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| ] concern throughout the developed and developing world. Scientists investigating the mechanisms and treatment of obesity are using ] animals, such as the mouse on left, to learn more.]] | |||
| '''Obesity''' is a condition in which the natural energy reserve of ]s or other ]s, which is stored in ], is expanded far beyond usual levels to the point where it impairs ]. Obesity in ]s is relatively rare, but it is common in ]s like ] and household ]s who may be ] and ]. In humans it is considered a major challenge to health. | |||
| While cultural and scientific definitions of obesity are subject to change, it is accepted that excessive body weight predisposes to various forms of ], particularly ]. Interventions, such as ] and ], are frequently recommended to reduce this risk, and many people undertake weight loss regimens for health as well as aesthetic reasons. | |||
| ==Definition== | |||
| ] member countries.]] | |||
| ''Obesity'' is a concept that is being continually redefined. In humans, the most common statistical estimate of obesity is the ] (BMI), calculated by dividing the weight by the height squared; its unit is therefore ]/], although no actual surface is implied. The BMI was created in the ] by the ] statistician ]. | |||
| Interpretation of the BMI: | |||
| * A person with a BMI over 25.0 kg/m<sup>2</sup> is considered '''overweight.''' | |||
| * A BMI over 30.0 kg/m<sup>2</sup> denotes '''obesity.''' | |||
| * A further threshold at 40.0 kg/m<sup>2</sup> is identified as urgent morbidity risk ('''morbid obesity'''). | |||
| The ] considers a ] 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 '']''). | |||
| The cut-off points between categories are occasionally redefined, and may indeed differ from country to country. In June ] the ] brought official U.S. category definitions into line with those used by the ], 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 (0.5–5 kg) "overweight". In ], WHO was advised to consider lowering the BMI threshold for overweight in ] from BMI 25 to BMI 23, and for obesity in Asians from BMI 30 to BMI 25, due to ] studies indicating that Asians suffer a greater number of obesity-related conditions at lower BMI; however, to date, WHO has not made any changes in recommendations. In addition, some clinicians suggest raising the BMI thresholds for those of ], ], and ] descent because members of these groups have a greater ratio of lean body mass to fat at all body weights; the proposed thresholds for these groups are BMI 26 for overweight, and BMI 32 for obesity. To date, no major professional or medical organization has officially adopted this suggestion. In future, healthy BMI for a given individual may be defined to some extent by his ethnic or racial origin. | |||
| As a result of this somewhat arbitrary process, the BMI cannot offer a complete diagnosis, in that it ignores fat distribution within the body (see ]), and the relative fat-muscle-bone contributions to total ]. 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 overweightness 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 ] due to visceral fat{{mn|Janssen|1}}); the ''skinfold test'', in which a pinch of skin is precisely measured to determine the thickness of the ] fat layer; or bioelectrical ] 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 ] ''obēsus'', which means "stout, fat, or plump." ''Ēsus'' is the past participle of ''edere'' (to eat), with ''ob'' added to it. In ], this verb is seen only in past participial form. Its first attested usage in ] was in ], in N. Biggs' ''Matæotechnia Medicinæ Praxeuus''{{mn|OED|2}}. | |||
| ==Cultural and social significance== | |||
| ===Culture and obesity=== | |||
| ] | |||
| In several human cultures, obesity is associated with attractiveness, strength, and fertility. Some of the earliest known cultural artefacts, known as ], 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 ] 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 ]. This was especially the case in the visual arts, such as the paintings of ] (]–]), 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 "]". A small minority of activists, especially clustered around the tradition of ], seek through the ] to challenge that emerging consensus. | |||
| ===Popular culture=== | |||
| ] | |||
| Various ]s of obese people have found their way into expressions of popular culture. A common stereotype is the obese character who has a warm and dependable personality, presumedly in compensation for social exclusion, but equally common is the obese vicious ]. ] and obesity are commonly depicted together in works of fiction. In cartoons, obesity is used to comedic effect, with fat cartoon characters having to squeeze through narrow spaces, frequently geting stuck. | |||
| It can be argued that depiction in popular culture adds to and maintains commonly perceived stereotypes, in turn harming ] of obese people. A charge of ] on the basis of appearance could be leveled against these depictions. | |||
