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*'''''The Peacemaker''''' is the name of a film; see ''[[The Peacemaker (film)|The Peacemaker]]''.
[[Image:Fatmouse.jpg|thumb|350px|Obesity is an excess storage of fat and can affect any mammal, such as the mouse on the left.]]
*'''Peacemaker''' is the name of a comic book character; see [[Peacemaker (comics)]].
'''Obesity''' is a condition in which the natural energy reserve of [[human]]s or other [[mammal]]s, which is stored in [[adipose tissue|fat tissue]], is expanded far beyond usual levels to the point where it impairs [[health]]. Obesity in [[wild animal]]s is relatively rare, but it is common in [[domestic animal]]s like [[pig|pigs]] and household [[pet]]s who may be [[overeating|overfed]] and [[exercise|underexercised]]. In humans it is considered a major challenge to health.
*'''''The Peacemaker''''' is the name of an anti-duelling pamphlet by [[Thomas Middleton]].
*'''Roger Clyne and the Peacemakers''' is a rock band [[Roger Clyne and the Peacemakers]].
While cultural and scientific definitions of obesity are subject to change, it is accepted that excessive body weight predisposes to various forms of [[disease]], particularly [[cardiovascular disease]]. Interventions, such as [[weight loss]] and [[medication]], are frequently recommended to reduce this risk, and many people undertake weight loss regimens for aesthetic reasons.
*'''The Peacemaker''' is a name for the [[Colt Single Action Army handgun]], a pistol first manufactured in 1873.
*'''The Great Peacemaker''', a prophet who helped found the [[Haudenosaunee|Haudenosaunee nation]]
==Definition==
{{disambig}}
''Obesity'' is a concept that is being continually redefined. In humans, the most common statistical estimate of obesity is the [[body mass index]] (BMI).
A person with a BMI over 25.0 [[kilogram|kg]]/[[square meter|m<sup>2</sup>]] is considered '''overweight'''; a BMI over 30.0 kg/m<sup>2</sup> is considered obese. A further threshold at 40.0 kg/m<sup>2</sup> is identified as urgent morbidity risk. The [[American Institute for Cancer Research]] considers a BMI between 18.5 and 25 to be an ideal target for a healthy individual (although several sources consider a person with a BMI of less than 20 to be ''underweight''). The BMI was created in the [[19th century]] by the [[Belgium|Belgian]] statistician [[Adolphe Quetelet]]. The cut-off points between categories are occasionally redefined, and may differ from country to country. In June [[1998]] the [[National Institutes of Health]] brought official US category definitions into line with those used by the [[WHO]], moving the American 'overweight' threshold from BMI 27 to BMI 25. About 30,000,000 Americans moved from "ideal" weight to being 1–10 pounds (0.45–4.55 kg) "overweight". As a result, the BMI cannot offer a complete diagnosis, in that it ignores fat distribution within the body (see [[central obesity]]), and the relative fat-muscle-bone contributions to total [[human weight|body weight]]. A powerful athlete may be classified as obese by the BMI due to heavy musculature, while a false 'normal' may be diagnosed in the case of an elderly person with very low lean mass, which masks excess adiposity. On its own, a BMI score is therefore inadequate as a diagnostic tool. In practice, in most examples of overweight that may be harmful to health, both doctor and patient can see 'by eye' that fat is an issue. In these cases, BMI thresholds provide simple targets all patients can understand. Doctors may also use a simple measure of waist circumference (which is a better predictor of complications such [[insulin resistance]] due to visceral fat - see Janssen et al, 2004); 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.
Such clinical data is rarely available in the statistical raw materials required for large public health studies, however - whereas height and weight is commonly recorded. For this essential reason, BMI remains the most commonly-used approach for public health studies, and the most useful for cross-border, longitudinal and other types of comparative analysis.
==Etymology==
''Obesity'' is the nominal form of ''obese'' which comes from the [[Latin]] ''obēsus'', which means "stout, fat, or plump." ''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. Its first attested usage in [[English language|English]] was in [[1651]], in N. Biggs' ''Matæotechnia Medicinæ Praxeuus''.
