Obesity is now so common within the world's population that it is beginning to replace undernutrition and infectious diseases as the most significant contributor to ill health. In particular, obesity is associated with diabetes mellitus, coronary heart disease, certain forms of cancer, and sleep-breathing disorders. Obesity is defined by a body-mass index (weight divided by square of the height) of 30 kg m(-2) or greater, but this does not take into account the morbidity and mortality associated with more modest degrees of overweight, nor the detrimental effect of intra-abdominal fat. The global epidemic of obesity results from a combination of genetic susceptibility, increased availability of high-energy foods and decreased requirement for physical activity in modern society. Obesity should no longer be regarded simply as a cosmetic problem affecting certain individuals, but an epidemic that threatens global well being.

Obesity as a medical problem

Obesity and the Regulation of Energy Balance

Design of the Women's Health Initiative clinical trial and observational study

The prevalence of clinical obesity in Britain has doubled in the past decade. The Health of the Nation initiative has set ambitious targets for reversing the trend in recognition of the serious health burden which will accrue, but efforts to develop prevention and treatment strategies are handicapped by uncertainty as to the aetiology of the problem. It is generally assumed that ready access to highly palatable foods induces excess consumption and that obesity is caused by simple gluttony. There is evidence that a high fat diet does override normal satiety mechanisms. However, average recorded energy intake in Britain has declined substantially as obesity rates have escalated. The implication is that levels of physical activity, and hence energy needs, have declined even faster. Evidence suggests that modern inactive lifestyles are at least as important as diet in the aetiology of obesity and possibly represent the dominant factor.

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Obesity in Britain: gluttony or sloth?

Fatty acid composition of adipose tissue and blood in humans and its use as a biomarker of dietary intake.

Background and Methods. Some obese subjects repeatedly fail to lose weight even though they report restricting their caloric intake to less than 1200 kcal per day. We studied two explanations for this apparent resistance to diet — low total energy expenditure and underreporting of caloric intake — in 224 consecutive obese subjects presenting for treatment. Group 1 consisted of nine women and one man with a history of diet resistance in whom we evaluated total energy expenditure and its main thermogenic components and actual energy intake for 14 days by indirect calorimetry and analysis of body composition. Group 2, subgroups of which served as controls in the various evaluations, consisted of 67 women and 13 men with no history of diet resistance. Results. Total energy expenditure and resting metabolic rate in the subjects with diet resistance (group 1) were within 5 percent of the predicted values for body composition, and there was no significant difference between groups 1 and 2 in the thermic...

https://www.nejm.org/doi/pdf/10.1056/NEJM199212313272701

Discrepancy between Self-Reported and Actual Caloric Intake and Exercise in Obese Subjects

Attachment in marital relations.

Research on psychiatric disorders in obesity has indicated that obese people are not psychiatrically different from nonobese people. Few studies, however, have addressed the potential impact of psychopathology on weight control. In the present study, a consecutive sample of 37 patients presenting to a major metropolitan weight control unit were given structured diagnostic interviews (Structured Clinical Interviews for Diagnosis I and II). These patients completed one of two 12-week diet programs involving either behavior modification or liquid protein diets. After 12 weeks of a liquid protein formula diet, patients with no personality disorder lost significantly more weight than personality disordered patients; personality disordered patients on a behavioral diet tended (p < .15) to lose more weight during a 12-week diet than the patients without personality disorders. These data suggest that there are differential responses to liquid protein and behavioral diets, depending on the presence or absence of a personality disorder.

The effect of psychiatric disorders on weight loss in obesity clinic patients.

Obesity is a medical disorder with genetic, metabolic, and biochemical components. The role of psychiatric disorders, however, has been a matter of controversy. Although there is no evidence for a causal role for psychopathology in obesity, comorbid psychopathology could explain the high attrition and relapse rates found in obesity treatment. Using structured clinical diagnostic interviews (SCID-I and -II), the present study found a lifetime prevalence of 50% for Axis I disorders and a 55% prevalence for Axis II disorders in a population seeking treatment for their obesity. Assessment of psychiatric disorders may be of benefit both to patients seeking treatment for obesity and to providers of weight control programs.

Ellen Raynes Berman

Papers

Discrepancy between Self-Reported and Actual Caloric Intake and Exercise in Obese Subjects

Attachment in marital relations.

The effect of psychiatric disorders on weight loss in obesity clinic patients.

The Incidence and Comorbidity of Psychiatric Disorders in Obesity