Difference between revisions of "Obesity"

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'''Obesity''' is a [[medical condition]] in which excess [[body fat]] has accumulated to the extent that it may have a negative effect on health, leading to reduced [[life expectancy]] and/or increased health problems.<ref name="HaslamJames" /> People are considered obese when their [[body mass index]] (BMI), a measurement obtained by dividing a person's weight by the square of the person's height, exceeds 30 kg/m2.
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Overweight and obesity are increasingly common conditions in the United States. They are caused by the increase in the size and the amount of fat cells in the body. Doctors measure body mass index (BMI) and waist circumference to screen and diagnose overweight and obesity. Obesity is a serious medical condition that can cause complications such as metabolic syndrome, high blood pressure, atherosclerosis, heart disease, diabetes, high blood cholesterol, cancers and sleep disorders. Treatment depends on the cause and severity of your condition and whether you have complications. Treatments include lifestyle changes, such as heart-healthy eating and increased physical activity, and Food and Drug Administration (FDA)-approved weight-loss medicines. For some people, surgery may be a treatment option.
  
[[File:Obesity.jpg|left|600px]]
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<br />
Obesity increases the likelihood of [[Obesity-associated morbidity|various diseases]], particularly [[heart disease|heart disease]], [[diabetes mellitus type 2|type 2 diabetes]], [[obstructive sleep apnea|sleep apnea]], certain types of [[cancer]], and [[osteoarthritis]].<ref name="HaslamJames" /> Obesity is most commonly caused by a combination of excessive [[food energy]] intake, lack of physical activity, and [[Polygenic inheritance|genetic susceptibility]], although a few cases are caused primarily by [[gene]]s, [[endocrine]] disorders, [[medication]]s or [[psychiatric illness]]. Evidence to support the view that some obese people eat little yet gain weight due to a slow metabolism is limited. On average obese people have a greater energy expenditure than their thin counterparts due to the energy required to maintain an increased body mass.
 
  
[[Dieting]] and [[physical exercise]] are the mainstays of treatment for obesity. Diet quality can be improved by reducing the consumption of energy-dense foods such as those high in fat and sugars, and by increasing the intake of [[dietary fiber]]. [[Anti-obesity drug]]s may be taken to reduce appetite or decrease fat absorption when used together with a suitable diet. If diet, exercise and medication are not effective, a [[gastric balloon]] may assist with weight loss, or [[bariatric surgery|surgery]] may be performed to reduce stomach volume and/or bowel length, leading to feeling full earlier and a reduced ability to absorb nutrients from food.
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== Causes- Overweight and Obesity ==
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Energy imbalances, somegenetic or endocrine medical conditions, and certain medicines are known to cause overweight or obesity.
  
Obesity is a leading [[preventable causes of death|preventable cause of death]] worldwide, with increasing rates in adults and [[childhood obesity|children]]. Authorities view it as one of the most serious [[public health]] problems of the 21st&nbsp;century. Obesity is [[Weight stigma|stigmatized]] in much of the modern world (particularly in the [[Western world]]), though it was widely seen as a symbol of wealth and fertility at other times in history, and still is in some parts of the world.<ref name="HaslamJames" /><ref name="Woodhouse" /> In 2013, the [[American Medical Association]] classified obesity as a disease.
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=== - Overweight and Obesity ===
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Energy imbalances can cause overweight and obesity. An energy imbalance means that your energy IN does not equal your energy OUT. This energy is measured in calories. Energy IN is the amount of calories you get from food and drinks. Energy OUT is the amount of calories that your body uses for things such as breathing, digesting, being physically active, and regulating body temperature.
  
==Classification==
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Overweight and obesity develop over time when you take in more calories than you use, or when energy IN is more than your energy OUT. This type of energy imbalance causes your body to store fat.
{{Main|Classification of obesity}}
 
Obesity is a [[medical condition]] in which excess [[body fat]] has accumulated to the extent that it may have an adverse effect on health.<ref name="WHO 2000 p.6" /> It is defined by [[body mass index|body mass index (BMI)]] and further evaluated in terms of fat distribution via the [[waist-hip ratio|waist–hip ratio]] and total cardiovascular risk factors.  BMI is closely related to both [[Body fat percentage|percentage body fat]] and total body fat.
 
  
In children, a healthy weight varies with age and sex. Obesity in children and adolescents is defined not as an absolute number but in relation to a historical normal group, such that obesity is a BMI greater than the 95th&nbsp;[[percentile]].  The reference data on which these percentiles were based date from 1963 to 1994, and thus have not been affected by the recent increases in weight.
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Your body uses certain nutrients such as carbohydrates or sugars, proteins, and fats from the foods you eat to:
  
{| class="wikitable" style="float: right; margin-left:15px; text-align:center"
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* '''make energy''' for immediate use to power routine daily body functions and physical activity.
|-
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* '''store energy''' for future use by your body. Sugars are stored asglycogen in the liver and muscles. Fats are stored mainly as triglyceride in fat tissue.
!BMI (kg/m<sup>2</sup>)!!Classification
 
|-
 
| width="50%" |< 18.50||underweight
 
|-
 
|18.50–24.99||normal weight
 
|-
 
|25.00–29.99||overweight
 
|-
 
|30.00–34.99||class I obesity
 
|-
 
|35.00–39.99||class II obesity
 
|-
 
|≥ 40.00||&nbsp;&nbsp;class III obesity&nbsp;&nbsp;
 
|}
 
  
BMI is defined as the subject's weight divided by the square of their height and is calculated as follows.
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The amount of energy that your body gets from the food you eat depends on the type of foods you eat, how the food is prepared, and how long it has been since you last ate.
  
:<math>\mathrm{BMI}= \frac{m}{h^2}</math>
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The body has three types of fat tissue—white, brown, and beige—that it uses to fuel itself, regulate its temperature in response to cold, and store energy for future use. Learn about the role of each fat type in maintaining energy balance in the body.
  
:where ''m'' and ''h'' are the subject's weight in kilograms and height in meters respectively.
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* '''White''' fat tissue can be found around the kidneys and under the skin in the buttocks, thighs, and abdomen. This fat type stores energy, makes hormone that control the way the body regulates urges to eat or stop eating, and makesinflammatory substances that can lead to complications.
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* '''Brown''' fat tissue is located in the upper back area of human infants. This fat type releases stored energy as heat energy when a baby is cold. It also can make inflammatory substances. Brown fat can be seen in children and adults.
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* '''Beige''' fat tissue is seen in the neck, shoulders, back, chest and abdomen of adults and resembles brown fat tissue. This fat type, which uses carbohydrates and fats to produce heat, increases when children and adults are exposed to cold.
  
BMI is usually expressed in kilograms per square metre. To convert from pounds per square inch multiply by {{nowrap|703 (kg/m<sup>2</sup>)/(lb/sq in)}}.
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=== - Overweight and Obesity ===
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Some genetic syndromes and endocrine disorders can cause overweight or obesity.
  
The most commonly used definitions, established by the [[World Health Organization]] (WHO) in 1997 and published in 2000, provide the values listed in the table at right.<ref name="WHO 2000 p.9" />
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=== Genetic syndromes ===
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Several genetic syndromes are associated with overweight and obesity, including the following.
  
Some modifications to the WHO definitions have been made by particular bodies. The surgical literature breaks down "class III" obesity into further categories whose exact values are still disputed.
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* Prader-Willi syndrome
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* Bardet-Biedl syndrome
 +
* Alström syndrome
 +
* Cohen syndrome
  
*Any BMI ≥ 35 or 40&nbsp;kg/m<sup>2</sup> is ''severe obesity''
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The study of these genetic syndromes has helped researchers understand obesity.
*A BMI of ≥ 35&nbsp;kg/m<sup>2</sup> and experiencing obesity-related health conditions or ≥40–44.9&nbsp;kg/m<sup>2</sup> is ''morbid obesity''
 
*A BMI of ≥ 45 or 50&nbsp;kg/m<sup>2</sup> is ''super obesity''
 
  
As Asian populations develop negative health consequences at a lower BMI than Caucasians, some nations have redefined obesity; the Japanese have defined obesity as any BMI greater than 25&nbsp;kg/m<sup>2</sup> while China uses a BMI of greater than 28&nbsp;kg/m<sup>2</sup>.
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=== Endocrine disorders ===
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Because the endocrine system produces hormones that help maintain energy balances in the body, the following endocrine disorders or tumor affecting the endocrine system can cause overweight and obesity.
  
