According to the World Health Organization (WHO), overweight and obesity are defined as “abnormal or excessive fat accumulation that presents a risk to health”.
There are currently 650 million people with obesity around the world.
Obesity
Obesity
Obesity as a Harbinger of Other Diseases
Obesity is associated with increased risk of mortality and with a higher risk of developing many other diseases and conditions, most typically type 2 diabetes, high blood pressure, elevated cholesterol and triglyceride levels, non-alcoholic liver disease (NAFLD/NASH), sleep apnea and also several forms of cancer.
Clinical Obesity
Research over the last several decades, however, has shown that excess adiposity in the body can directly affect the functioning of multiple organs, thus having an immediate negative impact on the health of affected individuals. For this reason, several healthcare professionals and medical organisations now consider obesity both a risk factor for other diseases and, at least in some people, a disease in and by itself.
A Lancet DE Commission has recently defined “clinical obesity” as a state of chronic illness directly caused by excess adiposity. The Commission has also identified clinical manifestations of ongoing organ/tissue dysfunction as diagnostic criteria (full report expected in 2024)
Body Mass Index - BMI
The body mass index (BMI), defined as a person’s weight in kilograms divided by the square of his height in meters (kg/m2) is the most commonly used criterion to define obesity.
For adults, a BMI above 25 Kg/m2 is considered overweight. People with BMI over 30 (or 27.5 for individuals of Asian descent) are considered as having obesity.
Although BMI provides a useful measure of obesity-related risk at population-level it should be considered with caution when assessing the health of individual patients. In fact, the same BMI may not correspond to the same degree of fatness in different individuals, such as persons of different age, gender or ethnicity. BMI alone also provides no information on the functioning of organs -hence on the presence of health/illness in an individual. Despite such limitations, BMI is still commonly used by healthcare professionals and health insurance as a criterion to decide indication to and coverage of treatments of obesity.
Obesity in Numbers
The prevalence of obesity has been growing at epidemic rates over the last 4 decades
Obesity has nearly tripled worldwide since 1975, according to WHO data
Estimated number of adults suffering from obesity worldwide
Estimated number of overweight adults, worldwide
In many western and middle eastern countries obesity can affect up to 30% of the population
>40% the people living in United States had obesity in 2018
Children and adolescents aged 5-19 had overweight or obesity in 2016
In 2016, 13% of the world’s population had obesity (WHO)
Causes of Obesity
Obesity is often represented – including by healthcare professionals or medical organizations – as the result of an energy imbalance between calories consumed and calories expended. This view is based on the assumption that body weight is regulated as a mere physical process (rather than a biological one), typically summarised by popular expressions such as ‘energy in versus energy out’ or ‘calories in versus calories out’.
Consistently with this view, obesity is often referred to as “entirely preventable”, as a “lifestyle choice” or as condition that can be complete resolved, no matter how severe, through voluntary decisions to eat less and exercise more.
Scientific evidence, however, shows a much different reality.
In consideration of the listed key facts, causal attribution of obesity to personal responsibility or lack of will power is a naive suggestion that is not supported by scientific evidence.
That is not to say that modern lifestyles, including increased intake of energy-dense foods high in fat and sugars, the increasingly sedentary nature of many forms of work, and increasing urbanization do not play role in the epidemic of obesity.
In fact, such changes may conjure with our biology and with genetics and facility the development of obesity. Such environmental and societal changes, however, are determined by forces that are largely not under control of the single individual.
For all these reasons, popular narratives that attribute obesity to personal choices or lack of self discipline are not supported by evidence and provide the foundation for stigmatizing views and weight bias.
Compounding the problem, such inaccurate portrayal misleads public health policies, undermines access to effective, evidence-based treatments, and compromise advances in the search of the cause and cure of obesity.
Key Facts
Obesity results primarily from a combination of genetic, epigenetic, and environmental factors.
A definitive body of evidence developed over the last several decades shows that body weight is regulated by a complex biological mechanism that is largely not under control of will power.
The biological mechanism that regulate body weight involves a number of signals and molecules that act in concert to defend the level of fat mass (hence resisting changes in body weight).
Mechanisms of weight regulation include hormonal and neuronal signals, bile acids, and even factors produced by the bacteria we host in our gut. None of these can be changed by merely deciding to do so!
There is very solid evidence demonstrating that voluntary efforts to reduce body weight activate potent compensatory biologic responses (for example, increased appetite, decreased metabolic rate) that typically promote long-term weight regain.
Treatments for Obesity
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