| On the other hand, obesity is often associated with positive characteristics such as good humor (the stereotype of the jolly fat man like ]), and some people are more ] to obese people than to slender people (see ], ]). | |||
| ==Causes== | |||
| ===Causative factors=== | |||
| Obesity is generally a result of a combination of factors: | |||
| * ] predisposition | |||
| * Limited exercise and sedentary lifestyle | |||
| * A high glycemic diet (i.e. a diet that consists of meals that give high postprandial blood sugar) | |||
| * Weight cycling, caused by repeated attempts to lose weight by dieting | |||
| * Underlying illness (e.g. ]) | |||
| * An ] (such as ]) | |||
| * ] mentality (debated) | |||
| * Insufficient ]ing (debated) | |||
| As with many medical conditions, obesity develops due to a combination between genetic and environmental factors. ]s in various ]s controlling ], rate of ], and ] release predispose to obesity, but the condition, to some extent, requires availability of sufficient calories and/or limited exercise, and possibly other factors, to develop fully. Various genetic abnormalities that predispose to obesity have been identified (such as ] and ] receptor mutations), but these are absent in most people with obesity. It is presumed that a large proportion of the causative genes are still to be identified. | |||
| Some eating disorders can lead to obesity, especially ] (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 ] 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. ] 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 ] ]. The ] vectors ] and AD-37 have been identified as a cause of obesity in animals and as potential stimulants on human ]{{mn|Vangipuram|3}}. While these viruses occur in humans, there is no clear evidence that their presence leads to in increased risk of obesity. | |||
| ===Evolutionary aspects=== | |||
| Although there is no definitive explanation for the recent increase of obesity, the ]ary 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. | |||
| ===Neurobiological mechanisms=== | |||
| Flier{{mn|ref|4}} summarizes the many possible ] mechanisms involved in the development and maintenance of obesity. This field of research had been almost unapproached until ] was discovered in ]. Since this discovery, many other hormonal mechanisms have been proposed that participate in the regulation of ] and food intake, storage patterns of ], development of ], and possible ways of interfering with these mechanisms. Since leptin's discovery, ], ], ], ], ], and numerous other mediators have been studied. The ]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 ] 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 in humans. | |||
| ] approaches hinge on the action of the aforementioned hormones and mediators on the ], the part of the brain that is thought to produce hunger signals for higher centers and induce food intake behavior. ] in the 1940s and 1950s identified two regions of the hypothalamus — the lateral hypothalamus (LH) and ventromedial hypothalamus (VMH) — as the brain's hunger and satiety centers, respectively. Specific lesions to a mouse's LH suppressed its appetite while damaging the VMH caused overeating. | |||
| Studies of the distribution of the leptin receptor in the mid-1990s cast doubt upon this dual center theory of hunger and satiety. Leptin's effect on the ] melanocortin system is now considered central to the regulation of feeding and metabolism. | |||
| ===Societal causes=== | |||
| While it may often be 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 ]. In the years from just after the ] until ] 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 ] the growth in the rate of obesity has accelerated markedly and is increasingly becoming a ] 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. | |||
| *''Lack of activity'': obese people appear to be less active in general than lean people, and not just because of their obesity. A controlled increase in calorie intake of lean people did not make them less active; correspondingly when obese people lost weight they did not become more active. Weight change does not affect activity levels, but the converse seems to be the case{{mn|Levine|5}}. | |||
| *One of the most important is the much ''lower relative cost of foodstuffs'': massive changes in agricultural policy in the United States and Europe have led to food prices for consumers being lower than at any point in history. ] and ], two huge sources of ], are some of the most subsidized products by the United States government. This can raise costs for consumers in some areas but greatly lower it in others. Current debates into trade policy highlight disagreements on the effects of subsidies. | |||
| *''Increased marketing'' has also played a role. In the early 1980s the ] administration lifted most regulations pertaining to ] to children. As a result, the number of commercials seen by the average child increased greatly, and a large proportion of these were for ] and ]. | |||
