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Obesity
Obesity is a medical condition in which excess body fat has

Obesity
accumulated to the extent that it may have a negative effect on
health.[1] People are generally 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, is over 30 kg/m2, with the range
25–30 kg/m2 defined as overweight.[1] Some East Asian countries use
lower values.[8] Obesity increases the likelihood of various diseases
and conditions, particularly cardiovascular diseases, type 2 diabetes,
obstructive sleep apnea, certain types of cancer, osteoarthritis and
depression.[2][3]
Obesity is most commonly caused by a combination of excessive food

intake, lack of physical activity, and genetic susceptibility.[1][4] A few
cases are caused primarily by genes, endocrine disorders, medications,
or mental disorder.[9] The view that obese people eat little yet gain
weight due to a slow metabolism is not generally supported.[10] On Silhouettes and waist circumferences
average, obese people have a greater energy expenditure than their representing optimal, overweight, and obese
normal counterparts due to the energy required to maintain an Specialty Endocrinology
increased body mass.[10][11]
Symptoms Increased fat[1]
Obesity is mostly preventable through a combination of social changes Complications Cardiovascular diseases, type
and personal choices.[1] Changes to diet and exercising are the main 2 diabetes, obstructive sleep
treatments.[2] Diet quality can be improved by reducing the apnea, certain types of cancer,
consumption of energy-dense foods, such as those high in fat or osteoarthritis, depression[2][3]
sugars, and by increasing the intake of dietary fiber.[1] Medications Causes Excessive food, lack of
can be used, along with a suitable diet, to reduce appetite or decrease exercise, genetics[1][4]
fat absorption.[5] If diet, exercise, and medication are not effective, a
Diagnostic BMI > 30 kg/m2[1]
gastric balloon or surgery may be performed to reduce stomach
method
volume or length of the intestines, leading to feeling full earlier or a
reduced ability to absorb nutrients from food.[6][12]
Prevention Societal changes, personal
choices[1]
Obesity is a leading preventable cause of death worldwide, with Treatment Diet, exercise, medications,
increasing rates in adults and children.[1][13] In 2015, 600 million surgery[1][5][6]
adults (12%) and 100 million children were obese in 195 countries.[7]
Prognosis Reduce life expectancy[2]
Obesity is more common in women than men.[1] Authorities view it as
one of the most serious public health problems of the 21st century.[14] Frequency 700 million / 12% (2015)[7]
Obesity is stigmatized in much of the modern world (particularly in the
Western world), though it was seen as a symbol of wealth and fertility at other times in history and still is in some parts of the
world.[2][15] In 2013, the American Medical Associationclassified obesity as a disease.[16][17]
Contents
Classification
Effects on health
Mortality
Morbidity
Survival paradox
Causes
Diet
Sedentary lifestyle
Genetics
Other illnesses
Social determinants
Gut bacteria
Pathophysiology
Public health
Reports
Management
Epidemiology
History
Etymology
Historical attitudes
The arts
Society and culture
Economic impact
Size acceptance
Industry influence on research
Childhood obesity
Other animals
References
Cited sources
Further reading
Classification
Obesity is a medical condition in which excess body fat has accumulated to the extent
that it may have an adverse effect on health.[19] It is defined by body mass index (BMI) BMI (kg/m2) Classification[18]
and further evaluated in terms of fat distribution via the waist–hip ratio and total from up to
cardiovascular risk factors.[20][21] BMI is closely related to both percentage body fat and
18.5 underweight
total body fat.[22] In children, a healthy weight varies with age and sex. Obesity in
18.5 25.0 normal weight
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 percentile.[23] 25.0 30.0 overweight
The reference data on which these percentiles were based date from 1963 to 1994, and 30.0 35.0 class I obesity
thus have not been affected by the recent increases in weight.[24] BMI is defined as the 35.0 40.0 class II obesity
subject's weight divided by the square of their height and is calculated as follows.
40.0 class III obesity
where m and h are the subject's weight and height respectively.
BMI is usually expressed in kilograms per square metre, resulting when weight is measured in kilograms and height in metres. To
convert from pounds per square inch multiply by703 (kg/m2)/(lb/sq in).[25]
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.[26][27]
Some modifications to the WHO definitions have been made by particular

