Obesity

By Lauren Fahy

Definition
Obesity is an abnormal accumulation of body fat, usually 20% or more over an
individual's ideal body weight. Obesity is associated with increased risk of illness,
disability, and death.

The branch of medicine that deals with the study and treatment of obesity is known
as bariatrics. As obesity has become a major health problem in the United States,
bariatrics has become a separate medical and surgical specialty.

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 What is Obesity
Overweight and obesity are defined as abnormal or excessive fat
accumulation that may impair health.

Body mass index (BMI) is a simple index of weight-for-height that is

commonly used to classify overweight and obesity in adults. It is defined
as a person's weight in kilograms divided by the square of his height in
meters (kg/m2).

Adults

For adults, WHO defines overweight and obesity as follows:

overweight is a BMI greater than or equal to 25; and

obesity is a BMI greater than or equal to 30.

BMI provides the most useful population-level measure of overweight and

obesity as it is the same for both sexes and for all ages of adults.
However, it should be considered a rough guide because it may not
correspond to the same degree of fatness in different individuals.

For children, age needs to be considered when defining overweight and

obesity.

Children under 5 years of age

For children under 5 years of age:

overweight is weight-for-height greater than 2 standard deviations above

WHO Child Growth Standards median; and
obesity is weight-for-height greater than 3 standard deviations above the
WHO Child Growth Standards median.
 Children aged between 519 years

Overweight and obesity are defined as follows for children aged between
519 years:

overweight is BMI-for-age greater than 1 standard deviation above the WHO

Growth Reference median; and
obesity is greater than 2 standard deviations above the WHO Growth
Reference median.

Facts about overweight and obesity

Some recent WHO global estimates follow.

In 2014, more than 1.9 billion adults aged 18 years and older were
overweight. Of these over 600 million adults were obese.

Overall, about 13% of the worlds adult population (11% of men and 15% of
women) were obese in 2014.

In 2014, 39% of adults aged 18 years and over (38% of men and 40% of
women) were overweight.

The worldwide prevalence of obesity more than doubled between 1980 and
2014.

In 2014, an estimated 41 million children under the age of 5 years were

overweight or obese. Once considered a high-income country problem,
overweight and obesity are now on the rise in low- and middle-income
countries, particularly in urban settings. In Africa, the number of children
who are overweight or obese has nearly doubled from 5.4 million in 1990
to 10.6 million in 2014. Nearly half of the children under 5 who were
overweight or obese in 2014 lived in Asia.

Overweight and obesity are linked to more deaths worldwide than

underweight. Globally there are more people who are obese than
underweight this occurs in every region except parts of sub-Saharan
Africa and Asia.

What causes obesity and overweight?

The fundamental cause of obesity and overweight is an energy imbalance

between calories consumed and calories expended. Globally, there has
been:

An increased intake of energy-dense foods that are high in fat; and

an increase in physical inactivity due to the increasingly sedentary nature of
many forms of work, changing modes of transportation, and increasing
urbanisation.

Changes in dietary and physical activity patterns are often the result of
environmental and societal changes associated with development and
lack of supportive policies in sectors such as health, agriculture, transport,
urban planning, environment, food processing, distribution, marketing,
and education.
 What are common health consequences of overweight and
obesity?

Raised BMI is a major risk factor for noncommunicable diseases such as:

Cardiovascular diseases (mainly heart disease and stroke), which were the
leading cause of death in 2012;
diabetes;
musculoskeletal disorders (especially osteoarthritis a highly disabling
degenerate disease of the joints);
some cancers (including endometrial, breast, ovarian, prostate, liver,
gallbladder, kidney, and colon).

The risk for these noncommunicable diseases increases, with increases

in BMI.

Childhood obesity is associated with a higher chance of obesity,

premature death and disability in adulthood. But in addition to increased
future risks, obese children experience breathing difficulties, increased
risk of fractures, hypertension, early markers of cardiovascular disease,
insulin resistance and psychological effects.
 Facing a double burden of disease

Many low- and middle-income countries are now facing a "double burden"
of disease.

While these countries continue to deal with the problems of infectious

diseases and undernutrition, they are also experiencing a rapid upsurge in
noncommunicable disease risk factors such as obesity and overweight,
particularly in urban settings.