| *Changes in ''the price of ] and ]'' are also believed to have had an effect, as unlike during the ] it is now affordable in the United States to drive everywhere — at a time when ] goes underused. At the same time more areas have been built without ]s and parks. | |||
| *The ''changing workforce'' as each year a greater percent of the population spends their entire workday behind a desk or ], seeing virtually no exercise. In the ] the ] has seen sales of unhealthy frozen convenience foods skyrocket and has encouraged more elaborate ]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{{mn|Lopez|6}}. | |||
| *Since 1980 both sit-in and ''] ]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, ] french fries portions rose from 200 calories (840 ]) 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. residents 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 ] in countries which are developing and becoming westernised . This is supported by a dip in American GDP after 1990, the year of the ], followed by an exponential increase. U.S. obesity statistics followed the same pattern, offset by two years . | |||
| Interestingly an increase in the number of Americans who ] and ] 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 established, known as weight cycling. Similarly those who work out 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 ] co-factor consistently appears across many studies. Comparing net worth with BMI scores, a 2004 study{{mn|Zagorsky|7}} 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 ] (male-type or waist-predomimant obesity), is an important risk factor for the "]" (Syndrome X), the clustering of a number of diseases and risk factors that heavily predispose for ]. These are ], ], ], and ] (]). An ] is present, which — together with the above — has been implicated in the high prevalence of ] (fatty lumps in the arterial wall), and a ] state may further worsen cardiovascular risk. | |||
| Apart from the metabolic syndrome, obesity is also ] (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 ] for general physicians: | |||
| * '']'': ], ] and its associated ] and dizziness, ], ], and ] | |||
| *'']'': ] (PCOS), ] disorders, and ] | |||
| * '']'': ] (GERD), ], ] (gallstones), ], and ] | |||
| * ''Renal and ]'': ], ], ] (male), ] (female), ] (female), ] | |||
| * '']'' (skin and appendages): ]s, ], ], ], ]s, ] | |||
| * ''Musculoskeletal'': ] (which predisposes to ]), immobility, ], ] | |||
| * ''Neurologic'': ], ], ], ], ]{{mn|Whitmer|8}} | |||
| * '']'': ], ], ] syndrome, ], ] | |||
| * '']'': ], low ], ], social stigmatization | |||
| While being severely obese has many health ramifications, those who are somewhat overweight face little increased ] or ]. Some studies suggest that the somewhat "overweight" tend to live longer than those at their "ideal" weight. ] is known to occur less in slightly overweight people. | |||
| ==Therapy== | |||
| The mainstay of treatment for obesity is an energy-limited ] and increased exercise. Although adherence to this regimen can cure obesity, many patients are unable to make the required sacrifices. In fact there are no studies showing that an energy restricted diet can lead to long term weight loss. It appears that the homeostatic mechanisms regulating body weight are very robust, thus impeding weight loss when attempted using calorie restriction. | |||
| In a ] by the ]{{mn|Snow|9}}, 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 ]s and the unavailability of long-term safety and efficacy data. | |||
| # Drug therapy may consist of ], ], ], ], ], and ]. Evidence is not sufficient to recommend ], ], or ]. | |||
| # 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 ] 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 ] 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 ] (Xenical®, which reduces intestinal fat absorption by inhibiting ] ]) and ] (Reductil®, Meridia®, an ]). In the presence of ], there is evidence that the ] ] (Glucophage®) can assist in ] — rather than ] derivatives and ], which often lead to further weight gain. The ]s (] or ]) can cause slight weight gain, but decrease the "pathologic" form of abdominal fat, and are therefore often used in obese ]. | |||
| Increasingly, '']'' is being used to limit stomach capacity (and thus food intake); this can happen ]. ] reduces the length of the intestine and hence absorbing surface, but has more complications. | |||
| ==Controversies== | |||
| There is continuous debate over obesity, at several levels. While ] for particular risks and treatments is fairly firm, the evidence informing debates on exact causation, social impact and necessary policy responses is much less clear-cut. In the area of policy and public debate, statistics demonstrating ]s are typically misinterpreted as demonstrating ], a fallacy known as the ]. As much of the data is open to interpretation, there have been many "experts" taking positions, as well as policy pressure groups, influencing the debate from various angles. | |||
| ===Medicalisation of obesity=== | |||
