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Obesity
Classification and external resources
Silhouettes representing standard, overweight, and obese.
ICD-10 E66.
ICD-9 278
DiseasesDB 9099
MedlinePlus 003101
eMedicine med/1653 
MeSH C23.888.144.699.500

Obesity is a condition in which the natural energy reserve, stored in the fatty tissue of humans and other mammals, exceeds healthy limits. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings E00-E35 - Endocrine diseases (E00-E07 Thyroid gland / Thyroid hormone ( Congenital iodine-deficiency syndrome ( The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. MedlinePlus, with the MedlinePlus Medical Encyclopedia, is a website network containing Health information from the world's largest medical Library eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books "Adipose" redirects here For the Doctor Who monster see " Partners in Crime " Human beings, humans or man (Origin 1590–1600 L homō man OL hemō the earthly one (see Humus Mammals ( class Mammalia) are a class of Vertebrate Animals characterized by the presence of Sweat glands, including sweat glands It is commonly defined as a body mass index (weight divided by height squared) of 30 kg/m2 or higher. The body mass index ( BMI) or Quetelet index, is a statistical measurement which compares a person's weight and height

Although obesity is an individual clinical condition, some authorities view it as a serious and growing public health problem. Public health is "the science and art of preventing disease prolonging life and promoting health through the organised efforts and informed choices of society organisations Some studies show that excessive body weight has been shown to predispose to various diseases, particularly cardiovascular diseases, diabetes mellitus type 2, sleep apnea and osteoarthritis. A disease is an abnormal condition of an organism that impairs bodily functions and can be deadly Cardiovascular disease or cardiovascular diseases refers to the class of diseases that involve the Heart or Blood vessels ( arteries and Diabetes mellitus type 2 or Type 2 Diabetes (formerly called non - Insulin -dependent Diabetes mellitus (NIDDM or adult-onset diabetes is a metabolic Sleep apnea is a sleep disorder characterized by pauses in Breathing during Sleep. Osteoarthritis ( OA, also known as degenerative Arthritis, degenerative joint disease) is a clinical syndrome in which low-grade inflammation [1][2]

Contents

Classification

Obesity can be defined in absolute or relative terms. In practical settings, obesity is typically evaluated in absolute terms by measuring BMI (body mass index), but also in terms of its distribution through waist circumference or waist-hip circumference ratio measurements. The body mass index ( BMI) or Quetelet index, is a statistical measurement which compares a person's weight and height [3] In addition, the presence of obesity needs to be regarded in the context of other risk factors and comorbidities (other medical conditions that could influence risk of complications). A risk factor is a variable associated with an increased risk of Disease or Infection. In Medicine, comorbidity (literally "additional Morbidity " is either * The presence of one or more disorders (or diseases in addition to [1]

BMI

BMI, or body mass index, is a simple and widely used method for estimating body fat. [4] BMI was developed by the Belgian statistician and anthropometrist Adolphe Quetelet. The Kingdom of Belgium is a Country in northwest Europe. It is a founding member of the European Union and hosts its headquarters as well as those Anthropometry ( Greek άνθρωπος man and μέτρον measure literally meaning "measurement of humans" in Physical anthropology, refers to the Lambert Adolphe Jacques Quételet ( 22 February 1796 &ndash 17 February 1874) was a Belgian Astronomer, Mathematician [5] It is calculated by dividing the subject's weight by the square of his/her height, typically expressed either in metric or US "Customary" units:

Metric: BMI = kg / m2

Where kg is the subject's weight in kilograms and m is the subject's height in metres. The metric system is a decimalised system of measurement. It exists in several variations with different choices of base units, though the choice of base units does US customary units, also known in the United States as English units or Imperial units (in reference to the British Empire) (but see English The metre or meter is a unit of Length. It is the basic unit of Length in the Metric system and in the International

US/Customary: BMI = lb * 703 / in2

Where lb is the subject's weight in pounds and in is the subject's height in inches. The pound or pound-mass (abbreviation lb, lbm, or sometimes in the United States #) is a unit of Mass Inches redirects here To see the Les Savy Fav album see Inches.

The most commonly used definitions, established by the WHO in 1997 and published in 2000, provide the following values:[6]

In a clinical setting, physicians take into account race, ethnicity, lean mass (muscularity), age, sex, and other factors which can affect the interpretation of BMI. BMI overestimates body fat in persons who are very muscular, and it can underestimate body fat in persons who have lost body mass (e. g. many elderly). [1] Mild obesity as defined by BMI alone is not a cardiac risk factor, and hence BMI cannot be used as a sole clinical and epidemiological predictor of cardiovascular health. [9]

Waist circumference

Main article: Central obesity

BMI does not take into account differing ratios of adipose to lean tissue; nor does it distinguish between differing forms of adiposity, some of which may correlate more closely with cardiovascular risk. Central obesity, the "apple-shaped" Obesity commonly referred to as belly fat, is the accumulation of Visceral fat ( fat deposited "Adipose" redirects here For the Doctor Who monster see " Partners in Crime " This is an article about the rock music band "Circulatory System" Increasing understanding of the biology of different forms of adipose tissue has shown that visceral fat or central obesity (male-type or apple-type obesity, also known as "belly fat") has a much stronger correlation, particularly with cardiovascular disease, than the BMI alone. Central obesity, the "apple-shaped" Obesity commonly referred to as belly fat, is the accumulation of Visceral fat ( fat deposited Cardiovascular disease or cardiovascular diseases refers to the class of diseases that involve the Heart or Blood vessels ( arteries and [10]

The absolute waist circumference (>102 cm in men and >88 cm in women) or waist-hip ratio (>0. Waist-hip ratio or Waist-to-hip ratio ( WHR) is the Ratio of the circumference of the Waist to that of the Hips It is calculated by 9 for men and >0. 85 for women)[10] are both used as measures of central obesity.

In a cohort of almost 15,000 subjects from the National Health and Nutrition Examination Survey (NHANES) III study, waist circumference explained obesity-related health risk significantly better than BMI when metabolic syndrome was taken as an outcome measure. The National Health and Nutrition Examination Survey ( NHANES) is a Survey Research program conducted by the National Center for Health Statistics Metabolic syndrome is a combination of medical disorders that increase the risk of developing Cardiovascular disease and diabetes. [11]

Body fat measurement

An alternative way to determine obesity is to assess percent body fat. "Adipose" redirects here For the Doctor Who monster see " Partners in Crime " Doctors and scientists generally agree that men with more than 25% body fat and women with more than 30% body fat are obese. However, it is difficult to measure body fat precisely. The most accepted method has been to weigh a person underwater, but underwater weighing is a procedure limited to laboratories with special equipment. Two simpler methods for measuring body fat are the skinfold test, in which a pinch of skin is precisely measured to determine the thickness of the subcutaneous fat layer; or bioelectrical impedance analysis, usually only carried out at specialist clinics. The subcutaneous tissue or subcutis is the layer of Loose connective tissue directly underlying the Dermis. Bioelectrical impedance analysis (BIA is a commonly used method for estimating body composition Their routine use is discouraged. [12]

Other measurements of body fat include computed tomography (CT/CAT scan), magnetic resonance imaging (MRI/NMR), and dual energy X-ray absorptiometry (DXA). Computed tomography (CT is a Medical imaging method employing Tomography. Dual energy X-ray absorptiometry ( DXA, previously DEXA is a means of measuring Bone mineral density (BMD [13]

Risk factors and comorbidities

The presence of risk factors and diseases associated with obesity are also used to establish a clinical diagnosis. Coronary heart disease, type 2 diabetes, and sleep apnea are possible life-threatening risk factors that would indicate clinical treatment of obesity. Coronary disease (or coronary heart disease) refers to the failure of Coronary circulation to supply adequate circulation to Cardiac muscle and surrounding Diabetes mellitus type 2 or Type 2 Diabetes (formerly called non - Insulin -dependent Diabetes mellitus (NIDDM or adult-onset diabetes is a metabolic Sleep apnea is a sleep disorder characterized by pauses in Breathing during Sleep. [1] Smoking, hypertension, age and family history are other risk factors that may indicate treatment. [1]