It is not uncommon to find undernutrition and obesity co-existing within the

same country, the same community and the same household.

Children in low- and middle-income countries are more vulnerable to

inadequate pre-natal, infant, and young child nutrition. At the same time,
these children are exposed to high-fat, high-sugar, high-salt, energy-
dense, and micronutrient-poor foods, which tend to be lower in cost but
also lower in nutrient quality. These dietary patterns, in conjunction with
lower levels of physical activity, result in sharp increases in childhood
obesity while undernutrition issues remain unsolved.

How can overweight and obesity be reduced?

Overweight and obesity, as well as their related noncommunicable

diseases, are largely preventable. Supportive environments and
communities are fundamental in shaping peoples choices, by making the
choice of healthier foods and regular physical activity the easiest choice
(the choice that is the most accessible, available and affordable), and
therefore preventing overweight and obesity.
At the individual level, people can:

Limit energy intake from total fats and sugars;

Increase consumption of fruit and vegetables, as well as legumes, whole

grains and nuts;

Engage in regular physical activity (60 minutes a day for children and 150
minutes spread through the week for adults).

Individual responsibility can only have its full effect where people have
access to a healthy lifestyle. Therefore, at the societal level it is important
to support individuals in following the recommendations above, through
sustained implementation of evidence based and population based
policies that make regular physical activity and healthier dietary choices
available, affordable and easily accessible to everyone, particularly to the
poorest individuals. An example of such a policy is a tax on sugar
sweetened beverages.

The food industry can play a significant role in promoting healthy diets by:

Reducing the fat, sugar and salt content of processed foods;

Ensuring that healthy and nutritious choices are available and affordable to
all consumers;
 Restricting marketing of foods high in sugars, salt and fats, especially those
foods aimed at children and teenagers;

Ensuring the availability of healthy food choices and supporting regular

physical activity practice in the workplace.

WHO response

Adopted by the World Health Assembly in 2004, the "WHO Global

Strategy on Diet, Physical Activity and Health" describes the actions
needed to support healthy diets and regular physical activity. The Strategy
calls upon all stakeholders to take action at global, regional and local
levels to improve diets and physical activity patterns at the population
level.

The Political Declaration of the High Level Meeting of the United Nations
General Assembly on the Prevention and Control of Noncommunicable
Diseases of September 2011, recognises the critical importance of
reducing unhealthy diet and physical inactivity. The political declaration
commits to advancing the implementation of the "WHO Global Strategy
on Diet, Physical Activity and Health", including, where appropriate,
through the introduction of policies and actions aimed at promoting
healthy diets and increasing physical activity in the entire population.

WHO has also developed the "Global Action Plan for the Prevention and
Control of Noncommunicable Diseases 2013-2020" which aims to achieve
the commitments of the UN Political Declaration on Noncommunicable
diseases (NCDs) which was endorsed by Heads of State and
Government in September 2011. The Global Action Plan will contribute
to progress on 9 global NCD targets to be attained by 2025, including a
25% relative reduction in premature mortality from NCDs by 2025 and a
halt in the rise of global obesity to match the rates of 2010.

In 2016 the World Health Assembly welcomed the report of the

Commission on Ending Childhood Obesity and its 6 recommendations to
address the obesogenic environment and critical periods in the life course
to tackle childhood obesity. The Assembly requested the Director-General
to develop an implementation plan to guide further action.
 Adult Body Mass Index (BMI)
Body Mass Index (BMI) is a person's weight in kilograms divided by the square of
height in meters. A high BMI can be an indicator of high body fatness.

To calculate BMI, see the Adult BMI Calculator or determine BMI by finding your
height and weight in this BMI Index Chart.
If your BMI is less than 18.5, it falls within the underweight range.
If your BMI is 18.5 to <25, it falls within the normal.
If your BMI is 25.0 to <30, it falls within the overweight range.
If your BMI is 30.0 or higher, it falls within the obese range.

Obesity is frequently subdivided into categories:

Class 1: BMI of 30 to < 35
Class 2: BMI of 35 to < 40
Class 3: BMI of 40 or higher. Class 3 obesity is sometimes categorised as
extreme or severe obesity.

