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{{Good article}}
{{Infobox disease
|Name        = Obesity
|Image      = Obesity-waist circumference.svg
|Alt        = Three silhouettes depicting the outlines of a normal sized (left), overweight (middle), and obese person (right).
|Caption    = Silhouettes and waist circumferences representing normal, overweight, and obese
|DiseasesDB  = 9099
|ICD10      = {{ICD10|E|66| |e|65}}
|ICD9        = {{ICD9|278}}
|MedlinePlus = 007297
|OMIM        = 601665
|eMedicineSubj  = med
|eMedicineTopic = 1653
|MeshName    = Obesity
|MeshNumber  = C23.888.144.699.500
|
}}
'''Obesity''' is a [[medical condition]] in which excess [[body fat]] has accumulated to the extent that it may have an adverse effect on health, leading to reduced [[life expectancy]] and/or increased health problems.<ref name="WHO 2000 p.6">WHO 2000 p.6</ref><ref name=HaslamJames/>  People are considered obese when their [[body mass index]] (BMI), a measurement obtained by dividing a person's weight in [[kilograms]] by the square of the person's height in [[metres]], exceeds 30&nbsp;kg/m<sup>2</sup>.<ref name="WHO 2000 p.9">WHO 2000 p.9</ref>
 
Obesity increases the likelihood of [[Obesity-associated morbidity|various diseases]], particularly [[cardiovascular diseases|heart disease]], [[diabetes mellitus type 2|type 2 diabetes]], [[obstructive sleep apnea]], certain types of [[cancer]], and [[osteoarthritis]].<ref name=HaslamJames/> Obesity is most commonly caused by a combination of excessive [[food energy]] intake, lack of physical activity, and [[Polygenic inheritance|genetic susceptibility]], although a few cases are caused primarily by [[gene]]s, [[endocrine]] disorders, [[medication]]s or [[psychiatric illness]].  Evidence to support the view that some obese people eat little yet gain weight due to a slow metabolism is limited; on average obese people have a greater energy expenditure than their thin counterparts due to the energy required to maintain an increased body mass.<ref>{{cite book|author=Kushner, Robert |title=Treatment of the Obese Patient (Contemporary Endocrinology) |publisher=Humana Press |location=Totowa, NJ |year=2007 |page=158 |isbn=1-59745-400-1 |url=http://books.google.com/?id=vWjK5etS7PMC |doi= |accessdate=April 5, 2009}}</ref><ref name=Anes2000>{{cite journal|last=Adams |first=PG |last2=Murphy |title=Obesity in anaesthesia and intensive care |journal=Br J Anaesth |volume=85 |issue=1 |pages=91–108 |date=July 2000 |pmid=10927998 |doi=10.1093/bja/85.1.91 |url=http://bja.oxfordjournals.org/cgi/content/full/85/1/91 |first2=PG |author-separator=,}}</ref>
 
[[Dieting]] and [[physical exercise]] are the mainstays of treatment for obesity. Diet quality can be improved by reducing the consumption of energy-dense foods such as those high in fat and sugars, and by increasing the intake of [[dietary fiber]]. [[Anti-obesity drug]]s may be taken to reduce appetite or inhibit fat absorption together with a suitable diet. If diet, exercise and medication are not effective, a [[gastric balloon]] may assist with weight loss, or [[bariatric surgery|surgery]] may be performed to reduce stomach volume and/or bowel length, leading to earlier [[satiety|satiation]] and reduced ability to absorb nutrients from food.<ref>NICE 2006 p.10–11</ref><ref name=balloon2008>{{cite journal|last=Imaz |first=I |last2=Martínez-Cervell |first2=C |last3=García-Alvarez |first3=EE |last4=Sendra-Gutiérrez |first4=JM |last5=González-Enríquez |first5=J |title=Safety and effectiveness of the intragastric balloon for obesity. A meta-analysis |journal=Obes Surg |volume=18 |issue=7 |pages=841–6 |date=July 2008 |pmid=18459025 |doi=10.1007/s11695-007-9331-8 |display-authors=3 |author-separator=,}}</ref>
 
Obesity is a leading [[preventable causes of death|preventable cause of death]] worldwide, with increasing [[prevalence]] in adults and [[childhood obesity|children]], and authorities view it as one of the most serious [[public health]] problems of the 21st&nbsp;century.<ref name=Barn1999>{{cite journal|last=Barness |first=LA |last2=Opitz |first2=JM |last3=Gilbert-Barness |first3=E |title=Obesity: genetic, molecular, and environmental aspects |journal=American Journal of Medical Genetics |volume=143A |issue=24 |pages=3016–34 |date=December 2007 |pmid=18000969 |doi=10.1002/ajmg.a.32035 |url=|author-separator=,}}</ref> Obesity is [[Weight stigma|stigmatized]] in much of the modern world (particularly in the [[Western world]]), though it was widely perceived as a symbol of wealth and fertility at other times in history, and still is in some parts of the world.<ref name=HaslamJames/><ref name=Woodhouse/> In 2013, the [[American Medical Association]] classified obesity as a disease.<ref name=NYTimes20130618>{{cite news|url=http://www.nytimes.com/2013/06/19/business/ama-recognizes-obesity-as-a-disease.html?_r=0 |title=A.M.A. Recognizes Obesity as a Disease |last=Pollack |first=Andrew |date=June 18, 2013 |newspaper=New York Times |archiveurl=http://www.webcitation.org/6Hav05TK0 |archivedate=June 18, 2013}}</ref><ref>{{cite web|url=http://www.hhnmag.com/hhnmag/HHNDaily/HHNDailyDisplay.dhtml?id=5870001020 |title=The Facts About Obesity |last1=Weinstock |first1=Matthew |date=June 21, 2013 |website=H&HN |publisher=[[American Hospital Association]] |accessdate=June 24, 2013}}</ref>
 
==Classification==
{{Main|Classification of obesity}}
Obesity is a [[medical condition]] in which excess [[body fat]] has accumulated to the extent that it may have an adverse effect on health.<ref name="WHO 2000 p.6"/> It is defined by [[body mass index|body mass index (BMI)]] and further evaluated in terms of fat distribution via the [[waist-hip ratio|waist–hip ratio]] and total cardiovascular risk factors.<ref>{{cite journal|journal=Nutr J |year=2007 |volume=6 |page=32 |title=Measurement and Definitions of Obesity In Childhood and Adolescence: A field guide for the uninitiated |author=Sweeting HN |doi=10.1186/1475-2891-6-32 |pmid=17963490 |url=http://www.nutritionj.com/content/6/1/32 |pmc=2164947 |issue=1}}</ref><ref>NHLBI p.xiv</ref>  BMI is closely related to both [[Body fat percentage|percentage body fat]] and total body fat.<ref>{{cite journal|last=Gray |first=DS |last2=Fujioka |first2=K |title=Use of relative weight and Body Mass Index for the determination of adiposity |journal=J Clin Epidemiol |volume=44 |issue=6 |pages=545–50 |year=1991 |pmid=2037859 |doi=10.1016/0895-4356(91)90218-X |author-separator=,}}</ref>
 
[[File:Obesity6.JPG|thumb|left|alt=A front and side view of a "super obese" male torso. Stretch marks of the skin are visible along with gynecomastia.|A "super obese" male with a BMI of 47&nbsp;kg/m<sup>2</sup>: weight 146&nbsp;kg (322&nbsp;lb), height 177&nbsp;cm (5&nbsp;ft 10&nbsp;in)]]
In children, a healthy weight varies with age and sex. Obesity in children and adolescents is defined not as an absolute number but in relation to a historical normal group, such that obesity is a BMI greater than the 95th&nbsp;[[percentile]].<ref name="cdc.gov">{{cite web|url=http://www.cdc.gov/nccdphp/dnpa/healthyweight/assessing/bmi/childrens_BMI/about_childrens_BMI.htm |title=Healthy Weight: Assessing Your Weight: BMI: About BMI for Children and Teens |publisher=[[Center for disease control and prevention]] |accessdate=April 6, 2009}}</ref>  The reference data on which these percentiles were based date from 1963 to 1994, and thus have not been affected by the recent increases in weight.<ref name="Flegal KM, Ogden CL, Wei R, Kuczmarski RL, Johnson CL 2001 1086–93">{{cite journal|last=Flegal |first=KM |last2=Ogden |first2=CL |last3=Wei |first3=R |last4=Kuczmarski |first4=RL |last5=Johnson |first5=CL |title=Prevalence of overweight in US children: comparison of US growth charts from the Centers for Disease Control and Prevention with other reference values for body mass index |journal=Am. J. Clin. Nutr. |volume=73 |issue=6 |pages=1086–93 |date=June 2001 |pmid=11382664 |doi= |url=http://www.ajcn.org/cgi/content/full/73/6/1086 |display-authors=3 |author-separator=,}}</ref>
 
{| class="wikitable" style = "float: right; margin-left:15px; text-align:center"
|-
! BMI !! Classification
|-
|width=50%| < 18.5 ||underweight
|-
|18.5–24.9 || normal weight
|-
|25.0–29.9 || overweight
|-
|30.0–34.9 || class I obesity
|-
|35.0–39.9 || class II obesity
|-
|≥ 40.0 || &nbsp;&nbsp;class III obesity&nbsp;&nbsp;
|}
 
BMI is defined as the subject's mass divided by the square of their height, expressed kilograms per square meter and calculated as:
 
{|
|-
! <math>\mathrm{BMI}</math>&nbsp;
| <math>= \frac{\text{mass}(\text{kg})}{\left(\text{height}(\text{m})\right)^2}</math>
|-
| &nbsp;
|-
| ||<math>= \frac{\text{mass}(\text{lb})}{\left(\text{height}(\text{in})\right)^2}\times 703</math>&nbsp;<sup>†</sup>||
|}
 
<sup>†</sup> The conversion factor for UK/US units is more precisely 703.06957964, but that level of precision is [[Significant figures|not meaningful]] for this calculation.
 
The most commonly used definitions, established by the [[World Health Organization]] (WHO) in 1997 and published in 2000, provide the values listed in the table at right.<ref name="WHO 2000 p.9"/>
 
Some modifications to the WHO definitions have been made by particular bodies. The surgical literature breaks down "class III" obesity into further categories whose exact values are still disputed.<ref name=morbid2007>{{cite journal|author=Sturm R |title=Increases in morbid obesity in the USA: 2000–2005 |journal=Public Health |volume=121 |issue=7 |pages=492–6 |date=July 2007 |pmid=17399752 |pmc=2864630 |doi=10.1016/j.puhe.2007.01.006 |author-separator=,}}</ref>
* Any BMI ≥ 35 or 40 is ''severe obesity''
* A BMI of ≥ 35 and experiencing obesity-related health conditions or ≥40–44.9 is ''morbid obesity''
* A BMI of ≥ 45 or 50 is ''super obesity''
 
As Asian populations develop negative health consequences at a lower BMI than Caucasians, some nations have redefined obesity; the Japanese have defined obesity as any BMI greater than 25<ref>{{cite journal|last=Kanazawa |first=M |last2=Yoshiike |first2=N |last3=Osaka |first3=T |last4=Numba |first4=Y |last5=Zimmet |first5=P |last6=Inoue |first6=S |title=Criteria and classification of obesity in Japan and Asia-Oceania |journal=Asia Pac J Clin Nutr |volume=11 Suppl 8 |issue= |pages=S732–S737 |date=December 2002 |pmid=12534701 |doi=10.1046/j.1440-6047.11.s8.19.x |display-authors=3 |author-separator=,}}</ref> while [[China]] uses a BMI of greater than 28.<ref>{{cite journal|author=Bei-Fan Z |author2=Cooperative Meta-Analysis Group of Working Group on Obesity in China |title=Predictive values of body mass index and waist circumference for risk factors of certain related diseases in Chinese adults: study on optimal cut-off points of body mass index and waist circumference in Chinese adults |journal=Asia Pac J Clin Nutr |volume=11 Suppl 8 |issue= |pages=S685–93 |date=December 2002 |pmid=12534691 |doi=10.1046/j.1440-6047.11.s8.9.x |author-separator=,}}</ref>
 
=={{anchor|Effects on health}}Effects on health==
<!-- [[Effects of obesity on health]] links here, please make corresponding changes if altering this section title or removing the anchor tag. -->
 
Excessive body [[Human weight|weight]] is associated with various [[diseases]], particularly [[cardiovascular diseases]], [[diabetes mellitus type 2]], [[obstructive sleep apnea]], certain types of [[cancer]], [[osteoarthritis]]<ref name=HaslamJames/> and [[asthma]].<ref name=HaslamJames/><ref name=Poulain/> As a result, obesity has been found to reduce [[life expectancy]].<ref name=HaslamJames/>
 
===Mortality===
{{Double image|right|MenBMIMort.png|200|WomenBMIMort.png|200|alt=(Left) A graph showing how the risk of death varies with BMI. The lowest risk is found at a BMI of 20 to 25 and increases in both directions. (Right) A graph showing how the risk of death varies with BMI. The lowest risk is found at a BMI of 20 to 25 and increases in both directions.|Relative risk of death over 10 years for white men (left) and women (right) who have never smoked in the United States by BMI.<ref name=NEJM10>{{cite journal|author=Berrington de Gonzalez A |title=Body-Mass Index and Mortality among 1.46 Million White Adults |journal=N. Engl. J. Med. |volume=363 |issue=23 |pages=2211–9 |date=December 2010 |pmid=21121834 |doi=10.1056/NEJMoa1000367 |url= |pmc=3066051 |display-authors=3 |author-separator=,}}</ref>||}}
 