==Cultural significance==
[[Image:VenusWillendorf.jpg|thumb|130px|Venus of Willendorf]]
In several human cultures, obesity is associated with attractiveness, strength and fertility. Some of the earliest known cultural artefacts, known as [[Venus of Willendorf|Venuses]], are pocket-sized statuettes representing an obese female figure. 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 implies cultural approval of (and perhaps reverence for) this body form.
Obesity functions as a [[symbol]] of wealth and success in cultures prone to food scarcity. Well into the early modern period in European cultures, it still served this role. But as food security was realised, it came to serve more as a visible signifier of 'lust for life', appetite and immersion in the realm of the [[erotic]]. This was especially the case in the visual arts, such as the paintings of [[Peter Paul Rubens|Rubens]] ([[1577]] - [[1640]]), whose regular use of the full female figures gives us the description ''Rubenesque'' for plumpness.
Contemporary cultures which approve of obesity, to a greater or lesser degree, include African, Arabic, Indian, and Pacific Island cultures. In Western cultures, obesity has come to be seen more as a medical condition than as a social statement. In American culture, many use a popular [[snap]], "Yo' momma's so fat...", in playing "[[the dozens]]". A small minority of activists, especially clustered around the tradition of [[feminism]], seek through the [[fat acceptance movement]] to challenge that emerging consensus.
==Causes==
===Causative factors===
Obesity is generally a result of a combination of factors:
* [[Genetic]] predisposition (rarely specific genetic disorders, such as [[Prader-Willi syndrome]])
* Energy-rich [[diet (nutrition)|diet]]
* Limited exercise and sedentary lifestyle
* Weight cycling, caused by repeated attempts to lose weight by dieting
* Underlying illness (e.g. [[hypothyroidism]])
* An [[eating disorder]] (such as [[binge eating disorder]])
* [[Stress (medicine)|Stressful]] mentality (debated)
* Insufficient [[sleep]]ing (debated)
Although there is no definitive explanation for the recent epidemic of obesity, the evolutionary hypothesis comes closest to providing some understanding of this phenomenon. In times when food was scarce, the ability to take advantage of rare periods of abundance and use such abundance by storing energy efficiently was undoubtedly an evolutionary advantage. This is precisely the opposite of what is required in a sedentary society, where high-energy food is available in abundant quantities in the context of decreased exercise. Although many people may have a genetic propensity towards obesity, it is only with the reduction in physical activity and a move towards high-calorie diets of modern society that it has become widespread. Significant proportions (up to 30%) of the population in wealthy countries are now obese, and seen to be at risk of ill [[health]].
Eating disorders can lead to obesity, especially [[binge eating disorder]] (BED). As the name indicates, patients with this disorder are prone to overeat, often in binges. A proposed mechanism is that the eating serves to reduce anxiety, and some parallels with [[substance abuse]] can be drawn. An important additional factor is that BED patients often lack the ability to recognize hunger and satisfaction, something that is normally learnt in childhood. [[Learning theory (education)|Learning theory]] suggests that early childhood conceptions may lead to an association between food and a calm mental state.
Some recent research has suggested that some human obesity may be caused by a [[virus|viral]] [[infection]]. The virus [[adenovirus]] vectors [[AD-36]] and AD-37 have been identified as a cause of obesity in animals and as potential stimulants on human [[adipose tissue|preadipocytes]] (Vangipuram ''et al'' 2004). While these viruses occur in humans, there is no clear evidence that their presence leads to in increased risk of obesity.
