A condition in which the energy stores of the body (mainly fat) are too great. It is common in prosperous countries and is increasing in developing countries, particularly amongst children and young people. Many believe that, along with antibiotic resistance, it represents the most serious public health threat of our age and that politicians consistently fail to come to grips with the issues raised.
Whatever the causes, the fact remains that energy intake (in the form of food and drink) must have exceeded energy output (in the form of activity and exercise) over a sufficiently long period of time.
Obesity tends to run in families, leading to a suggestion that some people inherit a ‘thrifty’ gene which lowers their energy output and so puts them at risk of obesity in later life. However, although a genetic component is possible, it is unlikely to be great or to prevent weight loss from being feasible in most people if they reduce their energy intake. Environmental influences, such as eating habits, are believed to be more important in explaining the familial association in obesity.
An inactive lifestyle plays some role in the development of obesity, but it is unclear whether people are obese because they are inactive or are inactive because they are obese. Sadly, it can be possible to identify by the time of their first birthday many of the children destined to be obese. In the US, in 2013–14, 17% of children and adolescents were obese and 6% extremely obese with the numbers having doubled over 25 years. In the UK, more than 31% of children were adjudged overweight or obese in 2014.
Rarely, obesity has an endocrine basis and is caused by hypothyroidism (see under THYROID GLAND, DISEASES OF), HYPOPITUITARISM, HYPOGONADISM or CUSHING'S SYNDROME.
Obesity can make you ill and is even a cause of death in some, from conditions such as cardiovascular disease and non-insulin-dependent DIABETES MELLITUS. It may lead to diseases of the gall-bladder (see GALL-BLADDER, DISEASES OF), OSTEOARTHRITIS, HERNIA, GOUT and possibly certain cancers (i.e. colon, rectum and prostate in men, and breast, ovary, endometrium and cervix in women). Menstrual irregularities and ovulatory failure are often experienced by obese women. Obese people are also at greater risk when they undergo surgery. With the exception of gall-stone formation, weight loss will reduce these health risks.
The key is persistence over a prolonged period eating less. Thus, eating 1,000 kcal/day less than one expends in energy (see CALORIE) will produce a loss of 1 kg of fat/week. Theoretically, this could also be achieved by increasing energy expenditure (exercise) but, in practice, this is relatively ineffective without accompanying control of food intake.
Anorectic drugs and BARIATRIC SURGERY are sometimes used to treat severe obesity. Surgery is probably the most effective intervention in the extremely obese.