OBESITY

The obesity is a chronic disease of multifactorial origin that is characterized by excessive accumulation of fat or hypertrophy overall adipose tissue in the body that is when the natural energy reserve of humans and other mammals, stored as body fat increases to a point where it is associated with numerous complications such as certain health conditions or diseases and increased mortality. The WHO ( World Health Organization ) obesity defined as a BMI or body mass index (calculated by height and weight of the individual) is less than 30 kg / m. is also considered a sign of obesity perimeter increased abdominal men greater than or equal to 102 cm and in women greater than or equal to 88 cm. ( See: diagnosis of obesity ). Obesity is part of the metabolic syndrome still a risk factor known, that is predisposed to various diseases, particularly cardiovascular disease , type 2 diabetes mellitus , sleep apnea , stroke , osteoarthritis and some forms of cancer , dermatological disorders and gastrointestinal. ( View: Effect on health ). Although obesity is an individual clinical condition has become a serious public health problem that is increasing and the WHO believes that " Obesity has reached epidemic proportions worldwide die each year at least 2.6 million of persons because of obesity or overweight. Although previously considered a problem confined to high-income countries, obesity is now also prevalent in countries of low and middle income . "(See: Policies and Measures public health ).

DEFINITION:
Practically speaking, obesity can be diagnosed typically in terms of health measuring body mass index (BMI), but also in terms of fat distribution through waist circumference or waist measurement hip. Furthermore, the presence of obesity needs to be considered in the context of other risk factors and comorbidities associated (other medical conditions that may influence the risk of complications).

BMI
The BMI is a simple and widely used to estimate the proportion of body fat. The BMI was developed by the statistical and anthropometrist Belgian Adolphe Quetelet . This is calculated by dividing the subject's weight (in kilograms) by the square of its height (m), therefore is expressed in kg / m . The WHO ( World Health Organization ) provides a definition commonly in use with the following values, agreed in 1997, published in 2000 and adjusted in 2010: BMI below 18.5 is underweight.

BMI of 18.5 to

24.9 is

normal weight BMI of 25.0 to 29.9 is overweight.

BMI of 30.0 to 34.9 is obese class I BMI of 35.0 to 39.9 is obese class II. BMI of 40.0 or higher is obese class III, severe (or morbid). BMI of 35.0 or greater in the presence of at least one or other significant comorbidity is also classified by some bodies as morbid obesity .

In a clinical setting, physicians take into account race, ethnicity, lean mass (muscularity), age, sex and other factors which may affect the interpretation of BMI. BMI overestimates body fat in very muscular and can underestimate body fat in people who have lost body mass (many elderly). 2 Mild obesity as defined by BMI, is not a cardiovascular risk factor and at BMI therefore can not be used as a sole clinical and epidemiological predictor of cardiovascular health.

waist circumference
BMI does not take into account the differences between fat tissue and lean , nor distinguishes between different forms of adiposity, some of which might be associated more closely with riskcardiovascular . A better understanding of the biology of adipose tissue has shown that central obesity (male-type obesity or apple type) has a link with cardiovascular disease , only with BMI. The absolute waist circumference (> 102 cm in men and> 88 cm in women) or waist-hip ratio (> 0.9 for men and> 0.85 for women) are used as measures of central obesity. In a cohort of nearly 15,000 subjects in the study National Health and Nutrition Examination Survey (NHANES) III, the waist circumference explained significantly better than BMI risk factors for obesity-related health when metabolic syndrome was taken as a measure.

Body Fat
An alternative way to determine obesity is to measure the percentage of body fat . Doctors and scientists generally agree that a man with more than 25% body fat and women with more than 30% body fat are obese. However, it is difficult to measure body fat accurately. The most accepted method has been to weigh a person underwater, but underwater weighing is a procedure limited to laboratories with special equipment. The simplest methods to measure body fat are the skinfold method, in which a pinch of skin is precisely measured to determine the thickness of the subcutaneous fat layer, or bioelectrical impedance analysis , usually conducted by clinicians. Its routine use is discouraged. Other measures of body fat include computed tomography, magnetic resonance and x-ray absorptiometry Dual energy.

Risk factors and comorbidities

The presence of risk factors and disease associated with obesity are also used to establish a clinical diagnosis. Coronary artery disease, type 2 diabetes and sleep apnea are risk factors that constitute a danger to the life that could indicate a clinical treatment for obesity. Smoking status, hypertension, age and family history are other risk factors that could indicate treatment.

