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A discussion on the issue of obesity in america

BuchananMD, and Stephen A. Find articles by Ryan T. Hurt Christopher Kulisek Dr. Find articles by Christopher Kulisek Laura A. Find articles by Laura A. Find articles by Stephen A. This article has been cited by other articles in PMC. Obesity is associated with a higher incidence of a number of diseases, including diabetes, cardiovascular disease, and cancer.

Consumption of fast food, trans fatty acids TFAsand fructose—combined with increasing portion sizes and decreased physical activity—has been implicated as a potential contributing factor in the obesity crisis. The use of body mass index BMI alone is of limited utility for predicting adverse cardiovascular outcomes, but a discussion on the issue of obesity in america utility of this measure may be strengthened when combined with waist circumference and other anthropomorphic measurements.

Certain public health initiatives have helped to identify and reduce some of the factors contributing to obesity. In New York City and Denmark, for example, such initiatives have succeeded in passing legislation to reduce or remove TFAs from residents' diets. The experience gained with previous epidemiologic problems such as smoking should help involved parties to expand needed health initiatives and increase the likelihood of preventing future generations from suffering the consequences of obesity.

Obesity is rapidly becoming the leading cause of preventable death in the United States, with obesity-related deaths projected to soon surpass deaths related to tobacco abuse. The incidence of obesity has doubled in the United States since 1960, with one third of the adult population currently obese.

In the current debate over healthcare reform in the United States, no proposed solution can reasonably ignore or minimize the role that obesity plays with regard to economic and health consequences. This article will give an overview of the epidemiology of obesity, provide measures of defining obesity, and discuss the impact of public health and environmental factors associated with the marked increase in obesity.

OBESITY: OVERVIEW OF AN EPIDEMIC

Potential health initiatives that might be successful in preventing obesity and its associated consequences in future generations will also be discussed. Obesity Epidemiology In 2001, the US Surgeon General released a report raising concerns about the growing obesity epidemic; this report was the first to note that obesity and obesity-related diseases might soon overtake smoking as the leading cause of preventable death in the United States. For children aged 19 years or younger, obesity is defined as a weight at or above the 95th percentile for age; overweight children are those whose weight is between the 85th and 95th percentiles for age.

The prevalence of obesity was lower among non-Hispanic white children 13. When gender and race were considered, significantly higher rates of obesity were seen in Mexican American boys 22.

Non-Hispanic A discussion on the issue of obesity in america American girls had significantly higher rates of obesity 21. While obesity is clearly a major public health issue in the United States, the increased prevalence of obesity is not limited to this country; indeed, obesity is now a global epidemic.

Over the past 10 years, the World Health Organization WHO has recognized the increasing number of people who are overweight or obese, and attention is now being given to the global implications associated with this trend. In an analysis of the leading causes of global mortality and burden of disease, obesity and being overweight were among the top 10 causes for each. Because Asian populations have a higher proportion of body fat, for example, lower BMIs have been proposed to identify individuals in these populations who are overweight or obese.

Compared to white subjects, BMI underestimated body fat percentage in Chinese, Malay, and Indian subjects, with the error ranging from 2. Furthermore, Asians had a higher risk of developing diabetes and CVD and had increased mortality at normal BMIs compared to other ethnic groups.

  • Social conditions and obesity BMJ noted here include Working and living conditions, such as having enough money for a healthy standard of living, underpin compliance with national health guidelines Increasingly less job control, security, flexibility of working hours, and access to paid family leave … undermining the material and psychosocial resources necessary for empowering individuals and communities to make healthy living choices;
  • Over the same period, the same meal in countries without a ban such as Hungary, Poland, and the United States still contained 36—42 g of TFAs.

Many of the larger international studies used to estimate the number of overweight and obese individuals in foreign countries have used surveys involving self-reported heights and weights. On average, BMIs in older individuals were 1 unit lower when calculated using self-reported values compared to BMIs calculated using measured values.

Furthermore, this self-reporting bias worsened as true BMI values increased. In an earlier French study of 7,250 individuals, values for both self-reported weight and height were inaccurate. In contrast, height was significantly overestimated by a mean of 0. This combination of errors led to an underestimation of BMI— by 0. When other risk factors such as smoking were removed from the analysis, higher BMIs were associated with an increased risk of mor-tality.

In a subsequent large prospective cohort study of 527,265 US men and women between the ages of 50 and 71 years, researchers evaluated the association between BMI and death from any cause over a 10-year period 1996—2005. When individuals without preexisting cardiovascular conditions including smoking were isolated, overweight individuals still showed an increase in mortality.

