Abstract

Obesity is a public health problem that has become an epidemic worldwide. A substantial

literature has emerged to show that overweight and obesity are major causes of co-morbidities,

including type II diabetes, cardiovascular diseases, various cancers, and other health problems,

which can lead to further morbidity and mortality. The related health care costs are also

substantial. Therefore, a public health approach to developing population-based strategies for

preventing excess weight gain is of great importance. However, public health intervention

programs have had limited success in tackling the rising prevalence of obesity. This paper

reviews the definition of obesity and the variations with age, health consequences, and factors

contributing to the development of obesity, and the ways to prevent obesity.

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1.0 Introduction
Obesity has been viewed as a growing epidemic of the past few decades that requires
intervention, similar to tobacco use and its accrued medical risks that have prompted
multifaceted preventive efforts. Obesity is a public health problem that has raised concern
worldwide. According to the World Health Organization (WHO), about 2.3 billion overweight
people aged 15 years and above will be about 700 million obese people worldwide in 2015.
Although a few developed countries such as the United Kingdom and Germany experienced a
drop in the prevalence rate of obesity in the past decade, the prevalence of obesity continues
to rise in many parts of the world, especially in the Asia Pacific region. For example, the
combined prevalence of overweight and obesity increased by 46% in Japan from 16.7% in
1976–1980 to 24.0% in 2000 and 41.4% in China from 3.7% in 1982 to 2002.

Overweight and obesity are major causes of co-morbidities, including type II diabetes,
cardiovascular diseases, various cancers, and other health problems, which can lead to further
morbidity and mortality. In view of the epidemic of obesity as a global public health concern,
this paper aims to discuss four topic areas: (1) definition of obesity (2) health consequences of
obesity (3) factors contributing to the development of obesity, and (4) the ways of preventing
obesity.

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2.0 Definition of Overweight and Obesity
Overweight and obesity result from an imbalance between energy consumed and energy
expended. Globally, there has been a shift in food consumption patterns whereby people are
consuming more energy-dense foods (those high in sugars and fats), at the same time, they are
engaging in significantly reduced physical activity. Using the World Health Organization’s (WHO)
cutoffs, adults with a body mass index (BMI; this is weight/height squared) of 25 or more are
classified as overweight; those with a BMI of 30 or more are classified as obese. The terms
overweight and obesity both identify people who are at risk for health problems from having
too much body fat.

2.1 In Adults

The WHO has classified overweight and obesity in adults based on various BMI cutoffs. These
cutoffs are set based on co-morbidities risk associated with BMI (Table 1). However, the use of
BMI does not distinguish between weight associated with muscle and weight associated with
fat, and the relationship between BMI and body fat content varies according to body build and
proportion. In contrast, the measure of intra-abdominal or central fat accumulation to reflect
changes in risk factors for cardiovascular diseases and other forms of chronic diseases is better
than BMI.

Table 1: Classification of overweight and obesity in adults

Classification BMI Risk of co-morbidities

Underweight <18.5 Low
Normal range 18.5-24.9 Average
Overweight 25.0-29.9 Increased
Obese class 1 30.0-34.9 Moderate
Obese class 2 35.0-39.9 Severe
Obese class 3 >40 Very severe

2.2 In Children
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The causes of obesity are complex and include genetic, biological, behavioral, and cultural
factors. Obesity occurs when a person eats more calories than the body burns. If one parent is
obese, there is a 50 percent chance that his or her child will also be obese. However, when both
parents are obese, their children have an 80 percent chance of being obese. Although certain
medical disorders can cause obesity, less than 1 percent of all obesity is caused by physical
problems.

Generally, a child is not considered obese until the weight is at least 10 percent higher than
what is recommended for their height and body type. Obesity most commonly begins between
the ages of 5 and 6, or during adolescence. Studies have shown that a child who is obese
between the ages of 10 and 13 has an 80 percent chance of becoming an obese adult.

2.3 In Elderly

Body composition changes with aging. Throughout adulthood, a natural increase in body fat
develops up to the 8th decade of life, after which there is a reduction. Redistribution of fat from
peripheral and subcutaneous sources to a central location leads to increased waist
circumference and waist-hip ratio in older adults. Importantly, there is a natural loss of muscle
mass and strength with aging, termed sarcopenia. This can also be accelerated in other
processes including deconditioning, immobility, or other acute illnesses. Muscle mass and
strength are believed to be vitally important in the preservation of physical function and
independence in this population.

however, BMI is a poor measure of adiposity in older adults. Individuals lose height as they age.
The Baltimore Longitudinal Study of Aging noted that both males and females lost height with
age, which impacts the BMI’s denominator, possibly leading to an overestimation of its overall
value in this population.

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3.0 Health Consequences of Obesity
Excess weight, especially obesity, diminishes almost every aspect of health, from reproductive
and respiratory function to memory and mood. Obesity increases the risk of several
debilitating, and deadly diseases, including diabetes, heart disease, and some cancers. It does
this through a variety of pathways, some as straightforward as the mechanical stress of carrying
extra pounds and some involving complex changes in hormones and metabolism. Obesity
decreases the quality and length of life and increases individual, national, and global healthcare
costs. Below there is a summarization of the approximate relative risk of physical health
problems associated with obesity.