===Mechanism===
Flier (2004) summarizes the many possible [[pathophysiology|pathophysiological]] mechanisms involved in the development and maintenance of obesity. This field of research had been almost unapproached until [[leptin]] was discovered in [[1994]]. Since this discovery, many other hormonal mechanisms have been proposed that participate in the regulation of [[appetite]] and food intake, storage patterns of [[adipose tissue]], development of [[insulin resistance]] and possible ways of interfering with these mechanisms. Since leptin, [[ghrelin]], [[orexin]], [[PYY 3-36]], [[cholecystokinin]], [[adiponectin]] and numerous other mediators have been studied. The [[adipokine]]s are mediators produced by adipose tissue; their action is thought to modify many obesity-related diseases.
Leptin and ghrelin are considered to be complementary in their influence on appetite, with the [[stomach]] producing ghrelin when relatively empty and leptin being produced by adipose tissue when satiated with nutrients. Resistance to the leptin signal and causes for this resistance have been implicated in dysregulation of appetite, although administration of leptin has not proven to be a feasible way of suppressing appetite.
[[Neuroscience|Neuroscientific]] approaches hinge on the action of the aforementioned hormones and mediators on the [[hypothalamus]], the part of the brain that is thought to produce hunger signals for higher centers and induce food intake behavior.
===Societal causes===
While it is often quite 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 who is obese, they cannot explain why one culture grows fatter than another.
This is most notable in the [[United States]]. In the years from just after the [[Second World War]] until [[1960]] the average person's weight increased, but few were obese. In 1960 almost the entire population was well fed, but not overweight. 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.
There are a number of theories as to the cause of this change since [[1980]]. Most believe it is a combination of various factors.
*One of the most important is the much ''lower relative cost of foodstuffs'': massive [[agriculture|agricultural]] [[subsidy|subsidies]] in the United States and Europe have led to food prices for consumers being lower than at any point in history. [[Sugar]] and [[corn syrup]], two huge sources of [[food energy]], are some of the most subsidized products by the United States government.
*''Increased marketing'' has also played a role. In the early 1980s the [[Ronald Reagan|Reagan]] administration lifted most regulations pertaining to [[advertising]] to children. As a result, the number of commercials seen by the average child increased greatly, and a large proportion of these were for [[fast food]] and [[candy]].
*Changes in ''the price of [[mineral oil]] and [[gasoline|petrol]]'' are also believed to have had an effect, as unlike during the [[1970s]] it is now affordable in the United States to drive everywhere - at a time when [[public transit]] goes underused. At the same time more areas have been built without [[sidewalk]]s and parks.
*The ''changing workforce'' as each year a greater percent of the population spends their entire workday behind a desk or [[computer]], seeing virtually no exercise. In the [[kitchen]] the [[microwave]] has seen sales of unhealthy frozen convenience foods skyrocket and has encouraged more elaborate [[snack]]ing.
*A social cause that is believed by many to play a role is the increasing number of ''two income households'' where one parent no longer remains home to look after the house. This increases the number of restaurant and take-out meals.
*''Urban sprawl'' may be a factor: obesity rates increase as urban sprawl increases, possibly due to less walking and less time for cooking (Lopez 2004).
*Since 1980 both sit-in and ''[[fast food]] [[restaurant]]s'' have seen dramatic growth in terms of the number of outlets and customers served. Low food costs, and intense competition for market share, led to increased portion sizes - for example, [[McDonalds]] french fries portions rose from 200 calories (840 [[joule|kilojoules]]) in 1960 to over 600 calories (2,500 kJ) today.
*''Increased food production'' is a likely factor. The U.S. produces three times more food than U.S. citizens eat.
*Increasing ''affluence'' itself (including many of the above factors as accompaniments of affluence) may be a cause, or contributing factor since obesity tends to flourish as a [[Diseases of affluence|disease of affluence]] in countries which are developing and becoming westernised.[http://www.iotf.org/]. This is supported by a dip in American GDP after 1990, the year of the first Iraq war, followed by an exponential increase. USA obesity statistics followed the same pattern, offset by two years.[[http://www.cdc.gov/brfss/]]
Interestingly an increase in the number of Americans who [[exercise]] and [[Dieting|diet]] occurred before the increase in obesity, and some scholars have even argued that these trends actually encouraged obesity. Nearly all diets fail, with participants resuming their previous eating habits or even engaging in binge eating. Many then see an overall increase in their weight. If the diet is then repeated and abandoned again, a pattern of rising and falling weight is establish, known as weight cycling. Similarly those who workout but then stop can end up being heavier than those who never exercised.