Obesity is one of the leading [[preventable causes of death]] worldwide.<ref name=Barn1999/><ref>{{cite journal|last=Mokdad |first=AH |last2=Marks |first2=JS |last3=Stroup |first3=DF |last4=Gerberding |first4=JL |title=Actual causes of death in the United States, 2000 |journal=[[JAMA (journal)|JAMA]] |volume=291 |issue=10 |pages=1238–45 |date=March 2004 |pmid=15010446 |doi=10.1001/jama.291.10.1238 |url=http://www.csdp.org/research/1238.pdf |format=PDF |display-authors=3 |author-separator=,}}</ref><ref name=Allison>{{cite journal|last=Allison |first=DB |last2=Fontaine |first2=KR |last3=Manson |first3=JE |authorlink3=JoAnn E. Manson |last4=Stevens |first4=J |last5=VanItallie |first5=TB |title=Annual deaths attributable to obesity in the United States |journal=[[JAMA (journal)|JAMA]] |volume=282 |issue=16 |pages=1530–8 |date=October 1999 |pmid=10546692 |doi=10.1001/jama.282.16.1530 |url=http://jama.ama-assn.org/cgi/content/full/282/16/1530 |display-authors=3 |author-separator=,}}</ref>  Large-scale American and European studies have found that mortality risk is lowest at a BMI of 20–25&nbsp;kg/m<sup>2</sup><ref name=NEJM10/><ref name=Lancet2009>{{cite journal|author=Whitlock G |title=Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies |journal=Lancet |volume=373 |issue=9669 |pages=1083–96 |date=March 2009 |pmid=19299006 |doi=10.1016/S0140-6736(09)60318-4 |url= |pmc=2662372 |author2=Lewington S |author3=Sherliker P |last4=Sherliker |first4=P |last5=Clarke |first5=R |last6=Emberson |first6=J |last7=Halsey |first7=J |last8=Qizilbash |first8=N |last9=Collins |first9=R |first10=R |display-authors=3 |author-separator=,}}</ref> in non-smokers and at 24–27&nbsp;kg/m<sup>2</sup> in current smokers, with risk increasing along with changes in either direction.<ref>{{cite journal|last=Calle |first=EE |last2=Thun |first2=MJ |last3=Petrelli |first3=JM |last4=Rodriguez |first4=C |last5=Heath |first5=CW |title=Body-mass index and mortality in a prospective cohort of U.S. adults |journal=N. Engl. J. Med. |volume=341 |issue=15 |pages=1097–105 |date=October 1999 |pmid=10511607 |doi=10.1056/NEJM199910073411501 |url=http://content.nejm.org/cgi/content/full/341/15/1097 |display-authors=3 |author-separator=,}}</ref><ref name=Euro2008>{{cite journal|author=Pischon T |title=General and abdominal adiposity and risk of death in Europe |journal=N. Engl. J. Med. |volume=359 |issue=20 |pages=2105–20 |date=November 2008 |pmid=19005195 |doi=10.1056/NEJMoa0801891 |url= |author2=Boeing H |author3=Hoffmann K |last4=Bergmann |first4=M. |last5=Schulze |first5=M.B. |last6=Overvad |first6=K. |last7=Van Der Schouw |first7=Y.T. |last8=Spencer |first8=E. |last9=Moons |first9=K.G.M. |first10=A. |first11=J. |first14=F. |first15=M.-C. |first16=V. |first17=J. |first18=R. |first19=A. |first20=D. |first21=C. |first24=R. |first25=P. |first26=S. |first27=P.H.M. |first28=A.M. |first29=H.B. |first30=F.J.B. |display-authors=3 |author-separator=,}}</ref>  A BMI above 32&nbsp;kg/m<sup>2</sup> has been associated with a doubled [[mortality rate]] among women over a 16-year period.<ref>{{cite journal|author=Manson JE |title=Body weight and mortality among women |journal=N. Engl. J. Med. |volume=333 |issue=11 |pages=677–85 |year=1995 |pmid=7637744 |doi=10.1056/NEJM199509143331101 |author2=Willett WC |author3=Stampfer MJ |last4=Colditz |first4=Graham A. |last5=Hunter |first5=David J. |last6=Hankinson |first6=Susan E. |last7=Hennekens |first7=Charles H. |last8=Speizer |first8=Frank E. |display-authors=3 |author-separator=,}}</ref>  In the United States obesity is estimated to cause 111,909 to 365,000 deaths per year,<ref name=HaslamJames>{{cite journal|author=Haslam DW, James WP |title=Obesity |journal=Lancet |volume=366 |issue=9492 |pages=1197–209 |year=2005 |pmid=16198769 |doi=10.1016/S0140-6736(05)67483-1}}</ref><ref name=Allison/> while 1 million (7.7%) of deaths in Europe are attributed to excess weight.<ref name=EuroG2008/><ref name=Euro2007>{{cite journal|author=Fried M |title=Inter-disciplinary European guidelines on surgery of severe obesity |journal=Int J Obes (Lond) |volume=31 |issue=4 |pages=569–77 |date=April 2007 |pmid=17325689 |doi=10.1038/sj.ijo.0803560 |url= |author2=Hainer V |author3=Basdevant A |last4=Buchwald |first4=H |last5=Deitel |first5=M |last6=Finer |first6=N |last7=Greve |first7=J W M |last8=Horber |first8=F |last9=Mathus-Vliegen |first9=E |first10=N |first11=R |first14=K |display-authors=3 |author-separator=,}}</ref>  On average, obesity reduces life expectancy by six to seven&nbsp;years,<ref name=HaslamJames/><ref>{{cite journal|last=Nedcom |first=A |last2=Barendregt |first2=JJ |last3=Willekens |first3=F |last4=Mackenbach |first4=JP |last5=Al Mamun |first5=A |last6=Bonneux |first6=L |title=Obesity in adulthood and its consequences for life expectancy: A life-table analysis |journal=Annals of Internal Medicine |volume=138 |issue=1 |pages=24–32 |date=January 2003 |pmid=12513041 |doi=10.7326/0003-4819-138-1-200301070-00008 |url=http://www.annals.org/cgi/reprint/138/1/24 |format=PDF |display-authors=3 |author-separator=,}}</ref> a BMI of 30–35&nbsp;kg/m<sup>2</sup> reduces life expectancy by two to four&nbsp;years,<ref name=Lancet2009/> while severe obesity (BMI&nbsp;>&nbsp;40&nbsp;kg/m<sup>2</sup>) reduces life expectancy by ten&nbsp;years.<ref name=Lancet2009/>
 
===Morbidity===
{{Main|Obesity-associated morbidity}}
Obesity increases the risk of many physical and mental conditions. These comorbidities are most commonly shown in [[metabolic syndrome]],<ref name=HaslamJames/>  a combination of medical disorders which includes: [[diabetes mellitus type 2]], [[hypertension|high blood pressure]], [[hypercholesterolemia|high blood cholesterol]], and [[hypertriglyceridemia|high triglyceride levels]].<ref>{{cite journal|author=Grundy SM |title=Obesity, metabolic syndrome, and cardiovascular disease |journal=J. Clin. Endocrinol. Metab. |volume=89 |issue=6 |pages=2595–600 |year=2004 |pmid=15181029 |doi=10.1210/jc.2004-0372}}</ref>
 
Complications are either directly caused by obesity or indirectly related through mechanisms sharing a common cause such as a poor diet or a [[sedentary lifestyle]]. The strength of the link between obesity and specific conditions varies. One of the strongest is the link with [[type 2 diabetes]]. Excess body fat underlies 64% of cases of diabetes in men and 77% of cases in women.<ref>Seidell 2005 p.9</ref>
 
Health consequences fall into two broad categories: those attributable to the effects of increased fat mass (such as [[osteoarthritis]], [[obstructive sleep apnea]], social stigmatization) and those due to the increased number of [[fat cells]] ([[diabetes mellitus|diabetes]], [[cancer]], [[cardiovascular disease]], [[non-alcoholic fatty liver disease]]).<ref name=HaslamJames/><ref name=Bray2004>{{cite journal|author=Bray GA |title=Medical consequences of obesity |journal=J. Clin. Endocrinol. Metab. |volume=89 |issue=6 |pages=2583–9 |year=2004 |pmid=15181027 |doi=10.1210/jc.2004-0535}}</ref>  Increases in body fat alter the body's response to insulin, potentially leading to [[insulin resistance]]. Increased fat also creates a [[inflammation|proinflammatory state]],<ref>{{cite journal|last=Shoelson |first=SE |last2=Herrero |first2=L |last3=Naaz |first3=A |title=Obesity, inflammation, and insulin resistance |journal=Gastroenterology |volume=132 |issue=6 |pages=2169–80 |date=May 2007 |pmid=17498510 |doi=10.1053/j.gastro.2007.03.059 |author-separator=,}}</ref><ref>{{cite journal|author=Shoelson SE, Lee J, Goldfine AB |title=Inflammation and insulin resistance |journal=J. Clin. Invest. |volume=116 |issue=7 |pages=1793–801 |date=July 2006 |pmid=16823477 |pmc=1483173 |doi=10.1172/JCI29069 |url=http://www.jci.org/articles/view/29069}}</ref> and a [[thrombosis|prothrombotic]] state.<ref name=Bray2004/><ref>{{cite journal|author=Dentali F, Squizzato A, Ageno W |title=The metabolic syndrome as a risk factor for venous and arterial thrombosis |journal=Semin. Thromb. Hemost. |volume=35 |issue=5 |pages=451–7 |date=July 2009 |pmid=19739035 |doi=10.1055/s-0029-1234140}}</ref>
 
{| class="wikitable"
|-
! Medical field
! Condition
! Medical field
! Condition
|-
<!--Alphabetized-->|width=10%| [[Cardiology]]
|
* [[ischemic heart disease]]:<ref name=Yusuf2004>{{cite journal|author=Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais P, Varigos J, Lisheng L, INTERHEART Study Investigators. |title=Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): Case-control study |journal=Lancet |year=2004 |pages=937–52 |volume=364 |pmid=15364185 |doi=10.1016/S0140-6736(04)17018-9 |issue=9438}}</ref> [[angina pectoris|angina]] and [[myocardial infarction]]
* [[congestive heart failure]]<ref name=HaslamJames/>
* [[high blood pressure]]<ref name=HaslamJames/>
* [[Dyslipidemia|abnormal cholesterol levels]]<ref name=HaslamJames/>
* [[deep vein thrombosis]] and [[pulmonary embolism]]<ref>{{cite journal|author=Darvall KA, Sam RC, Silverman SH, Bradbury AW, Adam DJ |title=Obesity and thrombosis |journal=Eur J Vasc Endovasc Surg |volume=33 |issue=2 |pages=223–33 |date=February 2007 |pmid=17185009 |doi=10.1016/j.ejvs.2006.10.006}}</ref>
| <!--Alphabetized-->[[Dermatology]]
|
* [[stretch marks]]<ref name=derm2007/>
* [[acanthosis nigricans]]<ref name=derm2007>{{cite journal|author=Yosipovitch G, DeVore A, Dawn A |title=Obesity and the skin: skin physiology and skin manifestations of obesity |journal=J. Am. Acad. Dermatol. |volume=56 |issue=6 |pages=901–16; quiz 917–20 |date=June 2007 |pmid=17504714 |doi=10.1016/j.jaad.2006.12.004 |url=}}</ref>
* [[lymphedema]]<ref name=derm2007/>
* [[cellulitis]]<ref name=derm2007/>
* [[hirsutism]]<ref name=derm2007/>
* [[intertrigo]]<ref>{{cite journal|author=Hahler B |title=An overview of dermatological conditions commonly associated with the obese patient |journal=Ostomy Wound Manage |volume=52 |issue=6 |pages=34–6, 38, 40 passim |date=June 2006 |pmid=16799182 |doi= |url=}}</ref>
|-
| <!--Alphabetized-->[[Endocrinology]] and [[Reproductive medicine]]
|
* [[diabetes mellitus]]<ref name=HaslamJames/>
* [[polycystic ovarian syndrome]]<ref name=HaslamJames/>
* [[menstruation|menstrual]] disorders<ref name=HaslamJames/>
* [[infertility]]<ref name=HaslamJames/><ref name=OBGYN2008>{{cite journal|author=Arendas K, Qiu Q, Gruslin A |title=Obesity in pregnancy: pre-conceptional to postpartum consequences |journal=J Obstet Gynaecol Can |volume=30 |issue=6 |pages=477–88 |date=June 2008 |pmid=18611299 |doi= |url=}}</ref>
* [[Maternal obesity|complications during pregnancy]]<ref name=HaslamJames/><ref name=OBGYN2008/>
* [[birth defects]]<ref name=HaslamJames/>
* [[Stillbirth|intrauterine fetal death]]<ref name=OBGYN2008/>
| <!--Alphabetized-->[[Gastrointestinal]]
|
* [[gastroesophageal reflux disease]]<ref name=HaslamJames/><ref name=GERD2008>{{cite journal|author=Anand G, Katz PO |title=Gastroesophageal reflux disease and obesity |journal=Rev Gastroenterol Disord |volume=8 |issue=4 |pages=233–9 |year=2008 |pmid=19107097 |doi= |url=http://www.medreviews.com/pubmed.cfm?j=3&v=8&i=4&p=233}}</ref>
* [[non-alcoholic fatty liver disease|fatty liver disease]]<ref name=HaslamJames/>
* [[cholelithiasis]] (gallstones)<ref name=HaslamJames/>
|-
| <!--Alphabetized-->[[Neurology]]
| style="width:40%;"|
* [[stroke]]<ref name=HaslamJames/>
* [[meralgia paresthetica]]<ref>{{cite journal|author=Harney D, Patijn J |title=Meralgia paresthetica: diagnosis and management strategies |journal=Pain Med |volume=8 |issue=8 |pages=669–77 |year=2007 |pmid=18028045 |doi=10.1111/j.1526-4637.2006.00227.x |url=}}</ref>
* [[migraines]]<ref>{{cite journal|author=Bigal ME, Lipton RB |title=Obesity and chronic daily headache |journal=Curr Pain Headache Rep |volume=12 |issue=1 |pages=56–61 |date=January 2008 |pmid=18417025 |doi=10.1007/s11916-008-0011-8 |url=}}</ref>
* [[carpal tunnel syndrome]]<ref>{{cite journal|author=Sharifi-Mollayousefi A |title=Assessment of body mass index and hand anthropometric measurements as independent risk factors for carpal tunnel syndrome |journal=Folia Morphol. (Warsz) |volume=67 |issue=1 |pages=36–42 |date=February 2008 |pmid=18335412 |doi= |url=|author-separator=, |author2=Yazdchi-Marandi M |author3=Ayramlou H |last4=Heidari |first4=P |last5=Salavati |first5=A |last6=Zarrintan |first6=S |last7=Sharifi-Mollayousefi |first7=A |display-authors=3}}</ref>
* [[dementia]]<ref>{{cite journal|author=Beydoun MA, Beydoun HA, Wang Y |title=Obesity and central obesity as risk factors for incident dementia and its subtypes: A systematic review and meta-analysis |journal=Obes Rev |volume=9 |issue=3 |pages=204–18 |date=May 2008 |pmid=18331422 |doi=10.1111/j.1467-789X.2008.00473.x}}</ref>
* [[idiopathic intracranial hypertension]]<ref>{{cite journal|author=Wall M |title=Idiopathic intracranial hypertension (pseudotumor cerebri) |journal=Curr Neurol Neurosci Rep |volume=8 |issue=2 |pages=87–93 |date=March 2008 |pmid=18460275 |doi=10.1007/s11910-008-0015-0 |url=}}</ref>
* [[multiple sclerosis]]<ref>{{cite journal|last1=Munger |first1=KL |last2=Chitnis |first2=T |last3=Ascherio |first3=A. |year=2009 |title=Body size and risk of MS in two cohorts of US women |url= |journal=Neurology |volume=73 |issue=19 |pages=1543–50 |doi=10.1212/WNL.0b013e3181c0d6e0 |pmc=2777074 |pmid=19901245 |author-separator=, |author-name-separator=}}</ref>
| <!--Alphabetized-->[[Oncology]]<ref>{{cite journal|author=Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ |title=Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults |journal=N. Engl. J. Med. |volume=348 |issue=17 |pages=1625–38 |date=April 2003 |pmid=12711737 |doi=10.1056/NEJMoa021423}}</ref>
|
* [[breast cancer|breast]], [[ovarian cancer|ovarian]]
* [[esophageal cancer|esophageal]], [[colorectal cancer|colorectal]]
* [[hepatocellular carcinoma|liver]], [[pancreatic cancer|pancreatic]]
* [[Gallbladder cancer|gallbladder]], [[stomach cancer|stomach]]
* [[Endometrial cancer|endometrial]], [[cervical cancer|cervical]]
* [[prostate cancer|prostate]], [[Renal cell carcinoma|kidney]]
* [[non-Hodgkin's lymphoma]], [[multiple myeloma]]
|-
| style="width:10%;"| <!--Alphabetized-->[[Psychiatry]]
| style="width:40%;"|
* [[Major depressive disorder|depression]] in women<ref name=HaslamJames/>
* social [[Social stigma|stigmatization]]<ref name=HaslamJames/>
| <!--Alphabetized-->[[Respirology]]
|
* [[sleep apnea|obstructive sleep apnea]]<ref name=HaslamJames/><ref name=Poulain>{{cite journal|author=Poulain M |title=The effect of obesity on chronic respiratory diseases: pathophysiology and therapeutic strategies |journal=CMAJ |volume=174 |issue=9 |pages=1293–9 |date=April 2006 |pmid=16636330 |pmc=1435949 |doi=10.1503/cmaj.051299 |url=http://www.cmaj.ca/cgi/content/full/174/9/1293 |author-separator=, |author2=Doucet M |author3=Major GC |last4=Drapeau |first4=V |last5=Sériès |first5=F |last6=Boulet |first6=LP |last7=Tremblay |first7=A |last8=Maltais |first8=F |display-authors=3}}</ref>
* [[obesity hypoventilation syndrome]]<ref name=HaslamJames/><ref name=Poulain/>
* [[asthma]]<ref name=HaslamJames/><ref name=Poulain/>
* increased complications during [[general anaesthesia]]<ref name=HaslamJames/><ref name=Anes2000/>
|-
| <!--Alphabetized-->[[Rheumatology]] and [[Orthopedics]]
|
* [[gout]]<ref>{{cite journal|author=Choi HK, Atkinson K, Karlson EW, Curhan G |title=Obesity, weight change, hypertension, diuretic use, and risk of gout in men: the health professionals follow-up study |journal=Arch. Intern. Med. |volume=165 |issue=7 |pages=742–8 |date=April 2005 |pmid=15824292 |doi=10.1001/archinte.165.7.742}}</ref>
* poor mobility<ref>{{cite journal|author=Tukker A, Visscher T, Picavet H |title=Overweight and health problems of the lower extremities: osteoarthritis, pain and disability |journal=Public Health Nutr |volume=12 |issue=3 |pages=1–10 |date=April 2008 |pmid=18426630 |doi=10.1017/S1368980008002103 |url=}}</ref>
* [[osteoarthritis]]<ref name=HaslamJames/>
* [[low back pain]]<ref>{{cite journal|author=Molenaar EA, Numans ME, van Ameijden EJ, Grobbee DE |title=[Considerable comorbidity in overweight adults: results from the Utrecht Health Project] |language=Dutch; Flemish |journal=Ned Tijdschr Geneeskd |volume=152 |issue=45 |pages=2457–63 |date=November 2008 |pmid=19051798 |doi= |url=}}</ref>
| <!--Alphabetized-->[[Urology]] and [[Nephrology]]
|
* [[erectile dysfunction]]<ref>{{cite journal|author=Esposito K, Giugliano F, Di Palo C, Giugliano G, Marfella R, D'Andrea F, D'Armiento M, Giugliano D |title=Effect of lifestyle changes on erectile dysfunction in obese men: A randomized controlled trial |journal=[[JAMA (journal)|JAMA]] |volume=291 |issue=24 |pages=2978–84 |year=2004 |pmid=15213209 |doi=10.1001/jama.291.24.2978}}</ref>
* [[urinary incontinence]]<ref>{{cite journal|author=Hunskaar S |title=A systematic review of overweight and obesity as risk factors and targets for clinical intervention for urinary incontinence in women |journal=Neurourol. Urodyn. |volume=27 |issue=8 |pages=749–57 |year=2008 |pmid=18951445 |doi=10.1002/nau.20635 |url=}}</ref>
* [[chronic renal failure]]<ref>{{cite journal|author=Ejerblad E, Fored CM, Lindblad P, Fryzek J, McLaughlin JK, Nyrén O |title=Obesity and risk for chronic renal failure |journal=J. Am. Soc. Nephrol. |volume=17 |issue=6 |pages=1695–702 |year=2006 |pmid=16641153 |doi=10.1681/ASN.2005060638}}</ref>
* [[hypogonadism]]<ref>{{cite journal|author=Makhsida N, Shah J, Yan G, Fisch H, Shabsigh R |title=Hypogonadism and metabolic syndrome: Implications for testosterone therapy |journal=J. Urol. |volume=174 |issue=3 |pages=827–34 |date=September 2005 |pmid=16093964 |doi=10.1097/01.ju.0000169490.78443.59}}</ref>
* [[buried penis]]<ref name="pmid19935302">{{cite journal|author=Pestana IA, Greenfield JM, Walsh M, Donatucci CF, Erdmann D |title=Management of "buried" penis in adulthood: an overview |journal=Plast. Reconstr. Surg. |volume=124 |issue=4 |pages=1186–95 |date=October 2009 |pmid=19935302 |doi=10.1097/PRS.0b013e3181b5a37f}}</ref>
|}
 