==Effects on health==
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* '''Hypothyroidism'''. People with this condition have low levels of thyroid hormones. These low levels are associated with decreased metabolism and weight gain, even when food intake is reduced. People with hypothyroidism also produce less body heat, have a lower body temperature, and do not efficiently use stored fat for energy.
<!-- [[Effects of obesity on health]] links here, please make corresponding changes if altering this section title or removing the anchor tag. -->
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* '''Cushing’s syndrome.''' People with this condition have high levels of glucocorticoids, such ascortisol, in the blood. High cortisol levels make the body feel like it is underchronic stress. As a result, people have an increase in appetite and the body will store more fat. Cushing’s syndrome may develop after taking certain medicines or because the body naturally makes too much cortisol.
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* '''Tumors'''. Some tumors, such as craneopharingioma, can cause severe obesity because the tumors develop near parts of the brain that control hunger.
  
Excessive body [[Human weight|weight]] is associated with various [[diseases]], particularly [[cardiovascular diseases]], [[diabetes mellitus type 2]], [[obstructive sleep apnea]], certain types of [[cancer]], [[osteoarthritis]]<ref name="HaslamJames" /> and [[asthma]].<ref name="HaslamJames" /><ref name="Poulain" /> As a result, obesity has been found to reduce [[life expectancy]].<ref name="HaslamJames" />
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Medicines such as antipsychotics, antidepressants, antiepileptics, and antihyperglycemics can cause weight gain and lead to overweight and obesity.
  
===Mortality===
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Talk to your doctor if you notice weight gain while you are using one of these medicines. Ask if there are other forms of the same medicine or other medicines that can treat your medical condition, but have less of an effect on your weight'''. Do not stop taking the medicine without talking to your doctor'''.
  
Obesity is one of the leading [[preventable causes of death]] worldwide.<ref name="Barn1999" />  Large-scale American and European studies have found that mortality risk is lowest at a BMI of 20–25&nbsp;kg/m<sup>2</sup><ref name="NEJM10" /> in non-smokers and at 24–27&nbsp;kg/m<sup>2</sup> in current smokers, with risk increasing along with changes in either direction.  A BMI above 32&nbsp;kg/m<sup>2</sup> has been associated with a doubled [[mortality rate]] among women over a 16-year period.  In the United States obesity is estimated to cause 111,909 to 365,000 deaths per year,<ref name="Allison" /> while 1 million (7.7%) of deaths in Europe are attributed to excess weight.<ref name="EuroG2008" />  On average, obesity reduces life expectancy by six to seven&nbsp;years,<ref name="HaslamJames" /> a BMI of 30–35&nbsp;kg/m<sup>2</sup> reduces life expectancy by two to four&nbsp;years,<ref name="Lancet2009" /> while severe obesity (BMI&nbsp;>&nbsp;40&nbsp;kg/m<sup>2</sup>) reduces life expectancy by ten&nbsp;years.<ref name="Lancet2009" />
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Several parts of your body, such as your stomach, intestines, pancreas, and fat tissue, use hormones to control how your brain decides if you are hungry or full. Some of these hormones are insulin, leptin, glucagon-like peptide (GLP-1), peptide YY, and ghrelin.
  
===Morbidity===
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== Risk Factors- Overweight and Obesity ==
{{Main|Obesity-associated morbidity}}
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There are many risk factors for overweight and obesity. Some risk factors can be changed, such as unhealthy lifestyle habits and environments. Other risk factors, such as age, family history and genetics, race and ethnicity, and sex, cannot be changed. Heathy lifestyle changes can decrease your risk for developing overweight and obesity.
Obesity increases the risk of many physical and mental conditions. These comorbidities are most commonly shown in [[metabolic syndrome]],<ref name="HaslamJames" />  a combination of medical disorders which includes: [[diabetes mellitus type 2]], [[hypertension|high blood pressure]], [[hypercholesterolemia|high blood cholesterol]], and [[hypertriglyceridemia|high triglyceride levels]].
 
  
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.
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=== - Overweight and Obesity ===
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Lack of physical activity, unhealthy eating patterns, not enough sleep, and high amounts of stress can increase your risk for overweight and obesity.
  
{{blame}}
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=== Lack of physical activity ===
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Lack of physical activity due to high amounts of TV, computer, videogame or other screen usage has been associated with a highbody mass index. Healthy lifestyle changes, such as being physically active and reducing screen time, can help you aim for a healthy weight.
  
Health consequences fall into two broad categories: those attributable to the effects of increased fat mass (such as [[osteoarthritis]], [[obstructive sleep apnea]], social stigmatization) and those due to the increased number of [[fat cells]] ([[diabetes mellitus|diabetes]], [[cancer]], [[cardiovascular disease]], [[non-alcoholic fatty liver disease]]).<ref name="HaslamJames" />  Increases in body fat alter the body's response to insulin, potentially leading to [[insulin resistance]]. Increased fat also creates a [[inflammation|proinflammatory state]], and a [[thrombosis|prothrombotic]] state.<ref name="Bray2004" />
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=== Unhealthy eating behaviors ===
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Some unhealthy eating behaviors can increase your risk for overweight and obesity.
  
{| class="wikitable"
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* '''Eating more calories than you use'''. The amount of calories you need will vary based on your sex, age, and physical activity level. Find out your daily calorie needs or goals with the Body Weight Plannerexternal link.
|-
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* '''Eating too much saturated and ''trans'' fats'''
!Medical field
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* '''Eating foods high in added sugars'''
!Condition
 
!Medical field
 
!Condition
 
|-
 
<!--Alphabetized-->| width="10%" |[[Cardiology]]
 
|
 
*[[ischemic heart disease]]: [[angina pectoris|angina]] and [[myocardial infarction]]
 
*[[congestive heart failure]]<ref name="HaslamJames" />
 
*[[high blood pressure]]<ref name="HaslamJames" />
 
*[[Dyslipidemia|abnormal cholesterol levels]]<ref name="HaslamJames" />
 
*[[deep vein thrombosis]] and [[pulmonary embolism]]
 
|<!--Alphabetized-->[[Dermatology]]
 
|
 
*[[stretch marks]]<ref name="derm2007" />
 
*[[acanthosis nigricans]]
 
*[[lymphedema]]<ref name="derm2007" />
 
*[[cellulitis]]<ref name="derm2007" />
 
*[[hirsutism]]<ref name="derm2007" />
 
*[[intertrigo]]
 
|-
 
|<!--Alphabetized-->[[Endocrinology]] and [[Reproductive medicine]]
 
|
 
*[[diabetes mellitus]]<ref name="HaslamJames" />
 
*[[polycystic ovarian syndrome]]<ref name="HaslamJames" />
 
*[[menstruation|menstrual]] disorders<ref name="HaslamJames" />
 
*[[infertility]]<ref name="HaslamJames" />
 
*[[Maternal obesity|complications during pregnancy]]<ref name="HaslamJames" /><ref name="OBGYN2008" />
 
*[[birth defects]]<ref name="HaslamJames" />
 
*[[Stillbirth|intrauterine fetal death]]<ref name="OBGYN2008" />
 
|<!--Alphabetized-->[[Gastrointestinal]]
 
|
 
*[[gastroesophageal reflux disease]]<ref name="HaslamJames" />
 
*[[non-alcoholic fatty liver disease|fatty liver disease]]<ref name="HaslamJames" />
 
*[[cholelithiasis]] (gallstones)<ref name="HaslamJames" />
 
|-
 
|<!--Alphabetized-->[[Neurology]]
 
| style="width:40%;" |
 
*[[stroke]]<ref name="HaslamJames" />
 
*[[meralgia paresthetica]]
 
*[[migraines]]
 
*[[carpal tunnel syndrome]]
 
*[[dementia]]
 
*[[idiopathic intracranial hypertension]]
 
*[[multiple sclerosis]]
 
|<!--Alphabetized-->[[Oncology]]
 
|
 
*[[breast cancer|breast]], [[ovarian cancer|ovarian]]
 
*[[esophageal cancer|esophageal]], [[colorectal cancer|colorectal]]
 