===Poverty link===
Some obesity co-factors are resistant to the theory that the 'epidemic' is a new phenomenon. In particular, a [[social class|class]] co-factor consistently appears across many studies. Comparing net worth with BMI scores, a 2004 study by Zagorsky 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. Another study finds women who married into higher status predictably thinner than women who married into lower status.
==Complications==
Obesity, especially [[central obesity]] (male-type or waist-predomimant obesity), is an important risk factor for the "[[metabolic syndrome]]" (Syndrome X), the clustering of a number of diseases and risk factors that heavily predispose for [[cardiovascular disease]]. These are [[Diabetes mellitus|diabetes mellitus type 2]], [[arterial hypertension|high blood pressure]], [[hypercholesterolemia|high blood cholesterol]] and [[hypertriglyceridemia|triglyceride levels]] ([[combined hyperlipidemia]]). An [[Inflammation|inflammatory state]] is present, which - together with the above - has been implicated in the high prevalence of [[atherosclerosis]] (fatty lumps in the arterial wall), and a [[thrombosis|prothrombotic]] state may further worsen cardiovascular risk.
Apart from the metabolic syndrome, obesity is also [[correlation|correlated]] (in population studies) with a variety of other complications. For many 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. Most confidence in a direct cause is given to the mechanical complications in the following list, compiled by the [[American Medical Association]] for general physicians:
* ''[[Cardiovascular]]'': [[congestive heart failure]], [[cardiomegaly|enlarged heart]] and its associated [[arrhythmia]] and dizziness, [[cor pulmonale]], [[varicose veins]] and [[pulmonary embolism]]
*''[[Endocrine]]'': [[polycystic ovarian syndrome]] (PCOS), [[menstruation|menstrual]] disorders and [[infertility]]
* ''[[Gastrointestinal]]'': [[gastroesophageal reflux disease]] (GERD), [[non-alcoholic steatohepatitis|fatty liver disease]], [[cholelithiasis]] (gallstones), [[hernia]] and [[colorectal cancer]]
* ''Renal and [[genitourinary]]'': [[urinary incontinence]], [[glomerulopathy]], [[hypogonadism]] (male), [[breast cancer]] (female), [[Endometrial cancer|uterine cancer]] (female), [[stillbirth]]
* ''[[Integument]]'' (skin and appendages): [[stretch mark]]s, [[acanthosis nigricans]], [[lymphedema]], [[cellulitis]], [[carbuncle]]s, [[intertrigo]]
* ''Musculoskeletal'': [[hyperuricemia]] (which predisposes to [[gout]]), immobility, [[osteoarthritis]], [[low back pain]]
* ''Neurologic'': [[stroke]], [[meralgia paresthetica]], [[headache]], [[carpal tunnel syndrome]], [[dementia]] (Whitmer ''et al'' 2005)
* ''[[Respiratory]]'': [[dyspnea]], [[obstructive sleep apnea]], [[hypoventilation]] syndrome, [[Pickwickian syndrome]], [[asthma]]
* ''[[Psychological]]'': [[Clinical depression|Depression]], low [[self esteem]], [[body image disorder]], social stigmatization
While being severely obese has many health ramifications, those who are somewhat overweight face little increased [[mortality]] or [[morbidity]]. Some studies suggest that the somewhat "overweight" tend to live longer than those at their "ideal" weight. [http://www.chron.com/cs/CDA/ssistory.mpl/nation/3142605] [[Osteoporosis]] is known to occur less in slightly overweight people.
==Therapy==
The mainstay of treatment for obesity is an energy-limited [[Dieting|diet]] and increased exercise. Although adherence to this regimen can cure obesity, many patients are unable to make the required sacrifices. There might be an additional behavioral factor at the brain level "forbidding" obesity patients from losing too much weight.