CLASSIFICATION

Depending on the source of obesity, it is classified into the following types: 1. Exogenous obesity: Obesity due to overeating. 2. Endogenous obesity: Those which cause metabolic disturbances. Among the causes endogenous , one speaks of obesity caused by endocrine when some endocrine gland dysfunction, such as thyroid (obese hypothyroid) or sex hormone deficiency as in the case of obesity gonadal .

EFFECT ON HEALTH
WHO notes that "Overweight and obesity are the fifth leading risk factor of death in the world. die each year at least 2.8 million adults as a result of overweight or obesity. In addition, 44% of the burden of diabetes, 23% of the burden of ischemic heart disease and between 7% and 41% of the burden of some cancers are attributable to overweight and obesity. " A large number of medical conditions have been associated with obesity. The health consequences are categorized as the result of increased fat mass ( osteoarthritis , sleep apnea , social stigma) or an increase in the number of fat cells ( diabetes , cancer , cardiovascular disease , NAFLD ). Mortality is increased in obesity, a BMI greater than 32 are associated with a twofold risk of death. There are alterations in the body's response the insulin ( insulin resistance ), a state pro- inflammatory and an increased tendency to the thrombosis (thrombotic pro status.) The association of other diseases may be dependent or independent of adipose tissue distribution. Central obesity (or obesity characterized by a radius waist hip ratio) is a major risk factor formetabolic syndrome , the accumulation of a number of diseases and risk factors that heavily predispose for cardiovascular disease. These are diabetes mellitus type two, high blood pressure , elevatedcholesterol and triglycerides in the blood ( combined hyperlipidemia ). In addition to the metabolic syndrome, obesity is also correlated with a variety of other complications. For some of these diseases, has been clearly established to what extent they are caused directly by obesity itself or have other causes (such as sedentary lifestyle) that also causes obesity. Cardiovascular : congestive heart failure , enlarged heart and arrhythmias and dizziness associated cor pulmonale, varicose veins and pulmonary embolism . Endocrine : polycystic ovarian syndrome , menstrual disorders and infertility . Gastrointestinal : illness of gastro-oesophageal reflux , fatty liver , gallstones , hernia and colorectal cancer . Renal and genitourinary: erectile dysfunction , urinary incontinence , chronic renal failure , hypogonadism (male), breast cancer (female), uterine cancer (female) Obstetrics: Fetal distress acute with stillbirth. Integument (skin and appendages): stretch marks , acanthosis nigricans , lymphedema , cellulitis , carbuncles , intertrigo . Musculoskeletal: hyperuricemia (which predisposes to gout ), loss of mobility, osteoarthritis , back pain . Neurologic: stroke , meralgia paresthetica , headaches , carpal tunnel syndrome , dementia , idiopathic intracranial hypertension . Respiratory : dyspnea , obstructive sleep apnea or Pickwickian syndrome, and asthma . Psychological : depression , low self-esteem , body dysmorphic disorder , social stigmatization. While being severely obese has many health complications, those who are overweight face a small increase in mortality or morbidity . In addition, some studies have found that osteoporosis occurs in people slightly less obese suggesting that the accumulation of visceral fat in particular, which is measured by waist circumference, is a protective factor for bone mineralization.

CAUSES AND MECHANISMS

The causes of obesity are multiple and include factors such as genetic inheritance, the behavior of the nervous system, endocrine and metabolic, and the type or style of life that takes. For Mazza (2001 ) among the factors that cause obesity can be attributed 30% to genetic factors, 40% to non-heritable factors and 30% for purely social factors, ie the relationship between genetic and environmental factors are 30% and 70% respectively. The mechanisms by which these factors cause excess body fat are: Increased intake of calories than your body needs. Low physical activity the body needs.

If ingested more energy than is needed it is stored as fat. If you consume more energy than is available using fat for energy. So that obesity is caused by excess energy as a result of alterations in the balance of input / output energy. Following several complications may occur, thediabetes mellitus and coronary heart disease.

such

as arterial

hypertension ,

Heredity plays an important role, both parents are obese the risk of obesity for children is 10 times higher than normal. This is partly due to trends metabolic fat accumulation, but partly due to cultural food habits and sedentary contribute to repeat the patterns of obesity in families. Another part of the obese are hormonal or endocrine diseases, and can be solved by a correct diagnosis and specialized treatment.