===Survival paradox===
{{See also|Obesity paradox}}
Although the negative health consequences of obesity in the general population are well supported by the available evidence, health outcomes in certain subgroups seem to be improved at an increased BMI, a phenomenon known as the obesity survival paradox.<ref name=Schmidt2007>{{cite journal|author=Schmidt DS, Salahudeen AK |title=Obesity-survival paradox-still a controversy? |journal=Semin Dial |volume=20 |issue=6 |pages=486–92 |year=2007 |pmid=17991192 |doi=10.1111/j.1525-139X.2007.00349.x}}</ref> The paradox was first described in 1999 in overweight and obese people undergoing hemodialysis,<ref name=Schmidt2007/> and has subsequently been found in those with [[heart failure]] and [[Peripheral vascular disease|peripheral artery disease]] (PAD).<ref name=paradox2003>{{cite journal|author=U.S. Preventive Services Task Force |title=Behavioral counseling in primary care to promote a healthy diet: recommendations and rationale |journal=Am Fam Physician |volume=67 |issue=12 |pages=2573–6 |date=June 2003 |pmid=12825847 |doi=}}</ref>
 
In people with heart failure, those with a BMI between 30.0 and 34.9 had lower mortality than those with a normal weight. This has been attributed to the fact that people often lose weight as they become progressively more ill.<ref>{{cite journal|author=Habbu A, Lakkis NM, Dokainish H |title=The obesity paradox: Fact or fiction? |journal=Am. J. Cardiol. |volume=98 |issue=7 |pages=944–8 |date=October 2006 |pmid=16996880 |doi=10.1016/j.amjcard.2006.04.039}}</ref> Similar findings have been made in other types of heart disease. People with class I obesity and heart disease do not have greater rates of further heart problems than people of normal weight who also have heart disease. In people with greater degrees of obesity, however, the risk of further cardiovascular events is increased.<ref>{{cite journal|author=Romero-Corral A |title=Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: A systematic review of cohort studies |journal=Lancet |volume=368 |issue=9536 |pages=666–78 |year=2006 |pmid=16920472 |doi=10.1016/S0140-6736(06)69251-9 |author-separator=, |author2=Montori VM |author3=Somers VK |last4=Korinek |first4=Josef |last5=Thomas |first5=Randal J |last6=Allison |first6=Thomas G |last7=Mookadam |first7=Farouk |last8=Lopez-Jimenez |first8=Francisco |display-authors=3}}</ref><ref>{{cite journal|author=Oreopoulos A, Padwal R, Kalantar-Zadeh K, Fonarow GC, Norris CM, McAlister FA |title=Body mass index and mortality in heart failure: A meta-analysis |journal=Am. Heart J. |volume=156 |issue=1 |pages=13–22 |date=July 2008 |pmid=18585492 |doi=10.1016/j.ahj.2008.02.014 |url=}}</ref>  Even after [[Coronary artery bypass surgery|cardiac bypass surgery]], no increase in mortality is seen in the overweight and obese.<ref>{{cite journal|author=Oreopoulos A, Padwal R, Norris CM, Mullen JC, Pretorius V, Kalantar-Zadeh K |title=Effect of obesity on short- and long-term mortality postcoronary revascularization: A meta-analysis |journal=Obesity (Silver Spring) |volume=16 |issue=2 |pages=442–50 |date=February 2008 |pmid=18239657 |doi=10.1038/oby.2007.36}}</ref>  One study found that the improved survival could be explained by the more aggressive treatment obese people receive after a cardiac event.<ref>{{cite journal|author=Diercks DB |title=The obesity paradox in non-ST-segment elevation acute coronary syndromes: Results from the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the American College of Cardiology/American Heart Association Guidelines Quality Improvement Initiative |journal=Am Heart J |date=July 2006 |volume=152 |issue=1 |pages=140–8 |pmid=16824844 |doi=10.1016/j.ahj.2005.09.024| author-separator=, |author2=Roe MT |author3=Mulgund J |last4=Pollack |first4=Charles V. |last5=Kirk |first5=J. Douglas |last6=Gibler |first6=W. Brian |last7=Ohman |first7=E. Magnus |last8=Smith |first8=Sidney C. |last9=Boden |first9=William E. |display-authors=3 |first10=Eric D.}}</ref>  Another found that if one takes into account [[chronic obstructive pulmonary disease]] (COPD) in those with PAD, the benefit of obesity no longer exists.<ref name=paradox2003/>
 
==Causes==
At an individual level, a combination of excessive [[food energy]] intake and a lack of [[physical activity]] is thought to explain most cases of obesity.<ref name=CADG2006/>  A limited number of cases are due primarily to genetics, medical reasons, or psychiatric illness.<ref>{{cite journal|author=Bleich S, Cutler D, Murray C, Adams A |title=Why is the developed world obese? |journal=Annu Rev Public Health |volume=29 |pages=273–95 |year=2008 |pmid=18173389 |doi=10.1146/annurev.publhealth.29.020907.090954}}</ref>  In contrast, increasing rates of obesity at a societal level are felt to be due to an easily accessible and palatable diet,<ref>{{cite journal|author=Drewnowski A, Specter SE |title=Poverty and obesity: the role of energy density and energy costs |journal=Am. J. Clin. Nutr. |volume=79 |issue=1 |pages=6–16 |date=January 2004 |pmid=14684391 |doi= |url=http://www.ajcn.org/cgi/content/full/79/1/6}}</ref> increased reliance on cars, and mechanized manufacturing.<ref>{{cite journal|author=Nestle M, Jacobson MF |title=Halting the obesity epidemic: a public health policy approach |journal=Public Health Rep |volume=115 |issue=1 |pages=12–24 |year=2000 |pmid=10968581 |pmc=1308552 |doi=10.1093/phr/115.1.12 |url=}}</ref><ref name=James2008>{{cite journal|author=James WP |title=The fundamental drivers of the obesity epidemic |journal=Obes Rev |volume=9 |issue=Suppl 1 |pages=6–13 |date=March 2008 |pmid=18307693 |doi=10.1111/j.1467-789X.2007.00432.x}}</ref>
 
A 2006 review identified ten other possible contributors to the recent increase of obesity: (1) insufficient sleep, (2) [[endocrine disruptor]]s (environmental [[pollutant]]s that interfere with lipid metabolism), (3) decreased variability in ambient temperature, (4) decreased rates of [[tobacco smoking|smoking]], because smoking suppresses appetite, (5) increased use of medications that can cause weight gain (e.g., [[atypical antipsychotics]]), (6) proportional increases in ethnic and age groups that tend to be heavier, (7) pregnancy at a later age (which may cause susceptibility to obesity in children), (8) [[epigenetic]] risk factors passed on generationally, (9) [[natural selection]] for higher BMI, and (10) [[assortative mating]] leading to increased concentration of obesity risk factors (this would  increase the number of obese people by increasing population variance in weight).<ref name="pmid16801930">{{cite journal|author=Keith SW |title=Putative contributors to the secular increase in obesity: Exploring the roads less traveled |journal=Int J Obes (Lond) |volume=30 |issue=11 |pages=1585–94 |year=2006 |pmid=16801930 |doi=10.1038/sj.ijo.0803326 |url=http://www.nature.com/ijo/journal/v30/n11/full/0803326a.html |author-separator=, |author2=Redden DT |author3=Katzmarzyk PT |last4=Boggiano |first4=M M |last5=Hanlon |first5=E C |last6=Benca |first6=R M |last7=Ruden |first7=D |last8=Pietrobelli |first8=A |last9=Barger |first9=J L |display-authors=3 |first10=K R |first11=C |first14=M |first15=N V |first16=M C |first17=C M |first18=M |first19=A O |first20=D B}}</ref> While there is substantial evidence supporting the influence of these mechanisms on the increased prevalence of obesity, the evidence is still inconclusive, and the authors state that these are probably less influential than the ones discussed in the previous paragraph.
 
===Diet===
{{Main|Diet and obesity}}
{{Double image|right|World map of Energy consumption 1961,2.svg|200|World map of Energy consumption 2001-2003.svg|200|alt=(Left) A world map with countries colored to reflect the food energy consumption of their people in 1961. North America, Europe, and Australia have relatively high intake, while Africa and Asia consume much less.(Right) A world map with countries colored to reflect the food energy consumption of their people in 2001–2003. Consumption in North America, Europe, and Australia has increased with respect to previous levels in 1971. Food consumption has also increased substantially in many parts of Asia. However, food consumption in Africa remains low.|Map of dietary energy availability per person per day in 1961 (left) and 2001–2003 (right) in kcal/person/day.<ref name=Earth09/>
{{Multicol}}
{{legend|#b3b3b3|no data}}
{{legend|#ffff65|<1600}}
{{legend|#fff200|1600–1800}}
{{legend|#ffdc00|1800–2000}}
{{legend|#ffc600|2000–2200}}
{{legend|#ffb000|2200–2400}}
{{legend|#ff9a00|2400–2600}}
{{Multicol-break}}
{{legend|#ff8400|2600–2800}}
{{legend|#ff6e00|2800–3000}}
{{legend|#ff5800|3000–3200}}
{{legend|#ff4200|3200–3400}}
{{legend|#ff2c00|3400–3600}}
{{legend|#cb0000|>3600}}
{{Multicol-end}}
||}}
 
[[File:World Per Person Energy Consumption.png|thumb|alt=A graph showing a gradual increase in global food energy consumption per person per day between 1961 and 2002.|Average per capita energy consumption of the world from 1961 to 2002<ref name=Earth09>{{cite web|url=http://earthtrends.wri.org/searchable_db/index.php?theme=8&variable_ID=212&action=select_countries |title=EarthTrends: Nutrition: Calorie supply per capita |work=World Resources Institute |accessdate=Oct 18, 2009 |archiveurl=https://web.archive.org/web/20110611160708/http://earthtrends.wri.org/searchable_db/index.php?theme=8&variable_ID=212&action=select_countries |archivedate=2011-06-11}}</ref>]]
 
The per capita [[dietary energy supply]] varies markedly between different regions and countries. It has also changed significantly over time.<ref name=Earth09/> From the early 1970s to the late 1990s the average calories available per person per day (the amount of food bought) increased in all parts of the world except Eastern Europe. The United States had the highest availability with 3,654&nbsp;calories per person in 1996.<ref name=Earth09/> This increased further in 2003 to 3,754.<ref name=Earth09/>  During the late 1990s Europeans had 3,394&nbsp;calories per person, in the developing areas of Asia there were 2,648&nbsp;calories per person, and in sub-Saharan Africa people had 2,176&nbsp;calories per person.<ref name=Earth09/><ref>{{cite web|url=http://www.scribd.com/doc/1470965/USDA-frsept99b |title=USDA: frsept99b |work=[[United States Department of Agriculture]] |accessdate=January 10, 2009}}</ref>  Total calorie consumption has been found to be related to obesity.<ref>{{cite web|url=http://www.statcan.gc.ca/pub/82-003-x/2009004/article/10933-eng.htm |title=Diet composition and obesity among Canadian adults |work=Statistics Canada |accessdate=}}</ref>
 