organizations.[28] The surgical literature breaks down class II and III obesity
[29]
into further categories whose exact values are still disputed.
A "super obese" male with a BMI of
Any BMI ≥ 35 or 40 kg/m2 is severe obesity. 53 kg/m2: weight 182 kg (400 lb), height
A BMI of ≥ 35 kg/m2 and experiencing obesity-related health 185 cm (6 ft 1 in). He presents withstretch
conditions or ≥40–44.9 kg/m2 is morbid obesity. marks and enlarged breasts
A BMI of ≥ 45 or 50 kg/m2 is super obesity.
As Asian populations develop negative health consequences at a lower BMI
than Caucasians, some nations have redefined obesity; Japan have defined obesity as any BMI greater than 25 kg/m2[8] while China
uses a BMI of greater than 28 kg/m2.[28]
Effects on health
Excessive body weight is associated with various diseases and conditions, particularly cardiovascular diseases, diabetes mellitus type
2, obstructive sleep apnea, certain types of cancer, osteoarthritis,[2] and asthma.[2][30] As a result, obesity has been found to reduce
life expectancy.[2]
Mortality
Obesity is one of the leading preventable causes
of death worldwide.[32][33][34] A number of
reviews have found that mortality risk is lowest
at a BMI of 20–25 kg/m2[35][36][37] in non-
smokers and at 24–27 kg/m2 in current smokers,
with risk increasing along with changes in either
direction.[38][39] This appears to apply in at least
four continents.[37] In contrast, a 2013 review
found that grade 1 obesity (BMI 30–35) was not Relative risk of death over 10 years for white men (left) and women
(right) who have never smoked in the United States by BMI. [31]
associated with higher mortality than normal
weight, and that overweight (BMI 25–30) was
associated with "lower" mortality than was
normal weight (BMI 18.5–25).[40] Other evidence suggests that the association of BMI and waist circumference with mortality is U-
or J-shaped, while the association between waist-to-hip ratio and waist-to-height ratio with mortality is more positive.[41] In Asians
the risk of negative health effects begins to increase between 22–25 kg/m2.[42] A BMI above 32 kg/m2 has been associated with a
doubled mortality rate among women over a 16-year period.[43] In the United States, obesity is estimated to cause 11,909 to 365,000
deaths per year,[2][34] while 1 million (7.7%) of deaths in Europe are attributed to excess weight.[44][45] On average, obesity reduces
life expectancy by six to seven years,[2][46] a BMI of 30–35 kg/m2 reduces life expectancy by two to four years,[36] while severe
obesity (BMI > 40 kg/m2) reduces life expectancy by ten years.[36]
Morbidity
Obesity increases the risk of many physical and mental conditions. These comorbidities are most commonly shown in metabolic
syndrome,[2] a combination of medical disorders which includes: diabetes mellitus type 2, high blood pressure, high blood
cholesterol, and high triglyceride levels.[47]
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
[48]
with type 2 diabetes. Excess body fat underlies 64% of cases of diabetes in men and 77% of cases in women.
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, cancer, cardiovascular
disease, non-alcoholic fatty liver disease).[2][49] Increases in body fat alter the body's response to insulin, potentially leading to
insulin resistance. Increased fat also creates aproinflammatory state,[50][51] and a prothrombotic state.[49][52]
Medical field Condition Medical field Condition
coronary heart disease:[53] angina and stretch marks[56]