LIFESTYLE
Most researchers have concluded that the combination of excessive consumption of nutrients and style of sedentary lifestyle are the main cause of the rapid acceleration of obesity in Western society in the last quarter century. Despite the widespread availability of nutritional information in schools, offices, Internet and grocery stores, it is clear that excess consumption remains a substantial problem. For example, confidence in the fast-food dense in energy, has tripled between 1977 and 1995, and calorie consumption has quadrupled over the same period. However, the consumption of food by itself is insufficient to explain the phenomenal rise in obesity levels in the industrialized world in recent years. An increase in sedentary lifestyle also has a significant role to play. More and more research into childhood obesity , for example, I read such things as running at school, with current high levels of this disease. Questions about lifestyle, less well established, that may influence obesity include mental stress and sleepenough.

Map of Calories Consumed per Capita per Day

Map of Energy consumption (kcal/person/day) per country in 1961. World average was 2,253.9 kcal/person/day.

Map of Energy consumption (kcal/person/day) per country in 2001-2003. World average was 2800 kcal/person/day no data <1600 1600-1800 1800-2000 2000-2200 2200-2400 2400-2600 2600-2800 2800-3000 3000-3200 3200-3400 3400-3600 >3600

Inheritance and genetics

As with many medical conditions, the caloric imbalance that results in obesity often develops from a combination of genetic and environmental factors. The polymorphism in several genes that control appetite , the metabolism and the integration of adipokine , predispose to obesity, but the condition requires the availability of sufficient calories, and possibly other factors to develop fully. Several genetic conditions that have as a feature of obesity have been identified (such as Prader-Willi syndrome , the Bardet-Biedl syndrome , MOMO syndrome , mutations in receptors for leptin and melanocortin ), but single mutations in locus have only been found in 5% of obese individuals. IF it is thought that a large proportion of the causative genes are still unidentified, for most obesity is probably the result of interactions between multiple genes where non-genetic factors are also probably important. A 2007 study identified many common mutations in the FTO gene , the heterozygotes had a risk of obesity increased 30%, while homozygotes had an increased risk of 70%. At the population level, the thrifty gene hypothesis , which postulates that certain ethnic groups may be more prone to obesity than others and the ability to take advantage of rare periods of abundance and and use this wealth to store energy efficiently, may have been an advantage evolutionary, in times when food was scarce. Individuals with greater adipose reserves were more likely to survive famine. This tendency to store fat is likely maladaptive in a society with a stable food supply.

Percentage of Obese Population in Both Genders by Country

Map of Obesity in Adult Males (% of adult population with en:BMI 30+) per country. Using data updated until December 2008.

Map of Obesity in Adult Females (% of adult population with en:BMI 30+) per country. Using data updated until December 2008.
no data <5% 510% 1015% 1520% 2025% 2530% 3035% 3540% 4045% 4550% 5055% >55%

Medical Conditions
Approximately 2% to 3% of the causes of obesity are a result of endocrine diseases such as hypothyroidism ,Cushing syndrome , hypogonadism , injury hypothalamic or deficiency of growth hormone . Also certain mental illnesses or substance may predispose to obesity. Among mental illnesses that may increase the risk of obesity are eating disorders such as bulimia nervosa and consumptioncompulsive food or food addiction. Quitting smoking is a known cause moderate weight gain, because nicotine suppresses the appetite. Certain medical treatments ( drugs , atypical antipsychotics and some drugs for fertility ) can cause weight gain. Apart from the fact that corrijiendo these situations can be improved obesity, the presence of an increase in body weight may complicate the management of others.

Neurobiological Mechanisms
Flier summarizes the many possible mechanisms pathophysiological involved in the development and maintenance of obesity. This field of research has been almost unattainable until leptin was discovered in 1994. Since this discovery, many other hormonal mechanisms involved in regulating appetite and food intake, storage patterns in adipose tissue and the development of [[ insulin resistance ]] have been elucidated. Since the discovery of leptin , the ghrelinas , orexin , PYY 336, cholecystokinin , adiponectin , and many other mediators have been studied. The adipokines