3.1 Diabetes

The condition most strongly influenced by body weight is type 2 diabetes. This type of diabetes
usually begins in adulthood but, is now actually occurring in children. Obesity can cause
resistance to insulin, the hormone that regulates blood sugar. When obesity causes insulin
resistance, the blood sugar becomes elevated. Even moderate obesity dramatically increases
the risk of diabetes.

3.2 High Blood Pressure

Additional fat tissue in the body needs oxygen and nutrients in order to live, which requires the
blood vessels to circulate more blood to the fat tissue. This increases the workload of the heart
because it must pump more blood through additional blood vessels. The more circulating blood
also means more pressure on the artery walls. Higher pressure on the artery walls increases the
blood pressure. In addition, extra weight can raise the heart rate and reduce the body’s ability
to transport blood through the vessels.

3.3 Heart disease

Atherosclerosis (hardening of the arteries) is present 10 times more often in obese people
compared to those who are not obese. Coronary artery disease is also more prevalent because
fatty deposits build up in arteries that supply the heart. Narrowed arteries and reduced blood

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flow to the heart can cause chest pain (angina) or a heart attack. Blood clots can also form in
narrowed arteries and cause a stroke.

3.4 Joint problems, including osteoarthritis

Obesity can affect the knees and hips because of the stress placed on the joints by extra weight.
Joint replacement surgery, while commonly performed on damaged joints, may not be an
advisable option for an obese person because the artificial joint has a higher risk of loosening
and causing further damage.

3.5 Sleep apnea and respiratory problems

Sleep apnea, which causes people to stop breathing for brief periods, interrupts sleep
throughout the night and causes sleepiness during the day. It also causes heavy snoring.
Respiratory problems associated with obesity occur when added weight of the chest wall
squeezes the lungs and causes restricted breathing. Sleep apnea is also associated with high
blood pressure.

3.6 Cancer

In women, being overweight contributes to an increased risk for a variety of cancers including
breast, colon, gallbladder, and uterus. Men who are overweight have a higher risk of colon and
prostate cancers.

3.7 Psychosocial effects

Overweight and obese persons are often blamed for their condition and may be considered to
be lazy or weak-willed. It is not uncommon for overweight or obese conditions to result in
persons having lower incomes or having fewer relationships. Disapproval of overweight persons
expressed by some individuals may progress to bias, discrimination, and even torment.

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4.0 Factors Contributing to the Development of Obesity
Several factors can play a role in gaining and retaining excess weight. These include diet, lack of
exercise, environmental factors, and genetics. At its most basic, obesity results when someone
regularly takes in more calories than needed. The body stores these excess calories as body fat,
and over time the extra pounds add up. Eat fewer calories than the body burns, weight goes
down. Some of these factors are discussed briefly in the following,

4.1 Genetics

Genetics may contribute to a person’s susceptibility to weight gain. Scientists believe that genes
may increase a person’s likelihood of having obesity. Outside factors, such as an abundant food
supply or little physical activity, also may be the cause for a person to have excess weight.

4.2 Not Getting Enough Sleep

People who do not sleep enough are more likely to be obese, studies show. Sleep deprivation
boosts a person's appetite by releasing the hunger-stimulating hormone ghrelin. As a result,
that person is likely to eat more calories than he needs.

4.3 Sitting Too Much

The more time a person spends sitting, the more likely he is to be obese—regardless of how
much he exercises. And it's not just that he is burning fewer calories when he is sitting: Studies
suggest that long periods of inactivity may actually affect the metabolism.

4.4 Drinking Sugary Beverages

Sipping fruit juice or sugary soda has been strongly linked to obesity. Liquid calories don't fill up
as much as food, so a person ends up eating more to satisfy their hunger. In addition, added
sugars have been shown to contribute to obesity, especially around the waist.

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4.5 Eating Processed Food

People who eat lots of processed food tend to gain more weight with time, research shows.
Processed foods like crackers and frozen dinners are often less satisfying than whole foods like
fruits, lean meats, and vegetables.

4.6 Feeling Stressed All the Time

High levels of stress are linked to larger waist sizes, studies show. Stress releases the fat-storing
hormone cortisol and may trigger cravings for sweet and fatty foods.

4.7 Not Exercising Enough

Even among people who are genetically predisposed to obesity, physical activity can help
maintain a healthy weight. Experts recommend 150 to 300 minutes of weekly moderate-
intensity activity, such as brisk walking, to ward off weight gain.

4.8 Skipping Meals

While some people think that cutting out a meal helps cut down on calories, this strategy often
backfires. If a person goes a long time without eating, they might become very hungry and
overeat.

4.9 Eating Because of Emotions

Some people eat more than usual when they're sad, stressed, bored, or angry. With time, this
pattern of emotional overeating can lead to obesity.