Effects on health

A large number of medical conditions have been associated with obesity. Health consequences are categorised as being the result of either increased fat mass (osteoarthritis, obstructive sleep apnea, social stigma) or increased number of fat cells (diabetes, cancer, cardiovascular disease, non-alcoholic fatty liver disease). Osteoarthritis ( OA, also known as degenerative Arthritis, degenerative joint disease) is a clinical syndrome in which low-grade inflammation Obstructive sleep apnea (OSA is a common Sleep apnea caused by obstruction of the airway Diabetes mellitus (ˌdaɪəˈbiːtiːz or /ˌdaɪəˈbiːtəs/ /məˈlaɪtəs/ or /ˈmɛlətəs/ often referred to simply as diabetes ( Ancient Greek: grc Cancer (medical term Malignant Neoplasm) is a class of Diseases in which a group of cells display uncontrolled Cardiovascular disease or cardiovascular diseases refers to the class of diseases that involve the Heart or Blood vessels ( arteries and Non-alcoholic fatty liver disease ( NAFLD) is fatty inflammation of the Liver when this is not due to excessive alcohol use [14] Mortality is increased in obesity, with a BMI of over 32 being associated with a doubled risk of death. [15] There are alterations in the body's response to insulin (insulin resistance), a proinflammatory state and an increased tendency to thrombosis (prothrombotic state). Insulin resistance is the condition in which normal amounts of Insulin are inadequate to produce a normal Insulin response from Fat, Muscle Inflammation ( Latin, inflamatio, to set on fire is the complex biological response of vascular tissues to harmful stimuli such as Pathogens Thrombosis is the formation of a blood Clot ( Thrombus) inside a Blood vessel, obstructing the flow of Blood through the Circulatory [14]

Disease associations may be dependent or independent of the distribution of adipose tissue. Central obesity (male-type or waist-predominant obesity, characterised by a high waist-hip ratio), is an important risk factor for the metabolic syndrome, the clustering of a number of diseases and risk factors that heavily predispose for cardiovascular disease. Central obesity, the "apple-shaped" Obesity commonly referred to as belly fat, is the accumulation of Visceral fat ( fat deposited Metabolic syndrome is a combination of medical disorders that increase the risk of developing Cardiovascular disease and diabetes. These are diabetes mellitus type 2, high blood pressure, high blood cholesterol, and triglyceride levels (combined hyperlipidemia). Diabetes mellitus type 2 or Type 2 Diabetes (formerly called non - Insulin -dependent Diabetes mellitus (NIDDM or adult-onset diabetes is a metabolic Hypertension, also referred to as high blood pressure, HTN or HPN, is a medical condition in which the Blood pressure is chronically elevated Hypercholesterolemia (literally high blood cholesterol is the presence of high levels of Cholesterol in the blood. In Medicine, hypertriglyceridemia (or "Hypertriglyceridaemia" denotes high ( hyper-) blood levels ( -emia) of Triglycerides the most In Medicine, combined hyperlipidemia (or - aemia) is a commonly occurring form of Hypercholesterolemia (elevated Cholesterol levels characterised [16]

Apart from the metabolic syndrome, obesity is also correlated with a variety of other complications. In Probability theory and Statistics, correlation, (often measured as a correlation coefficient) indicates the strength and direction of a linear For some of these complaints, it has not been clearly established to what extent they are caused directly by obesity itself, or have some other cause (such as limited exercise) that causes obesity as well.

While being severely obese has many health ramifications, those who are somewhat overweight face little increased mortality or morbidity. This is an article about the rock music band "Circulatory System" Heart failure is a Cardiac condition that occurs when a problem with the structure or function of the Heart impairs its ability to supply Cardiomegaly is a medical condition wherein the Heart is enlarged Dysrhythmia redirects here For the American band see Dysrhythmia (band. Varicose veins are Veins that have become enlarged and twisted Pulmonary embolism (PE is a blockage of the Pulmonary artery or one of its branches usually occurring when a venous Thrombus (blood clot from a vein The endocrine system is an integrated system of small organs that involve the release of extracellular signaling molecules known as Hormones The endocrine system is instrumental Polycystic ovary syndrome abbreviated PCOS or PCO (also known clinically as Stein-Leventhal syndrome, Sclerocystic ovary syndrome, Hyperthecosis See also "Mensuration" a term sometimes used to describe Measurement, particularly in the context of Forestry. Female infertility|Male infertility Infertility primarily refers to the biological inability of a Man or a Woman to contribute to conception. Gastroesophageal reflux disease ( American English and Canadian English) or Gastro-oesophageal reflux disease ( British English, Hiberno-English Non-alcoholic fatty liver disease ( NAFLD) is fatty inflammation of the Liver when this is not due to excessive alcohol use In Medicine, gallstones (choleliths are Crystalline bodies formed within the body by accretion or concretion of normal or abnormal Bile component A hernia is a protrusion of a tissue, structure or part of an organ through the muscular tissue or the membrane by which it is normally contained Colorectal cancer, also called colon cancer or large bowel cancer, includes Cancerous growths in the colon, Rectum and In Anatomy, the genitourinary system is the Organ system of all the Reproductive organs and the Urinary system. Urinary incontinence ( UI) is any involuntary leakage of Urine. Chronic kidney disease (CKD also known as chronic renal disease, is a progressive loss of renal function over a period of months or years Hypogonadism is a medical term for a defect of the Reproductive system that results in lack of function of the Gonads ( ovaries or testes) Breast cancer is a Cancer that starts in the cells of the Breast in women and men Endometrial cancer refers to several types of malignancy which arise from the Endometrium, or lining of the Uterus. A stillbirth occurs when a Fetus which has died in the Uterus or during labor or delivery exits a Woman 's body The Integumentary System is an organ system that protects the body from damage comprising the Skin, Hair, scales, nails, sweat glands and their " Striae " is also a general term referring to thin narrow grooves or channels or a thin line or band especially if several of them are parallel or close together Acanthosis nigricans is a brown to black poorly defined velvety Hyperpigmentation of the Skin, usually present in the posterior and lateral folds of the Neck Lymphedema, also spelled lymphoedema, also known as lymphatic obstruction, is a condition of localized Fluid retention caused by a compromised Cellulitis is an Infection of the deep Subcutaneous tissue of the Skin. A carbuncle is an Abscess larger than a Boil, usually with one or more openings draining Pus onto the Skin. An intertrigo is an Inflammation ( Rash) of the body folds (adjacent areas of Skin) Hyperuricemia ( American English) or hyperuricaemia ( British English) is the presence of high levels of Uric acid in the blood Gout (also called metabolic arthritis) is a disease created by a buildup of Uric acid. Osteoarthritis ( OA, also known as degenerative Arthritis, degenerative joint disease) is a clinical syndrome in which low-grade inflammation Low back pain (sometimes referred to generally as lumbago) is a common symptom of musculoskeletal disorders or of disorders involving the Lumbar vertebrae. A stroke is the rapidly developing loss of brain functions due to a disturbance in the blood vessels supplying blood to the brain Meralgia paraesthetica, or meralgia paresthetica (see Spelling differences) (me-ral'-gee-a par-es-thet'-i-ka and Bernhardt-Roth syndrome, is numbness A headache ( cephalalgia in medical terminology is a condition of pain in the Head; sometimes Neck or upper back pain may also be interpreted Carpal tunnel syndrome (CTS or median neuropathy at the wrist is a medical condition in which the Median nerve is compressed at the Wrist, leading Dementia (from Latin de- "apart away" + Mens ( genitive mentis) "mind" is the progressive decline Idiopathic intracranial hypertension (IIH sometimes called benign intracranial hypertension (BIH or pseudotumor cerebri (PTC is a Neurological disorder In living organisms a respiratory system functions to allow Gas exchange. Sleep apnea is a sleep disorder characterized by pauses in Breathing during Sleep. The obesity hypoventilation syndrome, also known as Pickwickian syndrome, is the combination of Obesity ( Body mass index above 30 kg/m2 Asthma is a chronic Condition involving the Respiratory system in which the airways occasionally constrict become inflamed, and are Psychology (from Greek grc ψῡχή psȳkhē, "breath life soul" and grc -λογία -logia) is an Academic and Major depressive disorder, also known as major depression, unipolar depression, unipolar disorder, clinical depression, or simply depression In Psychology, self-esteem reflects a Person 's overall evaluation or appraisal of her or his own worth Body dysmorphic disorder ( BDD) (previously known as Dysmorphophobia and sometimes referred to as Body dysmorphia) is a psychiatric disorder In Medicine, Epidemiology and Actuarial science, the term morbidity can refer to the state of poor health (from Latin Osteoporosis is known to occur less in slightly overweight people. Osteoporosis is a Disease of Bone that leads to an increased risk of fracture.