are mediators produced by adipose tissue, is thought to their actions and modify many obesityrelated diseases. The leptin and ghrelinas are considered complementary in their influence on appetite, the ghrelinas produced by the stomach , modulate appetite control in the short term (to eat when the stomach is empty and to stop the stomach is full). Leptin is produced by adipose tissue to signal fat reserves stored in the body and mediate the control of appetite long term (to eat more when fat reserves are low and less when fat reserves are high). Although administration of leptin may be effective in a small group of obese individuals who are leptin deficient, many more obese individuals appear to be resistant to leptin. This resistance explains in part why administration of leptin has not been shown to be efficient in suppressing appetite in most obese subjects. While leptin and ghrelin are produced peripherally, they control appetite through their actions on central nervous system . In particular, these and other appetite-related hormones act on thehypothalamus , a brain region central to the regulation of food intake and energy expenditure. There are several circles within the hypothalamus that contribute to this integration role of appetite, being the route of the melanocortin the best understood. The tour begins in the hypothalamic arcuate nucleus, which has outputs to the hypothalamus lateral (LH) and ventromedial ( HVM), feeding centers and satiety in the brain respectively. The arcuate nucleus contains two distinct groups of neurons . The first group coexpresses neuropeptide Y (NPY) and agouti-related peptide (AgRP) and has stimulatory inputs to the lateral hypothalamus and ventromedial hypothalamic inhibitory signals. The second group coexpresses pro-opiomelanocortin (POMC) and cocaine-regulated transcripts and amphetamine (CART) and has stimulatory inputs to the hypothalamic ventromedial and lateral hypothalamic inhibitory signals. Consequently, NPY / AgRP neurons stimulate feeding and inhibit satiety, while neuronasPOMC / CART, stimulates satiety and inhibit feeding. Both groups of neurons in the arcuate nucleus are regulated in part by leptin. Leptin inhibits the NPY group / AgRP group while stimulating the POMC / CART. Therefore a deficiency in leptin signaling via leptin deficiency or leptin resistance, leading to overfeeding and may account for some forms of genetic and acquired obesity

Microbiological Aspects
The role of bacteria that colonize the digestive tract in the development of obesity has recently begun to be investigated. The bacteria involved in digestion (especially fatty acids and polysaccharides ) and alterations in the ratio 10 films in particular and days may explain why certain people are more likely to gain weight than others. In the human digestive tract, bacteria are usually members of the edge of the bacteroids or Firmicutes . In obese people, there is a relative abundance of Firmicutes (which cause a relatively high energy absorption), which is restored by weight loss. From these results we can not conclude yet whether this imbalance is the cause of obesity or an effect.

Social Determinants
Some obesity co-factors are resistant to the theory that the epidemic is a new phenomenon. In particular, a cofactor of class that consistently appears across many studies. Comparing net worth with BMI, a 2004 study found that obese American subjects are half richer than the lean. When income differentials were compared, inequality persisted, lean subjects were by inheritance richer than the obese. A higher rate of low education and tendencies to rely on cheap fast food is seen as a reason why these results are so different. Another study found that women who married into higher status are predictably thinner than women who married into lower status. A 2007 study of 32,500 children of the original cohort of the Framingham study, followed by 32 years indicated that BMI changes in friends, siblings or spouses, regardless of geographic distance. The association was strongest among mutual friends and younger brothers and husbands (although these differences were not statistically significant). The authors concluded from these results that the acceptance of body mass plays an important role in changes in body size.

Obesity and Menopause

The menopause causes changes in body fat distribution and fat oxidation. Increased abdominal and visceral fat mass in postmenopausal accompanied with increased antioxidant capacity because of hormonal changes while age has no influence. However, the antioxidant capacity has a linear correlation with age, but not with truncal fat mass. In premenopausal women initially were followed for 4 years during the menopausal transition, they reported an increase in abdominal subcutaneous fat associated with age, whereas menopause is accompanied by an increase in total body fat mass and mass visceral fat. SWAN The American study links the increase in visceral fat during menopause to changes in bioavailable testosterone. Excess body weight (overweight and obesity produces greater change in the Kupperman Index, metabolism, sleep and quality of life. obese postmenopausal women also have higher prevalence of sexual problems in relating to themselves and factors related to their partners.

CULTURAL SIGNIFICANCE AND SOCIAL

Etymology
Obesity is the noun form of a veneer which comes from the Latin obesus, which means "stout, fat or plump." Esus edere the past participle of (eating) with b added to it. Classical Latin, this verb is found only in the past participle form.