The widespread availability of [[Nutrition#Advice and guidance|nutritional guidelines]]<ref>{{cite web|author=National Control for Health Statistics |title=Nutrition For Everyone |publisher=Centers for Disease Control and Prevention |url=http://www.cdc.gov/nccdphp/dnpa/nutrition/nutrition_for_everyone |accessdate=2008-07-09}}</ref> has done little to address the problems of overeating and poor dietary choice.<ref>{{cite journal|author=Marantz PR, Bird ED, Alderman MH |title=A call for higher standards of evidence for dietary guidelines |journal=Am J Prev Med |volume=34 |issue=3 |pages=234–40 |date=March 2008 |pmid=18312812 |doi=10.1016/j.amepre.2007.11.017 |url=}}</ref> From 1971 to 2000, obesity rates in the United States increased from 14.5% to 30.9%.<ref name=Flegal2002>{{cite journal|author=Flegal KM, Carroll MD, Ogden CL, Johnson CL |title=Prevalence and trends in obesity among US adults, 1999–2000 |journal=[[JAMA (journal)|JAMA]] |date=October 2002 |volume=288 |pages=1723–1727 |url=http://jama.ama-assn.org/cgi/content/full/288/14/1723 |doi=10.1001/jama.288.14.1723 |pmid=12365955 |issue=14}}</ref> During the same period, an increase occurred in the average amount of food energy consumed. For women, the average increase was 335&nbsp;calories per day (1,542&nbsp;calories in 1971 and 1,877&nbsp;calories in 2004), while for men the average increase was 168&nbsp;calories per day (2,450&nbsp;calories in 1971 and 2,618&nbsp;calories in 2004). Most of this extra food energy came from an increase in carbohydrate consumption rather than fat consumption.<ref>{{cite journal|author=Wright JD, Kennedy-Stephenson J, Wang CY, McDowell MA, Johnson CL |title=Trends in intake of energy and macronutrients—United States, 1971–2000 |journal=MMWR Morb Mortal Wkly Rep |date=February 2004 |volume=53 |issue=4 |pages=80–2 |url=http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5304a3.htm |pmid=14762332}}</ref>  The primary sources of these extra carbohydrates are sweetened beverages, which now account for almost 25 percent of daily food energy in young adults in America,<ref name=Caballero>{{cite journal|author=Caballero B |title=The global epidemic of obesity: An overview |journal=Epidemiol Rev |volume=29 |issue= |pages=1–5 |year=2007 |pmid=17569676 |doi=10.1093/epirev/mxm012 |url=}}</ref> and potato chips.<ref>{{cite journal|last=Mozaffarian |first=D |last2=Hao |first2=T |last3=Rimm |first3=EB |last4=Willett |first4=WC |last5=Hu |first5=FB |title=Changes in Diet and Lifestyle and Long-Term Weight Gain in Women and Men |journal=The New England Journal of Medicine |date=23 June 2011 |volume=364 |issue=25 |pages=2392–404 |pmid=21696306 |doi=10.1056/NEJMoa1014296 |pmc=3151731 |author-separator=, |display-authors=3}}</ref>  Consumption of sweetened drinks is believed to be contributing to the rising rates of obesity.<ref>{{cite journal|author=Malik VS, Schulze MB, Hu FB |title=Intake of sugar-sweetened beverages and weight gain: a systematic review |journal=Am. J. Clin. Nutr. |volume=84 |issue=2 |pages=274–88 |date=August 2006 |pmid=16895873 |doi= |url=http://www.ajcn.org/cgi/content/full/84/2/274 |pmc=3210834}}</ref><ref>{{cite journal|author=Olsen NJ, Heitmann BL |title=Intake of calorically sweetened beverages and obesity |journal=Obes Rev |volume=10 |issue=1 |pages=68–75 |date=January 2009 |pmid=18764885 |doi=10.1111/j.1467-789X.2008.00523.x |url=}}</ref>
 
As societies become increasingly reliant on [[food energy|energy-dense]], big-portions, and fast-food meals, the association between fast-food consumption and obesity becomes more concerning.<ref>{{cite journal|author=Rosenheck R |title=Fast food consumption and increased caloric intake: a systematic review of a trajectory towards weight gain and obesity risk |journal=Obes Rev |volume=9 |issue=6 |pages=535–47 |date=November 2008 |pmid=18346099 |doi=10.1111/j.1467-789X.2008.00477.x |url=}}</ref>  In the United States consumption of fast-food meals tripled and food energy intake from these meals quadrupled between 1977 and 1995.<ref>{{cite book|author=Lin BH, Guthrie J and Frazao E |editor=Frazão E |title=Agriculture Information Bulletin No. 750: America's Eating Habits: Changes and Consequences |url=http://www.ers.usda.gov/publications/aib750/ |year=1999 |publisher=US Department of Agriculture, Economic Research Service |location=Washington, DC |pages=213–239 |chapter=Nutrient contribution of food away from home}}</ref>
 
[[Agricultural policy]] and [[Green Revolution (agriculture)|techniques]] in the United States and Europe have led to lower food prices. In the United States, subsidization of corn, soy, wheat, and rice through the [[U.S. farm bill]] has made the main sources of processed food cheap compared to fruits and vegetables.<ref>{{cite news|author=Pollan, Michael |title=You Are What You Grow |work=New York Times |url=http://www.nytimes.com/2007/04/22/magazine/22wwlnlede.t.html?ex=1186027200&en=bbe0f6a2c10e3b3c&ei=5070 |date=22 April 2007 |accessdate=2007-07-30}}</ref>  [[Calorie count laws]] and [[nutrition facts label]]s attempt to steer people toward making healthier food choices, including awareness of how many calories are being consumed.
 
Obese people consistently under-report their food consumption as compared to people of normal weight.<ref>Kopelman and Caterson 2005:324.</ref>  This is supported both by tests of people carried out in a [[calorimeter]] room<ref>{{cite book|title=Metabolism alone doesn't explain how thin people stay thin |publisher=The Medical Post |work=John Schieszer}}</ref> and by direct observation.
 
===Sedentary lifestyle===
{{See also|Sedentary lifestyle|Exercise trends}}
A [[sedentary lifestyle]] plays a significant role in obesity.<ref>Seidell 2005 p.10</ref> Worldwide there has been a large shift towards less physically demanding work,<ref name=WHO2009>{{cite web|url=http://www.who.int/dietphysicalactivity/publications/facts/obesity/en/ |title=WHO: Obesity and overweight |work=[[World Health Organization]] |accessdate=January 10, 2009 |archiveurl=https://web.archive.org/web/20081218104805/http://www.who.int/dietphysicalactivity/publications/facts/obesity/en/ |archivedate=December 18, 2008}}</ref><ref name=WHOExercise>{{cite web|url=http://www.who.int/dietphysicalactivity/factsheet_inactivity/en/index.html |title=WHO &#124; Physical Inactivity: A Global Public Health Problem |work=[[World Health Organization]] |accessdate=February 22, 2009}}</ref><ref name=Ness2006>{{cite journal|author=Ness-Abramof R, Apovian CM |title=Diet modification for treatment and prevention of obesity |journal=Endocrine |volume=29 |issue=1 |pages=5–9 |date=February 2006 |pmid=16622287 |doi=10.1385/ENDO:29:1:135 |url=}}</ref> and currently at least 30% of the world's population gets insufficient exercise.<ref name=WHOExercise/> This is primarily due to increasing use of mechanized transportation and a greater prevalence of labor-saving technology in the home.<ref name=WHO2009/><ref name=WHOExercise/><ref name=Ness2006/>  In children, there appear to be declines in levels of physical activity due to less walking and physical education.<ref>{{cite journal|author=Salmon J, Timperio A |title=Prevalence, trends and environmental influences on child and youth physical activity |journal=Med Sport Sci |volume=50 |issue= |pages=183–99 |year=2007 |pmid=17387258 |doi=10.1159/000101391 |series=Medicine and Sport Science |isbn=978-3-318-01396-2}}</ref>  World trends in active leisure time [[physical activity]] are less clear.  The [[World Health Organization]] indicates people worldwide are taking up less active recreational pursuits, while a study from Finland<ref>{{cite journal|author=Borodulin K, Laatikainen T, Juolevi A, Jousilahti P |title=Thirty-year trends of physical activity in relation to age, calendar time and birth cohort in Finnish adults |journal=Eur J Public Health |volume=18 |issue=3 |pages=339–44 |date=June 2008 |pmid=17875578 |doi=10.1093/eurpub/ckm092 |url=}}</ref> found an increase and a study from the United States found leisure-time physical activity has not changed significantly.<ref>{{cite journal|author=Brownson RC, Boehmer TK, Luke DA |title=Declining rates of physical activity in the United States: what are the contributors? |journal=Annu Rev Public Health |volume=26 |issue= |pages=421–43 |year=2005 |pmid=15760296 |doi=10.1146/annurev.publhealth.26.021304.144437 |url=}}</ref>
 
In both children and adults, there is an association between television viewing time and the risk of obesity.<ref>{{cite journal|author=Gortmaker SL, Must A, Sobol AM, Peterson K, Colditz GA, Dietz WH |title=Television viewing as a cause of increasing obesity among children in the United States, 1986–1990 |journal=Arch Pediatr Adolesc Med |volume=150 |issue=4 |pages=356–62 |date=April 1996 |pmid=8634729 |doi=10.1001/archpedi.1996.02170290022003}}</ref><ref>{{cite journal|author=Vioque J, Torres A, Quiles J |title=Time spent watching television, sleep duration and obesity in adults living in Valencia, Spain |journal=Int. J. Obes. Relat. Metab. Disord. |volume=24 |issue=12 |pages=1683–8 |date=December 2000 |pmid=11126224 |doi=10.1038/sj.ijo.0801434 |url=}}</ref><ref>{{cite journal|author=Tucker LA, Bagwell M |title=Television viewing and obesity in adult females |journal=Am J Public Health |volume=81 |issue=7 |pages=908–11 |date=July 1991 |pmid=2053671 |pmc=1405200 |doi=10.2105/AJPH.81.7.908 |url=http://www.ajph.org/cgi/reprint/81/7/908 |format=PDF}}</ref>  A review found 63 of 73 studies (86%) showed an increased rate of childhood obesity with increased media exposure, with rates increasing proportionally to time spent watching television.<ref>{{cite web|url=http://ipsdweb.ipsd.org/uploads/IPPC/CSM%20Media%20Health%20Report.pdf |title=Media + Child and Adolescent Health: A Systematic Review |publisher=Common Sense Media |year=2008 |format=PDF |work=Ezekiel J. Emanuel |accessdate=April 6, 2009}}</ref>
 
===Genetics===
{{Main|Genetics of obesity}}
[[File:La monstrua desnuda (1680), de Juan Carreño de Miranda..jpg|thumb|upright|alt=A painting of a dark haired pink cheeked obese nude young female leaning against a table. She is holding grapes and grape leaves in her left hand which cover her genitalia.|A 1680 painting by [[Juan Carreno de Miranda]] of a girl presumed to have [[Prader–Willi syndrome]]<ref>{{cite web|url=http://www.esst.org/newsletter2000.htm |title=Case Study: Cataplexy and SOREMPs Without Excessive Daytime Sleepiness in Prader Willi Syndrome. Is This the Beginning of Narcolepsy in a Five Year Old? |author=Mary Jones |publisher=European Society of Sleep Technologists |accessdate=April 6, 2009}}</ref>]]
Like many other medical conditions, obesity is the result of an interplay between genetic and environmental factors. [[Polymorphism (biology)|Polymorphisms]] in various [[gene]]s controlling [[appetite]] and [[metabolism]] predispose to obesity when sufficient food energy present.  As of 2006, more than 41 of these sites on the human genome have been linked to the development of obesity when a favorable environment is present.<ref>{{cite journal|author=Poirier P |title=Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss |journal=Arterioscler. Thromb. Vasc. Biol. |volume=26 |issue=5 |pages=968–76 |date=May 2006 |pmid=16627822 |doi=10.1161/01.ATV.0000216787.85457.f3 |url=|author-separator=, |author2=Giles TD |author3=Bray GA |last4=Hong |first4=Y |last5=Stern |first5=JS |last6=Pi-Sunyer |first6=FX |last7=Eckel |first7=RH |display-authors=3}}</ref> People with two copies of the [[FTO gene]] (fat mass and obesity associated gene) have been found on average to weigh 3–4&nbsp;kg more and have a 1.67-fold greater risk of obesity compared with those without the risk [[allele]].<ref>{{cite journal|author=Loos RJ, Bouchard C |title=FTO: the first gene contributing to common forms of human obesity |journal=Obes Rev |volume=9 |issue=3 |pages=246–50 |date=May 2008 |pmid=18373508 |doi=10.1111/j.1467-789X.2008.00481.x |url=}}</ref>  The percentage of obesity that can be attributed to genetics varies, depending on the population examined, from 6% to 85%.<ref>{{cite journal|author=Yang W, Kelly T, He J |title=Genetic epidemiology of obesity |journal=Epidemiol Rev |volume=29 |issue= |pages=49–61 |year=2007 |pmid=17566051 |doi=10.1093/epirev/mxm004}}</ref>
 
Obesity is a major feature in several syndromes, such as [[Prader-Willi syndrome]], [[Bardet-Biedl syndrome]], [[Cohen syndrome]], and [[MOMO syndrome]]. (The term "non-syndromic obesity" is sometimes used to exclude these conditions.)<ref name="pmid19506576">{{cite journal|author=Walley AJ, Asher JE, Froguel P |title=The genetic contribution to non-syndromic human obesity |journal=Nature Reviews Genetics |volume=10 |issue=7 |pages=431–42 |date=June 2009 |pmid=19506576 |doi=10.1038/nrg2594 |url=}}</ref> In people with early-onset severe obesity (defined by an onset before 10&nbsp;years of age and body mass index over three [[standard deviation]]s above normal), 7% harbor a single point DNA mutation.<ref>{{cite journal|author=Farooqi S, O'Rahilly S |title=Genetics of obesity in humans |journal=Endocr. Rev. |volume=27 |issue=7 |pages=710–18 |date=December 2006 |pmid=17122358 |doi=10.1210/er.2006-0040 |url=http://edrv.endojournals.org/cgi/content/full/27/7/710}}</ref>
 
Studies that have focused on inheritance patterns rather than on specific genes have found that 80% of the offspring of two [[parental obesity|obese parents]] were also obese, in contrast to less than 10% of the offspring of two parents who were of normal weight.<ref>{{cite book|author=Kolata,Gina |title=Rethinking thin: The new science of weight loss&nbsp;– and the myths and realities of dieting |publisher=Picador |location= |year=2007 |page=122 |isbn=0-312-42785-9}}</ref>
 
The [[thrifty gene hypothesis]] postulates that, due to dietary scarcity during human evolution, people are prone to obesity. Their ability to take advantage of rare periods of abundance by storing energy as fat would be advantageous during times of varying food availability, and individuals with greater adipose reserves would be more likely to survive [[famine]]. This tendency to store fat, however, would be maladaptive in societies with stable food supplies.<ref>{{cite journal|author=Chakravarthy MV, Booth FW |title=Eating, exercise, and "thrifty" genotypes: Connecting the dots toward an evolutionary understanding of modern chronic diseases |journal=J. Appl. Physiol. |volume=96 |issue=1 |pages=3–10 |year=2004 |pmid=14660491 |doi=10.1152/japplphysiol.00757.2003}}</ref> This theory has received various criticisms, and other evolutionarily-based theories such as the [[drifty gene hypothesis]] and the [[thrifty phenotype|thrifty phenotype hypothesis]] have also been proposed.<ref>{{cite doi|10.1038/ijo.2009.175}}</ref><ref>{{cite doi|10.1002/ajhb.21100}}</ref>
 
===Other illnesses===
Certain physical and mental illnesses and the pharmaceutical substances used to treat them can increase risk of obesity. Medical illnesses that increase obesity risk include several rare genetic syndromes (listed above) as well as some congenital or acquired conditions: [[hypothyroidism]], [[Cushing's syndrome]], [[growth hormone deficiency]],<ref>{{cite journal|author=Rosén T, Bosaeus I, Tölli J, Lindstedt G, Bengtsson BA |title=Increased body fat mass and decreased extracellular fluid volume in adults with growth hormone deficiency |journal=Clin. Endocrinol. (Oxf) |volume=38 |issue=1 |pages=63–71 |year=1993 |pmid=8435887 |doi=10.1111/j.1365-2265.1993.tb00974.x}}</ref> and the [[eating disorder]]s: [[binge eating disorder]] and [[night eating syndrome]].<ref name=HaslamJames/> However, obesity is not regarded as a psychiatric disorder, and therefore is not listed in the [[Diagnostic and Statistical Manual of Mental Disorders|DSM-IVR]] as a psychiatric illness.<ref>{{cite journal|author=Zametkin AJ, Zoon CK, Klein HW, Munson S |title=Psychiatric aspects of child and adolescent obesity: a review of the past 10 years |journal=J Am Acad Child Adolesc Psychiatry |volume=43 |issue=2 |pages=134–50 |date=February 2004 |pmid=14726719 |doi=10.1097/00004583-200402000-00008}}</ref> The risk of overweight and obesity is higher in patients with psychiatric disorders than in persons without psychiatric disorders.<ref>{{cite journal|author=Chiles C, van Wattum PJ |title=Psychiatric aspects of the obesity crisis |journal=Psychiatr Times |year=2010 |volume=27 |issue=4 |pages=47–51}}</ref>
 
Certain medications may cause weight gain or changes in [[body composition]]; these include [[insulin]], [[sulfonylurea]]s, [[thiazolidinedione]]s, [[atypical antipsychotic]]s, [[antidepressant]]s, [[glucocorticoids|steroids]], certain [[anticonvulsant]]s ([[phenytoin]] and [[valproate]]), [[pizotifen]], and some forms of [[hormonal contraception]].<ref name=HaslamJames/>
 
===Social determinants===
{{Main|Social determinants of obesity}}
[[File:Yamai no Soshi - Obesity.JPG|thumb|The disease scroll (Yamai no soshi, late 12th century) depicts a woman moneylender with obesity, considered a disease of the rich.]]
While genetic influences are important to understanding obesity, they cannot explain the current dramatic increase seen within specific countries or globally.<ref>{{cite journal|author=Yach D, Stuckler D, Brownell KD |title=Epidemiologic and economic consequences of the global epidemics of obesity and diabetes |journal=Nat. Med. |volume=12 |issue=1 |pages=62–6 |date=January 2006 |pmid=16397571 |doi=10.1038/nm0106-62 |url=}}</ref> Though it is accepted that energy consumption in excess of energy expenditure leads to obesity on an individual basis, the cause of the shifts in these two factors on the societal scale is much debated. There are a number of theories as to the cause but most believe it is a combination of various factors.
 