Causes and mechanisms

Lifestyle

Most researchers have concluded that the combination of an excessive nutrient intake and a sedentary lifestyle are the main cause for the rapid acceleration of obesity in Western society in the last quarter of the 20th century. Sedentary lifestyle is a medical Neologism used to denote a type of Lifestyle most commonly found in modern (particularly Western) cultures [21] Obesity caused specifically by overeating is called exogenous obesity. Overeating can refer either to eating too much at one time or to eating too much on average Exogenous (or exogeneous) (from the Greek words "exo" and "gen" meaning "outside" and "production" refers to an action or

Despite the widespread availability of nutritional information in schools, doctors' offices, on the internet and on product packaging,[22] it is evident that overeating remains a substantial problem. For instance, reliance on energy-dense fast-food meals tripled between 1977 and 1995, and calorie intake quadrupled over the same period. Food energy is the amount of Energy in food that is available through Digestion. [23]

However, dietary intake in itself is insufficient to explain the phenomenal rise in levels of obesity in much of the industrialized world during recent years. An increasingly sedentary lifestyle also has a significant role to play. More and more research into child obesity, for example, links such things as the school run, with the current high levels of this disease. Childhood Obesity is a condition where excess body fat negatively affects a child's health or wellbeing The School Run is a modern phenomenon associated with Parents taking their Children to School by car. [24]

Less well established and possibly underinvestigated life style issues that may influence obesity include (1) insufficient sleep, (2) endocrine disruptors - food substances that interfere with lipid metabolism, (3) decreased variability in ambient temperature, (4) decreased rates of smoking, which suppresses appetite, (5) increased use of medication that leads to weight gain, (6) increased distribution of ethnic and age groups that tend to be heavier, (7) pregnancy at a later age, (8) intrauterine and intergenerational effects, (9) positive natural selection of people with a higher BMI, (10) assortative mating, heavier people tending to form relationships with each other. Sleep is a Natural state of bodily rest observed throughout the animal kingdom Endocrine disruptors (sometimes also referred to as hormonally active agents) are Exogenous substances that act like Hormones in the Endocrine system Tobacco Smoking is the inhalation of smoke from burned dried or cured leaves of the Tobacco plant most often in the form of a Cigarette. Natural selection is the process by which favorable Heritable traits become more common in successive Generations of a Population of Assortative mating (also called assortative pairing) takes place when sexually reproducing Organisms tend to Mate with individuals that are like [25]

Genetics

As with many medical conditions, the calorific imbalance that results in obesity is probably the result of a combination of genetic and environmental factors. Polymorphisms in various genes controlling appetite, metabolism, and adipokine release predispose to obesity, but the condition requires availability of sufficient calories, and possibly other factors, to develop fully. Polymorphism in biology occurs when two or more clearly different Phenotypes exist in the same population of a species — in other words the occurrence of more than one History See also History of genetics The existence of genes was first suggested by Gregor Mendel (1822-1884 who in the 1860s studied inheritance Metabolism is the set of Chemical reactions that occur in living Organisms in order to maintain Life. The adipokines or adipocytokines are a group of Cytokines ( cell -to-cell signalling Proteins secreted by Adipose tissue. Various genetic conditions that feature obesity have been identified (such as Prader-Willi syndrome, Bardet-Biedl syndrome, MOMO syndrome, leptin receptor mutations and melanocortin receptor mutations), but known single-locus mutations have been found in only about 7% of obese individuals; these people tend to be very obese from a very young age. Prader-Willi syndrome (abbreviated PWS) is a very rare Genetic disorder, in which seven genes (or some subset thereof on chromosome 15 are missing or unexpressed Laurence-Moon-Biedl syndrome and Laurence-Moon-Biedl-Bardet redirect here MOMO syndrome is an extremely rare Genetic disorder which belongs to the overgrowth syndromes and has been diagnosed in only four cases around the world and occurs in 1 in 100 Leptin receptor, also known as LEPR, is a human Gene. LEPR has also been designated as CD295 ( Cluster of differentiation 295 Melanocortin receptors are members of the Rhodopsin family of 7-transmembrane G-protein coupled receptors. [26] It is thought that a large proportion of the causative genes are still to be identified. Studies in over 5000 identical twins demonstrated that childhood obesity has a strong (77%) inherited component. Twins are Offspring resulting from the same Pregnancy, either of the same or opposite Sex. [27]

A 2007 study identified fairly common mutations in the FTO gene; heterozygotes had a 30% increased risk of obesity, while homozygotes faced a 70% increased risk. Fat mass and obesity associated, also known as FTO is a Gene on human chromosome 16 in which certain variants appear to be Correlated with [28]

On a population level, the thrifty gene hypothesis 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 use such abundance by storing energy efficiently may have been an evolutionary advantage in times when food was scarce. The thrifty gene hypothesis was proposed in 1962 by geneticist James V Individuals with greater adipose reserves were more likely to survive famine. This tendency to store fat is likely maladaptive in a society with stable food supplies. [29]

Medical illness

Certain physical and mental illnesses and particular pharmaceutical substances may predispose to obesity. Apart from the fact that correcting these situations may improve the obesity, the presence of increased body weight may complicate the management of others.

Medical illnesses that increase obesity risk include several rare congenital syndromes (listed above), hypothyroidism, Cushing's syndrome, growth hormone deficiency. Hypothyroidism is the disease state in humans and animals caused by insufficient production of Thyroid hormone by the Thyroid gland. Growth Hormone Deficiency is the medical condition of inadequate production of Growth hormone (GH and it effects on children and adults [30] Smoking cessation is a known cause for moderate weight gain, as nicotine suppresses appetite. Smoking cessation is the effort to stop smoking Tobacco products Certain medications (e. g. steroids, atypical antipsychotics, some fertility medication) may cause weight gain. Glucocorticoids (GC are a class of Steroid hormones characterised by an ability to bind with the glucocorticoid receptor ( GR) and trigger similar effects The atypical antipsychotics (also known as second generation antipsychotics) are a group of Antipsychotic drugs used to treat psychiatric conditions Fertility medication is medication that enhances Fertility. For women fertility medication is used to stimulate follicle development of the Ovary.