History
In several human cultures, obesity was associated with physical attractiveness, strength and fertility . Some of the earliest known cultural artifacts, known as Venus figurines , are pocket-sized statues representing an obese female figure. Although their cultural significance is not registered, its widespread use by all Mediterranean and European prehistoric cultures suggests a central role for the female form in magical rituals or visa and suggests cultural approval of (and perhaps reverence for) this body shape. This is most probably due to its ability to deal easily with children and survive famine. Obesity was considered a symbol of wealth and social status in cultures prone to food shortages or famine. This was seen also in the same way in the early modern period in European cultures, but when food security was realized, it served more as a visible sign of "lust for life", appetite, and immersion in the realm of the erotic . This was especially the case in the visual arts such as paintings of Rubens (1577-1640), whose coordinates regular representation of women gave us the description Rubenesque. Obesity can also be seen as a symbol within a system of prestige. "The type of food, the amount and manner in which it is served are among the important criteria of social class. In most tribal societies, even those with a highly stratified social system, worldwide and royalty- commoners, and ate the same kind of food and if there was famine everyone was hungry. With the ever increasing diversity of items, food has become not only a matter of social status, but also a mark of personality and individual taste. "

Contemporary Culture

In modern Western cultures, the obese body shape is widely considered unattractive and many negative stereotypes are commonly associated with obese people. Children, adolescents and adults who are obese may also face a heavy social stigma. Obese children are frequently the targets of threats and are often rejected by their peers. Although obesity rates are increasing among all social classes in the Western world, obesity is often seen as a sign of socioeconomic status low. Most people that have experienced negative thoughts about body image, and some of them take drastic measures to try to change the way including diet , use of medications including surgery . Not all contemporary cultures disapprove of obesity. There are many cultures which traditionally more approving (to varying degrees) obesity, including some African cultures, Arab, Indian and Pacific Islander. Especially in recent decades, obesity has begun to be seen more as a medical condition in modern Western culture has even referred to as an epidemic. Recently there has emerged a small but growing movement to fat acceptance that seeks to challenge the discrimination based on weight. Support groups and acceptance of obesity, have initiated a lawsuit to defend the rights of obese people and to prevent their social exclusion. Authors within this movement argue that the social stigma around obesity is based on the anxiety that cultural and public concern about the health risks associated with obesity are inappropriately used as a rationalization of this stigma. Government agencies and private medicine have warned Americans for years about the adverse health effects associated with overweight and obesity. Despite the warnings, the problem is getting worse. In 2004, the CDC reported that 66.3% of U.S. adults were overweight or obese. The cause in most cases it is the sedentary lifestyle, approximately 40% of U.S. adults do not participate in any physical activity during their leisure time and less than a third of adults are concerned with the amount of recommended physical activity. Overweight and obesity are easily determined using the body mass index (BMI), this index uses height and weight to determine body fat. A BMI between 25 and 29.9 is considered overweight and any value over 30 is obese. Individuals with a BMI above 30 increases the risk for various health hazards.

Popular culture
Various stereotypes of obese people has found its way into an expression of popular culture . A common stereotype is the obese person's character, who has a warm and reliable, but is equally common stereotype of obese vicious bully (as Dudley Dursley in the book series Harry Potter, Nelson Muntz of The Simpsons .) Gluttony and obesity are commonly depicted together in works of fiction. In cartoons, obesity is often used as comic effect, with fat cartoon characters (such as Piggy, Porky Pigy Tummi Gummi) having to squeeze through narrow spaces often being stuck or even exploding. A more unusual example of humor is linked to obesity Bustopher Jones , the poem by TS Eliot . Bustopher Jones: The Cat About Town contained in his book Old Possum's Book of Practical Cats and in the musical Cats , who became famous for being a regular visitor to many gentlemen's clubs . Due to his constant lunches at the club, he is extremely overweight, being described by others as "25 pounds ... and he is gaining weight every day." Another popular character is Garfield, cat cartoons, obesity is also for humor. When his owner, John, put on a diet, instead of losing weight, Garfield slowed weight gain. It can be argued that this representation in popular culture adds and maintains commonly perceived stereotypes, damaging self-esteem of obese people. On the other hand, obesity is often associated with positive characteristics such as humor (the stereotype of the jolly fat man like Santa Claus) and some people are sexually attracted to obese people than lean people.

OBESITY AND PUBLIC HEALTH Prevalence

In the UK, the Health Survey for England predicts that more than 12 million adults and one million children will be obese by 2010 if no action is taken. In the United States, the prevalence of overweight and obesity makes obesity a major public health problem. The United States has the highest rate of obesity in the developed world. From 1980 to 2002, obesity has doubled in adults and the prevalence of overweight has been criticized in children and adolescents. From 2003 to 2004, "in children and adolescents aged 2 to 19, 17.1% had overweight ... and 32.2% of adults 20 and older were obese. "The prevalence in the United States continues to increase. In China, average income increased due to the economic boom, the population of China has recently begun a more sedentary lifestyle and also began to eat more calories. From 1991 to 2004 the percentage of adults overweight or obese increased from 12.9% to 27.3%. Obesity is a public health problem and its prevalence life policy, costs and charges. decides prevalence has been increasing steadily for two decades. This sudden increase in the prevalence of obesity is attributed to environmental factors and population rather than individual behavior and biological due to continued rapid increase in the number of overweight and obese individuals. The current environment produces risk factors for decreased physical activity and increased calorie consumption. These environmental factors operate on the population to decrease their physical activity and increased calorie intake.