The correlation between [[social class]] and BMI varies globally. A review in 1989 found that in developed countries women of a high social class were less likely to be obese. No significant differences were seen among men of different social classes. In the developing world, women, men, and children from high social classes had greater rates of obesity.<ref>{{cite journal|author=Sobal J, Stunkard AJ |title=Socioeconomic status and obesity: A review of the literature |journal=Psychol Bull |volume=105 |issue=2 |pages=260–75 |date=March 1989 |pmid=2648443 |doi=10.1037/0033-2909.105.2.260}}</ref> An update of this review carried out in 2007 found the same relationships, but they were weaker. The decrease in strength of correlation was felt to be due to the effects of [[globalization]].<ref name=McLaren2007>{{cite journal|author=McLaren L |title=Socioeconomic status and obesity |journal=Epidemiol Rev |volume=29 |issue= |pages=29–48 |year=2007 |pmid=17478442 |doi=10.1093/epirev/mxm001}}</ref> Among developed countries, levels of adult obesity, and percentage of teenage children who are overweight, are correlated with [[economic inequality|income inequality]].  A similar relationship is seen among US states: more adults, even in higher social classes, are obese in more unequal states.<ref name="spirit">{{cite book|title=[[The Spirit Level: Why More Equal Societies Almost Always Do Better]] |last1=Wilkinson |first1=Richard |authorlink1=Richard G. Wilkinson |last2=Pickett |first2=Kate |publisher=Allen Lane |location=London |isbn=978-1-84614-039-6 |year=2009 |pages=91–101}}</ref>
 
Many explanations have been put forth for associations between BMI and social class. It is thought that in developed countries, the wealthy are able to afford more nutritious food, they are under greater social pressure to remain slim, and have more opportunities along with greater expectations for [[physical fitness]]. In [[undeveloped countries]] the ability to afford food, high energy expenditure with physical labor, and cultural values favoring a larger body size are believed to contribute to the observed patterns.<ref name=McLaren2007/> Attitudes toward body mass held by people in one's life may also play a role in obesity. A correlation in BMI changes over time has been found among friends, siblings, and spouses.<ref>{{cite journal|author=Christakis NA, [[James H. Fowler|Fowler JH]] |title=The Spread of Obesity in a Large Social Network over 32 Years |journal=New England Journal of Medicine |volume=357 |issue=4 |pages=370–379 |year=2007 |pmid=17652652 |doi=10.1056/NEJMsa066082}}</ref>  Stress and perceived low social status appear to increase risk of obesity.<ref name="spirit" /><ref>{{cite journal|author=Bjornstop P |title=Do stress reactions cause abdominal obesity and comorbidities? |journal=Obesity Reviews |volume=2 |issue=2 |pages=73–86 |year=2001 |doi=10.1046/j.1467-789x.2001.00027.x |pmid=12119665}}</ref><ref>{{cite journal|author=Goodman E, Adler NE, Daniels SR, Morrison JA, Slap GB, Dolan LM |title=Impact of objective and subjective social status on obesity in a biracial cohort of adolescents |journal=Obesity Reviews |volume=11 |issue=8 |pages=1018–26 |year=2003 |pmid=12917508 |doi=10.1038/oby.2003.140}}</ref>
 
Smoking has a significant effect on an individual's weight. Those who quit smoking gain an average of 4.4&nbsp;kilograms (9.7&nbsp;lb) for men and 5.0&nbsp;kilograms (11.0&nbsp;lb) for women over ten years.<ref>{{cite journal|author=Flegal KM, Troiano RP, Pamuk ER, Kuczmarski RJ, Campbell SM |title=The influence of smoking cessation on the prevalence of overweight in the United States |journal=N. Engl. J. Med. |volume=333 |issue=18 |pages=1165–70 |date=November 1995 |pmid=7565970 |doi=10.1056/NEJM199511023331801 |url=http://content.nejm.org/cgi/content/full/333/18/1165}}</ref>  However, changing rates of smoking have had little effect on the overall rates of obesity.<ref>{{cite journal|author=Chiolero A, Faeh D, Paccaud F, Cornuz J |title=Consequences of smoking for body weight, body fat distribution, and insulin resistance |journal=Am. J. Clin. Nutr. |volume=87 |issue=4 |pages=801–9 |date=1 April 2008 |pmid=18400700 |url=http://www.ajcn.org/cgi/content/full/87/4/801}}</ref>
 
In the United States the number of children a person has is related to their risk of obesity. A woman's risk increases by 7% per child, while a man's risk increases by 4% per child.<ref>{{cite journal|author=Weng HH, Bastian LA, Taylor DH, Moser BK, Ostbye T |title=Number of children associated with obesity in middle-aged women and men: results from the health and retirement study |journal=J Women's Health (Larchmt) |volume=13 |issue=1 |pages=85–91 |year=2004 |pmid=15006281 |doi=10.1089/154099904322836492}}</ref>  This could be partly explained by the fact that having dependent children decreases physical activity in Western parents.<ref>{{cite journal|author=Bellows-Riecken KH, Rhodes RE |title=A birth of inactivity? A review of physical activity and parenthood |journal=Prev Med |volume=46 |issue=2 |pages=99–110 |date=February 2008 |pmid=17919713 |doi=10.1016/j.ypmed.2007.08.003}}</ref>
 
In the developing world urbanization is playing a role in increasing rate of obesity.  In [[China]] overall rates of obesity are below 5%; however, in some cities rates of obesity are greater than 20%.<ref>{{cite web|url=http://www.who.int/dietphysicalactivity/media/en/gsfs_obesity.pdf |title=Obesity and Overweight |format=PDF |publisher=[[World Health Organization]] |accessdate=February 22, 2009}}</ref>
 
[[Malnutrition]] in early life is believed to play a role in the rising rates of obesity in the [[developing world]].<ref name=DC2001>{{cite journal|author=Caballero B |title=Introduction. Symposium: Obesity in developing countries: biological and ecological factors |journal=J. Nutr. |volume=131 |issue=3 |pages=866S–870S |date=March 2001 |pmid=11238776 |doi= |url=http://jn.nutrition.org/cgi/content/full/131/3/866S}}</ref>  Endocrine changes that occur during periods of malnutrition may promote the storage of fat once more food energy becomes available.<ref name=DC2001/>
 
Consistent with [[cognitive epidemiology|cognitive epidemiological]] data, numerous studies confirm that obesity is  associated with cognitive deficits.<ref name="Smith2011">{{cite doi|10.1111/j.1467-789X.2011.00920.x}}</ref> Whether obesity causes cognitive deficits, or vice versa is unclear at present.
 
===Infectious agents===
{{See also|Infectobesity}}
The study of the effect of infectious agents on metabolism is still in its early stages.  [[Gut flora]] has been shown to differ between lean and obese humans. There is an indication that gut flora in obese and lean individuals can affect the metabolic potential. This apparent alteration of the metabolic potential is believed to confer a greater capacity to harvest energy contributing to obesity. Whether these differences are the direct cause or the result of obesity has yet to be determined unequivocally.<ref>{{cite journal|author=DiBaise JK, Zhang H, Crowell MD, Krajmalnik-Brown R, Decker GA, Rittmann BE |title=Gut microbiota and its possible relationship with obesity |journal=Mayo Clinic proceedings. Mayo Clinic |volume=83 |issue=4 |pages=460–9 |date=April 2008 |pmid=18380992 |doi=10.4065/83.4.460}}</ref>
 
An association between [[viruses]] and obesity has been found in humans and several different animal species. The amount that these associations may have contributed to the rising rate of obesity is yet to be determined.<ref>{{cite journal|author=Falagas ME, Kompoti M |title=Obesity and infection |journal=Lancet Infect Dis |volume=6 |issue=7 |pages=438–46 |date=July 2006 |pmid=16790384 |doi=10.1016/S1473-3099(06)70523-0 |url=}}</ref>
 
==Pathophysiology==
[[File:Fatmouse.jpg|thumb|alt=Two white mice both with similar sized ears, black eyes, and pink noses. The body of the mouse on the left, however, is about three times the width of the normal sized mouse on the right.|A comparison of a mouse unable to produce [[leptin]] thus resulting in obesity (left) and a normal mouse (right)]]
 
There are many possible [[pathophysiology|pathophysiological]] mechanisms involved in the development and maintenance of obesity.<ref name="flier">{{cite journal|author=Flier JS |title=Obesity wars: Molecular progress confronts an expanding epidemic |journal=Cell |year=2004 |pages=337–50 |volume=116 |issue=2 |pmid=14744442 |doi=10.1016/S0092-8674(03)01081-X}}</ref> This field of research had been almost unapproached until [[leptin]] was discovered in 1994. Since this discovery, many other hormonal mechanisms have been elucidated that participate in the regulation of [[appetite]] and food intake, storage patterns of [[adipose tissue]], and development of [[insulin resistance]]. Since leptin's discovery, [[ghrelin]], [[insulin]], [[orexin]], [[PYY 3-36]], [[cholecystokinin]], [[adiponectin]], as well as many other mediators have been studied. The [[adipokine]]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 ghrelin produced by the stomach modulating short-term appetitive control (i.e. to eat when the stomach is empty and to stop when the stomach is stretched). Leptin is produced by adipose tissue to signal fat storage reserves in the body, and mediates long-term appetitive controls (i.e. to eat more when fat storages are low and less when fat storages are high). Although administration of leptin may be effective in a small subset of obese individuals who are leptin deficient, most obese individuals are thought to be leptin resistant and have been found to have high levels of leptin.<ref>{{cite journal|author=Hamann A, Matthaei S |title=Regulation of energy balance by leptin |journal=Exp. Clin. Endocrinol. Diabetes |volume=104 |issue=4 |pages=293–300 |year=1996 |pmid=8886745 |doi=10.1055/s-0029-1211457}}</ref> This resistance is thought to explain in part why administration of leptin has not been shown to be effective in suppressing appetite in most obese people.<ref name="flier"/>
 
[[File:Leptin.png|thumb|left|alt=A three dimensional model with two pairs of opposed curling columns attached together at their ends by more linear segments.|A graphic depiction of a [[leptin]] molecule]]
While leptin and ghrelin are produced peripherally, they control appetite through their actions on the [[central nervous system]]. In particular, they and other appetite-related hormones act on the [[hypothalamus]], a region of the brain central to the regulation of food intake and energy expenditure. There are several circuits within the hypothalamus that contribute to its role in integrating appetite, the [[melanocortin]] pathway being the most well understood.<ref name="flier"/> The circuit begins with an area of the hypothalamus, the [[arcuate nucleus]], that has outputs to the [[lateral hypothalamus]] (LH) and [[ventromedial hypothalamus]] (VMH), the brain's feeding and satiety centers, respectively.<ref>{{cite book|author=Boulpaep, Emile L.; Boron, Walter F. |title=Medical physiologya: A cellular and molecular approach |publisher=Saunders |location=Philadelphia |year=2003 |page=1227 |isbn=0-7216-3256-4}}</ref>
 
The arcuate nucleus contains two distinct groups of [[neuron]]s.<ref name="flier"/> The first group coexpresses [[neuropeptide Y]] (NPY) and [[agouti-related peptide]] (AgRP) and has stimulatory inputs to the LH and inhibitory inputs to the VMH. The second group coexpresses [[pro-opiomelanocortin]] (POMC) and [[cocaine- and amphetamine-regulated transcript]] (CART) and has stimulatory inputs to the VMH and inhibitory inputs to the LH. Consequently, NPY/AgRP neurons stimulate feeding and inhibit satiety, while POMC/CART neurons stimulate satiety and inhibit feeding. Both groups of arcuate nucleus neurons are regulated in part by leptin. Leptin inhibits the NPY/AgRP group while stimulating the POMC/CART group. Thus a deficiency in leptin signaling, either via leptin deficiency or leptin resistance, leads to overfeeding and may account for some genetic and acquired forms of obesity.<ref name="flier"/>
{{clear}}
 
==Public health==
The [[World Health Organization]] (WHO) predicts that [[overweight]] and obesity may soon replace more traditional [[public health]] concerns such as [[undernutrition]] and [[infectious diseases]] as the most significant cause of poor health.<ref>{{cite book|author=Loscalzo, Joseph; Fauci, Anthony S.; Braunwald, Eugene; Dennis L. Kasper; Hauser, Stephen L; Longo, Dan L. |title=Harrison's principles of internal medicine |publisher=McGraw-Hill Medical |location= |year=2008 |pages= |isbn=0-07-146633-9 |oclc= |doi= |accessdate=}}</ref> Obesity is a public health and policy problem because of its prevalence, costs, and health effects.<ref>{{cite book|author=Satcher D |title=The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity |year=2001 |publisher=U.S. Dept. of Health and Human Services, Public Health Service, Office of Surgeon General |url=http://www.ncbi.nlm.nih.gov/books/NBK44206/ |isbn=978-0-16-051005-2}}</ref> The [[United States Preventive Services Task Force]] recommends screening for all adults followed by behavioral interventions in those who are obese.<ref>{{cite journal|author1=Moyer, VA |author2=U.S. Preventive Services Task Force |title=Screening for and management of obesity in adults: U.S. Preventive Services Task Force recommendation statement |journal=Annals of Internal Medicine |date=4 September 2012 |volume=157 |issue=5 |pages=373–8 |pmid=22733087 |doi=10.7326/0003-4819-157-5-201209040-00475}}</ref> Public health efforts seek to understand and correct the environmental factors responsible for the increasing prevalence of obesity in the population. Solutions look at changing the factors that cause excess food energy consumption and inhibit physical activity. Efforts include federally reimbursed meal programs in schools, limiting direct [[junk food]] marketing to children,<ref>{{cite news|author=Brook Barnes |title=Limiting Ads of Junk Food to Children |url=http://www.nytimes.com/2007/07/18/business/18food.html |work=New York Times |date=2007-07-18 |accessdate=2008-07-24}}</ref> and decreasing access to sugar-sweetened beverages in schools.<ref>{{cite web|url=http://www.healthfinder.gov/news/newsstory.aspx?docID=625759 |title=Fewer Sugary Drinks Key to Weight Loss - healthfinder.gov |work=U.S. Department of Health and Human Services |accessdate=Oct 18,2009}}</ref>  When constructing urban environments, efforts have been made to increase access to parks and to develop pedestrian routes.<ref>{{cite journal|author=Brennan Ramirez LK |title=Indicators of activity-friendly communities: An evidence-based consensus process |journal=Am J Prev Med |date=December 2006 |issue=6 |pages=530–32 |pmid=17169714 |url= |doi=10.1016/j.amepre.2006.07.026 |volume=31 | author-separator=, |author2=Hoehner CM |author3=Brownson RC |last4=Cook |first4=R |last5=Orleans |first5=C |last6=Hollander |first6=M |last7=Barker |first7=D |last8=Bors |first8=P |last9=Ewing |first9=R |display-authors=3 |first10=R |first11=K}}</ref>
 