Mental illnesses may also increase obesity risk, specifically some eating disorders such as bulimia nervosa, binge eating disorder, and compulsive overeating (also known as food addiction). An eating disorder is a compulsion to eat or avoid eating that negatively affects both one's physical and mental health Bulimia nervosa is an Eating disorder characterized by recurrent Binge eating, followed by compensatory behaviors referred to as "purging" Binge eating disorder ( BED) is a Psychiatric disorder in which a subject shows the following symptoms Periodically does not exercise control over consumption Compulsive overeating, also sometimes called food addiction is characterized by a Compulsive relationship to food which is addressed by professionals with either a

Neurobiological mechanisms

Scientists investigating the mechanisms and treatment of obesity may use animal models such as mice to conduct experiments.
Scientists investigating the mechanisms and treatment of obesity may use animal models such as mice to conduct experiments. An animal model is a non-human Animal that has a Disease or injury that is similar to a human condition A mouse (plural mice) is a small Animal that belongs to one

Flier[31] summarizes the many possible pathophysiological mechanisms involved in the development and maintenance of obesity. Pathophysiology is the study of the disturbance of normal Mechanical, Physical, and Biochemical functions either caused by a Disease, or resulting This field of research had been almost unapproached until leptin was discovered in 1994. Leptin (Greek leptos meaning thin is a 16 kDa Since this discovery, many other hormonal mechanisms have been elucidated that participate in the regulation of appetite and food intake, storage patterns of adipose tissue, and development of insulin resistance. "Adipose" redirects here For the Doctor Who monster see " Partners in Crime " Insulin resistance is the condition in which normal amounts of Insulin are inadequate to produce a normal Insulin response from Fat, Muscle Since leptin's discovery, ghrelin, orexin, PYY 3-36, cholecystokinin, adiponectin, and many other mediators have been studied. Ghrelin is a Hormone produced mainly by P/D1 cells lining the fundus of the human Stomach and epsilon cells of the Pancreas that stimulates Orexins, also called hypocretins, are the common names given to a pair of highly excitatory Neuropeptide Hormones that were simultaneously discovered by Peptide YY is a short (36 Amino acid) Protein released by cells in the Ileum and colon in response to feeding Cholecystokinin ( CCK; from Greek chole, "bile" cysto, "sac" kinin, "move" hence move the bile-sac Adiponectin (also referred to as Acrp30, apM1) is a protein Hormone that modulates a number of metabolic processes including Glucose The adipokines are mediators produced by adipose tissue; their action is thought to modify many obesity-related diseases. The adipokines or adipocytokines are a group of Cytokines ( cell -to-cell signalling Proteins secreted by Adipose tissue.

Leptin and ghrelin are considered to be complementary in their influence on appetite, with ghrelin produced by the stomach modulating short-term appetitive control (i. In Human anatomy, the stomach is a J-shaped hollow muscular organ of the Gastrointestinal tract involved in the second phase of Digestion, following e. to eat when the stomach is empty and to stop when the stomach is stretched). Leptin is produced by adipose tissue to signal fat storage reserves in the body, and mediates long-term appetitive controls (i. e. to eat more when fat storages are low and less when fat storages are high). Although administration of leptin may be effective in a small subset of obese individuals who are leptin deficient, many more obese individuals are thought to be leptin resistant. This resistance is thought to explain in part why administration of leptin has not been shown to be effective in suppressing appetite in most obese subjects.

While leptin and ghrelin are produced peripherally, they control appetite through their actions on the central nervous system. In Vertebrates the central nervous system ( CNS) is the part of the Nervous system which is enclosed in the Meninges. 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. The hypothalamus links the Nervous system to the Endocrine system via the Pituitary gland (hypophysis There are several circuits within the hypothalamus that contribute to its role in integrating appetite, the melanocortin pathway being the most well understood. Melanocortins are a group of Pituitary Peptide hormones that include adrenocorticotropin ( ACTH) and the alpha beta and gamma Melanocyte-stimulating [31] The circuit begins with an area of the hypothalamus, the arcuate nucleus, that has outputs to the lateral hypothalamus (LH) and ventromedial hypothalamus (VMH), the brain's feeding and satiety centers, respectively. The arcuate nucleus (or infundibular nucleus is an aggregation of Neurons in the mediobasal Hypothalamus, adjacent to the Third ventricle and the Median The Lateral hypothalamus or lateral hypothalamic area is a part of the Hypothalamus. The ventromedial nucleus (sometimes referred to as the ventromedial hypothalamus) is a nucleus of the Hypothalamus. [32]

The arcuate nucleus contains two distinct groups of neurons. Neurons (ˈnjuːɹɒn also known as neurones and nerve cells) are responsive cells in the Nervous system that process and transmit information [31] 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. Neuropeptide Y (NPY is a 36 Amino acid peptide Neurotransmitter found in the Brain and Autonomic nervous system. Agouti-related protein also called Agouti-related peptide ( AgRP) is a Neuropeptide produced in the Brain (in the Arcuate nucleus 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. Pro-opiomelanocortin ( POMC) is a precursor Polypeptide with 241 Amino acid residues Cocaine- and amphetamine-regulated transcript ( CART) is a Neuropeptide which also serves as a Neurotransmitter. Consequently, NPY/AgRP neurons stimulate feeding and inhibit satiety, while POMC/CART neurons stimulate satiety and inhibit feeding. Both groups of arcuate nucleus neurons are regulated in part by leptin. Leptin inhibits the NPY/AgRP group while stimulating the POMC/CART group. Thus a deficiency in leptin signaling, either via leptin deficiency or leptin resistance, leads to overfeeding and may account for some genetic and acquired forms of obesity.

Microbiological aspects

The role of bacteria colonizing the digestive tract in the development of obesity has recently become the subject of investigation. The Bacteria ( singular: bacterium) are a large group of unicellular Microorganisms Typically a few Micrometres in length bacteria have Bacteria participate in digestion (especially of fatty acids and polysaccharides), and alterations in the proportion of particular strains of bacteria may explain why certain people are more prone to weight gain than others. In Chemistry, especially Biochemistry, a fatty acid is a Carboxylic acid often with a long unbranched Aliphatic tail ( chain) which Polysaccharides are relatively complex Carbohydrates They are Polymers made up of many Monosaccharides joined together by Glycosidic bonds Human digestive tract bacteria are generally either members of the phyla of bacteroidetes or of firmicutes. The phylum Bacteroidetes is composed of three large classes of Bacteria that are widely distributed in the environment including in soil in sediments sea water The Firmicutes ( Latin: firmus, strong and cutis, skin referring to the cell wall are a division of bacteria, most of which have Gram-positive In obese people, there is a relative abundance of firmicutes (which cause relatively high energy absorption), which is restored by weight loss. From these results it cannot yet be concluded whether this imbalance is the cause of obesity or an effect. [33]

Social determinants

Some obesity co-factors are resistant to the theory that the "epidemic" is a new phenomenon. In particular, a class co-factor consistently appears across many studies. Social class refers to the hierarchical distinctions (or stratification) between individuals or groups in Societies or Cultures. Comparing net worth with BMI scores, a 2004 study[34] found obese American subjects approximately half as wealthy as thin ones. When income differentials were factored out, the inequity persisted—thin subjects were inheriting more wealth than fat ones. A higher rate of a lower level of education and tendencies to rely on cheaper fast foods is seen as a reason why these results are so dissimilar. Fast food is the term given to food that can be prepared and served very quickly Another study finds women who married into higher status are predictably thinner than women who married into lower status.

A 2007 study of more than 32,500 children of the original Framingham Heart Study cohort followed for 32 years indicated that BMI change in friends, siblings or spouse predicted BMI change in subjects irrespective of geographical distance. The Framingham Heart Study is a cardiovascular study based in Framingham Massachusetts. The association was strongest among mutual friends and lower among siblings and spouses (although these differences were not statistically significant). The authors concluded from the results that acceptance of body mass plays an important role in changes in body size. [35]

Treatment

Main article: Weight loss

The main treatment for obesity is to reduce body fat by eating fewer calories and exercising more. Weight loss, in the context of Medicine or Health or Physical fitness, is a reduction of the total Body weight, due to a mean loss of fluid Dieting is the practice of ingesting food in a regulated fashion to achieve or maintain a controlled weight Diet and exercise programs produce an average weight loss of approximately 8% of total body mass (excluding program drop-outs). Not all dieters are satisfied with these results, but a loss of as little as 5% of body mass can create large health benefits.

