Obesity As A Public Health Problem

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Obesity is rapidly becoming the scourge of modern society. Presently, at least 34% of the U.S. population is obese (20% or more above their ideal weight) and more than 55% weigh in excess of ideal.1,2 This represents the highest prevalence ever recorded in the United States.3 Nor is the

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problem unique to Americans. It is estimated that there are now 250 million obese adults in the world (7% of the total population), with many more overweight.4 At the 1998 International Conference on Obesity, the World Health Organization identified obesity as a worldwide epidemic.5 In industrialized and developing countries alike, obesity ranks as one of the top five global health problems.6

One of the more sobering observations is that obesity is increasing rapidly among children and adolescents. The association between childhood obesity and obesity in adulthood indicates a strong relationship. Analysis by Serdula et al.7 indicates that about one third of obese preschool children become obese as adults, and approximately half of obese schoolage children become obese adults. The risk of adult obesity is greater for children with higher levels of obesity and for children who are obese at adolescence and beyond.

While many individuals bemoan their adiposity for aesthetic reasons, the major concern is the negative health impact that accompanies obesity. Since ancient times, it has been common knowledge that obesity is hazardous to health. It remained, however, for modern epidemiology to confirm the truth of this assumption. The list of illnesses that are attributable to, or aggravated by, overweight is a lengthy one. Some of the metabolic abnormalities and diseases linked to obesity include: athero-genic lipid profile, high fibrinogen levels, insulin resistance, hyperinsuline-mia, glucose intolerance, hyperuricemia, type 2 diabetes, coronary heart disease, hypertension, stroke, angina pectoris, cholecystitis, gout, obstructive sleep apnea, uric acid nephrolithiasis, and breast cancer (in post-menopausal women).8

Allison et al.9 attribute 280,000 deaths per year in the United States to excess body fat. Severely obese women are at triple the risk of having at least one major risk factor for cardiovascular disease, five times the risk of developing diabetes, and 1.5 times the risk of suffering from a herniated disk as compared with non-obese women. The risk of cardiovascular disease is even higher among obese men. Very obese men are five times more likely than non-obese men to have at least one cardiovascular risk factor. Very obese men also have five times the risk of diabetes compared with non-obese men.10

While there is consensus that obesity is a continuing and growing problem, intervention is notoriously ineffective. Weight loss, when it is achieved, is almost invariably followed by a gradual return to the previous corpulence. At any given time, almost two thirds of the population is engaged in some type of weight control, but follow-up data demonstrates that less than 5% are successful at maintaining weight loss over time. The sad fact remains that, of those who do reduce their weight, almost all regain it within 3 to 5 years.11

It has been observed that obesity is less prevalent among vegetarians than in their carnivorous counterparts.12 Thus, a meat-free diet has been suggested as beneficial in the primary prevention of obesity and possibly effective in secondary prevention of obesity, such as in weight loss and maintenance. To address the efficacy of a vegetarian diet, as either an intervention or in the prevention of obesity, it is necessary to compare measures of adiposity such as body mass index (BMI) of those subsisting on vegetarian fare with their carnivorous counterparts.

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