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The Obesity Epidemic - Food for Thought

The Obesity Epidemic - Food for Thought

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An essay for the 2011 Undergraduate Awards Competition by Nicola Meehan. Originally submitted for Research Skills Development at Royal College of Surgeons, Ireland, with lecturer Dr Steve Kerrigan in the category of Medical Sciences
An essay for the 2011 Undergraduate Awards Competition by Nicola Meehan. Originally submitted for Research Skills Development at Royal College of Surgeons, Ireland, with lecturer Dr Steve Kerrigan in the category of Medical Sciences

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Published by: Undergraduate Awards on Aug 29, 2012
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12/20/2013

 
The Obesity Epidemic Food for thought March 20111
Introduction to Obesity
Obesity is a major public health concern and has been described by the WorldHealth Organisation (WHO) as a global epidemic
1
. Despite such threats,obesity prevalence has significantly increased in recent years and this upwardspiral is set to continue into the foreseeable future. Obesity, a serious medical and psychosocial condition, is defined as anaccumulation of body fat to an extent that adversely affects health
2
. Thecauses of obesity are multifaceted with synergistic contributions frompsychology, socioeconomic status, lifestyle and genetics. The obesitypromoting environment has become known as the ‘obesogenic’
3
environmentand is determined by an imbalance between energy intake and expenditureover an extended period of time. Obesity is a leading cause of prematuremortality and numerous chronic health conditions. The Framingham HeartStudy demonstrated that 40 year-old female and male non-smokers lost 7.1and 5.8 years of life respectively due to obesity
4
. Being obese may reduce lifeexpectancy by predisposing individuals to potentially life-threatening diseasessuch as cardiovascular disease and diabetes. The WHO estimates that atleast 2.6 million people die annually as a result of being overweight/obese
5
.If the current trends continue, poor nutrition and physical inactivity may resultin obesity becoming the leading cause of preventive death and bypass that ofcigarette smoking
6
. Diet restriction, combined with exercise is considered thefirst line treatment in the management of obesity. With respect to medication,there is only one remaining therapy available on the market, limiting patients’pharmacological options to treatment.
Measurement of Obesity in Adults:
Obesity is defined by the National Institutes of Health as having a BMI of 30and above, where the weight in kilograms is divided by the height in metressquared
7
. An individual is considered healthy if their BMI is between 18.5-24.9, overweight if their BMI is between 25-29.9 and obese is their BMI isgreater than 30. A BMI of 40 or greater is considered morbidly obese
8
. While
 
The Obesity Epidemic Food for thought March 20112
BMI is currently the most commonly used indicator of obesity, it is not free oflimitations. There is no distinction between fat mass and lean mass whichleads to an inaccurate indication of body fat in muscular individuals. Inaddition, older adults may seem to have a desirable BMI despite havingexcess fat and reduced muscle mass
9
. In spite of these drawbacks, BMI canbe a trustworthy and legitimate measure for detecting individuals at increasedrisk of obesity-related co-morbidity and mortality
10.
Possibly a more appropriate measure of obesity in adults is waistcircumference. This measures the level of adiposity around the central region.Central adiposity creates more detrimental health consequences than lowerbody adiposity
11
. High risk waist circumference measurements are 102cm formen and 88cm for women
12
. They dictate a high proportion of abdominalobesity and correspond to an increased risk of obesity-related healthproblems. Data from numerous surveys support the opinion that waistcircumference is an important predictor of diabetes, coronary heart diseaseand mortality rate, independent of traditional methods such as blood pressure,blood glucose and cholesterol
13
.
Measurement of Obesity in Children:
 Childhood or adolescent obesity is however, more complicated, as weightchanges with height, and BMI varies with age and gender. Therefore, theweight status of children (aged 2-12) and adolescents/teenagers (aged 13-19)is measured with reference to gender-specific growth charts developed by theCenters for Disease Control
14
. After the BMI number is determined it is plottedagainst either boys or girls growth charts to obtain a percentile ranking. Thepercentile indicates the relative position of the child’s weight among childrenof the same age and sex. For example, children with a BMI equal to the 85
th
 percentile are considered of normal weight, whereas children with a BMI equalto greater than the 95
th
percentile are considered obese.
 
The Obesity Epidemic Food for thought March 20113
Obesity Epidemiology:
The increased prevalence rates of obesity are astonishing, resulting in obesityrapidly becoming one of the most detrimental global public health issues
15
. Itis a global problem affecting both developed and developing countriesworldwide. Rates of obesity vary between 10-20% for men and 10-25% forwomen in different countries
16
. Females have higher obesity prevalence thanmales possibly due to gender differences in the brain’s response to hungerand satiety
17
. Much research has shown that individuals of lowsocioeconomic status express the most disease associated morbidityconcomitant to having the poorest health outcomes
18
. Moreover, Everson etal
19
reported epidemiological evidence demonstrating that individuals with thelowest educational attainment showed the greatest levels of obesity. The useof an international standard BMI enables comparisons of obesity prevalencebetween countries
20
. Estimates of obesity prevalence are used to recognisethose at risk and assist policy makers and governments to develop strategiesto reduce incidence and prevalence of the condition.
Global
In 2000, an excess of 300 million individuals worldwide were obese and ifcurrent trends continue, it is anticipated that by 2025 approximately 50% ofthe US population will be obese
41
. While global obesity prevalence is risingsignificantly, it is considerably higher in economically developed countries
21
.That is not to say that obesity is absent in developing countries as alarmingly,obesity rates have tripled in the last 20 years in the developing world
22
. Thisis perhaps the result of an environment characterised by readily available,inexpensive, high-fat foods, combined with the lack of physical activity
23
.Although prevalence rates vary dramatically from country to country, thecurrent global obesity epidemic is represented by more than 1.6 billionoverweight adults, 400 million of which are classified as clinically obese
2
. Inaddition, an estimated 22 million children worldwide under the age of 5 arethought to be overweight
24
. The figure for the overall global burden ofchildhood obesity/overweight has been estimated at 110 million
25
.

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