Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have a

negative effect on health, leading to reduced life expectancy and/or increased health problems.1
Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an
adverse effect on health. It is defined by body mass index (BMI) and further evaluated in terms of fat
distribution via the waisthip ratio and total cardiovascular risk factors. BMI is closely related to
both percentage body fat and total body fat.
In children, a healthy weight varies with age and sex. Obesity in children and adolescents is defined not as an
absolute number but in relation to a historical normal group, such that obesity is a BMI greater than the
95th percentile. The reference data on which these percentiles were based date from 1963 to 1994, and thus
have not been affected by the recent increases in weight.
BMI is defined as the subject's weight divided by the square of their
height and is calculated as follows.

BMI (kg/m2)

Classification

< 18.50

underweight

where m and h are the subject's weight in kilograms and height

in meters respectively.
18.5024.99

normal weight

BMI is usually expressed in kilograms per square metre. To

convert from pounds per square inch multiply by 703
(kg/m2)/(lb/sq in).

25.0029.99

overweight

The most commonly used definitions, established by the World

Health Organization (WHO) in 1997 and published in 2000;
provide the values listed in the table at right.

30.0034.99

class I obesity

35.0039.99

class II obesity

40.00

class III obesity

Some modifications to the WHO definitions have been made by

particular bodies. The surgical literature breaks down "class III"
obesity into further categories whose exact values are still
disputed.

Any BMI 35 or 40 kg/m2 is severe obesity

A BMI of 35 kg/m2 and experiencing obesity-related
health conditions or 4044.9 kg/m2 is morbid obesity
A BMI of 45 or 50 kg/m2 is super obesity

As Asian populations develop negative health consequences at a lower BMI than Caucasians, some
nations have redefined obesity; the Japanese have defined obesity as any BMI greater than 25 kg/m2
while China uses a BMI of greater than 28 kg/m2.2

An anthropological perspective on obesity considers both its evolutionary background and cross-cultural
variation. It must explain three basic facts about obesity: gender dimorphism (women greater than men), an
1
2

WHO 2000 p 6
http://en.wikipedia.org/wiki/Obesity#cite_note-WHO_2000_p.6-1

increase with modernization (sedentary lifestyle), and a positive association with socioeconomic status
(social determinants). Preindustrial diets varied in quality but shared a tendency to periodic shortages. Such
shortages, particularly disadvantageous to women in their reproductive years, favored individuals who, for
biological and cultural reasons, stored fat. Not surprisingly, the majority of the worlds cultures had or has
ideals of feminine beauty that include plumpness. This is consistent with the hypothesis that fat stores
functioned as a cushion against food shortages during pregnancy and lactation. As obesity has increased, the
traditional gap between males and females in its prevalence has narrowed. Under Western conditions of
abundance, our biological tendency to regulate body weight at levels above our ideal cannot be easily
controlled even with a complete reversal of the widespread cultural ideal of plumpness.3
Gender dimorphism is a term for the phenotypic difference between males and females of the same
species.
Men are, in general, more muscular than women. Women are just over half as strong as men in their upper
bodies, and about two-thirds as strong in their lower bodies.
While the male metabolism burns calories faster, the female metabolism tends to convert more food to fat.
Women store the extra fat in their breasts, hips, buttocks, and as subcutaneous fat in the bottom layer of their
skin giving a woman's skin its softer, plumper feel.
Male and female bodies are well-designed for each gender's role in a primitive society. Women are built for
carrying and birthing children, and must have wider hips and keep extra fat in store for the ordeal of pregnancy.
Men, free from the requirements of childbirth, benefit from being as strong and lithe as possible, both in their
search for food, and when in competition with other men.4
Women's lead in the obesity epidemic
Worldwide obesity has more than doubled since the 1980s, and rates continue to push upward throughout the
world. By 2008, an estimated 1.46 billion adults and 170 million children worldwide were overweight (BMI 25
kg/m2) or obese (BMI 30), with higher rates in women, though varying widely by country. For example, an
estimated 18% of women in France are obese, in Greece 26%, in Mexico 35%, and in Saudi Arabia 44%; in
contrast, the percentage in both Japan and China was 3%. In the USA, with an overall prevalence of 68.3%
overweight and 33.9% obesity, women show higher rates than men of severe obesity (BMI 35, 17.8% vs.
10.7%) and morbid obesity (BMI 40, 7.2% vs. 4.2%) differences of 78% and 71.4%, respectively.
However, longitudinal trends previously showing women's increased obesity prevalencethat initially
preceded men'slater slowed, leading to a decline in the gender gap, with women's prevalence over the last
12-year period increasing by only 6.3% vs. men's by 17.1% (19992008).