Much more difficult than reducing body fat is keeping it off. Eighty to ninety-five percent of those who lose 10% or more of their body mass by dieting regain all that weight back within two to five years. Although many people prefer the less-ambiguous term body mass, the term body weight is overwhelmingly used in daily English speech and in biological and medical science contexts The body has systems that maintain its homeostasis at certain set points, including body weight. Homeostasis (from Greek: ὅμος hómos, "equal" and ιστημι istēmi, "to stand" lit Therefore, keeping weight off generally requires making exercise and eating right a permanent part of a person's lifestyle. A healthy diet is one that is arrived at with the intent of improving or maintaining optimal Health. The term lifestyle was originally coined by Austrian psychologist Alfred Adler in 1929

Clinical protocols

In a clinical practice guideline by the American College of Physicians, the following five recommendations are made:[36]

  1. People with a BMI of over 30 should be counseled on diet, exercise and other relevant behavioral interventions, and set a realistic goal for weight loss. A medical guideline (also called a clinical guideline, clinical protocol or clinical practice guideline) is a document with the aim of guiding decisions The American College of Physicians (ACP is a national organization of doctors of Internal medicine (internists physicians who specialize in the prevention detection and treatment
  2. If these goals are not achieved, pharmacotherapy can be offered. The patient needs to be informed of the possibility of side-effects and the unavailability of long-term safety and efficacy data. In Medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as Chemotherapy or Surgery.
  3. Drug therapy may consist of sibutramine, orlistat, phentermine, diethylpropion, fluoxetine, and bupropion. Sibutramine (trade name Meridia in the US and Canada Reductil in Europe and most other countries usually as sibutramine hydrochloride monohydrate is an orally Orlistat (marketed under the trade name Xenical by Roche; or over-the-counter as alli by GlaxoSmithKline (ˈælaɪ like the English Phentermine, a contraction for " '''phen'''yl - '''ter'''tiary-butyl[[amine a' mine' ]]" is an Appetite suppressant of the Amphetamine Diethylcathinone (also called Diethylpropion and Amfepramone) is a Sympathomimetic Stimulant drug marketed as an appetite Bupropion ( INN, previously known as amfebutamone; sold as Wellbutrin, Zyban, and several other Trade names is an atypical Antidepressant For more severe cases of obesity, stronger drugs such as amphetamine and methamphetamine may be used on a selective basis. Amphetamine, and related drugs such as Methamphetamine are a group of drugs that act by increasing levels of Norepinephrine, Serotonin, and Dopamine Evidence is not sufficient to recommend sertraline, topiramate, or zonisamide. Topiramate (brand name Topamax) is an Anticonvulsant drug produced by Ortho-McNeil Neurologics and Noramco Inc Zonisamide is a Sulfonamide Anticonvulsant approved for use as an adjunctive therapy in adults with partial-onset seizures History
  4. In patients with BMI > 40 who fail to achieve their weight loss goals (with or without medication) and who develop obesity-related complications, referral for bariatric surgery may be indicated. Bariatric surgery, also known as weight loss surgery, refers to the various surgical procedures performed to treat Obesity by modification of the Gastrointestinal The patient needs to be aware of the potential complications.
  5. Those requiring bariatric surgery should be referred to high-volume referral centers, as the evidence suggests that surgeons who frequently perform these procedures have fewer complications.

A clinical practice guideline by the US Preventive Services Task Force (USPSTF) concluded that the evidence is insufficient to recommend for or against routine behavioral counseling to promote a healthy diet in unselected patients in primary care settings, but that intensive behavioral dietary counseling is recommended in those with hyperlipidemia and other known risk factors for cardiovascular and diet-related chronic disease. A medical guideline (also called a clinical guideline, clinical protocol or clinical practice guideline) is a document with the aim of guiding decisions Hyperlipidemia, hyperlipoproteinemia or dyslipidemia is the presence of raised or abnormal levels of Lipids and/or Lipoproteins in the Intensive counseling can be delivered by primary care clinicians or by referral to other specialists, such as nutritionists or dietitians. [37][38]

Exercise

Exercise requires energy (calories). Calories are stored in body fat. The body breaks down its fat stores in order to provide energy during prolonged aerobic exercise. Aerobic exercise refers to Exercise that involves or improves oxygen consumption by the body The largest muscles in the body are the leg muscles, and naturally these burn the most calories, which make walking, running, and cycling among the most effective forms of exercise for reducing body fat.

A meta-analysis of randomized controlled trials by the international Cochrane Collaboration found that "exercise combined with diet resulted in a greater weight reduction than diet alone". In Statistics, a meta-analysis combines the results of several studies that address a set of related research hypotheses A randomized controlled trial (RCT is a type of scientific Experiment most commonly used in testing the Efficacy or Effectiveness of Healthcare The Cochrane Collaboration is a group of over 11500 volunteers in more than 90 countries who apply a rigorous systematic process to review the effects of interventions tested in biomedical [39]

Dieting

Main article: Dieting

In general, dieting means eating less. Dieting is the practice of ingesting food in a regulated fashion to achieve or maintain a controlled weight Various dietary approaches have been proposed, some of which have been compared by randomized controlled trials:

Low carbohydrate versus low fat

Main article: Medical research related to low-carbohydrate diets

Many studies have focused on diets that reduce calories via a low-carbohydrate (Atkins diet, Zone diet) diet versus a low-fat diet (LEARN diet, Ornish diet). Low-carbohydrate diets became a major weight loss and health maintenance trend during the late 1990s and early 2000s Atkins Nutritional Approach, popularly known as the Atkins Diet or just 'Atkins' is a well-known Low-carbohydrate diet created by Dr The Zone diet is a diet popularized in books by Biochemist Barry Sears. LEARN stands for Lifestyle Exercise Attitudes Relationships and Nutrition The Ornish Diet was developed by Dean Ornish MD and first detailed in his book Dr The Nurses' Health Study, an observational cohort study, found that low carbohydrate diets based on vegetable sources of fat and protein are associated with less coronary heart disease. The Nurses' Health Study, established in 1976 by Dr Frank Speizer, and the Nurses' Health Study II, established in 1989 by Dr A cohort study or panel study is a form of Longitudinal study used in Medicine and Social science. Coronary disease (or coronary heart disease) refers to the failure of Coronary circulation to supply adequate circulation to Cardiac muscle and surrounding [42]

A meta-analysis of randomized controlled trials by the international Cochrane Collaboration in 2002 concluded[43] that fat-restricted diets are no better than calorie restricted diets in achieving long term weight loss in overweight or obese people. In Statistics, a meta-analysis combines the results of several studies that address a set of related research hypotheses A randomized controlled trial (RCT is a type of scientific Experiment most commonly used in testing the Efficacy or Effectiveness of Healthcare The Cochrane Collaboration is a group of over 11500 volunteers in more than 90 countries who apply a rigorous systematic process to review the effects of interventions tested in biomedical

A more recent meta-analysis that included randomized controlled trials published after the Cochrane review[44][45][41] found that "low-carbohydrate, non-energy-restricted diets appear to be at least as effective as low-fat, energy-restricted diets in inducing weight loss for up to 1 year. In Statistics, a meta-analysis combines the results of several studies that address a set of related research hypotheses A randomized controlled trial (RCT is a type of scientific Experiment most commonly used in testing the Efficacy or Effectiveness of Healthcare However, potential favorable changes in triglyceride and high-density lipoprotein cholesterol values should be weighed against potential unfavorable changes in low-density lipoprotein cholesterol values when low-carbohydrate diets to induce weight loss are considered. "[46]

The Women's Health Initiative Randomized Controlled Dietary Modification Trial[47] found that a diet of total fat to 20% of energy and increasing consumption of vegetables and fruit to at least 5 servings daily and grains to at least 6 servings daily resulted in:

Additional recent randomized controlled trials have found that:

In young adults "Reducing glycemic [carbohydrate] load may be especially important to achieve weight loss among individuals with high insulin secretion. "[52] This is consistent with prior studies of diabetic patients in which low carbohydrate diets were more beneficial. [53][54]

The American Diabetes Association released for the first time a recommendation (in its January 2008 Clinical Practice Recommendations) for a low carbohydrate diet to reduce weight for those with or at risk of Type 2 diabetes. The American Diabetes Association, or the ADA is an American health organization providing Diabetes research information and advocacy [55]

Low glycemic index

"The glycemic index factor is a ranking of foods based on their overall effect on blood sugar levels. The Glycemic index (also glycaemic index) or GI is a measure of the effects of Carbohydrates on Blood glucose levels Low glycaemic index foods, such as lentils, provide a slower more consistent source of glucose to the bloodstream, thereby stimulating less insulin release than high glycaemic index foods, such as white bread. "[56][57]

The glycemic load is "the mathematical product of the glycemic index and the carbohydrate amount". [58]

In a randomized controlled trial that compared four diets that varied in carbohydrate amount and glycemic index found complicated results[59]:

Diets 2 and 3 lost the most weight and fat mass; however, low density lipoprotein fell in Diet 2 and rose in Diet 3. A randomized controlled trial (RCT is a type of scientific Experiment most commonly used in testing the Efficacy or Effectiveness of Healthcare Thus the authors concluded that the high-carbohydrate, low-glycemic index diet was the most favorable.

A meta-analysis by the Cochrane Collaboration concluded that low glycemic index or low glycemic load diets led to more weight loss and better lipid profiles. In Statistics, a meta-analysis combines the results of several studies that address a set of related research hypotheses The Cochrane Collaboration is a group of over 11500 volunteers in more than 90 countries who apply a rigorous systematic process to review the effects of interventions tested in biomedical However, the Cochrane Collaboration grouped low glycemic index and low glycemic load diets together and did not try to separate the effects of the load versus the index. The Cochrane Collaboration is a group of over 11500 volunteers in more than 90 countries who apply a rigorous systematic process to review the effects of interventions tested in biomedical [56]

Drugs

Main article: Anti-obesity drug

Medication most commonly prescribed for diet/exercise-resistant obesity is orlistat (Xenical, which reduces intestinal fat absorption by inhibiting pancreatic lipase) and sibutramine (Reductil, Meridia, an anorectic). Anti-obesity drugs or weight loss drugs refer to all pharmacological agents that reduce or control weight. Orlistat (marketed under the trade name Xenical by Roche; or over-the-counter as alli by GlaxoSmithKline (ˈælaɪ like the English The pancreas is a Gland organ in the digestive and Endocrine system of Vertebrates. A lipase is a Water-soluble Enzyme that Catalyzes the Hydrolysis of Ester bonds in water–insoluble Lipid Sibutramine (trade name Meridia in the US and Canada Reductil in Europe and most other countries usually as sibutramine hydrochloride monohydrate is an orally Note "Anorectic" is also a term for an anorexic person a person suffering from Anorexia nervosa Anorectics, anorexigenics Weight loss with these drugs is modest, and over the longer term average weight loss on orlistat is 2. 9 kg, sibutramine 4. 2 kg and rimonabant 4. 7 kg. Orlistat and rimonabant lead to a reduced incidence of diabetes, and all drugs have some effect on lipoproteins (different forms of cholesterol). A lipoprotein is a biochemical assembly that contains both Proteins and Lipids The lipids or their derivatives may be covalently or non-covalently bound Cholesterol is a Lipid found in the Cell membranes and transported in the Blood plasma of all Animals It is an essential component of mammalian There is little data, however, on longer-term complications of obesity such as heart attacks. Myocardial infarction ( MI or AMI for acute myocardial infarction) also known as a heart attack, occurs when the blood supply All drugs have side-effects and potential contraindications. [60] It is common for weight loss drugs to be tried for a period of time (e. g. 3 months), and to discontinue them or change to another agent if no benefit is achieved, such as weight loss less than 5% the total body weight. [12]

A meta-analysis of randomized controlled trials by the international Cochrane Collaboration concluded that in diabetic patients fluoxetine, orlistat and sibutramine could achieve significant but modest weight loss over 12-57 weeks, with long-term health benefits being unclear. In Statistics, a meta-analysis combines the results of several studies that address a set of related research hypotheses A randomized controlled trial (RCT is a type of scientific Experiment most commonly used in testing the Efficacy or Effectiveness of Healthcare The Cochrane Collaboration is a group of over 11500 volunteers in more than 90 countries who apply a rigorous systematic process to review the effects of interventions tested in biomedical [61]

Obesity may also influence the choice of drug treatment for diabetes. Metformin may lead to mild weight reduction (as opposed to sulfonylureas and insulin), and has been demonstrated to reduce the risk of cardiovascular disease in type 2 diabetics who are obese. Metformin ( INN; trade names Glucophage, Riomet, Fortamet, Glumetza, Obimet, Dianben, Diabex, Sulfonylurea (UK Sulphonylurea derivatives are a class of Antidiabetic drugs that are used in the management of Diabetes mellitus type 2 ("adult-onset" Insulin is a Hormone with intensive effects on both metabolism and several other body systems (eg vascular compliance Cardiovascular disease or cardiovascular diseases refers to the class of diseases that involve the Heart or Blood vessels ( arteries and [62] The thiazolidinediones may cause slight weight gain, but decrease the "pathologic" form of abdominal fat and may therefore be used in diabetics with central obesity. The Medication class of thiazolidinedione (also called glitazones) was introduced in the late 1990s as an adjunctive therapy for Diabetes mellitus (type [63]

Bariatric surgery

Main article: bariatric surgery

Bariatric surgery (or "weight loss surgery") is the use of surgical interventions in the treatment of obesity. Bariatric surgery, also known as weight loss surgery, refers to the various surgical procedures performed to treat Obesity by modification of the Gastrointestinal Bariatric surgery, also known as weight loss surgery, refers to the various surgical procedures performed to treat Obesity by modification of the Gastrointestinal As every surgical intervention may lead to complications, it is regarded as a last resort when dietary modification and pharmacological treatment have proven to be unsuccessful. Weight loss surgery relies on various principles; the most common approaches are reducing the volume of the stomach, producing an earlier sense of satiation (e. g. by adjustable gastric banding and vertical banded gastroplasty) while others also reduce the length of bowel that food will be in contact with, directly reducing absorption (gastric bypass surgery). A laparoscopic adjustable gastric band is a restrictive device implanted via Bariatric surgery and designed for obese patients with a Body mass index (BMI Vertical Banded Gastroplasty (VBG also known as Stomach stapling has been the most common restrictive operation for weight control Gastric bypass procedures (GBP are any of a group of similar operations used to treat Morbid obesity —the severe accumulation of excess weight as fatty tissue—and the health Band surgery is reversible, while bowel shortening operations are not. Some procedures can be performed laparoscopically. Laparoscopic surgery, also called Minimally invasive surgery (MIS, bandaid surgery, Keyhole surgery, or pinhole surgery Complications from weight loss surgery are frequent. [64]

Two large studies have demonstrated a mortality benefit from bariatric surgery. A marked decrease in the risk of diabetes mellitus, cardiovascular disease and cancer has been found. Diabetes mellitus (ˌdaɪəˈbiːtiːz or /ˌdaɪəˈbiːtəs/ /məˈlaɪtəs/ or /ˈmɛlətəs/ often referred to simply as diabetes ( Ancient Greek: grc Cardiovascular disease or cardiovascular diseases refers to the class of diseases that involve the Heart or Blood vessels ( arteries and Cancer (medical term Malignant Neoplasm) is a class of Diseases in which a group of cells display uncontrolled [65][66] Weight loss was most marked in the first few months after surgery, but the benefit was sustained in the longer term. In one study there was an unexplained increase in deaths from accidents and suicide that did not outweigh the benefit in terms of disease prevention. Gastric bypass surgery was about twice as effective as banding procedures. [66]

