A Holistic Approach to Overweight/obesity Issues
Sigman-Grant, Madeleine, Journal of Family and Consumer Sciences
Over the past two decades, obesity rates in the United States have increased dramatically.
Simply stated, being overweight or obese results from an energy imbalance. When energy consumed exceeds energy needs, there is weight gain; conversely when energy expended exceeds energy intake, weight is lost. The reality, however, is far from simple (Prentice, 2001). This article describes the prevalence of overweight/obesity, the complexity of adapting to a healthy lifestyle, and education, intervention, and research efforts.
Over the past two decades, obesity rates in the United States have increased dramatically. Using body mass index (BMI) as a reference, 61 % of adults in 1999 were overweight (BMI > 25.0) as compared to 56% in 1971-74, with obesity (BMI 30.0) rising from 14.6% to 26% (Centers for Disease Control, 2001). During the same timeframe, overweight rates (defined as a BMI - the sex, age specific 95 th percentile) for children (6 to 11 years) and adolescents (12 to 19) rose from 6.1 % to 14 % and 4.0% to 13 %, respectively (Ritchie et al., 2001). Similarly, overweight rates for preschool children increased from 8.5 % in 1983 to 10.2 % in 1995 (Mei et al., 1998). Increases permeated across all racial, ethnic, gender, and age sub-groups (although to varying degrees), stimulating public concern.
Weight alone is not the only issue; it is also the relationship of overweight/obesity as an independent risk factor in a host of chronic diseases (including cardiovascular and gall bladder illnesses, type 2 diabetes, psychological issues, stroke, hypertension, sleep apnea, osteoarthritis, asthma, and certain cancers (Centers for Disease Control, 2001; NHLBI Obesity Education Initiative Panel, 1998). Additionally, overweight/obese individuals suffer from discrimination in employment and societal relationships (U.S. Department of Health and Human Services, 2001; Puhl, 2001). Beyond personal costs, there are economic issues of health care and absenteeism. In 2000, obesity-associated costs were estimated at $117 billion. However, loss of 5% to 10% of body weight substantially improves health risks (even if a BMI <25 is not reached), and reduces medication use (NHLBI Obesity Education Initiative Expert Panel, 1998; Klein, 2001). Caution must be taken, however, not to equate weight status as the sole influence on health - overweight persons can live healthy lives (Sims, 2001). Nonetheless, efforts to prevent and treat overweight/obesity have intensified by targeting the determinants of increased body weight.
Using a modified ecological model, the many factors that influence eating and affect weight become clarified (Partnership for Promoting Healthy Eating and Active Living, 2001).* Three domains comprise the individual perspective: psychobiological, cultural, and social. Genetics plays a prominent role (Keller et al., 2002; Hebebrand et al., 2001; Froguel & Boutin, 2001), although it is not clearly understood how hormones, metabolic and appetite controls, and other mechanisms interact to support or prevent weight gain or loss (Krysiak et al., 2001; Pasquali, Vicennati,
Gambineri & Pagotto, 2001; Lustig, 2001). Such biological factors underlie pharmacological (Fernandez-Lopez, Remesar, Fox & Alemany, 2002; Clapham, Arch &Tadayyon, 2001; Bray, 2001) and surgical interventions (Buchwald, 2002; Sugarman, 2001). Less invasive interventions can result in successful weight loss (defined as 5%-- 10% of body weight) that is maintained for at least one year. These include lifestyle behaviors such as consuming a low-fat diet, monitoring body weight and food intake, and engaging in high levels of physical activity (Wing & Hill, 2001; Epstein & Roemmich, 2001; Blair & Nichaman, 2002).
Concomitantly, cultural and social domains interact with a variety of enhancers and/or barriers resulting in observable lifestyle behaviors (Wetter, Goldberg, King, et al. …