myocardial infarction
acanthosis nigricans[56]
congestive heart failure[2][54]
Cardiology Dermatology lymphedema[56]
high blood pressure[2]
cellulitis[56]
abnormal cholesterol levels[2]
hirsutism[56]
deep vein thrombosis and pulmonary
embolism[55] intertrigo[57]
diabetes mellitus[2]
polycystic ovarian syndrome[2] gastroesophageal reflux
Endocrinology
menstrual disorders[2] disease[14]
and
infertility[2][58] Gastroenterology fatty liver disease[14]
Reproductive
medicine complications during pregnancy[2][58] cholelithiasis
birth defects[2] (gallstones)[14]
intrauterine fetal death[58]
esophageal
stroke[2] colorectal
meralgia paresthetica[59] pancreatic
gallbladder
migraines[60]
Neurology Oncology[65] endometrial
carpal tunnel syndrome[61]
kidney
dementia[62]
Leukemia
idiopathic intracranial hypertension[63] Hepatocellular
multiple sclerosis[64] carcinoma[14]
malignant melanoma
obstructive sleep
apnea[2][30]
obesity hypoventilation
Psychiatry depression in women[2] Respirology syndrome[2][30]
social stigmatization[2] asthma[2][30]
increased complications
during general
anaesthesia[2]
erectile dysfunction[69]
gout[66]
Rheumatology urinary incontinence[70]
poor mobility[67] Urology and
and chronic renal failure[71]
Nephrology
Orthopedics osteoarthritis[2]
hypogonadism[72]
low back pain[68]
buried penis[73]
Survival 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.[74]
The paradox was first described in 1999 in overweight and obese people undergoing hemodialysis,[74] and has subsequently been
found in those with heart failure and peripheral artery disease(PAD).[75]
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
[76] Similar findings have been made in
been attributed to the fact that people often lose weight as they become progressively more ill.
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.[77][78] Even after cardiac bypass surgery, no increase in mortality is seen in the overweight and
obese.[79] One study found that the improved survival could be explained by the more aggressive treatment obese people receive after
a cardiac event.[80] Another found that if one takes into account chronic obstructive pulmonary disease (COPD) in those with PAD,
the benefit of obesity no longer exists.[75]
Causes
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.[81] A limited number of cases are due primarily to genetics, medical reasons, or psychiatric illness.[9] In contrast,
increasing rates of obesity at a societal level are felt to be due to an easily accessible and palatable diet,[82] increased reliance on cars,
and mechanized manufacturing.[83][84]
A 2006 review identified ten other possible contributors to the recent increase of obesity: (1) insufficient sleep, (2) endocrine
disruptors (environmental pollutants that interfere with lipid metabolism), (3) decreased variability in ambient temperature, (4)
decreased rates of 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).[85] While there is 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.
Diet
A 2016 review supported excess food as the primary factor.[87] Dietary energy supply per capita varies markedly between different
regions and countries. It has also changed significantly over time.[86] 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 3,654 calories (15,290 kJ) per person in 1996.[86] This increased further in 2003 to 3,754 calories
(15,710 kJ).[86] During the late 1990s Europeans had 3,394 calories (14,200 kJ) per person, in the developing areas of Asia there
were 2,648 calories (11,080 kJ) per person, and in sub-Saharan Africa people had 2,176 calories (9,100 kJ) per person.[86][88] Total
food energy consumption has been found to be related to obesity.[89]
The widespread availability of nutritional guidelines[90] has done little to address the problems of overeating and poor dietary
choice.[91] From 1971 to 2000, obesity rates in the United States increased from 14.5% to 30.9%.[92] During the same period, an
increase occurred in the average amount of food energy consumed. For women, the average increase was 335 calories (1,400 kJ) per
day (1,542 calories (6,450 kJ) in 1971 and 1,877 calories (7,850 kJ) in 2004), while for men the average increase was 168 calories
(700 kJ) per day (2,450 calories (10,300 kJ) in 1971 and 2,618 calories (10,950 kJ) in 2004). Most of this extra food energy came
from an increase in carbohydrate consumption rather than fat consumption.[93] 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,[94] and potato
chips.[95] Consumption of sweetened drinks such as soft drinks, fruit drinks, iced tea, and ener
gy and vitamin water drinks is believed
to be contributing to the rising rates of
obesity[96][97] and to an increased risk of
metabolic syndrome and type 2 diabetes.[98]
Vitamin D deficiency is related to diseases
associated with obesity.[99]
1961
As societies become increasingly reliant on
energy-dense, big-portions, and fast-food meals,
the association between fast-food consumption
and obesity becomes more concerning.[100] In
the United States consumption of fast-food meals
tripled and food energy intake from these meals 2001–03
quadrupled between 1977 and 1995.[101] Map of dietary energy availability per person per day in 1961 (left)
and 2001–2003 (right)[86] Calories per person per day (kilojoules per
Agricultural policy and techniques in the United person per day)
States and Europe have led to lower food prices. no data 2,600–2,800 (10,900–11,700)
In the United States, subsidization of corn, soy, <1,600 (<6,700) 2,800–3,000 (11,700–12,600)
wheat, and rice through the U.S. farm bill has 1,600–1,800 (6,700–7,500) 3,000–3,200 (12,600–13,400)
made the main sources of processed food cheap
1,800–2,000 (7,500–8,400) 3,200–3,400 (13,400–14,200)
compared to fruits and vegetables.[102] Calorie
2,000–2,200 (8,400–9,200) 3,400–3,600 (14,200–15,100)
count laws and nutrition facts labels attempt to
2,200–2,400 (9,200–10,000) >3,600 (>15,100)
steer people toward making healthier food
choices, including awareness of how much food 2,400–2,600 (10,000–10,900)
energy is being consumed.
Obese people consistently under-report their food