While BMI is thus a useful predictor in some settings, how BMI compares to other anthropo-metric measurements in terms of accurately determining obesity, associated comorbid diseases, and respective mortality has been a topic of recent debate. Central Adiposity While the WHO still uses BMI to identify individuals who are a discussion on the issue of obesity in america or obese, mounting evidence suggests that a pattern of central adiposity is more accurate in predicting obesity-related cardiovascular consequences.

WHR, waist circumference WCand hip circumference were individually associated with an increased risk of subsequent MI independent of other risk factors, including BMI. Two different meta-analyses evaluated measures of abdominal adiposity and their relationship to cardiac events, as well as their ability to predict the development of associated cardiac risk factors.

  • Obesity is associated with a higher incidence of a number of diseases, including diabetes, cardiovascular disease, and cancer;
  • Such behavior has been seen when tobacco products have been taxed at higher rates;
  • One study investigated 3,234 nondiabetic patients with elevated fasting glucose levels and randomly assigned them to treatment with placebo, metformin, or lifestyle modification including weight loss and exercise;
  • As a result, a larger number of endoscopic procedures may need to be performed under medical anesthesia care;
  • High body mass index for age among US children and adolescents, 2003-2006.

In the first of these meta-analyses, BMI was compared to measures of central adiposity—including WHR, WC, and waist-to-height ratio WHtR —to determine the best predictor for development of hypertension, type 2 diabetes, and hyperlip-idemia.

The majority of the patients included in this study were from Asia and the Middle East. In comparing these different measures of central adiposity, it is important to note that technical limitations can make it difficult to measure WHtR consistently.

The Obesity Epidemic: Challenges, Health Initiatives, and Implications for Gastroenterologists

Although visceral adipose stores can be directly measured by computerized axial tomography, magnetic resonance imaging, or dual energy x-ray absorptiometry, the high cost of these tests limits their applicability in large epidemiologic studies. Health Burden and Obesity-associated Diseases Several studies have shown a relationship between elevated BMI and chronic medical conditions such as diabetes mellitus, hypertension, hyperlipidemia, and obesity-related cancers.

  1. Because Asian populations have a higher proportion of body fat, for example, lower BMIs have been proposed to identify individuals in these populations who are overweight or obese. The Expert Committee of the American Medical Association recently concluded that there is strong evidence that eating away from home, specifically consumption of fast food, is a risk factor for childhood obesity.
  2. Action is needed that is grounded in principles of health equity.
  3. Obesity is associated with a higher incidence of a number of diseases, including diabetes, cardiovascular disease, and cancer. For example, fast food companies have reduced serving sizes to keep the amount of TFA below 0.
  4. The purpose of the workshop was to establish a reasonable index with which to assess adiposity overweight in children and adolescents worldwide. Beyond adding excess calories to an individual's diet, fructose has also been linked to central adiposity, gout, and hyperlipidemia.

These latter studies appear to reflect an increase in the diagnosis and early treatment of cardiovascular risk factors in this high-risk group more so than a decreased incidence of obesity-related comorbid conditions such as diabetes, hypertension, and hyperlipidemia. Postoperative complications occur more frequently in obese patients than lean controls, with an increased incidence of MI, peripheral nerve injury, wound infection, and cardiac arrest.

Impairment in activities of daily living—such as eating, dressing, and transferring to and from a bed or wheelchair—occur at a younger age in obese patients compared to nonobese controls. While the hazards of obesity have long been known, the benefits of weight loss and exercise have only recently become more apparent.

One study investigated 3,234 nondiabetic patients with elevated fasting glucose levels and randomly assigned them to treatment with placebo, metformin, or lifestyle modification including weight loss and exercise.

This study found a strong positive correlation between visits to fast food restaurants and weight gain with development of insulin resistance.

Higher baseline consumption of fast food was associated with increased weight gain after 15 years. Other cross-sectional studies have shown similar associations between fast food intake and increased body weight. One possibility is that the high caloric density of fast food is the sole culprit, but there may also be a specific component in fast food that contributes to the increased risk for obesity and diabetes.

Obesity Epidemiology

Compared to other fats, TFAs have higher melting points, better taste, and longer shelf lives. The Expert Committee of the American Medical Association recently concluded that there is strong evidence that eating away from home, specifically consumption of fast food, is a risk factor for childhood obesity. Branding involves developing recognition and positive associations with a product. Studies have found that children aged 3—6 years view, understand, and remember advertising when cartoon characters are used.

Half of these advertisements were specifically aimed at children, with most from fast food companies. The fast food advertisements seemed to focus on building brand recognition and positive associations through the use of logos and cartoon characters. A discussion on the issue of obesity in america primary outcome in this study was BMI. These children also consumed more soda and ate less fruits and vegetables. In the past 30 years, the portion sizes of many foods have increased, leading to increased energy intake.