Many countries and groups have published reports pertaining to obesity. In 1998 the first US Federal guidelines were published, titled "Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report".<ref>{{cite book|author=National Heart, Lung, and Blood Institute |title=Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults |publisher=International Medical Publishing, Inc |location= |year=1998 |isbn=1-58808-002-1 |oclc= |url=http://www.nhlbi.nih.gov/guidelines/obesity/ob_gdlns.pdf |format=PDF}}</ref> In 2006 the [[Canadian Obesity Network]] published the "Canadian Clinical Practice Guidelines (CPG) on the Management and Prevention of Obesity in Adults and Children". This is a comprehensive evidence-based guideline to address the management and prevention of overweight and obesity in adults and children.<ref>{{cite journal|author=Lau DC, Douketis JD, Morrison KM, Hramiak IM, Sharma AM, Ur E |title=2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children summary |journal=CMAJ |volume=176 |issue=8 |pages=S1–13 |date=April 2007 |pmid=17420481 |pmc=1839777 |doi=10.1503/cmaj.061409 |url=http://www.cmaj.ca/cgi/content/full/176/8/S1}}</ref>
 
In 2004, the United Kingdom [[Royal College of Physicians]], the [[Faculty of Public Health]] and the [[Royal College of Paediatrics and Child Health]] released the report "Storing up Problems", which highlighted the growing problem of obesity in the UK.<ref>{{cite book|title=Storing up problems; the medical case for a slimmer nation |date=2004-02-11 |publisher=Royal College of Physicians |location=London |isbn=1-86016-200-2 |author=}}</ref> The same year, the [[British House of Commons|House of Commons]] [[Health Select Committee]] published its "most comprehensive inquiry [...] ever undertaken" into the impact of obesity on health and society in the UK and possible approaches to the problem.<ref name =GB2004>{{cite book|author=Great Britain Parliament House of Commons Health Committee |title=Obesity – Volume 1 – HCP 23-I, Third Report of session 2003–04. Report, together with formal minutes |url=http://www.publications.parliament.uk/pa/cm200304/cmselect/cmhealth/23/2302.htm |accessdate=2007-12-17 |date=May 2004 |publisher=TSO (The Stationery Office) |location=London, UK |isbn=978-0-215-01737-6}}</ref> In 2006, the [[National Institute for Health and Clinical Excellence]] (NICE) issued a guideline on the diagnosis and management of obesity, as well as policy implications for non-healthcare organizations such as local councils.<ref>{{cite web|url=http://www.nice.org.uk/nicemedia/pdf/CG43NICEGuideline.pdf |title=Obesity: guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children |publisher=[[National Health Services]] (NHS) |year=2006 |format=PDF |work=National Institute for Health and Clinical Excellence(NICE) |accessdate=April 8, 2009}}</ref> A 2007 report produced by Sir [[Derek Wanless]] for the [[King's Fund]] warned that unless further action was taken, obesity had the capacity to cripple the [[National Health Service]] financially.<ref>{{cite book|last=Wanless |first=Sir Derek |last2=Appleby |first2=John |last3=Harrison |first3=Anthony |last4=Patel |first4=Darshan |title=Our Future Health Secured? A review of NHS funding and performance |year=2007 |publisher=The King's Fund |location=London, UK |isbn=1-85717-562-X}}</ref>
 
Comprehensive approaches are being looked at to address the rising rates of obesity. The Obesity Policy Action (OPA) framework divides measure into 'upstream' policies, 'midstream' policies, 'downstream' policies. 'Upstream' policies look at changing society, 'midstream' policies try to alter individuals' behavior to prevent obesity, and 'downstream' policies try to treat currently afflicted people.<ref>{{cite journal|last=Sacks |first=G |last2=Swinburn |first2=B |last3=Lawrence |first3=M |title=Obesity Policy Action framework and analysis grids for a comprehensive policy approach to reducing obesity |journal=Obes Rev |volume=10 |issue=1 |pages=76–86 |date=January 2009 |pmid=18761640 |doi=10.1111/j.1467-789X.2008.00524.X  |author-separator=, |display-authors=3}}</ref>
 
==Management==
{{Main|Management of obesity}}
[[File:Obesity Med2008.JPG|thumb|alt=The cardboard packaging of two medications used to treat obesity. Orlistat is shown above under the brand name Xenical in a white package with the Roche logo in the bottom right corner (the Roche name within a hexagon). Sibutramine is below under the brand name Meridia.  The package is white on the top and blue on the bottom separated by a measuring tape. The A of the Abbott Laboratories logo is on the bottom half of the package.|right|[[Orlistat]] (Xenical), the most commonly used medication to treat obesity, and [[sibutramine]] (Meridia), a recently withdrawn medication due to cardiovascular side effects]]
The main treatment for obesity consists of [[dieting]] and [[physical exercise]].<ref name=CADG2006>{{cite journal|author=Lau DC, Douketis JD, Morrison KM, Hramiak IM, Sharma AM, Ur E |title=2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children summary |journal=CMAJ |volume=176 |issue=8 |pages=S1–13 |date=April 2007 |pmid=17420481 |pmc=1839777 |doi=10.1503/cmaj.061409 |url=}}</ref> Diet programs may produce [[weight loss]] over the short term,<ref name=Strychar>{{cite journal|author=Strychar I |title=Diet in the management of weight loss |journal=CMAJ |volume=174 |issue=1 |pages=56–63 |date=January 2006 |pmid=16389240 |pmc=1319349 |doi=10.1503/cmaj.045037 |url=http://www.cmaj.ca/cgi/content/full/174/1/56}}</ref> but maintaining this weight loss is frequently difficult and often requires making exercise and a lower food energy diet a permanent part of a person's lifestyle.<ref>{{cite journal|author=Shick SM, Wing RR, Klem ML, McGuire MT, Hill JO, Seagle H |title=Persons successful at long-term weight loss and maintenance continue to consume a low-energy, low-fat diet |journal=J Am Diet Assoc |volume=98 |issue=4 |pages=408–13 |date=April 1998 |pmid=9550162 |doi=10.1016/S0002-8223(98)00093-5}}</ref><ref>{{cite journal|author=Tate DF, Jeffery RW, Sherwood NE, Wing RR |title=Long-term weight losses associated with prescription of higher physical activity goals. Are higher levels of physical activity protective against weight regain? |journal=Am. J. Clin. Nutr. |volume=85 |issue=4 |pages=954–9 |date=1 April 2007 |pmid=17413092 |url=http://www.ajcn.org/cgi/content/full/85/4/954}}</ref> Success rates of long-term weight loss maintenance with lifestyle changes are low, ranging from 2–20%.<ref>{{cite journal|author=Wing RR, Phelan, S |title=Science-Based Solutions to Obesity: What are the Roles of Academia, Government, Industry, and Health Care? Proceedings of a symposium, Boston, Massachusetts, USA, 10–11 March 2004 and Anaheim, California, USA, 2 October 2004 |journal=Am. J. Clin. Nutr. |volume=82 |issue=1 Suppl |pages=207S–273S |date=1 July 2005 |pmid=16002825 |url=http://www.ajcn.org/cgi/content/full/82/1/222S}}</ref> Dietary and lifestyle changes are effective in limiting excessive weight gain in [[pregnancy]] and improve outcomes for both the mother and the child.<ref>{{cite journal|last=Thangaratinam |first=S |last2=Rogozinska |first2=E |last3=Jolly |first3=K |last4=Glinkowski |first4=S |last5=Roseboom |first5=T |last6=Tomlinson |first6=JW |last7=Kunz |first7=R |last8=Mol |first8=BW |last9=Coomarasamy |first9=A |last10=Khan |first10=KS |title=Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence |journal=BMJ (Clinical research ed.) |date=16 May 2012 |volume=344 |pages=e2088 |pmid=22596383 |pmc=3355191 |doi=10.1136/bmj.e2088 |author-separator=, |display-authors=3}}</ref>
 
One medication, [[orlistat]] (Xenical), is currently widely available and approved for long term use. Weight loss however is modest with an average of 2.9&nbsp;kg (6.4&nbsp;lb) at 1 to 4&nbsp;years and there is little information on how these drugs affect longer-term complications of obesity.<ref name=Orli07>{{cite journal|author=Rucker D, Padwal R, Li SK, Curioni C, Lau DC |title=Long term pharmacotherapy for obesity and overweight: updated meta-analysis |journal=BMJ |volume=335 |issue=7631 |pages=1194–99 |year=2007 |pmid=18006966 |doi=10.1136/bmj.39385.413113.25 |url=http://www.bmj.com/cgi/content/full/335/7631/1194 |pmc=2128668}}</ref> Its use is associated with high rates of gastrointestinal side effects<ref name=Orli07/> and concerns have been raised about negative effects on the kidneys.<ref>{{cite web|last=Wood |first=Shelley |title=Diet Drug Orlistat Linked to Kidney, Pancreas Injuries |url=http://www.medscape.com/viewarticle/740855?src=mp&spon=30 |work=Medscape |publisher=Medscape News |accessdate=26 April 2011}}</ref> Two other medications are available in the United States but not Europe.<ref name=EMA2013>{{cite journal|last=Wolfe |first=SM |title=When EMA and FDA decisions conflict: differences in patients or in regulation? |journal=BMJ (Clinical research ed.) |date=21 August 2013 |volume=347 |pages=f5140 |pmid=23970394 |doi=10.1136/bmj.f5140 |author-separator=, |display-authors=3}}</ref> [[Lorcaserin]] (Belviq) results in an average 3.1&nbsp;kg weight loss (3% of body mass) greater than placebo over a year;<ref>{{cite journal|last=Bays |first=HE |title=Lorcaserin: drug profile and illustrative model of the regulatory challenges of weight-loss drug development |journal=Expert review of cardiovascular therapy |date=March 2011 |volume=9 |issue=3 |pages=265–77 |pmid=21438803 |doi=10.1586/erc.10.22}}</ref> however it may increase heart valve problems.<ref name=EMA2013/> A combination of [[Phentermine/topiramate|phentermine and topiramate]] (Qsymia) is also somewhat effective;<ref>{{cite journal|author=Bays HE, Gadde KM |title=Phentermine/topiramate for weight reduction and treatment of adverse metabolic consequences in obesity |journal=Drugs Today |volume=47 |issue=12 |pages=903–14 |date=December 2011 |pmid=22348915 |doi=10.1358/dot.2011.47.12.1718738 |url=|author-separator=, |display-authors=3}}</ref> however, it may be associated with heart problems.<ref name=EMA2013/>
 
The most effective treatment for obesity is [[bariatric surgery]].<ref>{{cite journal|last=Colquitt |first=JL |last2=Picot |first2=J |last3=Loveman |first3=E |last4=Clegg |first4=AJ |title=Surgery for obesity |journal=Cochrane database of systematic reviews (Online) |date=15 April 2009 |issue=2 |pages=CD003641 |pmid=19370590 |doi=10.1002/14651858.CD003641.pub3 |author-separator=, |display-authors=3 |editor1-last=Colquitt |editor1-first=Jill L |editor-separator=,}}</ref> Surgery for severe obesity is associated with long-term weight loss, improvement in obesity related conditions,<ref name=Chang2013>{{cite journal|last=Chang |first=Su-Hsin |last2=Stoll |first2=Carolyn R. T. |last3=Song |first3=Jihyun |last4=Varela |first4=J. Esteban |last5=Eagon |first5=Christopher J. |last6=Colditz |first6=Graham A. |title=The Effectiveness and Risks of Bariatric Surgery |journal=JAMA Surgery |date=18 December 2013 |doi=10.1001/jamasurg.2013.3654 |author-separator=, |display-authors=3}}</ref> and decreased overall mortality. One study found a weight loss of between 14% and 25% (depending on the type of procedure performed) at 10&nbsp;years, and a 29% reduction in all cause mortality when compared to standard weight loss measures.<ref>{{cite journal|author=Sjöström L |title=Effects of bariatric surgery on mortality in Swedish obese subjects |journal=N. Engl. J. Med. |volume=357 |issue=8 |pages=741–52 |date=August 2007 |pmid=17715408 |doi=10.1056/NEJMoa066254 |url=|author-separator=, |author2=Narbro K |author3=Sjöström CD |last4=Karason |first4=Kristjan |last5=Larsson |first5=Bo |last6=Wedel |first6=Hans |last7=Lystig |first7=Ted |last8=Sullivan |first8=Marianne |last9=Bouchard |first9=Claude |display-authors=3 |first10=Björn |first11=Calle |first14=Peter |first15=Jan |first16=Anna-Karin |first17=Hans |first18=Ingmar |first19=Torsten |first20=Kaj |first21=Jarl |first24=Study}}</ref> Complications occur in about 17% of cases and reoperation is needed in 7% of cases.<ref name=Chang2013/> Due to its cost and risks, researchers are searching for other effective yet less invasive treatments.
{{clear}}
 
==Epidemiology==
{{Main|Epidemiology of obesity}}
{{Double image|right|World map of Male Obesity, 2008.svg|200|World map of Female Obesity, 2008.svg|200|World obesity prevalence among males (left) and females (right).<ref name=IOTF2008>{{cite web|url=http://www.iotf.org/database/documents/GlobalPrevalenceofAdultObesity16thDecember08.pdf |title=Global Prevalence of Adult Obesity |format=PDF |work=[[International Obesity Taskforce]] |accessdate=January 29, 2008}}</ref>
{{Multicol}}
{{legend|#ffff65|<5%}}
{{legend|#fff200|5–10%}}
{{legend|#ffdc00|10–15%}}
{{Multicol-break}}
{{legend|#ffc600|15–20%}}
{{legend|#ffb000|20–25%}}
{{legend|#ff9a00|25–30%}}
{{Multicol-break}}
{{legend|#ff8400|30–35%}}
{{legend|#ff6e00|35–40%}}
{{legend|#ff5800|40–45%}}
{{Multicol-break}}
{{legend|#ff4200|45–50%}}
{{legend|#ff2c00|50–55%}}
{{legend|#cb0000|>55%}}
{{Multicol-end}}
|alt=A map of the world with countries colored to reflect the percentage of men who are obese.  Obese males and females have higher prevalence (above 30%) in the U.S. and some Middle Eastern and Oceanian countries, medium prevalence in the rest of North America and Europe, and lower prevalence (<5%) in most of Asia and Africa.||}}
 
Before the 20th&nbsp;century, obesity was rare;<ref name=Haslam2007/> in 1997 the WHO formally recognized obesity as a global epidemic.<ref name=Caballero/> As of 2008 the WHO estimates that at least 500&nbsp;million adults (greater than 10%) are obese, with higher rates among women than men.<ref name=WHO2009a>{{cite web|url=http://www.who.int/mediacentre/factsheets/fs311/en/index.html |title=Obesity and overweight |work=World Health Organization |accessdate=April 8, 2009}}</ref>  The rate of obesity also increases with age at least up to 50 or 60&nbsp;years old<ref>Seidell 2005 p.5</ref> and severe obesity in the United States, Australia, and Canada is increasing faster than the overall rate of obesity.<ref name=morbid2007/><ref>{{cite journal|last=Howard |first=NJ |last2=Taylor |first2=AW |last3=Gill |first3=TK |last4=Chittleborough |first4=CR |title=Severe obesity: Investigating the socio-demographics within the extremes of body mass index |journal=Obesity Research & Clinical Practice |volume=2 |issue=1 |pages=51–59 |date=March 2008 |pmid= |doi=10.1016/j.orcp.2008.01.001 |author-separator=, |display-authors=3}}</ref><ref name=Tjepkema2005>{{cite book|author=Tjepkema M |chapter=Measured Obesity–Adult obesity in Canada: Measured height and weight |title=Nutrition: Findings from the Canadian Community Health Survey |publisher=Statistics Canada |date=2005-07-06 |location=Ottawa, Ontario |url=http://www.statcan.gc.ca/pub/82-620-m/2005001/article/adults-adultes/8060-eng.htm}}</ref>
 