In a [[clinical practice guideline]] by the [[American College of Physicians]] (Snow ''et al'' 2005), the following five recommendations are made:
# 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.
# If these goals are not achieved, pharmacotherapy can be offered. The patient needs to be informed of the possibility of [[side-effect]]s and the unavailability of long-term safety and efficacy data.
# Drug therapy may consist of [[sibutramine]], [[orlistat]], [[phentermine]], [[diethylpropion]], [[fluoxetine]] and [[bupropion]]. Evidence is not sufficient to recommend [[sertraline]], [[topiramate]] or [[zonisamide]].
# 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. The patient needs to be aware of the potential complications.
# Those requiring bariatric surgery should be referred to high-volume referral centers, as the evidence suggests that surgeons who perform these procedures frequently have fewer complications.
Much research focuses on new [[medication|drugs]] to combat obesity, which is seen as the biggest health problem facing developed countries. Some nutritionists feel that these research funds would be better devoted to advice on good nutrition, healthy eating and promoting a more active lifestyle.
Medication most commonly prescribed for diet/exercise-resistant obesity is [[orlistat]] (Xenical®, reduced intestinal fat absorption by inhibiting [[pancreas|pancreatic]] [[lipase]]) and [[sibutramine]] (Reductil®, Medaria®, an [[anorectic]]). In the presence of [[diabetes mellitus]], there is evidence that the [[anti-diabetic drug]] [[metformin]] (Glucophage®) can assist in [[weight loss]] - rather than [[sulfonylurea]] derivatives and [[insulin]], which often lead to further weight gain. The [[thiazolidinedione]]s ([[rosiglitazone]] or [[pioglitazone]]) can cause slight weight gain, but decrease the "pathologic" form of abdominal fat, and are therefore often used in obese [[diabetes mellitus|diabetics]].
Increasingly, ''[[bariatric surgery]]'' is being used to limit stomach capacity (and thus food intake); this can happen [[Laparoscopic surgery|laparoscopically]]. [[Ileal bypass]] reduces the length of the intestine and hence absorbing surface, but has more complications.
==Controversies==
There is continuous debate over obesity, at several levels. The [[evidence based medicine|scientific evidence]] informing these debates is more contradictory than most simple arguments assume. Statistics demonstrating [[correlation]]s are typically misinterpreted in public discussion as demonstrating [[causation]], a fallacy known as the [[spurious relationship]].
===Causes of obesity===
Conventional wisdom holds that obesity is caused by over-indulgence in fatty or sugary foods, portrayed as either a failure of will power or a species of [[addiction]]. Various specialists strongly oppose this view. For example, Professor [[Thomas Sanders]], the director of the Nutrition, Food & Health Research Centre at [[King's College London]], emphasises the need for balance between activity and consumption:
:''In trials, there is no evidence suggesting that reducing fat intake has an effect on obesity. As long as your expenditure equals what you eat, you won't put on weight, regardless of how high the fat content is in your diet'' (''[[The Times]]'', London, 10 March 2004).
===Medicalisation of obesity===
Controversy also exists as to whether the concept of "obesity" is a valid one. These critics assert that physically active people are healthier than the sedentary regardless of their body weight. The focus on weight and body [[mass]] is fed, in their view, by a diet promotion industry, drug companies, and segments of the medical profession for profit purposes, by promoting a vision that equates health with slenderness, and makes extreme slenderness of a sort that is quite difficult for most people to achieve an ideal. In ''The Obesity Myth'', [[Paul Campos]] writes that:
:''... (F)rom the perspective of a profit-maximising medical and pharmaceutical industry, the ideal disease would be one that never killed those who suffered from it, that could not be treated effectively, and that doctors and their patients would nevertheless insist on treating anyway. Luckily for it, the American health care industry has discovered (or rather invented) just such a disease. It is called "obesity". Basically, obesity research in America is funded by the diet and drug industry - that is, the economic actors who have the most to gain from the conclusion that being fat is a disease that requires aggressive treatment. Many researchers have direct financial relationships with the companies whose products they are evaluating. ''[http://society.guardian.co.uk/publichealth/story/0,11098,1203533,00.html]
More militant "fat acceptors" reject any attempt to present obesity as a problem: Conventional wisdom, assuming obesity to be a health problem, is to be considered a [[prejudice]], directly equivalent to the medicalisation of [[homosexuality]] in the 19th Century, and the consequent persecution of this minority.
