Iii

>40.0

Extremely high

Adapted from Klein, S.; Wadden, T.; Sugerman, H. J. Gastroenterology 2002, 123, 882-932.

Adapted from Klein, S.; Wadden, T.; Sugerman, H. J. Gastroenterology 2002, 123, 882-932.

or more. Of the estimated 97 million adults who have a BMI of >25kgm_2, 44.3 million are obese. In general, the higher the BMI, the greater the risk of adiposity-related diseases and premature mortality (Table 2). However, the BMI does not capture the complete story. Other factors, such as physical fitness, fat distribution, and the time of life that the weight gain occurred can affect the overall risk profile. In general, higher levels of physical fitness decrease the risk profile while excess upper-body fat increases the risk of cardiovascular and diabetic diseases. Because of the importance of fat distribution in determining risk, this is often captured as waist circumference or waist-to-hip ratio. Weight gain during adulthood (greater than 18 years old) also increases the cardiovascular and diabetic risks.

Obesity is also associated with the metabolic syndrome, which consists of insulin resistance or type 2 diabetes, hypertension, high triglycerides, high uremic acid levels, and low levels of high-density lipoprotein cholesterol. A recent report35 outlines that the prevalence of the metabolic syndrome increases with age, affecting more than 40% of those older than 60 years. Based on age-adjusted estimates, about a quarter of the US population has the metabolic syndrome, representing approximately 47 million people. In the recently released third report36 of the National Cholesterol Education Program Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III), the metabolic syndrome is defined for the first time and its importance in the morbidity and mortality of cardiovascular disease is established. This report also highlights the importance of this syndrome as a new target of risk reduction therapy.

The root cause of obesity is the ingestion of more energy than is expended. Very small but chronic differences between energy intake and expenditure over long periods of time can lead to large increases in body fat. Ingestion of only 8 kcal of excess energy per day over a period of 30 years may lead to an increase of 10 kg in body weight. This is the average amount of weight American adults gain during the 30-year period from 25 to 55 years of age. The prevalence of obesity in the US increases progressively from 20 to 50 years of age, but begins to decline after 60-70. In all, approximately 61% (110 million) of adults in the US (10-74 years of age) are overweight or obese. Since 1960, the prevalence of overweight has increased slightly while the prevalence of obesity has more than doubled, from 12.8% to 27%. The prevalence of obesity is particularly high in many ethnic-minority women such as African-American, Mexican-American, Native American, Pacific Islander American, Puerto Rican, and Cuban-American women. In the UK and Europe, approximately 15% of men and 20% of women are obese. Obesity has also increased in South-East Asia, Japan, and China. In the adult population worldwide, it is estimated that there are more than 500 million overweight and greater than 250 million obese people. It is also likely that these numbers will continue to increase.

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