*[[hepatocellular carcinoma|liver]], [[pancreatic cancer|pancreatic]]
 
*[[Gallbladder cancer|gallbladder]], [[stomach cancer|stomach]]
 
*[[Endometrial cancer|endometrial]], [[cervical cancer|cervical]]
 
*[[prostate cancer|prostate]], [[Renal cell carcinoma|kidney]]
 
*[[non-Hodgkin's lymphoma]], [[multiple myeloma]]
 
|-
 
| style="width:10%;" |<!--Alphabetized-->[[Psychiatry]]
 
| style="width:40%;" |
 
*[[Major depressive disorder|depression]] in women<ref name="HaslamJames" />
 
*social [[Social stigma|stigmatization]]<ref name="HaslamJames" />
 
|<!--Alphabetized-->[[Respirology]]
 
|
 
*[[sleep apnea|obstructive sleep apnea]]<ref name="HaslamJames" />
 
*[[obesity hypoventilation syndrome]]<ref name="HaslamJames" /><ref name="Poulain" />
 
*[[asthma]]<ref name="HaslamJames" /><ref name="Poulain" />
 
*increased complications during [[general anaesthesia]]<ref name="HaslamJames" /><ref name="Anes2000" />
 
|-
 
|<!--Alphabetized-->[[Rheumatology]] and [[Orthopedics]]
 
|
 
*[[gout]]
 
*poor mobility
 
*[[osteoarthritis]]<ref name="HaslamJames" />
 
*[[low back pain]]
 
|<!--Alphabetized-->[[Urology]] and [[Nephrology]]
 
|
 
*[[erectile dysfunction]]
 
*[[urinary incontinence]]
 
*[[chronic renal failure]]
 
*[[hypogonadism]]
 
*[[buried penis]]
 
|}
 
  
{{1-5}}
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Visit Heart-healthy eating for more information about healthy eating patterns.
===Survival paradox===
 
{{See also|Obesity paradox}}
 
Although the negative health consequences of obesity in the general population are well supported by the available evidence, health outcomes in certain subgroups seem to be improved at an increased BMI, a phenomenon known as the obesity survival paradox. The paradox was first described in 1999 in overweight and obese people undergoing hemodialysis,<ref name="Schmidt2007" /> and has subsequently been found in those with [[heart failure]] and [[Peripheral vascular disease|peripheral artery disease]] (PAD).
 
  
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. 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. Even after [[Coronary artery bypass surgery|cardiac bypass surgery]], no increase in mortality is seen in the overweight and obese.  One study found that the improved survival could be explained by the more aggressive treatment obese people receive after a cardiac event.  Another found that if one takes into account [[chronic obstructive pulmonary disease]] (COPD) in those with PAD, the benefit of obesity no longer exists.<ref name="paradox2003" />
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=== Not enough sleep ===
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Many studies have seen a high BMI in people who do not get enough sleep. Some studies have seen a relationship between sleep and the way our bodies use nutrients for energy and how lack of sleep can affect hormones that control hunger urges. Visit our Sleep Deprivation and Deficiency Health Topic for more information about lack of sleep.
  
==Causes==
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=== High amounts of stress ===
At an individual level, a combination of excessive [[food energy]] intake and a lack of [[physical activity]] is thought to explain most cases of obesity.<ref name="CADG2006" />  A limited number of cases are due primarily to genetics, medical reasons, or psychiatric illness. In contrast, increasing rates of obesity at a societal level are felt to be due to an easily accessible and palatable diet, increased reliance on cars, and mechanized manufacturing.
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Acute stress and chronic stress affect the brain and trigger the production of hormones, such as cortisol, that control our energy balances and hunger urges. Acute stress can trigger hormone changes that make you not want to eat. If the stress becomes chronic, hormone changes can make you eat more and store more fat.
  
{{causes}}
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== Other Risk factors ==
  
A 2006 review identified ten other possible contributors to the recent increase of obesity: (1) insufficient sleep, (2) [[endocrine disruptor]]s (environmental [[pollutant]]s that interfere with lipid metabolism), (3) decreased variability in ambient temperature, (4) decreased rates of [[tobacco smoking|smoking]], because smoking suppresses appetite, (5) increased use of medications that can cause weight gain (e.g., [[atypical antipsychotics]]), (6) proportional increases in ethnic and age groups that tend to be heavier, (7) pregnancy at a later age (which may cause susceptibility to obesity in children), (8) [[epigenetic]] risk factors passed on generationally, (9) [[natural selection]] for higher BMI, and (10) [[assortative mating]] leading to increased concentration of obesity risk factors (this would  increase the number of obese people by increasing population variance in weight). While there is substantial evidence supporting the influence of these mechanisms on the increased prevalence of obesity, the evidence is still inconclusive, and the authors state that these are probably less influential than the ones discussed in the previous paragraph.
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== Age ==
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Childhood obesity remains a serious problem in the United States, and some populations are more at risk for childhood obesity than others. The risk of unhealthy weight gain increases as you age. Adults who have a healthy BMI often start to gain weight in young adulthood and continue to gain weight until 60 to 65 years old, when they tend to start losing weight.
  
===Diet===
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=== Genetic studies have found that overweight and obesity can run in families, so it is possible that our genes or DNA can cause these conditions. Research studies have found that certain DNA elements are associated with obesity. ===
{{Main|Diet and obesity}}
 
{{Double image|right|World map of Energy consumption 1961,2.svg|200|World map of Energy consumption 2001-2003.svg|200|alt=(Left) A world map with countries colored to reflect the food energy consumption of their people in 1961. North America, Europe, and Australia have relatively high intake, while Africa and Asia consume much less.(Right) A world map with countries colored to reflect the food energy consumption of their people in 2001–2003. Consumption in North America, Europe, and Australia has increased with respect to previous levels in 1971. Food consumption has also increased substantially in many parts of Asia. However, food consumption in Africa remains low.|Map of dietary energy availability per person per day in 1961 (left) and 2001–2003 (right)<ref name=Earth09/> Calories per person per day (kilojoules per person per day)
 
{{Multicol}}
 
{{legend|#b3b3b3|no data}}
 
{{legend|#ffff65|<1,600 (<6,700)}}
 
{{legend|#fff200|1,600–1,800 (6,700–7,500)}}
 
{{legend|#ffdc00|1,800–2,000 (7,500–8,400)}}
 
{{legend|#ffc600|2,000–2,200 (8,400–9,200)}}
 
{{legend|#ffb000|2,200–2,400 (9,200–10,000)}}
 
{{legend|#ff9a00|2,400–2,600 (10,000–10,900)}}
 
{{Multicol-break}}
 
{{legend|#ff8400|2,600–2,800 (10,900–11,700)}}
 
{{legend|#ff6e00|2,800–3,000 (11,700–12,600)}}
 
{{legend|#ff5800|3,000–3,200 (12,600–13,400)}}
 
{{legend|#ff4200|3,200–3,400 (13,400–14,200)}}
 
{{legend|#ff2c00|3,400–3,600 (14,200–15,100)}}
 
{{legend|#cb0000|>3,600 (>15,100)}}
 
{{Multicol-end}}
 
}}
 
  
[[Dietary energy supply]] per capita varies markedly between different regions and countries. It has also changed significantly over time.<ref name="Earth09" /> 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 {{convert|3654|Cal}} per person in 1996.<ref name="Earth09" /> This increased further in 2003 to {{convert|3754|Cal}}.<ref name="Earth09" />  During the late 1990s Europeans had {{convert|3394|Cal}} per person, in the developing areas of Asia there were {{convert|2648|Cal}} per person, and in sub-Saharan Africa people had {{convert|2176|Cal}} per person.<ref name="Earth09" />  Total food energy consumption has been found to be related to obesity.
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=== Did you know obesity can change your DNA and the DNA you pass on to your children? Learn more about these DNA changes. ===
  
The widespread availability of [[Nutrition#Advice and guidance|nutritional guidelines]] has done little to address the problems of overeating and poor dietary choice. From 1971 to 2000, obesity rates in the United States increased from 14.5% to 30.9%. During the same period, an increase occurred in the average amount of food energy consumed. For women, the average increase was {{convert|335|Cal}} per day ({{convert|1542|Cal}} in 1971 and {{convert|1877|Cal}} in 2004), while for men the average increase was {{convert|168|Cal}} per day ({{convert|2450|Cal}} in 1971 and {{convert|2618|Cal}} in 2004). Most of this extra food energy came from an increase in carbohydrate consumption rather than fat consumption. The primary sources of these extra carbohydrates are sweetened beverages, which now account for almost 25 percent of daily food energy in young adults in America, and potato chips.  Consumption of sweetened drinks is believed to be contributing to the rising rates of obesity.
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=== Eating too much or eating too little during your pregnancy can change your baby’s DNA and can affect how your child stores and uses fat later in life. Also, studies have shown that obese fathers have DNA changes in their sperm that can be passed on to their children. ===
  
As societies become increasingly reliant on [[food energy|energy-dense]], big-portions, and fast-food meals, the association between fast-food consumption and obesity becomes more concerning.  In the United States consumption of fast-food meals tripled and food energy intake from these meals quadrupled between 1977 and 1995.
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== Screening and Prevention- Overweight and Obesity ==
 +
Children and adults should be screened at least annually to see if they have a high or increasing body mass index (BMI), which allows doctors to recommend healthy lifestyle changes to prevent overweight and obesity.
  