consumption as compared to people of normal weight.[103]
This is supported both by tests of people carried out in a
calorimeter room[104] and by direct observation.
Sedentary lifestyle
A sedentary lifestyle plays a significant role in obesity.[105]
Worldwide there has been a large shift towards less
physically demanding work,[106][107][108] and currently at
least 30% of the world's population gets insufficient Average per capita energy consumption of the world from
exercise.[107] This is primarily due to increasing use of 1961 to 2002[86]
mechanized transportation and a greater prevalence of
labor-saving technology in the home.[106][107][108] In
children, there appear to be declines in levels of physical activity due to less walking and physical education.[109] 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[110] found an increase and a study from the United States found leisure-time
physical activity has not changed significantly.[111] A 2011 review of physical activity in children found that it may not be a
significant contributor.[112]
In both children and adults, there is an association between television viewing time and the risk of obesity.[113][114][115] 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.[116]
Genetics
Like many other medical conditions, obesity is the result of an
interplay between genetic and environmental factors.[118]
Polymorphisms in various genes 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.[119] People with two copies of the FTO gene (fat mass and
obesity associated gene) have been found on average to weigh 3–4 kg
more and have a 1.67-fold greater risk of obesity compared with those
without the risk allele.[120] The differences in BMI between people
that are due to genetics varies depending on the population examined
from 6% to 85%.[121]
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.)[122] In people with early-onset severe
obesity (defined by an onset before 10 years of age and body mass
index over three standard deviations above normal), 7% harbor a single
point DNA mutation.[123]
Studies that have focused on inheritance patterns rather than on