===Health effects of obesity===
Opposing Campos are voices such as [[Greg Critser]], who writes in ''Fat Land'' that the statistics such campaigners use are based on a selective sample of research data - a selection designed to emphasise obesity co-factors such as poor fitness, rather than obesity itself. Critser notes that advocates of the ''Obesity Myth'' position typically rely heavily on a study by Dr. Steven Blair at the Cooper Institute, Texas, which showed that fit, fat subjects were healthier than unfit, skinny subjects:
:''... Taking out the fitness variable and looking at body weight only, Blair admitted: "Men with a BMI of >30 were generally less physically fit and had more unfavorable risk factors than men in the lower BMI groups". Lower weight men had higher good cholesterol, lower bad cholesterol, and higher treadmill times than fatter men. "The highest death rate," he added, "was observed among those men in the highest BMI category and correspondingly lower death rates were observed in each subsequently lower BMI category." And when one looks at the ''difference'' between low fit men in all categories - which one might think would be most useful since most obese people are not fit - Blair's upbeat message fades: Normal weight nonfit men had an age-adjusted death rate (the number of excess deaths in the studied group) of 52.1; unfit fat men had the higher rate of 62.1. More: Unfit lean men were half as likely to have a history of hypertension than unfit fat men. In the real world, even according to Blairism, the fat are more likely to die early - and to live precariously - than the lean.''
===Medical responses to obesity===
Conventional wisdom recommends that the obese adopt strategies to lose weight in order to mitigate the health risks associated with obesity. There is controversy both over what those strategies realistically include, and also whether such a goal does actually result in better health outcomes.
Weight reduction strategies include dietary changes, exercise regimes, weight loss drugs, and surgical interventions (see [[Obesity#Therapy|Therapy]], above, for complete list). Of these, "miracle diets" are most contested, with several studies suggesting that short-term weight loss typically results in metabolic adjustments leading to weight ''gain'' in the longer term.
===Prevalence and public interest===
What qualifies a medical condition as a matter of public interest, rather than a private health issue between doctor and patient, are its social costs. The estimation or measurement of the social cost of obesity is an extraordinarily hazardous statistical task, for two separate reasons.
Firstly, the collation of evidence concerning the prevalence of obesity, or especially changing rates of prevalence, is open to several types of distortion. In the case of the UK, for one example, ''uninterpreted'' public health statistics may contradict the common belief that obesity is reaching epidemic proportions [http://www.spiked-online.com/Articles/0000000CA8D9.htm]. More generally, average weight increases with age - so a population with an increasing proportion of older people will have a higher average weight, regardless of changes to diet or activity.
Secondly, since obesity is the ''correlate'' of a long list of factors which have significant health consequences in their own right, there may be no fact of the matter about which costs to attribute to obesity ''per se'', and which are more properly costed to these co-factors. For one example, the proven relationship between obesity and low social status means that any group of obese persons' health outcomes will be significantly lowered by their average access to medical care, ''as a socioeconomic class'', which will be, on average, lower than that of any non-obese control group.
Researchers from the US Centers of Disease Control and Prevention in Atlanta (Mokdad ''et al'' 2004) reported that approximately 400,000 US deaths annually were associated with poor diet and little exercise, and that if the trend continued, this would be 500,000 in 2005, overtaking [[smoking]] as the leading cause of death. These statistics are fiercely contested [http://server1.consumerfreedom.com/article_detail.cfm/article/141], and error was admitted by the CDC in November 2004 [http://www.cbsnews.com/stories/2004/11/24/health/main657636.shtml]. In particular, studies of this nature are normally unable to distinguish causes of death, so include many accidental deaths, murders etc, which ought not to be costed to obesity.