This chart compares obesity figures in the population of OECD countries; it shows the percentage of total population (aged 15 and above) with a body-mass index greater than 30. The year the figures used for this chart were published, collected or compiled range from 1996 to 2003.

Life expectancy
A study of people over forty years of age by the Framingham Heart Study from 1948 to 1990 revealed that in patients with overweight ( BMI of 24 to 29.9 kg / m 2 ) nonsmokers had a lower life expectancy than the average 3.3 years for women and 3.1 years for men. In obese patients ( BMI greater than 30 kg / m 2 ) nonsmokers were 7.1 years less in women and 5.8 years less for men. The obese smokers had a lower life expectancy than the average non-obese smokers of 7.2 years for females and 6.7 years for men and compared to the average of the nonsmokers and were of normal weight was a difference of 13.3 years for women and 13.7 for men.

Environmental Factors
While often it may seem obvious why a certain individual gets fat, it is more difficult to understand why the average weight of a certain society has recently been increasing. While genetic causes are central to understanding obesity, they can not fully explain why a fat culture

over another. This is most notably the United States . In the years just after World War II until 1960 the average per person weight increased, but few were obese. In the two and a half decades since 1980, growth in the rate of obesity has accelerated markedly and is increasingly becoming a problem of public health . A number of theories to explain the cause of this change since 1980. The most credible is the combination of several factors. Loss of activity: obese people are less active in general than thin people and not by their obesity. A controlled increase in calorie intake of lean people does not make them less active, correspondingly when obese people lose weight does not begin to be more active. Weight change does not affect activity levels. Lower relative cost of food: massive changes in agricultural policies in the United States and America has led to a decline in food prices at the consumer level, as at any time in history. In the current debate about trade policy highlight disagreements on the effects of subsidies. In the United States, production of corn , soybeans , wheat and rice are subsidized through the U.S. farm bill.Corn and soybeans, which are the main source of sugar and fat in processed foods are so cheap compared to fruits and vegetables. Marketing increased: this also played a role. At the beginning of 1980 the administration Reagan in the United States lifted most regulations pertaining to advertising aimed at children on sweets and fast food. As a result, the number of advertisements seen by the average child increased greatly and a large proportion of these ate fast food and sweets . The change in the labor force: each year a greater percentage of the population spend their entire work day behind a desk or computer , doing virtually no exercise. Has increased the consumption of frozen foods dense in calories that are cooked in the microwave (very comfortable) and has encouraged the production of " snacks "increasingly elaborate. A social cause that many believe plays a role is the increasing number two-income families in which neither parent stays home to care for the house. This increases the number of restaurants andtakeaways . The uncontrolled expansion of cities can be a factor: the rate of obesity increases as the expansion of cities increases, possibly because there is less time walking and cooking. Since 1980, fast food restaurants have seen dramatic growth in terms of sales and number of consumers served. Meals at low cost and intense competition for market share, has led to an increased portion sizes, for example, portions of fries McDonald's , rose from 200 calories in 1960 to over 600 calories today.

Consequences Nonmedical
In addition to increased morbidity and mortality there are other implications for the current global trend of obesity. Among these are: Increased pressure on airline revenues (or rate increase) due to the pressure to achieve an increase in the width of the seats in commercial aircraft and due to higher fuel costs: in 2000, the weight obese passengers extra cost to airlines and consumers 275,000,000 U.S. dollars. An increase in litigation by obese people suing restaurants (for causing obesity) and airlines (about the width of the seats).Decree on Personal Responsibility in Food Consumption in 2005 was motivated by a need to reduce number of lawsuits from activist obese. Considerable social and economic cost attributable to obesity, with medical costs attributable to obesity increased to 78.5 trillion or 9.1% of all medical spending in the United States for 1988. A decrease in worker productivity as measured by the use of disability leave and absenteeism at work. A study examining Duke University employees found that those with a BMI greater than 40 sheets filled claim, two times more than workers whose BMI was between 18.5 and 24.9 lost work days and more than 12 times more than other workers. The most common injury was due to falls and lifting floors, affecting the lower limbs, hands, wrists and back.