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Obesity is a condition in which excess body fat has accumulated to such an extent that health may be negatively affected. It is commonly defined as a body mass index (BMI = weight divided by height squared) of 30 kg/m2 or higher. This distinguishes it from being overweight as defined by a BMI of between 25–29.9 kg/m2.
Excessive body weight is associated with various diseases, particularly cardiovascular diseases, diabetes mellitus type 2, obstructive sleep apnea, certain types of cancer, and osteoarthritis. As a result, obesity has been found to reduce life expectancy. The primary treatment for obesity is dieting and physical exercise. If this fails, anti-obesity drugs and (in severe cases) bariatric surgery can be tried.
A combination of excessive caloric intake, lack of physical activity, and genetic susceptibility is thought to explain most cases of obesity, with a limited number of cases due solely to genetics, medical reasons, or psychiatric illness.
With rates of adult and childhood obesity increasing, authorities view it as a serious public health problem. Between 1980-2000, obesity among adults has more than doubled; obesity among adolescents has tripled. In the US, obesity is the second-leading cause of preventable death after smoking.
Although obesity is often stigmatized in the modern Western world, it has been perceived as a symbol of wealth and fertility at other times in history.
Classification
Obesity, in absolute terms, is an increase of body adipose tissue (fat tissue) mass. In a practical setting it is difficult to determine this directly. Therefore obesity is typically assessed by BMI (body mass index) and in terms of its distribution via the waist circumference. In addition, the presence of obesity needs to be evaluated in the context of other risk factors such as medical conditions that could influence the risk of complications.
BMI
Body mass index or BMI is a simple and widely used method for estimating body fat mass. BMI was developed in the 19th century by the Belgian statistician and anthropometrist Adolphe Quetelet. BMI is an accurate reflection of body fat percentage in the majority of the adult population. It is less accurate in people such as body builders and pregnant women in whom body composition is affected.
BMI is calculated by dividing the subject's weight by the square of his or her height, typically expressed either in metric or US "Customary" units:
where kg is the subject's weight in kilograms and m is the subject's height in metres.
where lb is the subject's weight in pounds and in is the subject's height in inches.
The most commonly used definitions, established by the WHO in 1997 and published in 2000, provide the values listed in the table at right.
Some modifications to the WHO definitions have been made by particular bodies:
- A BMI of 35.0 or higher in the presence of at least one other significant comorbidity is also classified by some bodies as class III obesity.
- For Asians, overweight is a BMI between 23 and 29.9 kg/m2 and obesity a BMI >30 kg/m2.
The surgical literature breaks down "class III" obesity into further catergories.
- Any BMI > 40 is severe obesity
- A BMI of 40.0–49.9 is morbid obesity
- A BMI of >50 is super obese
Waist circumference and waist–hip ratio
In those with a BMI under 35, intra-abdominal body fat is related to negative health outcomes independent of total body fat. Intra-abdominal or visceral fat has a particularly strong correlation with cardiovascular disease. In a study of 15,000 subjects, waist circumference also correlated better with metabolic syndrome than BMI. Women who have abdominal obesity have a cardiovascular risk similar to that of men. In people with a BMI over 35, measurement of waist circumference however adds little to the predictive power of BMI as most individuals with this BMI have an abnormal waist circumferences.
The absolute waist circumference (>102 cm in men and >88 cm in women) or waist–hip ratio (>0.9 for men and >0.85 for women) are both used as measures of central obesity.
Body fat percentage
Body fat percentage is total body fat expressed as a percentage of total body weight. It is generally agreed that men with more than 25% body fat and women with more than 33% body fat are obese. Body fat percentage can be estimated from a person's BMI by the following formula:
This formula takes into account the fact that body fat percentage is 10% greater in women than in men for a given BMI. It recognizes that a person's percentage body fat increases as they age even if their weight remains constant. The results have an accuracy of 4%.
Direct attempts to determine body fat percent are difficult and often expensive. One of the most accurate methods is to weigh a person underwater which is known as hydrostatic weighting. Two other simpler and less accurate methods for measuring body fat therefore have historically been used. The first is the skinfold test, in which a pinch of skin is precisely measured to determine the thickness of the subcutaneous fat layer. It has not, however, been adequately evaluated in obese subjects. The other is bioelectrical impedance analysis which uses electrical resistance. Bioelectrical impedance however has not been shown to provide an advantage over BMI. Therefore the routine use of these tests are discouraged.
Body fat percentage measurement techniques used mainly for research include computed tomography (CT scan), magnetic resonance imaging (MRI), and dual energy X-ray absorptiometry (DEXA). These techniques provide very accurate measurements, but it may be difficult to scan the severely obese due to weight limits of the equipment and insufficient diameter of the CT or MRI scanner.
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 complications that would indicate a need to commence or intensify treatment for obesity. Smoking, high blood pressure, age and family history are other risk factors that, in combination with obesity, may indicate an additional reason for treatment.
Childhood obesity
Obesity in children and adolescents is defined as a BMI greater then the 95th percentile. Rates of obesity among this group have increased by 3 to 5 % from 1990 to the year 2000. Rates have also increased in most other developed countries worldwide.
Many different factors contribute to the rising rates of childhood obesity. As more parents work children end up eating alone in front of the TVs. Parents also compensate for their absence by giving children fast food, sweets and chocolate. There has been an increase in snacking and soft drink consumption in children over the past years which might also play a major role. Over 50% of the commercials children view are based on food. The food depicted are generally sweetened and proceed and the advertisements encourage children to purchase and consume more.
Effects on health
Mortality
Obesity is one of the leading preventable causes of death. Mortality risk varies with BMI; the lowest risk is found at a BMI of 22–24 kg/m2 and increases with changes in either direction. A BMI of over 32 is associated with a doubling of risk of death and obesity is estimated to cause an excess 111,909 to 365,000 death per year in the United States. Obesity on average reduces life expectancy by 6–7 years. Severe obesity (BMIs >40) reduces life expectancy by 20 years for men and 5 years for women.
Morbidity
A large number of physical and mental conditions have been associated with obesity.
Health consequences can be categorized by the effects of increased fat mass (osteoarthritis, obstructive sleep apnea, social stigmatization) or by the increased number of fat cells (diabetes, cancer, cardiovascular disease, non-alcoholic fatty liver disease). Increases in body fat alter the body's response to insulin, potentially leading to insulin resistance. Increased fat also creates a proinflammatory state, increasing the risk of thrombosis.
Central obesity, characterized by its high waist to hip ratio, is an important risk for metabolic syndrome. Metabolic syndrome is a combination of medical disorders which often includes diabetes mellitus type 2, high blood pressure, high blood cholesterol, and triglyceride levels.
Obesity is related to a variety of other complications. Some of these are directly caused by obesity and others are indirectly related through mechanisms sharing a common cause such as poor diet or a sedentary lifesty
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Sometimes Continuity Trumps Change - Washington Post
Sometimes Continuity Trumps Change
The Irrawaddy News Magazine
Washington Post -
By Alec MacGillis and Ann Scott Tyson As President-elect Barack Obama prepares to fill top positions for his incoming government, he faces a stubborn reality: Some of the key individuals he will rely upon to tackle the country's most serious challenges ...
So much else happened while people eyed election
Obama's foreign policy goals will face a reality check
Transition, too, for Michelle Obama to first lady
(AP)
AP - She's been compared to Jacqueline Kennedy, is every bit as high-powered as Hillary Rodham Clinton was and has praised Laura Bush's calm and rational approach to issues.