[[Canada]] and [[Europe]] are generally considered to be somewhat behind the United States in the trend towards overweight, with the rest of the world mixed. Some nations like [[Egypt]] and [[Mexico]] have also suffered from greatly increasing rates of obesity.
In March 2005 the [[International Obesity Task Force]], a global coalition of obesity scientists and research centres advising the European Union, estimated that [[Finland]], [[Germany]], [[Greece]], [[Cyprus]], the [[Czech Republic]], [[Slovakia]] and [[Malta]] have exceeded the [[United States]] figure of 67% for overweight or obese [[males]]. The task force estimated in 2003 that about 200m of the 350m adults living in what is now the [[European Union]] may be overweight or obese.[http://www.guardian.co.uk/medicine/story/0,11381,1438700,00.html 1]
===Policy responses to obesity===
On top of controversies about the causes of obesity, and about its precise health implications, come policy controversies about the correct [[policy]] approach to obesity. The main debate is between "personal responsibility" advocates, who resist regulatory attempts to intervene in citizen's private dietary habits, and 'public interest' advocates, who promote regulations, on the same public health grounds as the restrictions applied to tobacco products. In the [[USA]], a recent bout in this controversy involves the so-called [[Cheeseburger Bill]], an attempt to indemnify food industry businesses from frivolous law suits by obese clients.
"Personal responsibility" advocates work on the basis that, as the [[microbiologist]] [[Rene Dubos]] once said, health ought not to be considered an end in itself, but 'the condition best suited to reach goals that each individual formulates for himself' [http://www.spiked-online.com/Articles/0000000CA7A4.htm]. Any other definition permits authorities to curtail the autonomy of the self-determining individual, imposing quantity over quality of life onto them, undermining their civil liberties. As much as principled doctors, personal responsibility arguments have also been offered by food producer lobbies. In 1961, for example, as President [[John F Kennedy]] raised concerns about a lack of fitness in American society, a spokesman for the US Dairy industry, Frank R. Neu, wrote [[advertorial]]s warning ''We May Be Sitting Ourselves To Death'' [http://www.theatlantic.com/issues/61nov/neu.htm]. Not food regulation, but personal exercising, is moved as the solution.
The "public interest" advocate [[John Banzhaf]] has found a way to harness personal responsibility arguments to the public interest side of the debate in the USA, via recent changes [http://banzhaf.net/docs/fatrates] to [[HMO]] regulations which enable health insurance providers to differentiate between obese and regular customers in their pricing. The 'public interest' objective is that obese people will have to pay extra for their health maintenance, bringing "personal responsibility" to bear on their consumption choices. This new tactic is controversial itself - if a causal link pertains from low social status to obesity (see [[Obesity#Poverty_link.3F|above]]), the net effect will be increased costs for low income members of HMOs, particularly ethnic minorities, and reduced costs for slim, middle class white members.
On [[July 16]], [[2004]], the US Department of Health and Human Services officially classified obesity as a disease. Speaking to a Senate committee, [[Tommy Thompson]], the Secretary of Health and Human Services, stated that Medicare would cover obesity-related health problems. However, reimbursement would not be given if a treatment was not proven to be effective.
==See also==
*[[Fat acceptance movement]]
*[[Fat admirer]]
*[[Pickwickian syndrome]]
*[[Healthy eating]]
*[[Dieting]]
==References==
* Bruch H. ''Eating Disorders, Obesity, Anorexia Nervosa and the Person Within''. New York: Basic Books, 1973.
* Flier JS. ''Obesity wars: molecular progress confronts an expanding epidemic''. Cell 2004;116:337-50. PMID 14744442.