specific genes have found that 80% of the offspring of two obese A 1680 painting by Juan Carreno de Mirandaof a
parents were also obese, in contrast to less than 10% of the offspring of girl presumed to have Prader–Willi syndrome[117]
two parents who were of normal weight.[124] Different people exposed
to the same environment have different risks of obesity due to their
underlying genetics.[125]
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.[126] This theory has received various criticisms, and other
evolutionarily-based theories such as the drifty gene hypothesis and the thrifty phenotype hypothesis have also been
proposed.[127][128]
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,[129] and the eating disorders: binge eating disorder
and night eating syndrome.[2] However, obesity is not regarded as a psychiatric disorder, and therefore is not listed in the DSM-IVR
as a psychiatric illness.[130] The risk of overweight and obesity is higher in patients with psychiatric disorders than in persons
without psychiatric disorders.[131]
Certain medications may cause weight gain or changes in body composition; these include insulin, sulfonylureas, thiazolidinediones,
atypical antipsychotics, antidepressants, steroids, certain anticonvulsants (phenytoin and valproate), pizotifen, and some forms of
hormonal contraception.[2]
Social determinants
While genetic influences are important to understanding obesity, they
cannot explain the current dramatic increase seen within specific
countries or globally.[132] 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 betweensocial 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.[133] 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.[134]
Among developed countries, levels of adult obesity, and percentage of
The disease scroll (Yamai no soshi, late 12th
teenage children who are overweight, are correlated with income
century) depicts a woman moneylender with
inequality. A similar relationship is seen among US states: more adults, obesity, considered a disease of the rich.
[135]
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.[134] 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.[136] Stress and perceived low social status appear to increase risk of
obesity.[135][137][138]
Smoking has a significant effect on an individual's weight. Those who quit smoking gain an average of 4.4 kilograms (9.7 lb) for men
and 5.0 kilograms (11.0 lb) for women over ten years.[139] However, changing rates of smoking have had little effect on the overall
rates of obesity.[140]
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.[141] This could be partly explained by the fact that having dependent children decreases
physical activity in Western parents.[142]
In the developing world urbanization is playing a role in increasing rate of obesity. In China overall rates of obesity are below 5%;
[143]
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.[144] Endocrine changes that
gy becomes available.[144]
occur during periods of malnutrition may promote the storage of fat once more food ener
Consistent with cognitive epidemiological data, numerous studies confirm that obesity is associated with cognitive deficits.[145]
Whether obesity causes cognitive deficits, or vice versa is unclear at present.
Gut bacteria
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
.[146]
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
[147]
associations may have contributed to the rising rate of obesity is yet to be determined.
Pathophysiology
There are many possible pathophysiological mechanisms involved in
the development and maintenance of obesity.[148] This field of
research had been almost unapproached until the leptin gene was
discovered in 1994 by J. M. Friedman's laboratory.[149] 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.[148] The circuit begins with an area of the A comparison of a mouse unable to produce
hypothalamus, the arcuate nucleus, that has outputs to the lateral leptin thus resulting in obesity (left) and a normal
hypothalamus (LH) and ventromedial hypothalamus (VMH), the mouse (right)
.[150]
brain's feeding and satiety centers, respectively
The arcuate nucleus contains two distinct groups of neurons.[148] 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
.[148]
leptin resistance, leads to overfeeding and may account for some genetic and acquired forms of obesity
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.[151] Obesity is a public health
and policy problem because of its prevalence, costs, and health effects.[152] The United States Preventive Services Task Force
recommends screening for all adults followed by behavioral interventions in those who are obese.[153] 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,[154] and decreasing access to sugar-sweetened
beverages in schools.[155] The World Health Organization recommends the taxing of sugary drinks.[156] When constructing urban
environments, efforts have been made to increaseaccess to parks and to develop pedestrian routes.[157]
Reports
Many organizations 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".[158] 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
[81]
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.[159] The same
year, the 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.[160] 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.[161] A 2007 report produced by Derek Wanless for the King's Fund warned
that unless further action was taken, obesity had the capacity to cripple theNational Health Servicefinancially.[162]
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.[163]
Management
The main treatment for obesity consists of dieting and physical exercise.[81] Diet programs may produce weight loss over the short
term,[164] 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.[165][166]
In the short-term low carbohydrate diets appear better than low fat diets for weight loss.[167] In the long term; however, all types of
low-carbohydrate and low-fat diets appear equally beneficial.[167][168] A 2014 review found that the heart disease and diabetes risks
associated with different diets appear to be similar.[169] Promotion of the Mediterranean diets among the obese may lower the risk of
heart disease.[167] Decreased intake of sweet drinks is also related to weight-loss.[167] Success rates of long-term weight loss
maintenance with lifestyle changes are low, ranging from 2–20%.[170] Dietary and lifestyle changes are effective in limiting
excessive weight gain in pregnancy and improve outcomes for both the mother and the child.[171] Intensive behavioral counseling is
[172]
recommended in those who are both obese and have other risk factors for heart disease.
Five medications have evidence for long-term use orlistat, lorcaserin, liraglutide, phentermine–topiramate, and naltrexone–
bupropion.[173] They result in weight loss after one year ranged from 3.0 to 6.7 kg over placebo.[173] Orlistat, liraglutide, and
naltrexone–bupropion are available in both the United States and Europe, whereas lorcaserin and phentermine–topiramate are
available only in the United States.[174] European regulatory authorities rejected the latter two drugs in part because of associations
of heart valve problems with lorcaserin and more general heart and blood vessel problems with phentermine–topiramate.[174] Orlistat
use is associated with high rates of gastrointestinal side effects[175] and concerns have been raised about negative effects on the
kidneys.[176] There is no information on how these drugs affect longer-term complications of obesity such as cardiovascular disease
or death.[5]
The most effective treatment for obesity is bariatric surgery.[6] The types of procedures include laparoscopic adjustable gastric
banding, Roux-en-Y gastric bypass, vertical-sleeve gastrectomy, and biliopancreatic diversion.[173] Surgery for severe obesity is
associated with long-term weight loss, improvement in obesity-related conditions,[177] and decreased overall mortality. One study
found a weight loss of between 14% and 25% (depending on the type of procedure performed) at 10 years, and a 29% reduction in all
cause mortality when compared to standard weight loss measures.[178] Complications occur in about 17% of cases and reoperation is
needed in 7% of cases.[177] Due to its cost and risks, researchers are searching for other effective yet less invasive treatments
[179]
including devices that occupy space in the stomach.
Epidemiology
In earlier historical periods obesity was rare, and achievable only by a small elite, although already recognised as a problem for
health. But as prosperity increased in theEarly Modern period, it affected increasingly larger groups of the population.[182]
In 1997 the WHO formally
recognized obesity as a
global epidemic.[94] As of
2008 the WHO estimates that
at least 500 million adults
(greater than 10%) are obese,
with higher rates among World obesity prevalence among males (left)and females (right) in 2008.[180]
women than men.[183] The <5% 15–20% 30–35% 45–50%
percentage of adults affected 5–10% 20–25% 35–40% 50–55%
in the United States as of
10–15% 25–30% 40–45% >55%
2015-2016 is about 39.6%
overall (37.9% of males and
41.1% of females).[184]
The rate of obesity also increases with ►