[[Agricultural policy]] and [[Green Revolution (agriculture)|techniques]] in the United States and Europe have led to lower food prices. In the United States, subsidization of corn, soy, wheat, and rice through the [[U.S. farm bill]] has made the main sources of processed food cheap compared to fruits and vegetables.  [[Calorie count laws]] and [[nutrition facts label]]s attempt to steer people toward making healthier food choices, including awareness of how much food energy is being consumed.
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=== - Overweight and Obesity ===
 +
To screen for overweight and obesity, doctors measure BMI using calculations that depend on whether you are a child or an adult. After reading the information below, talk to your doctor or your child’s doctor to determine if you or your child has a high or increasing BMI.
  
Obese people consistently under-report their food consumption as compared to people of normal weight. This is supported both by tests of people carried out in a [[calorimeter]] room and by direct observation.
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* '''Children''': A healthy weight is usually when your child’s BMI is at the 5th percentile up to the 85th percentile, based on growth charts for children who are the same age and sex. To figure out your child’s BMI, use the Center for Disease Control and Prevention (CDC) BMI Percentile Calculator for Child and Teenexternal link and compare the BMI with the table below.
 +
* '''Adults''': A healthy weight for adults is usually when your BMI is 18.5 to less than 25. To figure out your BMI, use the National Heart, Lung, and Blood Institute’s online BMI calculator and compare it with the table below. You can also download the BMI calculator app for iPhoneexternal link and Androidexternal link.
  
===Sedentary lifestyle===
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Body mass index (BMI) is used to determine if you or your child are underweight, healthy, or overweight or obese. Children are underweight if their BMI is below the 5th percentile, healthy weight if their BMI is between the 5th to less than the 85th percentile, overweight if their BMI is the 85th percentile to less than the 95th percentile, and obese if their BMI is the 95th percentile or above. Adults are underweight if their BMI is below 18.5, healthy weight if their BMI is 18.5 to 24.9, overweight if their BMI is 25 to 29.9, and obese if their BMI is 30 or above. *A child’s BMI percentile is calculated by comparing your child’s BMI to growth charts for children who are the same age and sex as your child.
{{See also|Sedentary lifestyle|Exercise trends}}
 
A [[sedentary lifestyle]] plays a significant role in obesity. Worldwide there has been a large shift towards less physically demanding work, and currently at least 30% of the world's population gets insufficient exercise.<ref name="WHOExercise" /> This is primarily due to increasing use of mechanized transportation and a greater prevalence of labor-saving technology in the home.<ref name="WHO2009" /><ref name="WHOExercise" /><ref name="Ness2006" />  In children, there appear to be declines in levels of physical activity due to less walking and physical education. 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 a study from Finland found an increase and a study from the United States found leisure-time physical activity has not changed significantly.
 
  
In both children and adults, there is an association between television viewing time and the risk of obesity.  A review found 63 of 73 studies (86%) showed an increased rate of childhood obesity with increased media exposure, with rates increasing proportionally to time spent watching television.
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===== Healthy lifestyles =====
 +
If your BMI indicates you are getting close to being overweight, or if you have certain risk factors, your doctor may recommend you adopt healthy lifestyle changes to prevent you from becoming overweight and obese. Changes include healthy eating, being physically active, aiming for a healthy weight, and getting healthy amounts of sleep. Read healthy lifestyle changes for more information
  
===Genetics===
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There are no specific symptoms of overweight and obesity. The signs of overweight and obesity include a high body mass index (BMI) and an unhealthy body fat distribution that can be estimated by measuring your waist circumference. Obesity can cause complications in many parts of your body.  
{{Main|Genetics of obesity}}
 
  
Like many other medical conditions, obesity is the result of an interplay between genetic and environmental factors. [[Polymorphism (biology)|Polymorphisms]] in various [[gene]]s 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. People with two copies of the [[FTO gene]] (fat mass and obesity associated gene) have been found on average to weigh 3–4&nbsp;kg more and have a 1.67-fold greater risk of obesity compared with those without the risk [[allele]].  The percentage of obesity that can be attributed to genetics varies, depending on the population examined, from 6% to 85%.
+
=== - Body Mass Index ===
 +
A high BMI is the most common sign of overweight and obesity.
  
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.) In people with early-onset severe obesity (defined by an onset before 10&nbsp;years of age and body mass index over three [[standard deviation]]s above normal), 7% harbor a single point DNA mutation.
+
Body mass index (BMI) is used to determine if you or your child are underweight, healthy, or overweight or obese. Children are underweight if their BMI is below the 5th percentile, healthy weight if their BMI is between the 5th to less than the 85th percentile, overweight if their BMI is the 85th percentile to less than the 95th percentile, and obese if their BMI is the 95th percentile or above. Adults are underweight if their BMI is below 18.5, healthy weight if their BMI is 18.5 to 24.9, overweight if their BMI is 25 to 29.9, and obese if their BMI is 30 or above. *A child’s BMI percentile is calculated by comparing your child’s BMI to growth charts for children who are the same age and sex as your child.
  
Studies that have focused on inheritance patterns rather than on specific genes have found that 80% of the offspring of two [[parental obesity|obese parents]] were also obese, in contrast to less than 10% of the offspring of two parents who were of normal weight.
+
== Prevalence of obesity in the US ==<!--Alphabetized-->
 
+
{{obesity-state}}
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. This theory has received various criticisms, and other evolutionarily-based theories such as the [[drifty gene hypothesis]] and the [[thrifty phenotype|thrifty phenotype hypothesis]] have also been proposed.
 
 
 
===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]], and the [[eating disorder]]s: [[binge eating disorder]] and [[night eating syndrome]].<ref name="HaslamJames" /> However, obesity is not regarded as a psychiatric disorder, and therefore is not listed in the [[Diagnostic and Statistical Manual of Mental Disorders|DSM-IVR]] as a psychiatric illness. The risk of overweight and obesity is higher in patients with psychiatric disorders than in persons without psychiatric disorders.
 
 
 
Certain medications may cause weight gain or changes in [[body composition]]; these include [[insulin]], [[sulfonylurea]]s, [[thiazolidinedione]]s, [[atypical antipsychotic]]s, [[antidepressant]]s, [[glucocorticoids|steroids]], certain [[anticonvulsant]]s ([[phenytoin]] and [[valproate]]), [[pizotifen]], and some forms of [[hormonal contraception]].<ref name="HaslamJames" />
 
 
 
===Social determinants===
 
{{Main|Social determinants of obesity}}
 
While genetic influences are important to understanding obesity, they cannot explain the current dramatic increase seen within specific countries or globally. Though it is accepted that energy consumption in excess of energy expenditure leads to obesity on an individual basis, the cause of the shifts in these two factors on the societal scale is much debated. There are a number of theories as to the cause but most believe it is a combination of various factors.
 
 
 
The correlation between [[social class]] and BMI varies globally. A review in 1989 found that in developed countries women of a high social class were less likely to be obese. No significant differences were seen among men of different social classes. In the developing world, women, men, and children from high social classes had greater rates of obesity. An update of this review carried out in 2007 found the same relationships, but they were weaker. The decrease in strength of correlation was felt to be due to the effects of [[globalization]]. Among developed countries, levels of adult obesity, and percentage of teenage children who are overweight, are correlated with [[economic inequality|income inequality]].  A similar relationship is seen among US states: more adults, even in higher social classes, are obese in more unequal states.
 
