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The risks and the treatments

Taking the United States as the benchmark, there has been a marked increase in the percentage of the population overweight and obese. According to the Third National Health and Nutrition Examination Survey data, about 55% of adults, i.e. about 97m, were either overweight or obese. For these purposes, the definition of “overweight” is having a BMI in the range 25.0 to 29.9 kg/m2, and “obesity” is having a BMI of 30 kg/m2. The most recent figures from the Centers for Disease Control and Prevention show an increase to 65% of adults, i.e. about 129.6m. The data show that being overweight substantially increases the risk of illness from:

• blood pressure above the normal range and coronary heart disease, particularly where the individuals smoke and are physically inactive;
• type 2 or non-insulin dependent diabetes, usually arising after the age of 40 years;
• stroke;
• gallstones and their complications, and stress incontinence;
• osteoarthritis;
• sleep apnea and other respiratory problems; and
• uterine, breast, prostate and colon cancers.

As a generalization, there is a clear association between higher body weights and increases in early death, regardless of cause. The increase in death rates is modest for those with a BMI less than 30 kg/m2. But for those with a BMI higher than 30 kg/m2, death rates from all causes, but particularly from cardiovascular disease, are generally increased by 50 to 100% as against those with BMIs less than 30 kg/m2. Because these are usually preventive deaths, those who are overweight and obese represent a major public health challenge. During their lives, the obese may also suffer from social stigmatization and discrimination which reduces their quality of life.

Physicians agree that there are serious health risks associated with carrying excessive weight, but there is no consensus on how to manage those risks. There is good evidence showing there are negative consequences when people “weight cycle”, i.e. reduce then recover body weight. Some have therefore argued that the difficulty of maintaining long-term weight loss should make the medical profession cautious in how they “treat” obesity. Others argue that no matter what dangers there may be in treatment, they do not outweigh the known dangers of being obese. This latter view is considered stronger because the percentage of those overweight is rising dramatically among the young and among low-income women and minority groups.

Excessive weight gain is a complex process. A proportion of the population seem genetically predisposed to gain weight quickly when eating too many calories while leading a sedentary lifestyle. Those most at risk are non-Hispanic Black women, Mexican-American women and Mexican-American men. Women with low incomes or low education are generally more likely to be obese than those of higher socioeconomic status. As a contrast, obesity is less common after the age of 70 among both men and women, possibly because the overweight die younger.