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What is obesity and what is its impact?
2–3
How is weight controlled? Is obesity ‘in our genes’?
4–5
How does lifestyle and environment impacton our weight?
6
Real voices: obese people and an obesitydoctor have their say
7, 12–13
How can we treat or prevent obesity?
10–11
Whose responsibility is it to tackle obesity?
14–15
The big picture
16
This is the era of the expanding waistline. Overthe past few decades we have been steadily pilingon the pounds. One in five adult men and one infour adult women are obese. A staggering two-thirds of all men and half of all women are eitheroverweight or obese – that’s 24 million people.Globally, more than 300 million adults are obese.
BigPicture
Newspapers warn of an ‘obesity timebomb’:
obesity may be about to overtake smokingas the major cause of preventable disease
;our children are growing up to be couch potatoes,putting down Playstations only long enough topick up the TV remote control, or the telephoneto order another pizza.
But why is obesity such a problem?
Is it justa personal matter? Are we simply prejudicedagainst heavier people? And if there is a problem, who should be doingsomething about it?
Is it just down to peopleto show more self-control?
Should foodmanufacturers be more responsible about whatthey put in their products or in how they marketthem? What about schools and parents?Or should governments intervene, slapping on‘fat taxes’ or banning fast food advertisements? And what have science and medicine to say?
Are we likely to see wonderdrugs that keepus slim no matter what we eat?
How well dowe understand the human physiology that controlsour weight? Or the psychological factors thatinfluence what (and why) we eat? This interplay between science, medicine andsociety, and people, institutions and politics,forms the focus of this
Big Picture
.
OBESITY
on
ISSUE 1
JANUARY 2005
The
Big Picture 
series is the successor to
LabNotes 
.Up-to-date science. Real-life issues. For teachersand students. Authoritative, balanced andaccessible, the
Big Picture 
series is the essentialguide to biomedical science and its social impact.
   R  e  x   F  e  a   t  u  r  e  s
 
2|BIG PICTURE 1
Obesity is a sign of excess fat storage by the body. This can increasethe risk of many serious health problems. Obesity is usually classifiedas a disease, but we seem to have little sympathy for overweight people.
Education editor:
Hannah Russell
Education adviser:
Peter Finegold
Editor:
Ian Jones
Writers:
Jackie Adam, Penny Bailey,Lisa Melton, Julie Reza
Illustrator:
Glen McBeth
Editorial advisory board:
Nan Davies,Nick Finer, Susan Jebb, Wing-May Kong,DeanMadden, Michael Reiss, Neville Rigby,Dell Stanford
 All images, unless otherwise indicated, are fromthe Wellcome Trust’s Medical Photographic Library. The Wellcome Trust is an independentbiomedicalresearch funding charity (registered charity no. 210183). The Trust’s mission is to foster and promote researchwith the aim of improving human and animal health.Reflecting the profound impact today’sresearch willhave on society, the Wellcome Trust also seeks to raiseawareness of the medical, ethical and social implicationsof research and promote dialogue between scientists,the public and policy makers.
© The Trustee of the Wellcome Trust, London, 2004. All rights reserved. Except as set out below, no partof this publication may be reproduced, stored in a retrievalsystem, or transmitted, in any form or by any  means, electronic, mechanical, photocopying, recording or otherwise, without the prior permissionof the Wellcome Trust.The Wellcome Trust consents to photocopies of all or part of this publicationbeing made by educational  institutions for non-profit, educational classroom use provided that the above copyright notice and any credits attaching to images or text featured in the photocopy appear clearly in such a photocopy.
MC-3267.p/30K/01–2005/SW
DIABETES
Very strong link withobesity. Relative riskrises rapidly withweight, particularlyin women
HIGH BLOODPRESSURE ANDCORONARY HEART DISEASE
Risk increased3–4-fold in obesepeople
CANCER
Increased risk forcancer of the colon,breast (post-menopause), womb,kidney and oesophagus
STROKE
Obesity doubles therisk of stroke
 The increasing size of people is having othereffects. One airline has introduced a policythat larger persons pay for two seats; hospitalshave had to purchase larger beds, biggercommodes, and wider wheelchairs for theirpatients, and finally, with death, comes biggercoffins and wider burial plots.Clothes sizes are going up: in 2000, Marksand Spencer relabelled its women’s size 14as size 12. Children’s clothes now have to bemade in larger sizes.
On the other hand…
Some insist that obesity is neither a disease,nor does it necessarily signify poor health. A portlybut fit person may well be healthierthan somebody who is slim but inactive. Theexact amount of ill-health attributable to obesityis not certain.Others argue that we are unnecessarilyobsessed with weight, driven by commercialinterests keen to exploit a popular desire to bethin. Finally,
many people are ‘happy to be fat’.