 
 
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 [[physical fitness]]. In [[undeveloped countries]] the ability to afford food, high energy expenditure with physical labor, and cultural values favoring a larger body size are believed to contribute to the observed patterns.<ref name="McLaren2007" /> Attitudes toward body weight held by people in one's life may also play a role in obesity. A correlation in BMI changes over time has been found among friends, siblings, and spouses.  Stress and perceived low social status appear to increase risk of obesity.<ref name="spirit" />
 
 
 
Smoking has a significant effect on an individual's weight. Those who quit smoking gain an average of 4.4&nbsp;kilograms (9.7&nbsp;lb) for men and 5.0&nbsp;kilograms (11.0&nbsp;lb) for women over ten years.  However, changing rates of smoking have had little effect on the overall rates of obesity.
 
 
 
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.  This could be partly explained by the fact that having dependent children decreases physical activity in Western parents.
 
 
 
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%.
 
 
 
[[Malnutrition]] in early life is believed to play a role in the rising rates of obesity in the [[developing world]].  Endocrine changes that occur during periods of malnutrition may promote the storage of fat once more food energy becomes available.<ref name="DC2001" />
 
 
 
Consistent with [[cognitive epidemiology|cognitive epidemiological]] data, numerous studies confirm that obesity is  associated with cognitive deficits. Whether obesity causes cognitive deficits, or vice versa is unclear at present.
 
 
 
===Infectious agents===
 
{{See also|Infectobesity}}
 
The study of the effect of infectious agents on metabolism is still in its early stages.  [[Gut flora]] has been shown to differ between lean and obese humans. There is an indication that gut flora in obese and lean individuals can affect the metabolic potential. This apparent alteration of the metabolic potential is believed to confer a greater capacity to harvest energy contributing to obesity. Whether these differences are the direct cause or the result of obesity has yet to be determined unequivocally.
 
 
 
An association between [[viruses]] and obesity has been found in humans and several different animal species. The amount that these associations may have contributed to the rising rate of obesity is yet to be determined.
 
 
 
==Pathophysiology==
 
 
 
There are many possible [[pathophysiology|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]], and development of [[insulin resistance]]. Since leptin's discovery, [[ghrelin]], [[insulin]], [[orexin]], [[PYY 3-36]], [[cholecystokinin]], [[adiponectin]], as well as many other mediators have been studied. The [[adipokine]]s 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, most obese individuals are thought to be leptin resistant and have been found to have high levels of leptin. This resistance is thought to explain in part why administration of leptin has not been shown to be effective in suppressing appetite in most obese people.<ref name="flier" />
 
 
 
While leptin and ghrelin are produced peripherally, they control appetite through their actions on the [[central nervous system]]. In particular, they and other appetite-related hormones act on the [[hypothalamus]], a region of the brain central to the regulation of food intake and energy expenditure. There are several circuits within the hypothalamus that contribute to its role in integrating appetite, the [[melanocortin]] pathway being the most well understood.<ref name="flier" /> The circuit begins with an area of the hypothalamus, the [[arcuate nucleus]], that has outputs to the [[lateral hypothalamus]] (LH) and [[ventromedial hypothalamus]] (VMH), the brain's feeding and satiety centers, respectively.
 
 
 
The arcuate nucleus contains two distinct groups of [[neuron]]s.<ref name="flier" /> The first group coexpresses [[neuropeptide Y]] (NPY) and [[agouti-related peptide]] (AgRP) and has stimulatory inputs to the LH and inhibitory inputs to the VMH. The second group coexpresses [[pro-opiomelanocortin]] (POMC) and [[cocaine- and amphetamine-regulated transcript]] (CART) and has stimulatory inputs to the VMH and inhibitory inputs to the LH. Consequently, NPY/AgRP neurons stimulate feeding and inhibit satiety, while POMC/CART neurons stimulate satiety and inhibit feeding. Both groups of arcuate nucleus neurons are regulated in part by leptin. Leptin inhibits the NPY/AgRP group while stimulating the POMC/CART group. Thus a deficiency in leptin signaling, either via leptin deficiency or leptin resistance, leads to overfeeding and may account for some genetic and acquired forms of obesity.<ref name="flier" />
 
{{clear}}
 
 
 
==Public health==
 
The [[World Health Organization]] (WHO) predicts that [[overweight]] and obesity may soon replace more traditional [[public health]] concerns such as [[undernutrition]] and [[infectious diseases]] as the most significant cause of poor health. Obesity is a public health and policy problem because of its prevalence, costs, and health effects. The [[United States Preventive Services Task Force]] recommends screening for all adults followed by behavioral interventions in those who are obese. 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, and decreasing access to sugar-sweetened beverages in schools.  When constructing urban environments, efforts have been made to increase access to parks and to develop pedestrian routes.
 
 
 
Many countries and groups 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 2006 the [[Canadian Obesity Network]] published the "Canadian Clinical Practice Guidelines (CPG) on the Management and Prevention of Obesity in Adults and Children". This is a comprehensive evidence-based guideline to address the management and prevention of overweight and obesity in adults and children.
 
 
 
In 2004, the United Kingdom [[Royal College of Physicians]], the [[Faculty of Public Health]] and the [[Royal College of Paediatrics and Child Health]] released the report "Storing up Problems", which highlighted the growing problem of obesity in the UK. The same year, the [[British House of Commons|House of Commons]] [[Health Select Committee]] published its "most comprehensive inquiry [...] ever undertaken" into the impact of obesity on health and society in the UK and possible approaches to the problem. In 2006, the [[National Institute for Health and Clinical Excellence]] (NICE) issued a guideline on the diagnosis and management of obesity, as well as policy implications for non-healthcare organizations such as local councils. A 2007 report produced by Sir [[Derek Wanless]] for the [[King's Fund]] warned that unless further action was taken, obesity had the capacity to cripple the [[National Health Service]] financially.
 
 
 
Comprehensive approaches are being looked at to address the rising rates of obesity. The Obesity Policy Action (OPA) framework divides measure into 'upstream' policies, 'midstream' policies, 'downstream' policies. 'Upstream' policies look at changing society, 'midstream' policies try to alter individuals' behavior to prevent obesity, and 'downstream' policies try to treat currently afflicted people.
 
 
 
==Management==
 
{{Main|Management of obesity}}
 
(Xenical), the most commonly used medication to treat obesity, and [[sibutramine]] (Meridia), a medication recently withdrawn due to cardiovascular side effects]]
 
The main treatment for obesity consists of [[dieting]] and [[physical exercise]]. Diet programs may produce [[weight loss]] over the short term, but maintaining this weight loss is frequently difficult and often requires making exercise and a lower food energy diet a permanent part of a person's lifestyle. Success rates of long-term weight loss maintenance with lifestyle changes are low, ranging from 2–20%. Dietary and lifestyle changes are effective in limiting excessive weight gain in [[pregnancy]] and improve outcomes for both the mother and the child.
 
 
 
Three medication, [[orlistat]] (Xenical), [[lorcaserin]] (Belviq) and a combination of [[Phentermine/topiramate|phentermine and topiramate]] (Qsymia) are currently available and have evidence for long term use. Weight loss with orlistat is modest, an average of 2.9&nbsp;kg (6.4&nbsp;lb) at 1 to 4&nbsp;years. Its use is associated with high rates of gastrointestinal side effects<ref name="Orli07" /> and concerns have been raised about negative effects on the kidneys. The other two medications are available in the United States but not Europe. Lorcaserin results in an average 3.1&nbsp;kg weight loss (3% of body weight) greater than placebo over a year; however it may increase heart valve problems.<ref name="EMA2013" /> A combination of phentermine and topiramate is also somewhat effective; however, it may be associated with heart problems.<ref name="EMA2013" /> There is no information on how these drugs affect longer-term complications of obesity such as cardiovascular disease or death.<ref name="Yan2014" />
 
 
 
The most effective treatment for obesity is [[bariatric surgery]]. Surgery for severe obesity is associated with long-term weight loss, improvement in obesity related conditions, and decreased overall mortality. One study found a weight loss of between 14% and 25% (depending on the type of procedure performed) at 10&nbsp;years, and a 29% reduction in all cause mortality when compared to standard weight loss measures. Complications occur in about 17% of cases and reoperation is needed in 7% of cases.<ref name="Chang2013" /> Due to its cost and risks, researchers are searching for other effective yet less invasive treatments.
 