Despite this action, items on McDonald's current menu still dwarf the portion sizes introduced in 1955. The largest increase in portion sizes has come with the ever expanding size of hamburger options. Consumption of soft drinks has been linked with metabolic syndrome and cardiovascular risk based on the Framingham study.

These trends coincided with the expansion of the obesity epidemic. Prospective studies have linked increased intake of sweetened beverages directly with increased weight gain. A second prospective study examined the effect of sucrose and artificial sweeteners on weight gain in a population of overweight adults. The change in weight differed significantly between groups, with the sucrose-supplement group gaining a mean of 1.

A recent systematic review of prospective studies reached similar conclusions, finding that increased sugar-sweetened beverage consumption was associated with weight gain and obesity and proposing that strategies to reduce consumption of these beverages would likely help reverse the obesity epidemic. In contrast, the HFCS added to soft drinks contains much higher concentrations of fructose and has no other nutritional benefits. Beyond adding excess calories to an individual's diet, fructose has also been linked to central adiposity, gout, and hyperlipidemia.

Not surprisingly, adolescents have the highest daily consumption of fructose 72. Physical Inactivity Physical activity PA has been suggested as an essential requirement for decreasing the incidence of obesity and reducing the number of overweight individuals.

A study using the NHANES database found that adults who reported low levels of PA were more likely to have gained significant weight over the previous 10-year period. Self-reported levels of PA low, medium, or high were compared to change in weight after 10 years. Individuals who reported low PA at the follow-up visit were more likely to have experienced major weight gain greater than 13 kg. The study found no significant correlation between baseline PA and subsequent weight gain.

A recent analysis of PA showed no clear decline in PA among adolescents over the a discussion on the issue of obesity in america 20 years. Vigorous PA was defined as any activity that caused increased sweating and a sensation of breathing hard for more than 20 minutes during 3 of the previous 7 days.

The amount of vigorous PA reported by adolescents did not differ significantly between 1993 65. Furthermore, the adolescent attendance rate for physical education class and the amount of exercising for over 20 minutes during class has significantly increased in recent years, and the amount of television viewing has significantly decreased. One of the factors thought to be responsible for decreased PA is the increase in time spent watching television.

A recent study examined the role of increased television viewing on all-cause and cardiovascular mortality. This study found a significant positive linear relationship with both BMI and WC as hours of television increased, when adjusted for age and sex.

A meta-analysis examined the effect of exercise, exercise plus diet, and diet alone on weight gain. The weight loss that occurred by combining diet with exercise was not significantly different from that seen with diet alone. At the 1-year follow-up visit, however, the diet-plus-exercise group had maintained the weight loss better than the diet-only group mean 8.

Other studies have confirmed that exercise alone usually incurs only a small amount of weight loss and that the more important role of exercise is maintaining weight loss after a successful diet program.

  1. Determining the degree of obesity normal weight, overweight, obese, and so on and the distribution of adiposity will help to identify patients at increased risk for complications from certain gastrointestinal disorders.
  2. Maybe this hints at how extreme the problem might be for a medical doctor to be so extreme in a possible solution, as there are problems with this type of suggestion. Health Burden and Obesity-associated Diseases Several studies have shown a relationship between elevated BMI and chronic medical conditions such as diabetes mellitus, hypertension, hyperlipidemia, and obesity-related cancers.
  3. At the end of the industrial food chain, you need an industrial eater. Higher baseline consumption of fast food was associated with increased weight gain after 15 years.
  4. The purpose of the workshop was to establish a reasonable index with which to assess adiposity overweight in children and adolescents worldwide. Indeed, there are little data to suggest that this labeling has been effective in preventing smoking.
  5. Furthermore, the adolescent attendance rate for physical education class and the amount of exercising for over 20 minutes during class has significantly increased in recent years, and the amount of television viewing has significantly decreased.

By many estimates, obesity has already surpassed smoking as the most pressing public health threat. In much the same way that antismoking campaigns were developed, health initiatives must now be developed to effectively prevent obesity and its associated diseases. While smoking and obesity share many similarities from a public health perspective, obesity is potentially more problematic since adequate nutrition is essential to survival; therefore, abstinence from food is not an option.

Also, what constitutes good nutrition as opposed to harmful food choices is often not clearly understood by the general public. As changes to the healthcare system in the United States are discussed, plans should be offered that directly and aggressively target obesity through health initiatives and prevention programs. Food Labeling Labeling the nutritional content of food products and fast food has been proposed as a way to allow consumers to make informed choices about the types of foods they consume.

Beginning in the 1960s, the government required tobacco products to have labels from the US Surgeon General stating that smoking may be hazardous to one's health.