age at least up to 50 or 60 years
old[185] and severe obesity in the
United States, Australia, and Canada
is increasing faster than the overall
rate of obesity.[29][186][187]
Once considered a problem only of

high-income countries, obesity rates
are rising worldwide and affecting
both the developed and developing
world.[44] These increases have been
felt most dramatically in urban
settings.[183] The only remaining
See or edit source data.
region of the world where obesity is .[181]
Percentage of the population either overweight or obese by year
not common is sub-Saharan Africa.[2]
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.[188] The Oxford English Dictionary documents its first usage in 1611 by Randle Cotgrave.[189]
Historical attitudes
Ancient Greek medicinerecognizes obesity as a medical disorder, and records that the Ancient Egyptians saw it in the same way.[182]
Hippocrates wrote that "Corpulence is not only a disease itself, but the harbinger of others".[2] The Indian surgeon Sushruta (6th
century BCE) related obesity to diabetes and heart disorders.[191] He recommended physical work to help cure it and its side
effects.[191] For most of human history mankind struggled with food scarcity
.[192] 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[190] as well as in
Ancient East Asian civilizations.[193] In the 17th century, English medical authorTobias Venner is credited with being one of the first
[182][194]
to refer to the term as a societal disease in a published English language book.
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.[94] 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.[94] Height and weight thus both
increased through the 19th 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.[94] In the 1950s increasing wealth in the
developed world decreased child mortality, but as body weight increased heart and
kidney disease became more common.[94][195] During this time period, insurance
companies realized the connection between weight and life expectancy and
increased premiums for the obese.[2]
Many cultures throughout history have viewed obesity as the result of a character
flaw. The obesus or fat character in Ancient Greek comedy was a glutton and figure
of mockery. During Christian times the food was viewed as a gateway to the sins of
sloth and lust.[15] 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.[196] During the Middle Ages and the
Renaissance obesity was often seen
Public perceptions in Western society regarding healthy body weight differ from as a sign of wealth, and was
those regarding the weight that is considered ideal – and both have changed since relatively common among the elite:
the beginning of the 20th century. The weight that is viewed as an ideal has become The Tuscan General Alessandro del
Borro, attributed to Charles Mellin,
lower since the 1920s. This is illustrated by the fact that the average height of Miss
1645[190]
America pageant winners increased by 2% from 1922 to 1999, while their average
weight decreased by 12%.[197] 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.[198] These changes are believed to be due to increasing rates of adiposity
[198]
leading to increased acceptance of extra body fat as being normal.
Obesity is still seen as a sign of wealth and well-being in many parts of Africa. This
has become particularly common since theHIV epidemic began.[2]
The arts
The first sculptural representations of the human body 20,000–35,000 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.[15] 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.[15]
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 dal Borro.[15]
Rubens (1577–1640) regularly depicted full-bodied women in his pictures, from
which derives the term Rubenesque. These women, however, still maintained the Venus of Willendorf created 24,000–
22,000 BC
[199]
"hourglass" shape with its relationship to fertility.[199] During the 19th century, views on obesity changed in the Western world. After
[15]
centuries of obesity being synonymous with wealth and social status, slimness began to be seen as the desirable standard.
Society and culture
Economic impact
In addition to its health impacts, obesity leads to many problems including disadvantages in employment[200][201] and increased
business costs. These effects are felt by all levelsof society from individuals, to corporations, to governments.
In 2005, the medical costs attributable to obesity in the US were an estimated $190.2 billion or 20.6% of all medical
expenditures,[202][203][204] while the cost of obesity in Canada was estimated at CA$2 billion in 1997 (2.4% of total health
costs).[81] 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.[205] The estimate range for annual expenditures on diet products is
$40 billion to $100 billion in the US alone.[206]
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.[207]
Obesity can lead to social stigmatization and disadvantages in