{{clear}}
 
 
 
==Epidemiology==
 
{{Main|Epidemiology of obesity}}
 
{{Double image|right|World map of Male Obesity, 2008.svg|200|World map of Female Obesity, 2008.svg|200|World obesity prevalence among males (left) and females (right).<ref name=IOTF2008>{{cite web|url=http://www.iotf.org/database/documents/GlobalPrevalenceofAdultObesity16thDecember08.pdf |title=Global Prevalence of Adult Obesity |format=PDF |work=[[International Obesity Taskforce]] |accessdate=January 29, 2008}}</ref>
 
{{Multicol}}
 
{{legend|#ffff65|<5%}}
 
{{legend|#fff200|5–10%}}
 
{{legend|#ffdc00|10–15%}}
 
{{Multicol-break}}
 
{{legend|#ffc600|15–20%}}
 
{{legend|#ffb000|20–25%}}
 
{{legend|#ff9a00|25–30%}}
 
{{Multicol-break}}
 
{{legend|#ff8400|30–35%}}
 
{{legend|#ff6e00|35–40%}}
 
{{legend|#ff5800|40–45%}}
 
{{Multicol-break}}
 
{{legend|#ff4200|45–50%}}
 
{{legend|#ff2c00|50–55%}}
 
{{legend|#cb0000|>55%}}
 
{{Multicol-end}}
 
|alt=A map of the world with countries colored to reflect the percentage of men who are obese.  Obese males and females have higher prevalence (above 30%) in the U.S. and some Middle Eastern and Oceanian countries, medium prevalence in the rest of North America and Europe, and lower prevalence (<5%) in most of Asia and Africa.||}}
 
 
 
Before the 20th&nbsp;century, obesity was rare;<ref name="Haslam2007" /> in 1997 the WHO formally recognized obesity as a global epidemic.<ref name="Caballero" /> As of 2008 the WHO estimates that at least 500&nbsp;million adults (greater than 10%) are obese, with higher rates among women than men.  The rate of obesity also increases with age at least up to 50 or 60&nbsp;years old and severe obesity in the United States, Australia, and Canada is increasing faster than the overall rate of obesity.<ref name="morbid2007" />
 
 
 
Once considered a problem only of high-income countries, obesity rates are rising worldwide and affecting both the developed and developing world. These increases have been felt most dramatically in urban settings.<ref name="WHO2009a" />  The only remaining region of the world where obesity is not common is [[sub-Saharan Africa]].<ref name="HaslamJames" />
 
{{clear}}
 
 
 
==History==
 
 
 
===Etymology===
 
''Obesity'' is from the [[Latin]] ''obesitas'', which means "stout, fat, or plump".  ''Ēsus'' is the past participle of ''edere'' (to eat), with ''ob'' (over) added to it.  ''[[The Oxford English Dictionary]]'' documents its first usage in 1611 by [[Randle Cotgrave]].
 
 
 
===Historical trends===
 
The [[Greeks]] were the first to recognize obesity as a medical disorder. [[Hippocrates]] wrote that "Corpulence is not only a disease itself, but the harbinger of others".<ref name="HaslamJames" /> The Indian surgeon [[Sushruta]] (6th century BCE) related obesity to diabetes and heart disorders.<ref name="Dwivedi&Dwivedi07" /> He recommended physical work to help cure it and its side effects. For most of human history mankind struggled with food scarcity. Obesity has thus historically been viewed as a sign of wealth and prosperity. It was common among high officials in Europe in the [[Middle Ages]] and the [[Renaissance]]<ref name="Zach2003" /> as well as in Ancient East Asian civilizations.
 
 
 
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.<ref name="Caballero" /> 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.<ref name="Caballero" /> Height and weight thus both increased through the 19th&nbsp;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.<ref name="Caballero" /> In the 1950s increasing wealth in the developed world decreased child mortality, but as body weight increased heart and kidney disease became more common.<ref name="Caballero" />
 
During this time period insurance companies realized the connection between weight and life expectancy and increased premiums for the obese.<ref name="HaslamJames" />
 
 
 
Many cultures throughout history have viewed obesity as the result of a character flaw. The ''obesus'' or fat character in [[Greek comedy]] was a glutton and figure of mockery. During Christian times food was viewed as a gateway to the sins of [[Sloth (deadly sin)|sloth]] and [[lust]].<ref name="Woodhouse" /> 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. Obesity is once again a reason for discrimination.
 
 
 
Public perceptions in Western society regarding healthy body weight differ from those regarding the weight that is considered ideal &nbsp;– 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%.  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.  These changes are believed to be due to increasing rates of adiposity leading to increased acceptance of extra body fat as being normal.<ref name="John2008" />
 
 
 
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.<ref name="HaslamJames" />
 
 
 
===The arts===
 
The first sculptural representations of the human body 20,000–35,000&nbsp;years ago depict obese females. Some attribute the [[Venus figurines]] to the tendency to emphasize fertility while others feel they represent "fatness" in the people of the time.<ref name="Woodhouse" /> Corpulence is, however, absent in both Greek and Roman art, probably in keeping with their ideals regarding moderation. This continued through much of Christian European history, with only those of low socioeconomic status being depicted as obese.<ref name="Woodhouse" />
 
 
 
During the [[Renaissance]] some of the upper class began flaunting their large size, as can be seen in portraits of [[Henry VIII of England]] and [[Alessandro del Borro]]. [[Peter Paul Rubens|Rubens]] (1577–1640) regularly depicted full-bodied women in his pictures, from which derives the term [[Rubenesque]]. These women, however, still maintained the "hourglass" shape with its relationship to fertility. During the 19th&nbsp;century, views on obesity changed in the Western world. After centuries of obesity being synonymous with wealth and social status, slimness began to be seen as the desirable standard.<ref name="Woodhouse" />
 
 
 
==Society and culture==
 
===Economic impact===
 
In addition to its health impacts, obesity leads to many problems including disadvantages in employment 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&nbsp;billion or 20.6% of all medical expenditures, while the cost of obesity in Canada was estimated at CA$2 billion in 1997 (2.4% of total health costs).<ref name="CADG2006" /> 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. The estimate range for annual expenditures on diet products is $40&nbsp;billion to $100&nbsp;billion in the US alone.
 
 
 
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.
 
 
 
Obesity can lead to social stigmatization and disadvantages in employment.<ref name="Puhl R. p.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. A study examining Duke University employees found that people with a BMI over 40&nbsp;kg/m<sup>2</sup> filed twice as many [[workers' compensation]] claims as those whose BMI was 18.5–24.9&nbsp;kg/m<sup>2</sup>. They also had more than 12&nbsp;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. 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&nbsp;kg/m<sup>2</sup> and who fail to make improvements in their health after one year.
 
  
Some research shows that obese people are less likely to be hired for a job and are less likely to be promoted.<ref name="Bias2001" /> 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.
 
 
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. In 2000, the extra weight of obese passengers cost airlines US$275&nbsp;million.  The healthcare industry has had to invest in special facilities for handling severely obese patients, including special lifting equipment and [[bariatric ambulance]]s. Costs for restaurants are increased by litigation accusing them of causing obesity. 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.<ref name="Govtrack" />
 
 
With the [[American Medical Association]]'s 2013 classification of obesity as chronic disease,<ref name="NYTimes20130618" /> 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.<ref name="WashPost20130620" />  The AMA classification is not legally binding, however, so health insurers still have the right to reject coverage for a treatment or procedure.
 
 
===Size acceptance===
 
{{See also|Fat acceptance movement|Social stigma of obesity}}
 
The principal goal of the fat acceptance movement is to decrease discrimination against people who are overweight and obese. However, some in the movement are also attempting to challenge the established relationship between obesity and negative health outcomes.
 
 
A number of organizations exist that promote the acceptance of obesity. They have increased in prominence in the latter half of the 20th&nbsp;century. 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.
 