U.S. Obesity Trends

In 2010, 36 states had obesity rates of 25 percent or higher, and 12 of those had
obesity rates of 30 percent or higher. See a figure that maps U.S. obesity trends
over the past 20 years.
 Measuring Body Fat

There are a number of ways to measure body fat. Some are well suited to the
doctors office, such as calculating a persons BMI. Other, more complex methods
require specialised equipment, such as magnetic resonance imaging or dual energy
X-ray absorptiometry machines; while these machines can measure body fat very
accurately, they are typically only used for this purpose in research settings.

Globally, there are 1.5 billion adults who are either overweight or obese, a number
expected to increase to 3 billion by 2030. The epidemic is reaching catastrophic
proportions, and one of the key-if small- steps to bringing it under control is to have
a common language to describe the problem.

Waist Size Matters: Abdominal Obesity

One important category of obesity not captured by BMI is so-called abdominal

obesity-the extra fat found around the middle that is an important factor in health,
even independent of BMI.

The simplest and most often used measure of abdominal obesity is waist
size. Guidelines generally define abdominal obesity in women as a waist size
35 inches or higher, and in men as a waist size of 40 inches or higher.
In America more than two-thirds (68.8 percent) of adults are considered to be
overweight or obese. More than one-third (35.7 percent) of adults are considered to
be obese. More than 1 in 20 (6.3 percent) have extreme obesity. Almost 3 in 4 men
(74 percent) are considered to be overweight or obese.

WHY ARE AMERICANS OBESE?

To understand the true size of the American obesity epidemic, we first need to
understand what it really means to be overweight. Generally, doctors and
nutritionists classify people as either underweight, healthy weight, overweight, or
obese. These dierent classifications are determined by body mass index (BMI), or
a measure of body fat based on your height and weight.To get a basic idea, this
chart from the CDC approximates what that means for someone who is 59 tall.

Confusing Diet for Nutrition

The role of diet in the U.S. obesity epidemic is obviously major, but its also
complex. Consumers are sent wildly mixed messages when it comes to what to
eat and how much. One one hand, larger portions, processed packaged food, and
drive-thru meals are branded as almost classically American fast, cheap, filling
and delicious. On the other hand, we spend over $20 billion annually on weight
loss schemes, from diet books and pills all the way up to last-resort surgeries like
lap-bands and liposuction. Its no wonder were looking for fast food and fast
weight loss options, we spend more time at work and less time in our homes and
kitchens than our parents did. Sometimes you only have time to pack a leftover
pizza slice and a slim-fast for lunch, irony be damned.

This schizophrenic relationship with food is easy to explain in terms of marketing

schemes. As decades of soda and tv dinners caught up with our waistlines, the
U.S. diet industry grew bigger, faster and smarter. Since the 1970s, popular
nutrition wisdom and fad diets have flamed in and out just as quickly as the Arch
Deluxe or the McRib. In the 1990s, our big enemy was fat. Low-fat and fat-free
products flew o supermarket shelves. It took us decades to learn that when
something is fat-free and full-flavoured, its probably too good to be true.

As it turns out, most food companies were just swapping hydrogenated oils and
sugar in for the animal fats they removed from low-fat products. Hydrogenated oils
are restructured vegetable oils that carry high levels of trans-fats, an amazingly evil
type of fat that can raise your bad cholesterol, lower your good cholesterol and
increase your risks of developing heart disease, stroke and diabetes. While
somewhat less sinister, added sugar can also wreak major damage on a diet.
Technically low in calories, high-quantities of sugar disrupts our metabolisms,
causing surges in insulin and energy levels and ultimately contributing to diabetes.

Obesity Facts & Figures: World Health Organisation

Key facts
Worldwide obesity has nearly doubled since 1980.
In 2008, more than 1.4 billion adults, 20 and older, were overweight. Of these
over 200 million men and nearly 300 million women were obese.
35% of adults aged 20 and over were overweight in 2008, and 11% were
obese.
65% of the worlds population live in countries where overweight and obesity
kills more people than underweight.
Overweight and obesity are the fifth leading risk for global deaths. At least 2.8
million adults die each year as a result of being overweight or obese.
44% of the diabetes burden, 23% of the ischaemic heart disease burden and
between 7% and 41% of certain cancer burdens are attributable to
overweight and obesity.
More than 40 million children under the age of five were overweight in 2011.
Obesity is preventable.