employment.[200] 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.[209] A study examining Duke University
employees found that people with a BMI over 40 kg/m2 filed twice as
many workers' compensation claims as those whose BMI was 18.5–
24.9 kg/m2. They also had more than 12 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.[210]
The Alabama State Employees' Insurance Board approved a
controversial plan to charge obese workers $25 a month for health
Services must accommodate obese people with insurance that would otherwise be free unless they take steps to lose
specialist equipment such as much wider weight and improve their health. These measures started in January
chairs.[208] 2010 and apply to those state workers whose BMI exceeds 35 kg/m2
.[211]
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.[196] 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.[212]
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.[213] In 2000, the extra weight of obese passengers cost airlines
US$275 million.[214] The healthcare industry has had to invest in special facilities for handling severely obese patients, including
special lifting equipment and bariatric ambulances.[215] Costs for restaurants are increased by litigation accusing them of causing
obesity.[216] 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.[216]
With the American Medical Association's 2013 classification of obesity as a chronic disease,[16] 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.[217] The AMA
classification is not legally binding, however, so health insurers still have the right to reject coverage for a treatment or
procedure.[217]
In 2014, The European Court of Justice ruled that morbid obesity is a disability. The Court said that if an employee's obesity prevents
him from "full and effective participation of that person in professional life on an equal basis with other workers", then it shall be
.[218]
considered a disability and that firing someone on such grounds is discriminatory
Size acceptance
The principal goal of the fat acceptance movement is to decrease
discrimination against people who are overweight and obese.[219][220]
However, some in the movement are also attempting to challenge the
established relationship between obesity and negative health
outcomes.[221]
A number of organizations exist that promote the acceptance of

obesity. They have increased in prominence in the latter half of the
20th century.[222] 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.[223]
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.[224]
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.[221]
Industry influence on research

United States PresidentWilliam Howard Taft was
In 2015 the New York Times published an article on the Global Energy
often ridiculed for being overweight
Balance Network, a nonprofit founded in 2014 that advocated for
people to focus on increasing exercise rather than reducing calorie
intake to avoid obesity and to be healthy. The organization was founded with at least $1.5M in funding from the Coca-Cola
Company, and the company has provided $4M in research funding to the two founding scientists Gregory A. Hand and Steven N.
Blair since 2008.[225][226]
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 percentile.[23] 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.[24] Childhood obesity has reached epidemic proportions in the 21st century, with rising rates
in both the developed and the developing world. Rates of obesity in Canadian boys have increased from 11% in the 1980s to over
[227]
30% in the 1990s, while during this same time period rates increased from 4 to 14% in Brazilian children.
As with obesity in adults, many factors contribute to the rising rates of childhood obesity. Changing diet and decreasing physical
activity are believed to be the two most important causes for the recent increase in the incidence of child obesity.[228] 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.[81] Treatments used in children are primarily lifestyle interventions
and behavioral techniques, although efforts to increase activity in children have had little success.[229] In the United States,
medications are not FDA approved for use in this age group.[227] Multi-component behaviour change interventions that include
changes to dietary and physical activity may reduce BMI in the short term in children aged 6 to 11 years, although the benefits are
small and quality of evidence is low.[230]
Other animals
Obesity in pets is common in many countries. In the United States, 23–41% of dogs are overweight, and about 5.1% are obese.[231]
The rate of obesity in cats was slightly higher at 6.4%.[231] In Australia the rate of obesity among dogs in a veterinary setting has
been found to be 7.6%.[232] The risk of obesity in dogs is related to whether or not their owners are obese; however, there is no
similar correlation between cats and their owners.[233]
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Classification ICD-10: E66 · V · T · D

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OMIM: 601665 ·
DiseasesDB: 9099
External MedlinePlus:
resources 007297 ·
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Obesity

Obesity is a medical condition in which excess body fat has

Obesity is most commonly caused by a combination of excessive food

where m and h are the subject's weight and height respectively.

Some modifications to the WHO definitions have been made by particular

Medical field Condition Medical field Condition

coronary heart disease:[53] angina and stretch marks[56]

intrauterine fetal death[58]

energy is being consumed.

Obese people consistently under-report their food

Obesity is a major feature in several syndromes, such as Prader–Willi

Studies that have focused on inheritance patterns rather than on

The correlation betweensocial class and BMI varies globally. A review

The rate of obesity also increases with ►

Once considered a problem only of

Society and culture

Obesity can lead to social stigmatization and disadvantages in

A number of organizations exist that promote the acceptance of

The International Size Acceptance Association (ISAA) is a non-

Industry influence on research

Classification ICD-10: E66 · V · T · D

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