 
The [[International Size Acceptance Association]] (ISAA) is a [[non-governmental organization]] (NGO) which was founded in 1997. It has more of a global orientation and describes its mission as promoting size acceptance and helping to end weight-based discrimination. These groups often argue for the recognition of obesity as a disability under the US [[Americans With Disabilities Act]] (ADA). The American legal system, however, has decided that the potential public health costs exceed the benefits of extending this anti-discrimination law to cover obesity.<ref name="Pulver2007" />
 
 
==Childhood obesity==
 
{{Main|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&nbsp;[[percentile]].<ref name="cdc.gov" /> 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.<ref name="Flegal KM, Ogden CL, Wei R, Kuczmarski RL, Johnson CL 2001 1086–93" /> Childhood obesity has reached epidemic proportions in 21st&nbsp;century, with rising rates in both the developed and developing world. Rates of obesity in Canadian boys have increased from 11% in 1980s to over 30% in 1990s, while during this same time period rates increased from 4 to 14% in Brazilian children.<ref name="flynn2006" />
 
 
As with obesity in adults, many different factors contribute to the rising rates of childhood obesity. Changing diet and decreasing physical activity are believed to be the two most important in causing the recent increase in the rates. 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]].<ref name="CADG2006" /> Treatments used in children are primarily lifestyle interventions and behavioral techniques, although efforts to increase activity in children have had little success. In the United States, medications are not FDA approved for use in this age group.
 
 
'''[[County obesity rate]] in the [[United States]]'''
 
 
{{obesity-state}}
 
  
 
'''Also see'''
 
'''Also see'''
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[[Category:Body shape]]
 
[[Category:Body shape]]
 
[[Category:Nutrition]]
 
[[Category:Nutrition]]
 +
<references />

Revision as of 15:45, 17 June 2019

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Editor-In-Chief: Prab R. Tumpati M.D.. Founder, WikiMD and W8MD Weight Loss, Sleep and MedSpa Centers.

Dr. Tumpati is board certified physician practicing sleep medicine, obesity medicine, aesthetic medicine and internal medicine. Dr. Tumpati’s passion is prevention rather than cure. As a physician with fellowship training in Obesity Medicine, Dr. Tumpati has a unique approach to wellness, weight loss, aesthetics with a focus on prevention rather than cure. Dr. Tumpati believes in educating the public on the true science and art of medicine, nutrition, wellness and beauty.

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List of terms related to Obesity

Overweight and obesity are increasingly common conditions in the United States. They are caused by the increase in the size and the amount of fat cells in the body. Doctors measure body mass index (BMI) and waist circumference to screen and diagnose overweight and obesity. Obesity is a serious medical condition that can cause complications such as metabolic syndrome, high blood pressure, atherosclerosis, heart disease, diabetes, high blood cholesterol, cancers and sleep disorders. Treatment depends on the cause and severity of your condition and whether you have complications. Treatments include lifestyle changes, such as heart-healthy eating and increased physical activity, and Food and Drug Administration (FDA)-approved weight-loss medicines. For some people, surgery may be a treatment option.


Causes- Overweight and Obesity

Energy imbalances, somegenetic or endocrine medical conditions, and certain medicines are known to cause overweight or obesity.

- Overweight and Obesity

Energy imbalances can cause overweight and obesity. An energy imbalance means that your energy IN does not equal your energy OUT. This energy is measured in calories. Energy IN is the amount of calories you get from food and drinks. Energy OUT is the amount of calories that your body uses for things such as breathing, digesting, being physically active, and regulating body temperature.

Overweight and obesity develop over time when you take in more calories than you use, or when energy IN is more than your energy OUT. This type of energy imbalance causes your body to store fat.

Your body uses certain nutrients such as carbohydrates or sugars, proteins, and fats from the foods you eat to:

  • make energy for immediate use to power routine daily body functions and physical activity.
  • store energy for future use by your body. Sugars are stored asglycogen in the liver and muscles. Fats are stored mainly as triglyceride in fat tissue.

The amount of energy that your body gets from the food you eat depends on the type of foods you eat, how the food is prepared, and how long it has been since you last ate.

The body has three types of fat tissue—white, brown, and beige—that it uses to fuel itself, regulate its temperature in response to cold, and store energy for future use. Learn about the role of each fat type in maintaining energy balance in the body.

  • White fat tissue can be found around the kidneys and under the skin in the buttocks, thighs, and abdomen. This fat type stores energy, makes hormone that control the way the body regulates urges to eat or stop eating, and makesinflammatory substances that can lead to complications.
  • Brown fat tissue is located in the upper back area of human infants. This fat type releases stored energy as heat energy when a baby is cold. It also can make inflammatory substances. Brown fat can be seen in children and adults.
  • Beige fat tissue is seen in the neck, shoulders, back, chest and abdomen of adults and resembles brown fat tissue. This fat type, which uses carbohydrates and fats to produce heat, increases when children and adults are exposed to cold.

- Overweight and Obesity

Some genetic syndromes and endocrine disorders can cause overweight or obesity.

Genetic syndromes

Several genetic syndromes are associated with overweight and obesity, including the following.

  • Prader-Willi syndrome
  • Bardet-Biedl syndrome
  • Alström syndrome
  • Cohen syndrome

The study of these genetic syndromes has helped researchers understand obesity.

Endocrine disorders

Because the endocrine system produces hormones that help maintain energy balances in the body, the following endocrine disorders or tumor affecting the endocrine system can cause overweight and obesity.

  • Hypothyroidism. People with this condition have low levels of thyroid hormones. These low levels are associated with decreased metabolism and weight gain, even when food intake is reduced. People with hypothyroidism also produce less body heat, have a lower body temperature, and do not efficiently use stored fat for energy.
  • Cushing’s syndrome. People with this condition have high levels of glucocorticoids, such ascortisol, in the blood. High cortisol levels make the body feel like it is underchronic stress. As a result, people have an increase in appetite and the body will store more fat. Cushing’s syndrome may develop after taking certain medicines or because the body naturally makes too much cortisol.
  • Tumors. Some tumors, such as craneopharingioma, can cause severe obesity because the tumors develop near parts of the brain that control hunger.

Medicines such as antipsychotics, antidepressants, antiepileptics, and antihyperglycemics can cause weight gain and lead to overweight and obesity.

Talk to your doctor if you notice weight gain while you are using one of these medicines. Ask if there are other forms of the same medicine or other medicines that can treat your medical condition, but have less of an effect on your weight. Do not stop taking the medicine without talking to your doctor.

Several parts of your body, such as your stomach, intestines, pancreas, and fat tissue, use hormones to control how your brain decides if you are hungry or full. Some of these hormones are insulin, leptin, glucagon-like peptide (GLP-1), peptide YY, and ghrelin.

Risk Factors- Overweight and Obesity

There are many risk factors for overweight and obesity. Some risk factors can be changed, such as unhealthy lifestyle habits and environments. Other risk factors, such as age, family history and genetics, race and ethnicity, and sex, cannot be changed. Heathy lifestyle changes can decrease your risk for developing overweight and obesity.

- Overweight and Obesity

Lack of physical activity, unhealthy eating patterns, not enough sleep, and high amounts of stress can increase your risk for overweight and obesity.

Lack of physical activity

Lack of physical activity due to high amounts of TV, computer, videogame or other screen usage has been associated with a highbody mass index. Healthy lifestyle changes, such as being physically active and reducing screen time, can help you aim for a healthy weight.

Unhealthy eating behaviors

Some unhealthy eating behaviors can increase your risk for overweight and obesity.

  • Eating more calories than you use. The amount of calories you need will vary based on your sex, age, and physical activity level. Find out your daily calorie needs or goals with the Body Weight Plannerexternal link.
  • Eating too much saturated and trans fats
  • Eating foods high in added sugars

Visit Heart-healthy eating for more information about healthy eating patterns.

Not enough sleep

Many studies have seen a high BMI in people who do not get enough sleep. Some studies have seen a relationship between sleep and the way our bodies use nutrients for energy and how lack of sleep can affect hormones that control hunger urges. Visit our Sleep Deprivation and Deficiency Health Topic for more information about lack of sleep.

High amounts of stress

Acute stress and chronic stress affect the brain and trigger the production of hormones, such as cortisol, that control our energy balances and hunger urges. Acute stress can trigger hormone changes that make you not want to eat. If the stress becomes chronic, hormone changes can make you eat more and store more fat.