| Controversy exists as to whether the concept of "obesity" is a valid one. 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'', ] 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.{{mn|Campos|10}} | |||
| 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 ], directly equivalent to the medicalisation of ] in the 19th century, and the consequent persecution of this minority. | |||
| ===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 ]. Various specialists strongly oppose this view. For example, Professor Thomas Sanders of ] 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'' ('']'', London, 10 March 2004). | |||
| ===Health effects of obesity=== | |||
| Opposing Campos are voices such as ], 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.''{{mn|Critser|11}} | |||
| ===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 ], 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 . 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 U.S. Centers of Disease Control and Prevention in Atlanta{{mn|Mokdad|12}} 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 ] as the leading cause of death. These statistics are fiercely contested , and error was admitted by the CDC in November 2004 . 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. | |||
| ] and ] 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 ] and ] have also suffered from greatly increasing rates of obesity. | |||
| In March 2005 the ], a global coalition of obesity scientists and research centres advising the European Union, estimated that ], ], ], ], the ], ], and ] have exceeded the ] figure of 67% for overweight or obese ]. The task force estimated in 2003 that about 200m of the 350m adults living in what is now the ] may be overweight or obese . | |||
| ===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 ] 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 U.S., a recent bout in this controversy involves the so-called ], an attempt to indemnify food industry businesses from frivolous law suits by obese clients. | |||
| "Personal responsibility" advocates work on the basis that, as the ] ] 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" . 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 ] raised concerns about a lack of fitness in American society, a spokesman for the U.S. Dairy industry, Frank R. Neu, wrote ]s warning ''We May Be Sitting Ourselves To Death'' . Not food regulation, but personal exercising, is moved as the solution. | |||
| The "public interest" advocate ] has found a way to harness personal responsibility arguments to the public interest side of the debate in the U.S., via recent changes to ] 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 ]), 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 ], ], the U.S. Department of Health and Human Services officially classified obesity as a disease. Speaking to a Senate committee, ], 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== | |||
| *] | |||
| *] | |||
| *] | |||
| *] | |||
| *] | |||
| *] | |||
| *] | |||
| *] | |||
| ==References== | |||
| * {{mnb|Janssen|1}} 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 | |||
| * {{mnb|OED|2}} '']'' (website) | |||
| * {{mnb|Vangipuram|3}} Vangipuram SD, Sheele J, Atkinson RL, Holland TC, Dhurandhar NV. ''A human adenovirus enhances preadipocyte differentiation.'' Obes Res 2004;12:770-7. PMID 15166297. | |||
| * {{mnb|Flier|4}} Flier JS. ''Obesity wars: molecular progress confronts an expanding epidemic''. Cell 2004;116:337-50. PMID 14744442. | |||
| * {{mnb|Levine|5}} Levine JA, Lanningham-Foster LM, McCrady SK, Krizan AC, Olson LR, Kane PH, Jensen MD, Clark MM. ''Interindividual variation in posture allocation: possible role in human obesity.'' Science 2005;307:584-6. PMID 15681386. | |||
| * {{mnb|Lopez|6}} Lopez R. ''Urban sprawl and risk for being overweight or obese.'' Am J Publ Health 2004;94:1574-9. PMID 15333317. | |||
| * {{mnb|Zagorsky|7}} Zagorsky JL. ''Is Obesity as Dangerous to Your Wealth as to Your Health?'' Res Aging 2004;26:130-152. . <!--not PMID indexed--> | |||
| * {{mnb|Whitmer|8}} Whitmer RA, Gunderson EP, Barrett-Connor E, Quesenberry CP Jr, Yaffe K. ''Obesity in middle age and future risk of dementia: a 27 year longitudinal population based study.'' BMJ 2005;330:1360. PMID 15863436. | |||
| * {{mnb|Snow|9}} 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. . PMID 15809464. | |||
| * {{mnb|Campos|10}} Campos, Paul. ''The Obesity Myth''. Gotham Books, May 2004. ISBN 1592400663. | |||
| * {{mnb|Critser|11}} Critser, Greg. ''Fat Land: how Americans became the fattest people in the World''. Houghton Miffin Jan 2003. ISBN 0618164723. | |||
| * {{mnb|Mokdad|12}} Mokdad AH, Marks JS, Stroup DF, Gerberding JL. ''Actual causes of death in the United States, 2000.'' ] 2004;291:1238-45. PMID 15010446 | |||
| == External links == | |||
| * | |||
| * - obesity pages | |||
| * - To quell obesity, who should regulate food marketing to children? | |||
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Revision as of 13:38, 4 October 2005
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