* Janssen I, Katzmarzyk PT, Ross R. ''Waist circumference and not body mass index explains obesity-related health risk.'' Am J Clin Nutr 2004;79:379-84 PMID 14985210
* Lopez R. ''Urban sprawl and risk for being overweight or obese.'' Am J Publ Health 2004;94:1574-9. PMID 15333317.
* Mokdad AH, Marks JS, Stroup DF, Gerberding JL. ''Actual causes of death in the United States, 2000.'' [[JAMA]] 2004;291:1238-45. PMID 15010446
* Roberts SB, Savage J, Coward WA, Chew B, Lucas A. Energy expenditure and intake in infants born to lean and overweight mothers. [[N Engl J Med]] 1988;318:461-6. PMID 3340127
* Ross JG, Pate RR. ''The National Children and Youth Fitness Study II: A summary of findings.'' J Phys Educ Recr Dance 1987;58:51-6.
* Snow V, Barry P, Fitterman N, Qaseem A, Weiss K; Clinical Efficacy Assessment Subcommittee of the American College of Physicians. ''Pharmacologic and surgical management of obesity in primary care: a clinical practice guideline from the American College of Physicians.'' Ann Intern Med 2005;142:525-31. [http://www.annals.org/cgi/content/full/142/7/525 Fulltext]. PMID 15809464.
* Tillotson JE. ''America's Obesity: Conflicting Public Policies, Industrial Economic Development, and Unintended Human Consequences.'' Annu Rev Nutr 2004;24:617-43. PMID 15189134
* Vangipuram SD, Sheele J, Atkinson RL, Holland TC, Dhurandhar NV. ''A human adenovirus enhances preadipocyte differentiation.'' Obes Res 2004;12:770-7. PMID 15166297.
* Whitmer RA, Gunderson EP, Barrett-Connor E, Quesenberry CP, Yaffe K. ''Obesity in middle age and future risk of dementia''. BMJ 2005 [http://dx.doi.org/10.1136/bmj.38446.466238.E0 DOI] (early online publication)
* Wolf MC, Cohen KR, Rosenfeld JG. ''School-based interventions for obesity: Current approaches and future prospects.'' Psychology in the Schools 1985;22:187-200.
* Zagorsky JL. ''Is Obesity as Dangerous to Your Wealth as to Your Health?'' Res Aging 2004;26:130-152. [http://roa.sagepub.com/cgi/reprint/26/1/130 PDF fulltext]. <!--not PMID indexed-->
* ''[[The Oxford English Dictionary]]'' (website) (for the etymology)
== External links ==
* [http://www.thedoctorslounge.net/centers/nutrition/calculators/index.htm Obesity, BMI and Calorie assessment Calculators]
* [http://www.nutri.info/body_mass_index_download.htm Body Mass Index Calculator]
* [http://web4health.info/en/answers/life-obesity-menu.htm Obesity advice / FAQs]
* [http://www.iotf.org/ International Task Force on Obesity]
* [http://www.ericdigests.org/pre-9218/obesity.htm Childhood Obesity]
* [http://www.guardian.co.uk/weekend/story/0,3605,1200549,00.html Argument that the concern for obesity is overwrought]
* [http://bmj.bmjjournals.com/cgi/content/full/328/7452/1327 BMJ Article on Obesity and Public policy]
*[http://www.thepublicinterest.com/current/article3.html Economics of Obesity]
* [http://www.hsph.harvard.edu/symposium/sacks_files/v3_document.htm ''The Worldwide Obesity Epidemic''] by Frank Sacks MD
[[Category:Metabolic disorders]]
[[Category:Endocrinology]]
[[Category:Health]]
[[Category:Nutrition]]
[[Category:Bariatrics]]
[[bg:Затлъстяване]]
[[de:Adipositas]]
[[eo:Trodikiĝo]]
[[fr:Obésité]]
[[nl:Obesitas]]
[[ja:肥満]]
[[pl:Otyłość]]
[[pt:Obesidade]]
[[ru:Ожирение]]
[[fi:Liikalihavuus]]
[[zh:肥胖症]]
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