Once considered a problem only of high-income countries, obesity rates are rising worldwide and affecting both the developed and developing world.<ref name=EuroG2008>{{cite journal|author=Tsigosa Constantine |title=Management of Obesity in Adults: European Clinical Practice Guidelines |journal=The European Journal of Obesity |volume=1 |date=April 2008 |pmid=20054170 |doi=10.1159/000126822 |url=http://www.gojaznost.org/gs/dodatak/OMTFManagementofObesityinAdults2008.pdf |first2=Vojtech |issue=2 |first3=Arnaud |first4=Nick |first5=Martin |first6=Elisabeth |first7=Dragan |first8=Maximo |first9=Gabriela |pages=106–16 |last2=Hainer |last3=Basdevant |last4=Finer |last5=Fried |last6=Mathus-Vliegen |last7=Micic |last8=Maislos |last9=Roman |display-authors=3 |first10=Yves |first11=Hermann |first12=Barbara}}</ref> These increases have been felt most dramatically in urban settings.<ref name=WHO2009a/>  The only remaining region of the world where obesity is not common is [[sub-Saharan Africa]].<ref name=HaslamJames/>
{{clear}}
 
==History==
 
===Etymology===
''Obesity'' is from the [[Latin]] ''obesitas'', which means "stout, fat, or plump".  ''Ēsus'' is the past participle of ''edere'' (to eat), with ''ob'' (over) added to it.<ref name=etymol>{{cite web|url=http://www.etymonline.com/index.php?term=obesity |title=Online Etymology Dictionary: Obesity |work=Douglas Harper |accessdate=December 31, 2008}}</ref>  ''[[The Oxford English Dictionary]]'' documents its first usage in 1611 by [[Randle Cotgrave]].<ref>{{cite web|url=http://www.oed.com/ |title=Obesity, n |work=[[Oxford English Dictionary]] 2008 |accessdate=March 21, 2009}}</ref>
 
===Historical trends===
[[File:Italienischer Maler des 17. Jahrhunderts 001.jpg|thumb|upright|alt=A very obese gentleman with a prominent double chin and mustache dressed in black with a sword at his left side.|During the [[Middle Ages]] and the [[Renaissance]] obesity was often seen as a sign of wealth, and was relatively common among the elite: ''The Tuscan General [[Alessandro del Borro]]'', attributed to Charles Mellin, 1645<ref name=Zach2003>{{cite journal|author=Zachary Bloomgarden |title=Prevention of Obesity and Diabetes |journal=Diabetes Care |volume=26 |pages=3172–3178 |year=2003 |pmid=14578257 |doi=10.2337/diacare.26.11.3172 |url=http://care.diabetesjournals.org/content/26/11/3172.full |issue=11}}</ref>]]
[[File:Venus von Willendorf 01.jpg|thumb|upright|alt=A carved stone miniature figurine depicted an obese female.|''[[Venus of Willendorf]]'' created 24,000–22,000 BC]]
The [[Greeks]] were the first to recognize obesity as a medical disorder.<ref name=Haslam2007>{{cite journal|author=Haslam D |title=Obesity: a medical history |journal=Obes Rev |volume=8 Suppl 1 |issue= |pages=31–6 |date=March 2007 |pmid=17316298 |doi=10.1111/j.1467-789X.2007.00314.x |url=}}</ref> [[Hippocrates]] wrote that "Corpulence is not only a disease itself, but the harbinger of others".<ref name=HaslamJames/> The Indian surgeon [[Sushruta]] (6th century BCE) related obesity to diabetes and heart disorders.<ref name=Dwivedi&Dwivedi07/> He recommended physical work to help cure it and its side effects.<ref name=Dwivedi&Dwivedi07>{{cite web|url=http://medind.nic.in/iae/t07/i4/iaet07i4p243.pdf |format=PDF |title=History of Medicine: Sushruta – the Clinician – Teacher par Excellence |accessdate=2008-09-19 |work=Dwivedi, Girish & Dwivedi, Shridhar |publisher= |year=2007}}</ref> For most of human history mankind struggled with food scarcity.<ref>{{cite book|author=Theodore Mazzone; Giamila Fantuzzi |title=Adipose Tissue And Adipokines in Health And Disease (Nutrition and Health) |publisher=Humana Press |location=Totowa, NJ |year=2006 |page=222 |isbn=1-58829-721-7 |oclc= |doi= |accessdate=}}</ref> Obesity has thus historically been viewed as a sign of wealth and prosperity. It was common among high officials in Europe in the [[Middle Ages]] and the [[Renaissance]]<ref name=Zach2003/> as well as in Ancient East Asian civilizations.<ref>Keller p. 49</ref>
 
With the onset of the [[industrial revolution]] it was realized that the military and economic might of nations were dependent on both the body size and strength of their soldiers and workers.<ref name=Caballero/> Increasing the average body mass index from what is now considered underweight to what is now the normal range played a significant role in the development of industrialized societies.<ref name=Caballero/> Height and weight thus both increased through the 19th&nbsp;century in the developed world. During the 20th century, as populations reached their genetic potential for height, weight began increasing much more than height, resulting in obesity.<ref name=Caballero/> In the 1950s increasing wealth in the developed world decreased child mortality, but as body weight increased heart and kidney disease became more common.<ref name=Caballero/><ref>{{cite journal|doi=10.2105/AJPH.42.9.1116 |author=Breslow L |title=Public Health Aspects of Weight Control |journal=Am J Public Health Nations Health |date=September 1952 |volume=42 |issue=9 |pages=1116–20 |pmid=12976585 |pmc=1526346}}</ref>
During this time period insurance companies realized the connection between weight and life expectancy and increased premiums for the obese.<ref name=HaslamJames/>
 
Many cultures throughout history have viewed obesity as the result of a character flaw. The ''obesus'' or fat character in [[Greek comedy]] was a glutton and figure of mockery. During Christian times food was viewed as a gateway to the sins of [[Sloth (deadly sin)|sloth]] and [[lust]].<ref name=Woodhouse/> In modern Western culture, excess weight is often regarded as unattractive, and obesity is commonly associated with various negative stereotypes. People of all ages can face social stigmatization, and may be targeted by bullies or shunned by their peers. Obesity is once again a reason for discrimination.<ref name=Bias2001>{{cite journal|author=Puhl R, Brownell KD |title=Bias, discrimination, and obesity |journal=Obes. Res. |volume=9 |issue=12 |pages=788–805 |date=December 2001 |pmid=11743063 |doi=10.1038/oby.2001.108 |url=}}</ref>
 
Public perceptions in Western society regarding healthy body weight differ from those regarding the weight that is considered ideal &nbsp;– and both have changed since the beginning of the 20th century. The weight that is viewed as an ideal has become lower since the 1920s. This is illustrated by the fact that the average height of Miss America pageant winners increased by 2% from 1922 to 1999, while their average weight decreased by 12%.<ref>{{cite journal|author=Rubinstein S, Caballero B |title=Is Miss America an undernourished role model? |journal=[[JAMA (journal)|JAMA]] |volume=283 |issue=12 |page=1569 |year=2000 |pmid=10735392 |doi=10.1001/jama.283.12.1569 |url=}}</ref>  On the other hand, people's views concerning healthy weight have changed in the opposite direction. In Britain the weight at which people considered themselves to be overweight was significantly higher in 2007 than in 1999.<ref name=John2008>{{cite journal|author=Johnson F, Cooke L, Croker H, Wardle J |title=Changing perceptions of weight in Great Britain: comparison of two population surveys |journal=BMJ |volume=337 |issue= |pages=a494 |year=2008 |pmid=18617488 |pmc=2500200 |doi=10.1136/bmj.a494 |url=http://www.bmj.com/cgi/content/full/337/jul10_1/a494}}</ref>  These changes are believed to be due to increasing rates of adiposity leading to increased acceptance of extra body fat as being normal.<ref name=John2008/>
 
Obesity is still seen as a sign of wealth and well-being in many parts of [[Africa]]. This has become particularly common since the [[HIV]] epidemic began.<ref name=HaslamJames/>
 
===The arts===
The first sculptural representations of the human body 20,000–35,000&nbsp;years ago depict obese females. Some attribute the [[Venus figurines]] to the tendency to emphasize fertility while others feel they represent "fatness" in the people of the time.<ref name=Woodhouse/> Corpulence is, however, absent in both Greek and Roman art, probably in keeping with their ideals regarding moderation. This continued through much of Christian European history, with only those of low socioeconomic status being depicted as obese.<ref name=Woodhouse/>
 
During the [[Renaissance]] some of the upper class began flaunting their large size, as can be seen in portraits of [[Henry VIII of England]] and [[Alessandro del Borro]].<ref name=Woodhouse>{{cite journal|author=Woodhouse R |title=Obesity in art: A brief overview |journal=Front Horm Res |volume=36 |issue= |pages=271–86 |year=2008 |isbn=978-3-8055-8429-6 |pmid=18230908 |doi=10.1159/000115370 |url=http://books.google.com/?id=nXRU4Ea1aMkC&pg=PA271&lpg=PA271 |series=Frontiers of Hormone Research}}</ref> [[Peter Paul Rubens|Rubens]] (1577–1640) regularly depicted full-bodied women in his pictures, from which derives the term [[Rubenesque]]. These women, however, still maintained the "hourglass" shape with its relationship to fertility.<ref name=Fumento>{{cite book|author=Fumento, Michael |title=The Fat of the Land: Our Health Crisis and How Overweight Americans Can Help Themselves |publisher=Penguin (Non-Classics) |year=1997 |page=126 |isbn=0-14-026144-3}}</ref> During the 19th&nbsp;century, views on obesity changed in the Western world. After centuries of obesity being synonymous with wealth and social status, slimness began to be seen as the desirable standard.<ref name=Woodhouse/>
 
==Society and culture==
 
===Economic impact===
In addition to its health impacts, obesity leads to many problems including disadvantages in employment<ref name="Puhl R. p.29">Puhl R., Henderson K., and Brownell K. 2005 p.29</ref><ref>{{cite journal|doi=10.1016/j.ehb.2009.01.008 |author=Johansson E, Bockerman P, Kiiskinen U, Heliovaara M |title=Obesity and labour market success in Finland: The difference between having a high BMI and being fat |journal=Economics and Human Biology |volume=7 |issue=1 |pages=36–45 |year=2009 |pmid=19249259}}</ref> and increased business costs.  These effects are felt by all levels of society from individuals, to corporations, to governments.
 
In 2005, the medical costs attributable to obesity in the US were an estimated $190.2&nbsp;billion or 20.6% of all medical expenditures,<ref name=medical-costs>{{cite journal|last=Cawley |first=J |last2=Meyerhoefer |first2=C |title=The medical care costs of obesity: An instrumental variables approach |journal=Journal of Health Economics |date=January 2012 |volume=31 |issue=1 |pages=219–230 |accessdate=2 August 2012 |doi=10.1016/j.jhealeco.2011.10.003 |pmid=22094013 |author-separator=,}}</ref><ref>{{cite journal|author=Finkelstein EA, Fiebelkorn IA, Wang G |title=National medical spending attributable to overweight and obesity: How much, and who's paying |journal=Health Affairs |volume=Online |issue=May |pages= |date=1 January 2003 |url=http://content.healthaffairs.org/cgi/content/full/hlthaff.w3.219v1/DC1}}</ref><ref>{{cite web|url=http://www.cdc.gov/nccdphp/dnpa/obesity/economic_consequences.htm |title=Obesity and overweight: Economic consequences |publisher=[[Centers for Disease Control and Prevention]] |date=22 May 2007 |accessdate=2007-09-05}}</ref> while the cost of obesity in Canada was estimated at CA$2 billion in 1997 (2.4% of total health costs).<ref name="CADG2006"/> The total annual direct cost of overweight and obesity in Australia in 2005 was A$21 billion. Overweight and obese Australians also received A$35.6 billion in government subsidies.<ref name=MJA2009>{{Cite journal|title=The cost of overweight and obesity in Australia |url=http://www.mja.com.au/public/issues/192_05_010310/col10841_fm.html |year=2009 |author=Colagiuri, Stephen |journal=The Medical Journal of Australia |accessdate=2011-06-18 |last2=Lee |first2=Crystal M. Y. |last3=Colagiuri |first3=Ruth |display-authors=3 |author5=<Please add first missing authors to populate metadata.>}}</ref> The estimate range for annual expenditures on diet products is $40&nbsp;billion to $100&nbsp;billion in the US alone.<ref>{{cite news|last=Cummings |first=Laura |title=The diet business: Banking on failure |publisher=BBC News |date=5 February 2003 |url=http://news.bbc.co.uk/2/hi/business/2725943.stm |accessdate=25 February 2009}}</ref>
 
Obesity prevention programs have been found to reduce the cost of treating obesity-related disease. However, the longer people live, the more medical costs they incur. Researchers therefore conclude that reducing obesity may improve the public's health, but it is unlikely to reduce overall health spending.<ref>{{cite journal|author=van Baal PH |title=Lifetime Medical Costs of Obesity: Prevention No Cure for Increasing Health Expenditure |journal=PLoS Med. |volume=5 |issue=2 |pages=e29 |date=February 2008 |pmid=18254654 |pmc=2225430 |doi=10.1371/journal.pmed.0050029 |url=http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050029 |author-separator=, |author2=Polder JJ |author3=de Wit GA |last4=Hoogenveen |first4=Rudolf T. |last5=Feenstra |first5=Talitha L. |last6=Boshuizen |first6=Hendriek C. |last7=Engelfriet |first7=Peter M. |last8=Brouwer |first8=Werner B. F. |display-authors=3}}</ref>
 
[[File:Wide Chair.jpg|thumb|left|alt=An extra wide chair beside a number of normal sized chairs.|Services must accommodate obese people with specialist equipment such as much wider chairs.<ref>{{cite journal|author=Bakewell J |title=Bariatric furniture: Considerations for use |journal=Int J Ther Rehabil |issue=7 |pages=329–33 |year=2007 |url=http://www.ijtr.co.uk/cgi-bin/go.pl/library/article.cgi?uid=23858;article=IJTR_14_7_329_333 |volume=14}}</ref>]]
Obesity can lead to social stigmatization and disadvantages in employment.<ref name="Puhl R. p.29"/> When compared to their normal weight counterparts, obese workers on average have higher rates of absenteeism from work and take more disability leave, thus increasing costs for employers and decreasing productivity.<ref>{{cite journal|author=Neovius K, Johansson K, Kark M, Neovius M |title=Obesity status and sick leave: a systematic review |journal=Obes Rev |volume=10 |issue=1 |pages=17–27 |date=January 2009 |pmid=18778315 |doi=10.1111/j.1467-789X.2008.00521.x |url=}}</ref> A study examining Duke University employees found that people with a BMI over 40&nbsp;kg/m<sup>2</sup> filed twice as many [[workers' compensation]] claims as those whose BMI was 18.5–24.9&nbsp;kg/m<sup>2</sup>. They also had more than 12&nbsp;times as many lost work days. The most common injuries in this group were due to falls and lifting, thus affecting the lower extremities, wrists or hands, and backs.<ref>{{cite journal|author=Ostbye T, Dement JM, Krause KM |title=Obesity and workers' compensation: Results from the Duke Health and Safety Surveillance System |journal=Arch. Intern. Med. |volume=167 |issue=8 |pages=766–73 |year=2007 |pmid=17452538 |doi=10.1001/archinte.167.8.766}}</ref> The Alabama State Employees' Insurance Board approved a controversial plan to charge obese workers $25 a month for health insurance that would otherwise be free unless they take steps to lose weight and improve their health. These measures started in January 2010 and apply to those state workers whose BMI exceeds 35&nbsp;kg/m<sup>2</sup> and who fail to make improvements in their health after one year.<ref>{{cite web|url=http://www.webmd.com/diet/news/20080825/alabama-obesity-penalty-stirs-debate |title=Alabama "Obesity Penalty" Stirs Debate |work=Don Fernandez |accessdate=April 5, 2009}}</ref>
 