Counseling

A meta-analysis of randomized controlled trials concluded that "compared with usual care, dietary counseling interventions produce modest weight losses that diminish over time. In Statistics, a meta-analysis combines the results of several studies that address a set of related research hypotheses A randomized controlled trial (RCT is a type of scientific Experiment most commonly used in testing the Efficacy or Effectiveness of Healthcare "[67]

Cultural and social significance

Etymology

Obesity is the nominal form of obese which comes from the Latin obēsus, which means "stout, fat, or plump. Latin ( lingua Latīna, laˈtiːna is an Italic language, historically spoken in Latium and Ancient Rome. " Ēsus is the past participle of edere (to eat), with ob added to it. In Classical Latin, this verb is seen only in past participial form. Classical Latin is the form of the Latin language used by the ancient Romans in what is usually regarded as "classical" Latin literature. Its first attested usage in English was in 1651, in Noah Biggs's Matæotechnia Medicinæ Praxeos. English is a West Germanic language originating in England and is the First language for most people in the United Kingdom, the United States Noah Biggs was an English medical reformer and Alchemical writer of the middle of the seventeenth century [68]

History

Obesity was a status symbol in European culture: "The Tuscan General" by Alessandro del Borro, 17th century.
Obesity was a status symbol in European culture: "The Tuscan General" by Alessandro del Borro, 17th century.

In several human cultures, obesity was associated with physical attractiveness, strength, and fertility. Physical strength is the ability of a person or animal to exert Force on physical objects using muscles. Fertility is the natural capability of giving life As a measure "Fertility Rate" is the number of children born per couple person or population Some of the earliest known cultural artifacts, known as Venus figurines, are pocket-sized statuettes representing an obese female figure. In Archaeology, an artifact or artefact is any object made or modified by a human culture, and often one later recovered by some archaeological Venus figurines is an Umbrella term for a number of prehistoric Statuettes of women sharing common attributes (many depicted as apparently Obese A statue is a Sculpture in the round representing a person or persons an animal or an event normally full-length as opposed to a bust, and at least close to life-size Although their cultural significance is unrecorded, their widespread use throughout pre-historic Mediterranean and European cultures suggests a central role for the obese female form in magical rituals, and suggests cultural approval of (and perhaps reverence for) this body form. A belief in magic as a means of influencing the world seems to have been common in all Cultures Some of these beliefs crossed over into nascent Religions influencing This is most likely due to their perceived ability to easily bear children and survive famine. A famine is a widespread shortage of food that may apply to any Faunal species which phenomenon is usually accompanied by regional Malnutrition, Starvation

Obesity was considered a symbol of wealth and social status in cultures prone to food shortages or famine. The musical instrument is spelled Cymbal. A symbol is something --- such as an object, Picture, written word a sound a piece Wealth derives from the old English word "weal" which means "well-being In Sociology or Anthropology, social status is the honor or prestige attached to one's position in Society (one's Social position) It was viewed in the same manner well into the early modern period in European cultures as well, but as food security was realized, it came to serve more as a visible signifier of "lust for life", appetite, and immersion in the realm of the erotic. Food security refers to the availability of food and one's access to it

This was especially the case in the visual arts, such as the paintings of Rubens (1577–1640), whose regular depiction of fat women gives us the description Rubenesque. Obesity can also be seen as a symbol within a system of prestige. "The kind of food, the quantity, and the manner in which it is served are among the important criteria of social class. In most tribal societies, even those with a highly stratified social system, everyone – royalty and the commoners – ate the same kind of food, and if there was famine everyone was hungry. With the ever increasing diversity of foods, food has become not only a matter of social status, but also a mark of one's personality and taste. "[69]

Contemporary culture

In modern Western culture, the obese body shape is widely regarded as unattractive and many negative stereotypes are commonly associated with obese people. Obese children, teenagers and adults can also face a heavy social stigma. Obese children are frequently the targets of bullies and are often shunned by their peers. Although obesity rates are rising amongst all social classes in the West, obesity is often seen as a sign of lower socio-economic status. In Sociology or Anthropology, social status is the honor or prestige attached to one's position in Society (one's Social position) [70] Most obese people have experienced negative thoughts about their body image, and some take drastic steps to try to change their shape including dieting, the use of diet pills, and even surgery. Dieting is the practice of ingesting food in a regulated fashion to achieve or maintain a controlled weight Anti-obesity drugs or weight loss drugs refer to all pharmacological agents that reduce or control weight. Bariatrics is the branch of Medicine that deals with the causes prevention and treatment of Obesity. Not all contemporary cultures disapprove of obesity. There are many cultures which are traditionally more approving (to varying degrees) of obesity, including some African, Arabic, Indian, and Pacific Island cultures. Especially in recent decades, obesity has come to be seen more as a medical condition in modern Western culture even being referred to as an epidemic. [71]

Recently emerging is a small but vocal fat acceptance movement that seeks to challenge weight-based discrimination. The fat acceptance movement, also the size acceptance movement or fat liberation movement or fat power, is a Grassroots effort to change societal Unlike most discrimination policies discrimination between, which is the discernment of qualities and recognition of the differences focused here discrimination against is Obesity acceptance and advocacy groups have initiated litigation to defend the rights of obese people and to prevent their social exclusion. Some notable figures within this movement, such as Paul Campos, argue that the social stigma surrounding obesity is founded in cultural anxiety, and that public concern over health risks associated with obesity are inappropriately used as a rationalization for this stigma. Paul Campos is a law professor author and journalist currently on the faculty of the University of Colorado in Boulder. Anxiety is a physiological and psychological state characterized by Cognitive, Somatic, Emotional and Behavioral components [72]

Government agencies and private medicine have warned Americans for years of 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 adults in the United States were overweight or obese. The cause in most cases is a sedentary lifestyle; approximately 40% of adults in the United States do not participate in any leisure-time physical activity and less than 1/3 of adults engage in the recommended amount of physical activity. [73] Overweight and obesity are easily determined by using Body Mass Index (BMI); this index uses your weight and height to determine body fat. An index A BMI range of 25 to 29. 9 is considered overweight and anything over 30 obese. Individuals with a BMI over 30 increase the risk of several heath hazards. [74]

Popular culture

The theatrical poster for the film Idiocracy, a movie set in the distant future, features an obese version of Da Vinci's Vitruvian Man.
The theatrical poster for the film Idiocracy, a movie set in the distant future, features an obese version of Da Vinci's Vitruvian Man. Idiocracy is a 2006 American dark comedy directed by Mike Judge, and starring Luke Wilson and Maya Rudolph. The Vitruvian Man is a world-renowned Drawing with accompanying notes created by Leonardo da Vinci around the year 1487 as recorded in one of his journals

Various stereotypes of obese people have found their way into expressions of popular culture. A stereotype (from Greek: stereo + týpos = "solid impression" is a generalized perception of first impressions behaviors presumed by a group Popular culture (or pop culture) is the Culture — patterns of human activity and the symbolic structures that give such activities significance and importance — A common stereotype is the obese character who has a warm and dependable personality, or a jolly fat man like Santa Claus. Santa Claus, also known as Saint Nicholas, Father Christmas, Kris Kringle, or simply " Santa " is the Equally common is the obese vicious bully (such as Dudley Dursley from the Harry Potter book series, Eric Cartman from South Park, Nelson Muntz from The Simpsons). The following are Fictional characters in the Harry Potter book series written by J Harry Potter is a series of seven Fantasy novels written by British author J Eric Theodore Cartman,commonly referred to by his Family name, Cartman, is one of the four main Fictional characters in the animated series South Park is an animated American television comedy series created and written by Trey Parker and Matt Stone for Comedy Central Nelson Muntz, is a Fictional character from the Animated TV series The Simpsons.