Other Risk factors

Age

Childhood obesity remains a serious problem in the United States, and some populations are more at risk for childhood obesity than others. The risk of unhealthy weight gain increases as you age. Adults who have a healthy BMI often start to gain weight in young adulthood and continue to gain weight until 60 to 65 years old, when they tend to start losing weight.

Genetic studies have found that overweight and obesity can run in families, so it is possible that our genes or DNA can cause these conditions. Research studies have found that certain DNA elements are associated with obesity.

Did you know obesity can change your DNA and the DNA you pass on to your children? Learn more about these DNA changes.

Eating too much or eating too little during your pregnancy can change your baby’s DNA and can affect how your child stores and uses fat later in life. Also, studies have shown that obese fathers have DNA changes in their sperm that can be passed on to their children.

Screening and Prevention- Overweight and Obesity

Children and adults should be screened at least annually to see if they have a high or increasing body mass index (BMI), which allows doctors to recommend healthy lifestyle changes to prevent overweight and obesity.

- Overweight and Obesity

To screen for overweight and obesity, doctors measure BMI using calculations that depend on whether you are a child or an adult. After reading the information below, talk to your doctor or your child’s doctor to determine if you or your child has a high or increasing BMI.

  • Children: A healthy weight is usually when your child’s BMI is at the 5th percentile up to the 85th percentile, based on growth charts for children who are the same age and sex. To figure out your child’s BMI, use the Center for Disease Control and Prevention (CDC) BMI Percentile Calculator for Child and Teenexternal link and compare the BMI with the table below.
  • Adults: A healthy weight for adults is usually when your BMI is 18.5 to less than 25. To figure out your BMI, use the National Heart, Lung, and Blood Institute’s online BMI calculator and compare it with the table below. You can also download the BMI calculator app for iPhoneexternal link and Androidexternal link.

Body mass index (BMI) is used to determine if you or your child are underweight, healthy, or overweight or obese. Children are underweight if their BMI is below the 5th percentile, healthy weight if their BMI is between the 5th to less than the 85th percentile, overweight if their BMI is the 85th percentile to less than the 95th percentile, and obese if their BMI is the 95th percentile or above. Adults are underweight if their BMI is below 18.5, healthy weight if their BMI is 18.5 to 24.9, overweight if their BMI is 25 to 29.9, and obese if their BMI is 30 or above. *A child’s BMI percentile is calculated by comparing your child’s BMI to growth charts for children who are the same age and sex as your child.

Healthy lifestyles

If your BMI indicates you are getting close to being overweight, or if you have certain risk factors, your doctor may recommend you adopt healthy lifestyle changes to prevent you from becoming overweight and obese. Changes include healthy eating, being physically active, aiming for a healthy weight, and getting healthy amounts of sleep. Read healthy lifestyle changes for more information

There are no specific symptoms of overweight and obesity. The signs of overweight and obesity include a high body mass index (BMI) and an unhealthy body fat distribution that can be estimated by measuring your waist circumference. Obesity can cause complications in many parts of your body.  

- Body Mass Index

A high BMI is the most common sign of overweight and obesity.

Body mass index (BMI) is used to determine if you or your child are underweight, healthy, or overweight or obese. Children are underweight if their BMI is below the 5th percentile, healthy weight if their BMI is between the 5th to less than the 85th percentile, overweight if their BMI is the 85th percentile to less than the 95th percentile, and obese if their BMI is the 95th percentile or above. Adults are underweight if their BMI is below 18.5, healthy weight if their BMI is 18.5 to 24.9, overweight if their BMI is 25 to 29.9, and obese if their BMI is 30 or above. *A child’s BMI percentile is calculated by comparing your child’s BMI to growth charts for children who are the same age and sex as your child.

Prevalence of obesity in the US

In the United States, the prevalence of obesity was 39.8% and affected about 93.3 million of US adults in 2015, according to the data from Centers for Disease Control. Obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of cancer that are some of the leading causes of preventable, premature death. The estimated annual medical cost of obesity in the United States was $147 billion in 2008 US dollars; the medical cost for people who have obesity was $1,429 higher than those of normal weight.

Obesity statistics, strategies, and treatment options by State and Territory in the United States.

Prevalence of Self-Reported Obesity by State and Territory in the United States, BRFSS, 2017
Obesity statistics
US State Obesity Prevalence 95% Confidence Interval
Alabama 36.3 (34.7, 38.0)
Alaska 34.2 (31.4, 37.1)
Arizona 29.5 (28.5, 30.5)
Arkansas 35.0 (32.6, 37.5)
California 25.1 (23.8, 26.4)
Colorado 22.6 (21.6, 23.7)
Connecticut 26.9 (25.6, 28.1)
Delaware 31.8 (29.7, 34.0)
District of Columbia 23.0 (21.4, 24.7)
Florida 28.4 (27.0, 29.9)
Georgia 31.6 (30.0, 33.2)
Guam 34.3 (31.2, 37.6)
Hawaii 23.8 (22.4, 25.2)
Idaho 29.3 (27.5, 31.2)
Illinois 31.1 (29.5, 32.7)
Indiana 33.6 (32.5, 34.7)
Iowa 36.4 (35.1, 37.7)
Kansas 32.4 (31.5, 33.2)
Kentucky 34.3 (32.6, 36.0)
Louisiana 36.2 (34.4, 38.1)
Maine 29.1 (27.7, 30.6)
Maryland 31.3 (30.0, 32.6)
Massachusetts 25.9 (24.1, 27.7)
Michigan 32.3 (31.1, 33.4)
Minnesota 28.4 (27.5, 29.4)
Mississippi 37.3 (35.3, 39.3)
Missouri 32.5 (30.9, 34.0)
Montana 25.3 (23.8, 26.9)
Nebraska 32.8 (31.6, 34.0)
Nevada 26.7 (24.5, 29.0)
New Hampshire 28.1 (26.3, 29.9)
New Jersey 27.3 (25.8, 28.7)
New Mexico 28.4 (26.8, 30.0)
New York 25.7 (24.6, 26.9)
North Carolina 32.1 (30.4, 34.0)
North Dakota 33.2 (31.6, 34.7)
Ohio 33.8 (32.5, 35.1)
Oklahoma 36.5 (34.9, 38.1)
Oregon 29.4 (27.9, 30.9)
Pennsylvania 31.6 (30.0, 33.2)
Puerto Rico 32.9 (31.0, 34.9)
Rhode Island 30.0 (28.1, 31.9)
South Carolina 34.1 (32.8, 35.4)
South Dakota 31.9 (29.8, 34.1)
Tennessee 32.8 (31.1, 34.6)
Texas 33.0 (31.2, 34.9)
Utah 25.3 (24.2, 26.4)
Vermont 27.6 (26.0, 29.2)
Virginia 30.1 (28.7, 31.4)
Washington 27.7 (26.6, 28.7)
West Virginia 38.1 (36.4, 39.7)
Wisconsin 32.0 (30.3, 33.8)
Wyoming 28.8 (27.1, 30.6)


Also see

Portions of content adapted from Wikipedias article on Obesity licensed under GNU FDL.

References

Metabolic.jpg

Featured disease

Metabolic syndrome is a cluster of the most dangerous heart attack risk factors: diabetes and prediabetes, abdominal obesity, high triglycerides, low HDL cholesterol and high blood pressure.

Affects one in three adults

Affecting about 35 percent of all adults in the United States according to the CDC, metabolic syndrome contributes to weight gain, by causing a state of internal starvation called metabolic starvation. This in turn leads to increases hunger, sugar cravings and increased portions leading to overeating and weight gain.

Cause and effect misunderstood

Since we traditionally thought that the portion control (which in turn was attributed wrongly to poor will power)is the cause of weight gain, rather than the effect of this metabolic starvation, all our traditional ideas about cause and effect of obesity were not only wrong but lead to the “blame the victim” attitude when it comes to obesity.

Secret of weight gain revealed

Secret of weight gain, and metabolic syndrome revealed - it has been recently proven that metabolic syndrome, and the weight gain itself are caused by a process called insulin resistance. Check your metabolic syndrome risk using the free Metabolic syndrome meter. Watch this amazing Ted Med video that reveals the secret of weight loss - Stop blaming the victim for obesity



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