4.10 Drinking Heavily

Alcoholic drinks contain empty calories and increase appetite. People who drink heavily or
binge drink have an increased risk for obesity, studies show.

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5.0 Strategies to Prevent Obesity
Overweight and obesity, as well as their related non-communicable diseases, are largely
preventable. Supportive environments and communities are fundamental in shaping people’s
choices. The prevention and control options are individual or community, organizational, and
environment based as explained below.

5.1 Individual or community-based interventions

People can prevent overweight and obesity by reducing the intake of high energy-dense foods
(i.e. foods high in fat/sugar), increasing the intake of low energy-dense foods(especially
vegetables, fruits, legumes, whole grains, and nuts), reducing the consumption of sugar-
sweetened soft drinks and juices, reducing the level of food prepared outside of the home,
reducing portion sizes, increasing energy expenditure like regular physical activity (60minutes a
day for children and 150minutes spread through the week for adults) or increasing participation
in active recreation or increasing use of active transport and reducing time spent in sedentary
behaviors and reducing the likelihood of the development of a disease or disorder by practicing
good lifestyles.

The community or population-based overweight and obesity intervention approaches can be

upstream, midstream, or downstream, but most interventions are likely to be upstream and
midstream.

The upstream or socio-ecological approach aims to shape the underlying determinants of

overweight and obesity. Actions target the food environments, physical activity environments,
and broader socioeconomic environments.

The midstream or behavioral approaches aim to improve population dietary and physical
activity behavior patterns. Midstream approaches will typically be targeted at the settings level,
where programs, social marketing, education, and other initiatives to motivate individuals to
change diet and physical activity behaviors can be implemented. These settings may include
childcare centers, schools, community, and recreational facilities, or household settings.

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The downstream approaches are typically directed towards supporting health services and
medical (clinical) interventions. The downstream approaches are typically individual-based,
rather than population-based.

5.2 Organization based interventions

The healthcare systems need greater emphasis on helping people to stay healthy through
stronger investment in prevention, early detection, and appropriate interventions to keep
people in the best possible health. The healthcare systems should promote healthy lifestyles
through primary healthcare services by designing effective public health approaches. Schools
are also responsible to prevent overweight and obesity by promoting physical exercise, a
healthy diet, and other healthy behaviors. Moreover, schools should provide more healthful
food options to the students if they have a feeding program. The food industry can play a
significant role in preventing overweight and obesity by reducing the fat, sugar, and salt content
of processed foods; ensuring that healthy and nutritious choices are available and affordable to
all consumers; restricting marketing of foods high in sugars, salt, and fats, especially those
foods aimed at children and teenagers, and ensuring the availability of healthy food choices,
providing information, introducing point of sale menu labeling and supporting regular physical
activity in the workplace

5.3 Environment based interventions

The built environment including the working environment should play roles promote health and
healthy behaviors. The built environment can promote a healthy lifestyle if the walking
network, the cycling network, public open spaces (parks) and recreation facilities are well
designed. The physical, social, political, and economic environments have a profound effect on
the way people live and behave. Each day people interact with a wide range of services,
systems, and pressures in settings such as schools, the workplace, home, and commercial
settings. In turn, these settings are influenced by laws, policies, economic imperatives, and the
attitudes of governments, industry, and society as a whole. Each of the features of this complex
system has the capacity to inhibit or encourage appropriate dietary and physical activity
patterns.

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6.0 Conclusion
The health risks and health care costs associated with overweight and obesity are considerable.
The etiology of obesity is multifactorial, involving complex interactions among genetic
background, hormones, and different social and environmental factors. In general, simple and
effective strategies are available to prevent and control overweight and obesity. Governments
have a responsibility to coordinate health reform to deliver preventative programs and to make
sure adequate supports are put in place to enable individuals, families, and communities, and
the health system to make useful contributions. Addressing overweight and obesity requires
much greater multi-sectoral collaboration, leadership, and coordination. Furthermore,
integrating overweight and obesity interventions with community or public health programs is
vital.

The prevention and reduction of overweight and obesity depend ultimately on individual
lifestyle changes, and further research on motivations for behavior change would be important
in combating the obesity epidemic.

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References and Bibliography
1. World Health Organization. Fact sheet: obesity and overweight. Available online:
http://www.who.int/mediacentre/factsheets/fs311/en/ (accessed on 5 October 2009).

2. Gill, T. Epidemiology and health impact of obesity: an Asia Pacific perspective. Asia Pacific J.
Clin. Nutr. 2006.

3. Low, S.; Chin, M.C.; Deurenberg-Yap, M. Review on the epidemic of obesity. Ann. Acad. Med.,
Singapore 2009.

4. Asia Pacific Cohort Studies Collaboration. The burden of overweight and obesity in the Asia-
Pacific region. Obes. Rev. 2007, 8.

5. Brown, W.V.; Fujioka, K.; Wilson, P.W.; Woodworth, K.A. Obesity: why be concerned? Am. J.
Med. 2009.

6. Gizaw Z. Prevention and control strategies of overweight and obesity. Adv Obes Weight
Manag Control. 201

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