rise.

Environmental causes of obesity

While it may often appear obvious why a certain individual gets fat, it is far more difficult to understand why the average weight of certain societies have recently been growing. While genetic causes are central to understanding obesity, they cannot fully explain why one culture grows fatter than another.

This is most notable in the United States. In the years from just after the Second World War until 1960 the average person's weight increased, but few were obese. In the two and a half decades since 1980 the growth in the rate of obesity has accelerated markedly and is increasingly becoming a public health concern.

There are a number of theories as to the cause of this change since 1980. Most believe it is a combination of various factors.

Causes and consequences of starchy, cereal based diet

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Why exercise alone is useless for weight loss?

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  • Lack of activity: obese people appear to be less active in general than lean people, and not just because of their obesity. A controlled increase in calorie intake of lean people did not make them less active; correspondingly when obese people lost weight they did not become more active. Weight change does not affect activity levels, but the converse seems to be the case.
  • One of the most important is the much lower relative cost of foodstuffs: massive changes in agricultural policy in the United States and Europe have led to food prices for consumers being lower than at any point in history. Sugar and corn syrup, two huge sources of food energy, are some of the most subsidized products by the United States government. This can raise costs for consumers in some areas but greatly lower it in others. Current debates into trade policy highlight disagreements on the effects of subsidies.
  • Increased marketing has also played a role. In the early 1980s in America the Reagan administration lifted most regulations pertaining to sweets and fast food advertising to children. As a result, the number of advertisements seen by the average child increased greatly, and a large proportion of these were for fast food and sweets.
  • Changes in the price of mineral oil and petrol are also believed to have had an effect, as unlike during the 1970s it is now affordable in the United States to drive everywhere — at a time when public transit goes underused. At the same time more areas have been built without sidewalks and parks.
  • A social cause that is believed by many to play a role is the increasing number of two income households in which one parent no longer remains home to look after the house. This increases the number of restaurant and take-out meals.
  • Urban sprawl may be a factor: obesity rates increase as urban sprawl increases, possibly due to less walking and less time for cooking.
  • Since 1980 both sit-in and fast food restaurants have seen dramatic growth in terms of the number of outlets and customers served. Low food costs, and intense competition for market share, led to increased portion sizes — for example, McDonalds french fries portions rose from 200 Calories (840 kilojoules) in 1960 to over 600 Calories (2,500 kJ) today.
  • Increased food production is a probable factor. The U.S. produces three times more food than U.S. residents eat.
  • Increasing affluence itself (including many of the above factors as accompaniments of affluence) may be a cause, or contributing factor since obesity tends to flourish as a disease of affluence in countries which are developing and becoming westernised [2]. This is supported by a dip in American GDP after 1990, the year of the Gulf War, followed by an exponential increase. U.S. obesity statistics followed the same pattern, offset by two years [3].
  • An aging population may also be a major factor, as the likelihood of becoming obese increases with age. Beyond their twenties, the older a person becomes the slower their metabolism becomes, reducing the amount of calories required to sustain the body, thus if a person does not reduce their intake of food with age, they will become obese over time. As the average age of individuals within a society increases, the rate of obesity also increases. This situation is exacerbated by the baby boom generation, which represents a disproportionately large portion of the population in many countries and is currently nearing the latter end of the typical lifespan in affluent nations, and therefore is in the high-risk zone for obesity.

Interestingly an increase in the number of Americans who exercise and diet occurred before the increase in obesity, and some scholars have even argued that these trends actually encouraged obesity. Nearly all diets fail, with participants resuming their previous eating habits or even engaging in binge eating. Many then see an overall increase in their weight. If the diet is then repeated and abandoned again, a pattern of rising and falling weight is established, known as weight cycling. Similarly those who work out but then stop can end up being heavier than those who never exercised.

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  • Our experienced weight loss doctors understand the complex causes of weight gain.
  • We use the best tools to help burn fat fast and effectively unlike many fad diets that make you lose weight by losing muscle.
  • We offer delicious, low cost and affordable weight loss supplements or meal replacements to help reduce caloric intake and burn fat.
  • We offer FDA approved weight loss medications or diet pills to help control hunger, reduce cravings and burn unhealthy fat.

Prab R. Tumpati, MD Founder, WikiMD & W8MD

Dr Tumpati is a board certified physician with significant practice experience in managing sleep disorders, internal medicine, aesthetic and obesity medicine. As one of the few physicians that have the privilege of a fellowship training in Obesity Medicine, Dr Tumpati is very passionate about educating the public and physicians about how some of the nutritional concepts were misunderstood. As the founder of W8MD Weight Loss, Sleep and MedSpa centers, Dr Tumpati is the medical director for the New York, New Jersey and Pennsylvania locations and commutes weekly between the locations.