SIZE MATTERS
FASTFACT
The demandfor ready-meals in theUK grew by
44%
between 1990and 2002.
Does it matter?
 The medical consensus is that
obesity hasserious implications for health
. It is associatedwith increased risk for a variety of disorders,including type 2 diabetes, high blood pressure,stroke, heart disease and cancer (Figure 1).It can also impact on
quality of life
(infertility,mobility problems and sleep disorders). Andit can have
psychological consequences
,such as lowered self-esteem, anxiety andclinical depression – though, arguably, thesemay be more related to the social stigmaattached to obesity than obesity itself.In the USA, the Centers for Disease Controland Prevention have said that
obesity isclosing in on smoking as the mostimportant cause of premature death
. And it is not just a personal issue. The
economic costs
are substantial, with recentestimates suggesting that between 2 and 8per cent of sick care costs in Western countriesare attributable to obesity – an amountcomparable to that spent on cancer therapy.
FIGURE 1: MAJOR HEALTH RISKSASSOCIATED WITH OBESITY.
 
JANUARY 2005
|3
Why is obesity bad for you? How does it cause diabetes or increasethe risk of cancer?
Find out at Big Picture Online
www.wellcome.ac.uk/bigpicture/obesity
The energy content of food is usuallyexpressed in kilojoules (kJ). These units aresuperseding the former term, the calorie.Different parts of food have differentenergy densities:Because of its high energy density, fat is anexcellent way of storing energy in the body.
The people in Englandare getting fatter......and that’s not good newsfor their health
05
% of English population
101520251980199320002002012
Relative risk
Body mass index
345621222324252627282930
Diabetes
WomenWomenMenMen
Heart disease
THE INCREASING SIZE OF PEOPLEMEANS BIGGER COFFINS ARE NEEDED.
Rex Features
The media have also fuelled the currentnear-hysteria about obesity. The ‘obesitytimebomb’ makes for good headlines, andthere is a strong human interest angle thatcan sell newspapers. Why has it suddenlybecome an issue? In 1966, when the USPublic Health Service declared obesity amajor health problem, it passed unnoticed.Yet the media’s ‘war on obesity’ presentsmany difficulties. Newspapers want toincrease sales, and that can lead tosensationalism at the expense of accuracy.The media promote slimness predominantlyin terms of beauty, rather than as a routeto long-term health.Also, demonising obesity may actually becounterproductive – encouraging feelingsof inadequacy or unhappiness that maywell affect eating patterns. Promotingunrealistic body forms as desirable couldhave a similar impact.The stereotyped view is that fat people eatcakes and crisps all day – they are greedy,slothful and lack self-control. We are hookedon appearances, but are the media to blame?Images in newspapers, magazines andtelevision glorify slimness. Rake-thincelebrities like Kate Moss and VictoriaBeckham exude glamour. Gossipmagazines marvel at the svelte figures ofactressesand film stars, or their ability tolose weight after giving birth.Fat is different. The media demonise flab.Celebrities with even a hint of fat are mockedfor appearing scantily clad on the beach.Few people manage to overcome fattism:comedian Dawn French is a rare exception.
OBESITY AND THE MEDIA
ENERGY
What is obesity?
How do we know if someone isoverweight or obese? The idealapproach would be to measurebody fat levels directly. Unfortunately,this is hard to do without specialistequipment, so
body mass index
(BMI) tends to be assessed instead.
BMI is easy to measure and is moreuseful than other simple measures
(such as waist circumference, waist-hip ratio, skinfold measurements).But BMI is best used as a guideto
fat levels in the generalpopulation rather than in individuals.
For instance, athletes typically havehigh BMIs despite having little bodyfat (muscle is heavier than fat). Also, ‘ideal’ BMI thresholds may nothold for young children, the elderly,or for people of different ethnicbackgrounds.
BMI
UnderweightLess than 18.5Normal range18.5–24.9Overweight25–29.9Obese>30
Percentage of the male (left) and female(right) population who are obese or severelyobese (dark shade).Increased risk for two common diseasesas BMI increases.
Caution:
Statistics usually hide as much as they reveal. For example, health risks
increase
at BMIless than 19. And in older people, higher BMI may be an
advantage
. More on this in Big Picture Online.
ST  AT S CORNER
B ACKGROUND
Carbohydrate:
17 kJ/g
Fat:
38 kJ/g
Protein:
17 kJ/g
Alcohol:
29kJ/g
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