Some research shows that obese people are less likely to be hired for a job and are less likely to be promoted.<ref name=Bias2001/> Obese people are also paid less than their non-obese counterparts for an equivalent job; obese women on average make 6% less and obese men make 3% less.<ref>Puhl R., Henderson K., and Brownell K. 2005 p.30</ref>
 
Specific industries, such as the airline, healthcare and food industries, have special concerns. Due to rising rates of obesity, airlines face higher fuel costs and pressures to increase seating width.<ref>{{cite web|author=Lisa DiCarlo |url=http://www.forbes.com/2002/10/24/cx_ld_1024obese.html |title=Why Airlines Can't Cut The Fat |work=Forbes.com |date=2002-10-24 |accessdate=2008-07-23}}</ref> In 2000, the extra weight of obese passengers cost airlines US$275&nbsp;million.<ref>{{cite journal|author=Dannenberg AL, Burton DC, Jackson RJ |title=Economic and environmental costs of obesity: The impact on airlines |journal=American journal of preventive medicine |volume=27 |issue=3 |page=264 |year=2004 |pmid=15450642 |doi=10.1016/j.amepre.2004.06.004}}</ref>  The healthcare industry has had to invest in special facilities for handling severely obese patients, including special lifting equipment and [[bariatric ambulance]]s.<ref>{{cite web|url=http://abcnews.go.com/Health/Diet/obese-health-care-bariatric-ambulances/story?id=7981746 |title=Who Should Pay for Obese Health Care? |author=Lauren Cox |publisher=ABC News |date=July 2, 2009 |accessdate=2012-08-06}}</ref> Costs for restaurants are increased by litigation accusing them of causing obesity.<ref name=Govtrack>{{cite web|url=http://www.govtrack.us/congress/bill.xpd?bill=h109-554 |title=109th U.S. Congress (2005–2006) H.R. 554: 109th U.S. Congress (2005–2006) H.R. 554: Personal Responsibility in Food Consumption Act of 2005 |publisher=GovTrack.us |accessdate=2008-07-24}}</ref> In 2005 the US Congress discussed legislation to prevent civil lawsuits against the food industry in relation to obesity; however, it did not become law.<ref name=Govtrack/>
 
With the [[American Medical Association]]'s 2013 classification of obesity as chronic disease,<ref name=NYTimes20130618/> it is thought that health insurance companies will more likely pay for obesity treatment, counseling and surgery, and the cost of research and development of fat treatment pills or gene therapy treatments should be more affordable if insurers help to subsidize their cost.<ref name=WashPost20130620/>  The AMA classification is not legally binding, however, so health insurers still have the right to reject coverage for a treatment or procedure.<ref name=WashPost20130620>{{cite web|url=http://www.washingtonpost.com/blogs/innovations/wp/2013/06/20/a-changing-battlefield-in-the-fight-against-fat/?wpisrc=nl_tech_b |title=A changing battlefield in the fight against fat |last=Basulto |first=Dominic |date=June 20, 2013 |website=The Washington Post |publisher= |accessdate=June 20, 2013}} ([http://www.webcitation.org/6HWwftXgI WebCite archive])</ref>
 
===Size acceptance===
[[File:PresidentTaftTelephoneCrop.jpg|thumb|150px|right|right|United States President [[William Howard Taft]] was often ridiculed for being overweight]]
{{See also|Fat acceptance movement}}
The principal goal of the fat acceptance movement is to decrease discrimination against people who are overweight and obese.<ref>{{cite web|url=http://www.capitalnaafa.org/whatisnaafa.html |title=What is NAAFA |work=[[National Association to Advance Fat Acceptance]] |accessdate=February 17, 2009}}</ref><ref>{{cite web|url=http://www.size-acceptance.org/mission.html |title=ISAA Mission Statement |work=[[International Size Acceptance Association]] |accessdate=February 17, 2009}}</ref> However, some in the movement are also attempting to challenge the established relationship between obesity and negative health outcomes.<ref name=Pulver2007>{{cite book|author=Pulver, Adam |title=An Imperfect Fit: Obesity, Public Health, and Disability Anti-Discrimination Law |publisher=Social Science Electronic Publishing |location= |year=2007 |pages= |isbn= |oclc= |doi= |url=http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1316106 |accessdate=January 13, 2009}}</ref>
 
A number of organizations exist that promote the acceptance of obesity. They have increased in prominence in the latter half of the 20th&nbsp;century.<ref>{{cite journal|author=Neumark-Sztainer D |title=The weight dilemma: a range of philosophical perspectives |journal=Int. J. Obes. Relat. Metab. Disord. |volume=23 Suppl 2 |issue= |pages=S31–7 |date=March 1999 |pmid=10340803 |doi=10.1038/sj.ijo.0800857 |url=}}</ref> The US-based [[National Association to Advance Fat Acceptance]] (NAAFA) was formed in 1969 and describes itself as a civil rights organization dedicated to ending size discrimination.<ref>{{cite web|author=National Association to Advance Fat Acceptance |url=http://www.naafaonline.com/dev2/ |title=We come in all sizes |publisher=NAAFA |year=2008 |accessdate=2008-07-29}}</ref>
 
The [[International Size Acceptance Association]] (ISAA) is a [[non-governmental organization]] (NGO) which was founded in 1997. It has more of a global orientation and describes its mission as promoting size acceptance and helping to end weight-based discrimination.<ref>{{cite web|url=http://www.size-acceptance.org/ |title=International Size Acceptance Association – ISAA |work=International Size Acceptance Association |accessdate=January 13, 2009}}</ref> These groups often argue for the recognition of obesity as a disability under the US [[Americans With Disabilities Act]] (ADA). The American legal system, however, has decided that the potential public health costs exceed the benefits of extending this anti-discrimination law to cover obesity.<ref name=Pulver2007/>
 
==Childhood obesity==
{{Main|Childhood obesity}}
The healthy BMI range varies with the age and sex of the child. Obesity in children and adolescents is defined as a BMI greater than the 95th&nbsp;[[percentile]].<ref name="cdc.gov"/> The reference data that these percentiles are based on is from 1963 to 1994 and thus has not been affected by the recent increases in rates of obesity.<ref name="Flegal KM, Ogden CL, Wei R, Kuczmarski RL, Johnson CL 2001 1086–93"/> Childhood obesity has reached epidemic proportions in 21st&nbsp;century, with rising rates in both the developed and developing world. Rates of obesity in Canadian boys have increased from 11% in 1980s to over 30% in 1990s, while during this same time period rates increased from 4 to 14% in Brazilian children.<ref name=flynn2006/>
 
As with obesity in adults, many different factors contribute to the rising rates of childhood obesity. Changing diet and decreasing physical activity are believed to be the two most important in causing the recent increase in the rates.<ref>{{cite journal|author=Dollman J, Norton K, Norton L |title=Evidence for secular trends in children's physical activity behaviour |journal=Br J Sports Med |volume=39 |issue=12 |pages=892–7; discussion 897 |date=December 2005 |pmid=16306494 |pmc=1725088 |doi=10.1136/bjsm.2004.016675 |url=}}</ref> Because childhood obesity often persists into adulthood and is associated with numerous chronic illnesses, children who are obese are often tested for [[hypertension]], [[diabetes]], [[hyperlipidemia]], and [[fatty liver]].<ref name=CADG2006/> Treatments used in children are primarily lifestyle interventions and behavioral techniques, although efforts to increase activity in children have had little success.<ref>{{cite journal|last=Metcalf |first=B. |last2=Henley |first2=W. |last3=Wilkin |first3=T. |title=Effectiveness of intervention on physical activity of children: systematic review and meta-analysis of controlled trials with objectively measured outcomes (EarlyBird 54) |journal=BMJ |date=27 September 2012 |volume=345 |issue=sep27 1 |pages=e5888–e5888 |doi=10.1136/bmj.e5888 |author-separator=, |display-authors=3}}</ref> In the United States, medications are not FDA approved for use in this age group.<ref name=flynn2006>{{cite journal|author=Flynn MA |title=Reducing obesity and related chronic disease risk in children and youth: a synthesis of evidence with 'best practice' recommendations |journal=Obes Rev |volume=7 Suppl 1 |issue= |pages=7–66 |date=February 2006 |pmid=16371076 |doi=10.1111/j.1467-789X.2006.00242.x |url=|author-separator=, |author2=McNeil DA |author3=Maloff B |last4=Mutasingwa |first4=D. |last5=Wu |first5=M. |last6=Ford |first6=C. |last7=Tough |first7=S. C. |display-authors=3}}</ref>
 
==Other animals==
{{Main|Obesity in pets}}
Obesity in pets is common in many countries. Rates of overweight and obesity in dogs in the United States range from 23 to 41% with about 5.1% obese.<ref name=Lund2006>{{cite journal|author=Lund Elizabeth M. |title=Prevalence and Risk Factors for Obesity in Adult Dogs from Private US Veterinary Practices |journal=Intern J Appl Res Vet Med |volume=4 |issue=2 |pages=177–86 |year=2006 |pmid= |doi= |url=http://www.jarvm.com/articles/Vol4Iss2/Lund.pdf}}</ref> Rates of obesity in cats was slightly higher at 6.4%.<ref name= Lund2006/> In Australia the rate of obesity among dogs in a veterinary setting has been found to be 7.6%.<ref>{{cite journal|last=McGreevy |first=PD |last2=Thomson |first2=PC |last3=Pride |first3=C |last4=Fawcett |first4=A |last5=Grassi |first5=T |last6=Jones |first6=B |title=Prevalence of obesity in dogs examined by Australian veterinary practices and the risk factors involved |journal=Vet. Rec. |volume=156 |issue=22 |pages=695–702 |date=May 2005 |pmid=15923551 |doi= |url=|author-separator=, |display-authors=3}}</ref> The risk of obesity in dogs is related to whether or not their owners are obese; however, there is no similar correlation between cats and their owners.<ref>{{cite journal|last=Nijland |first=ML |last2=Stam |first2=F |last3=Seidell |first3=JC |title=Overweight in dogs, but not in cats, is related to overweight in their owners |journal=Public Health Nutr |volume=13 |issue=1 |pages=1–5 |date=June 2009 |pmid=19545467 |doi=10.1017/S136898000999022X |author-separator=, |display-authors=3}}</ref>
 
==Notes==
{{Reflist|30em}}
 
;References
{{Refbegin|30em}}
* {{cite journal|doi=10.1079/BJN2002739 |last1=Bhargava |first1=Alok |last2=Guthrie |first2=J. |year=2002 |title=Unhealthy eating habits, physical exercise and macronutrient intakes are predictors of anthropometric indicators in the Women's Health Trial: Feasibility Study in Minority Populations |url= |journal=British Journal of Nutrition |volume=88 |issue=6 |pages=719–728 |pmid=12493094 |author-separator=, |display-authors=3}}
* {{cite journal|last1=Bhargava |first1=Alok |year=2006 |title=Fiber intakes and anthropometric measures are predictors of circulating hormone, triglyceride, and cholesterol concentration in the Women's Health Trial |url= |journal=Journal of Nutrition |volume=136 |issue=8 |pages=2249–2254 |pmid=16857849 |author-separator=, |display-authors=3}}
* Jebb S. and Wells J. Measuring body composition in adults and children In:{{cite book|author=Peter G. Kopelman, Ian D. Caterson, Michael J. Stock, William H. Dietz |title=Clinical obesity in adults and children: In Adults and Children |publisher=Blackwell Publishing |location= |year=2005 |pages=12–28 |isbn=1-4051-1672-2}}
* Kopelman P., Caterson I. An overview of obesity management In:{{cite book|author=Peter G. Kopelman, Ian D. Caterson, Michael J. Stock, William H. Dietz |title=Clinical obesity in adults and children: In Adults and Children |publisher=Blackwell Publishing |location= |year=2005 |pages=319–326 |isbn=1-4051-1672-2}}
* {{cite book|author=[[National Heart, Lung, and Blood Institute]] (NHLBI) |title=Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults |publisher=International Medical Publishing, Inc |location= |year=1998 |pages= |isbn=1-58808-002-1 |oclc= |url=http://www.nhlbi.nih.gov/guidelines/obesity/ob_gdlns.pdf |format=PDF}}
* {{cite web|url=http://www.nice.org.uk/nicemedia/pdf/CG43NICEGuideline.pdf |title=Obesity: guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children |publisher=[[National Health Services]] (NHS) |year=2006 |format=PDF |work=[[National Institute for Health and Clinical Excellence]](NICE) |accessdate=April 8, 2009}}
* Puhl R., Henderson K., and Brownell K. Social consequences of obesity In:{{cite book|author=Peter G. Kopelman, Ian D. Caterson, Michael J. Stock, William H. Dietz |title=Clinical obesity in adults and children: In Adults and Children |publisher=Blackwell Publishing |location= |year=2005 |pages=29–45 |isbn=1-4051-1672-2}}
* Seidell JC. Epidemiology — definition and classification of obesity In:{{cite book|author=Peter G. Kopelman, Ian D. Caterson, Michael J. Stock, William H. Dietz |title=Clinical obesity in adults and children: In Adults and Children |publisher=Blackwell Publishing |location= |year=2005 |pages=3–11 |isbn=1-4051-1672-2}}
* {{cite book|author=[[World Health Organization]] (WHO) |title=Technical report series 894: Obesity: Preventing and managing the global epidemic. |location=Geneva |publisher=World Health Organization |year=2000 |url=http://whqlibdoc.who.int/trs/WHO_TRS_894_(part1).pdf |format=PDF |isbn=92-4-120894-5}}
{{Refend}}
 
==Further reading==
<!-- Please only include material which addresses obesity in general, rather than specific aspects, or related topics -->
{{Sister project links|display=Obesity}}
{{Refbegin}}
* {{dmoz|Health/Conditions_and_Diseases/Nutritional_and_Metabolic_Disorders/Obesity/}}
* {{cite book|author=Fumento, Michael |authorlink=Michael Fumento |title=The Fat of the Land: Our Health Crises and How Overweight Americans can Help Themselves |publisher=Penguin Books |location=New York |year=1997 |isbn=0-14-026144-3 |url=http://books.google.com/books?id=Qr8hAQAAMAAJ}}
* {{cite book|author=Keller, Kathleen |title=Encyclopedia of Obesity |publisher=Sage Publications, Inc |location=Thousand Oaks, Calif |year=2008 |isbn=1-4129-5238-7 |oclc= |url=http://books.google.com/?id=aRp2rJrEqZsC}}
* {{cite book|author=Kolata, Gina |authorlink=Gina Kolata |title=Rethinking Thin: The New Science of Weight Loss – and the Myths and Realities of Dieting |publisher=Picador |location= |year=2007 |pages= |isbn=0-312-42785-9}}
* {{cite book|editor-last=Kopelman|editor-first=Peter G.|editor2-last=Caterson|editor2-first=Ian D.|editor3-last=Dietz |editor3-first=William H. |title=Clinical obesity in Adults and Children |publisher=John Wiley & Sons |edition=3rd |location= |year=2009 |isbn=978-1-4443-0763-4 |url=http://books.google.com/books?id=1W2M1lnHeccC}}
* {{cite book|author=Levy-Navarro, Elena |title=The Culture of Obesity in Early and Late Modernity |publisher=Palgrave Macmillan |location= |year=2008 |pages= |isbn=0-230-60123-5}}
* {{cite book|author=Pool, Robert |title=Fat: Fighting the Obesity Epidemic |publisher=[[Oxford University Press]] |location=Oxford, UK |year=2001 |pages= |isbn=0-19-511853-7}}
{{Refend}}
{{Nutritional pathology}}
 
[[Category:Obesity| ]]
[[Category:Bariatrics]]
[[Category:Body shape]]
[[Category:Nutrition]]
 
{{Link FA|ar}}
{{Link FA|ms}}
{{Link FA|sl}}

Latest revision as of 19:12, 14 September 2014

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