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How Can W8MD Help?

W8MD’s insurance physician weight loss program is unique in many ways with a comprehensive multidisciplinary approach to weight loss that addresses all the complex issues leading to weight gain, both in adults and children. Since its inception in 2011, W8MD has successfully helped thousands of patients succeed in not only losing weight but also keep it off with an ongoing maintenance plan.

Sleep medicine program uses state of the art technology including the convenient home sleep studies or in lab sleep diagnostic studies to diagnose and treat over 80 different sleep disorders including sleep apnea, narcolepsy, restless leg syndrome, insomnia to name a few. Learn more…

Medical aesthetic program offers a wide variety of advanced laser skin treatments including oxygen super facials, photofacials, microneedling, PRP (Platelet Rich Plasma) therapy, non-ablative laser skin resurfacing,botox, fillers and aesthetic treatments. The variety of technology and technique, combined with knowledgeable staff, allows doctors to customize treatment plans to each patient. One-size-fits-all procedures are not performed at W8MD Weight Loss, Sleep & Aesthetic Centers. Learn more…

IM and IV nutrition therapy includes booster shots for B12, vitamin B complex, Vitamin C, Detox treatments and IV nutrition therapy. Studies have shown that as many as 39% of those taking vitamins on a regular basis in a nursing home setting were not absorbing the same vitamins they are taking by mouth leading to significant deficiencies. Learn more…

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W8MD weight loss, sleep and medspa center locations

Pennsylvania

Call 215-676-2334

New York

2632 E 21st Street Ste L2 Brooklyn New York 11235.

Call 718-946-5500

New Jersey

  • W8MD's NJ weight loss, sleep and medical spa in New Jersey at Cherry Hill, NJ at 140 E. Evesham Road, Cherry Hill, NJ 08003.

Call 800-W8MD-007

Weight loss success stories | Physicians join w8md weight loss physician network.

Public health and policy responses to obesity

On top of controversies about the causes of obesity, and about its precise health implications, come policy controversies about the correct policy approach to obesity. The main debate is between "personal responsibility" advocates, who resist regulatory attempts to intervene in citizen's private dietary habits, and "public interest" advocates, who promote regulations, on the same public health grounds as the restrictions applied to tobacco products. In the U.S., a recent bout in this controversy involves the so-called Cheeseburger Bill, an attempt to indemnify food industry businesses from what some consider to be frivolous lawsuits by obese clients.

"Personal responsibility" advocates work on the basis that, as the microbiologist Rene Dubos once said, health ought not to be considered an end in itself, but "the condition best suited to reach goals that each individual formulates for himself" [4]. Any other definition permits authorities to curtail the autonomy of the self-determining individual, imposing quantity over quality of life onto them, undermining their civil liberties. As much as principled doctors, personal responsibility arguments have also been offered by food producer lobbies. In 1961, for example, as President John F Kennedy raised concerns about a lack of fitness in American society, a spokesman for the U.S. Dairy industry, Frank R. Neu, wrote advertorials warning We May Be Sitting Ourselves To Death [5]. Not food regulation, but personal exercising, is moved as the solution.

When it comes to childhood obesity, personal responsibility also means parental responsibility. A survey by the nonpartisan group Public Agenda found 68 percent of American parents said it was "absolutely essential" to teach their children good eating habits, but only 40 percent believe they had succeeded. Fewer parents say it's essential to teach their children about physical fitness (51 percent), but more believe they have succeeded (53 percent). Overall, parents said they found it difficult to protect their children from negative social messages on a range of topics, including bad nutrition.


On July 16, 2004, the United States Department of Health and Human Services officially classified obesity as a disease. Speaking to a Senate committee, Tommy Thompson, the Secretary of Health and Human Services, stated that Medicare would cover obesity-related health problems. However, reimbursement would not be given if a treatment was not proven to be effective.

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If you are a medical professional or an expert in any field of medicine, please join us in building the world's largest weight loss and wellness encyclopedia created by experts in the field, not by the crowd. WikiMD is sponsored by W8MD weight loss, sleep and medical aesthetic centers


W8MD Weight Loss, Sleep & Medical Aesthetic Centers

Since its inception in 2011, W8MD’s insurance physician weight loss program has successfully helped thousands of patients succeed in not only losing weight but also keep it off with an ongoing maintenance plan.

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