Gluttony and obesity are commonly depicted together in works of fiction. Derived from the Latin gluttire, meaning to gulp down or swallow gluttony is the over-indulgence and Over-consumption of food drink or intoxicants

In cartoons, obesity is often used to comedic effect, with fat animal characters (such as Piggy, Porky Pig, Tummi Gummi, and Podgy Pig) having to squeeze through narrow spaces, frequently getting stuck or even exploding. Piggy is an animated cartoon character in the Merrie Melodies series of films distributed by Warner Bros Porky Pig is an animated cartoon character in the Warner Bros Disney's Adventures of the Gummi Bears is an American Animated television series that aired in the United States in the mid-1980s through the Rupert is an Animated television series based on the Mary Tourtel character Rupert Bear, produced by Nelvana,

A more unusual example of obesity-related humour is Bustopher Jones, from T. S. Eliot's poem "Bustopher Jones: The Cat About Town" featured in Old Possum's Book of Practical Cats, and the musical Cats derived from the poem. " Bustopher Jones The Cat About Town " is a poem from T Thomas Stearns Eliot, OM (September 26 1888 – January 4 1965 was a poet Dramatist, and Literary critic. Old Possum's Book of Practical Cats is a set of whimsical Poems by T Cats is an award-winning musical composed by Andrew Lloyd Webber based on Old Possum's Book of Practical Cats by T Bustopher's claim to fame is that he is a regular visitor to many gentlemen's clubs including Drones, Blimp's and the Tomb. A gentlemen's club is a members-only private Club of a type originally set up by and for English Upper class men Due to his constant lunching at these clubs, he is remarkably fat, being described by others as "a twenty-five pounder. . . And he's putting on weight everyday. " Another popular character, Garfield, a cartoon cat, is also obese for humor. Garfield is a daily-syndicated Comic strip created by Jim Davis. When his owner, Jon, puts him on diets, rather than losing weight, Garfield slows down his weight gain.

It can be argued that depiction in popular culture adds to and maintains commonly perceived stereotypes, in turn harming the self esteem of obese people. In Psychology, self-esteem reflects a Person 's overall evaluation or appraisal of her or his own worth On the other hand, obesity is often associated with positive characteristics such as good humor. In addition, some people are sexually attracted to obese people (see chubby culture and fat admirer). NOTICE TO WOULD-BE-ROMEOS*************** The chubby community is a subculture in the Gay community Chubbies (or "chubs" are gay men who are Overweight or obese. Fat Admiration is the attraction of an individual to people who are overweight or obese whose bodies have what may be considered excessive adipose tissue

Public health and policy

Graphic chart comparing obesity percentages of the total population in OECD member countries.
Graphic chart comparing obesity percentages of the total population in OECD member countries.

Prevalence

United Kingdom

The Health Survey for England predicts that more than 12 million adults and 1 million children will be obese by 2010 if no action is taken. [75][76]

United States

The prevalence of overweight and obesity in the United States makes obesity a leading public health problem. The United States has the highest rates of obesity in the developed world. The term developed country, or advanced country, is used to categorize countries with developed Economies in which the tertiary and quaternary sectors [77] From 1980 to 2002, obesity has doubled in adults and overweight prevalence has tripled in children and adolescents. [78] From 2003-2004, "children and adolescents aged 2 to 19 years, 17. 1% were overweight. . . and 32. 2% of adults aged 20 years or older were obese. "[78] Currently, about 119 million, or 64. 5%, of US adults are either overweight or obese. [79] The prevalence in the United States continues to rise. [80]

China

Because of the booming economy increasing average incomes, the population of China has recently begun a more sedentary lifestyle and at the same time begun consuming more calorie-rich foods. China ( Wade-Giles ( Mandarin) Chung¹kuo² is a cultural region, an ancient Civilization, and depending on perspective a National From 1991 to 2004 the percentage of adults who are overweight or obese increased from 12. 9% to 27. 3%. [81]

Obesity is a public health and policy problem because of its prevalence, costs and burdens. [82] The prevalence of obesity has been continually rising for two decades. [83] This sudden rise in obesity prevalence is attributed to environmental and population factors rather than individual behavior and biology because of the rapid and continual rise in the number of overweight and obese individuals. [84] The current environment produces risk factors for decreased physical activity and for increased calorie consumption. These environmental factors operate on the population to decrease physical activity and increase calorie consumption.

Environmental factors

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

This is most notable in the United States. The United States of America —commonly referred to as the In the years from just after the Second World War until 1960 the average person's weight increased, but few were obese. World War II, or the Second World War, (often abbreviated WWII) was a global military conflict which involved a majority of the world's nations, including In the two and a half decades since 1980 the growth in the rate of obesity has accelerated markedly and is increasingly becoming a public health concern[79]

There are a number of theories as to the cause of this change since 1980. Public health is "the science and art of preventing disease prolonging life and promoting health through the organised efforts and informed choices of society organisations Most believe it is a combination of various factors.

Public health and policy responses

Some U.S. Kaiser Permanente facilities now provide oversized chairs such as this one at Richmond Medical Center for obese patients.
Some U.S. Kaiser Permanente facilities now provide oversized chairs such as this one at Richmond Medical Center for obese patients. The United States of America —commonly referred to as the Kaiser Permanente is an integrated Managed care organization based in Oakland California, founded in 1945 by industrialist Henry J Richmond Medical Center is a large Kaiser Permanente hospital in downtown Richmond, California which serves 77000 members registered

Public health and policy responses to obesity seek to understand and correct the environmental factors responsible for shifts in the prevalence of overweight and obesity in a population. Obesity and overweight are, currently, primarily policy problems in the United States. Policy and public health solutions look to change the environmental factors that promote calorie dense, low nutrient food consumption and that inhibit physical activity.

In the United States, policy has focused primarily on controlling childhood obesity which has the most serious long-term public health implication. Childhood Obesity is a condition where excess body fat negatively affects a child's health or wellbeing Efforts have been underway to target schools. There are efforts underway to reform federally-reimbursed meal programs, limit food marketing to children, and ban or limit access to sugar sweetened beverages. In Europe, policy has focused on limiting marketing to children. There has been international focus on sugar policy and the role of agriculture policy in producing food environments that produce overweight and obesity in a population. To confront physical activity, efforts have examined zoning and access parks and safe routes in cities.

In the United Kingdom, a 2004 report by the Royal College of Physicians, the Faculty of Public Health and the Royal College of Paediatrics and Child Health, titled "Storing up Problems",[89] was followed by a report by the British House of Commons Health Select Committee - the "the most comprehensive inquiry" ever by that body - on the impact of obesity on health and society in the UK and possible approaches to the problem. The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom, the UK or Britain,is a Sovereign state located The Royal College of Physicians of London was the first medical institution in England to receive a Royal Charter The Faculty of Public Health is the standard setting body for specialists in Public health in the United Kingdom. Royal College of Paediatrics and Child Health in London is responsible for the training of Postgraduate doctors in Paediatrics and conducting the MRCPCH The House of Commons' is the Lower house of the Parliament of the United Kingdom, which also comprises the Sovereign and the House of Lords The Health Select Committee is one of the Select Committees of the British House of Commons. [90] 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. [12] A 2007 report produced by Sir Derek Wanless for the King's Fund warned that unless further action was taken, obesity had the capacity to cripple the National Health Service financially. Sir Derek Wanless (born 1948 in Newcastle upon Tyne) is an English banker and adviser to the United Kingdom Government. The King's Fund is a Charitable foundation in England. Founded as the Prince of Wales Hospital Fund for London in 1897 the fund changed its name in 1902 The National Health Service is the name commonly used to refer to the four Publicly-funded healthcare systems of the United Kingdom collectively or individually (although [91]

Non-medical consequences

Besides increases in disease and mortality there are other implications of the present world trend in obesity. Among these are:

See also

References

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External links

Dictionary

obesity

-noun

  1. the act or state of being obese due to an excess of body fat
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