http://www.ncbi.nlm.nih.gov/pubmed/3300488#
http://www.livescience.com/33513-men-vs-women-our-physical-differences-explained.html

Women's body fat percentage vs. BMI as risk-predictive

Though the definition of obesity is uniform for women and men, women typically have higher body fat
percentage and lower fat-free mass (FFM) for the same BMI cut-off point. In NHANES III, women's average
body fat percentage, at 2080 years, was higher than men's by 44% (34.9% vs. 24.3%, respectively), despite
similar corresponding BMIs (26.27 vs. 26.83). Thus, women's BMI may not accurately reflect but rather may
partially mask their actual obesity. This may lead women to a condition of metabolically obese/normal
weightalready at a young agewherein despite having a normal BMI, they display body composition and
metabolic characteristics that may predispose them to development of metabolic syndrome (MetS).
Women's tendency toward obesity compared to men's is manifested by several metabolic patterns, including
lower fat oxidation, especially postprandially, with more efficient fat storage; lower resting energy expenditure
rates; higher response to insulin (as shown in glucose metabolism in both the liver and muscle) and to an
exercise with weight loss diet combination; higher adipose tissue-expanding capacity with long-term high-fat
feeding; and higher leptin levels, associated with higher inflammatory (C-reactive protein [CRP] and MetS risk,
that were independent of adiposity.
In metabolically obese normal-weight women, there is a tendency toward greater central fat mass, associated
with reduced insulin sensitivity, shown even with normal glucose tolerance. Further, they may have smaller
particles of low-density lipoprotein (LDL); higher concentrations of oxidised LDL, TNF-alpha, interleukin (IL)-6,
and leptin; and lower plasma adiponectin than women with normal visceral adiposity, all of which contribute to
increased obesity-related disease risk. Such hidden obesity was found in underactive Western women and in
Asian women, who were observed to have a higher body fat percentage for each BMI level, potentially
associated with prominent abdominal obesity, higher intramuscular and liver fat content, and predisposition to
insulin resistance and diabetes mellitus.
According to body fat percentage, the prevalence of at risk (preobese or obese) among normal BMI men and
women was 69% and 85%, respectively, suggesting that screening for adiposity in individuals with a normal
BMI could further identify those at higher risk for cardiometabolic disturbances and cardiovascular mortality,
especially among women, as the false-negative classification of BMI was stronger for women than for men.
Together, the above places women at risk for greater obesity and sequelae, especially with increasing
exposure to the global obesogenic environment.
Women's earlier and greater predisposition to obesity
Women's obesity tendencies begin much earlier than men's, already in the womb. Girls aged 10 years have
28% greater total fat and 30% more subcutaneous fat than boys, with similar amounts of visceral fat.
Dimorphism in total fat mass and in fat tissue distribution (visceral vs. subcutaneous) progresses from
prepuberty, where body fat percentage declines in boys as they gain muscle, but increases in girls;
correspondingly, early-maturing boys are thinner, whereas early-maturing girls are fatter, and menarche seems
to occur most frequently with 17% body fat. Further, adult women's age of increasing obesity is much earlier

than men's, rates higher at 2039 years of age by 23.7% for BMI 30 and 100% for BMI 35 and at 4059
years by 11.4% and 68.1%, respectively.
These epidemiological trends and gender differences underscore the importance of defining sex-specific
characteristics and women's earlier and stricter prevention and management of obesity and related risks, such
as MetS, diabetes mellitus, coronary heart disease (CHD), and cancer.5
A sedentary lifestyle is a type of lifestyle with no or irregular physical activity. A person who lives a sedentary
lifestyle may colloquially be known as a couch potato. It is commonly found in both the developed and
developing world. Sedentary activities include sitting, reading, watching television, playing video games,
and computer use for much of the day with little or no vigorous physical exercise. A sedentary lifestyle can
contribute to many preventable causes of death. Screen time is the amount of time a person spends watching
a screen such as a television, computer monitor, or mobile device. Excessive screen time is linked to negative
health consequences.6
Increase with modernization
As societies become increasingly reliant on energy-dense, big-portions, and fast-food meals, the association
between fast-food consumption and obesity becomes more concerning. In the United States consumption of
fast-food meals tripled and food energy intake from these meals quadrupled between 1977 and 1995.
Agricultural policy and techniques in the United States and Europe have led to lower food prices. In the United
States, subsidization of corn, soy, wheat, and rice through the U.S. farm bill has made the main sources of
processed food cheap compared to fruits and vegetables. Calorie count laws and nutrition facts labels attempt
to steer people toward making healthier food choices, including awareness of how much food energy is being
consumed.7
The Global Nutrition Transition

http://www.epmajournal.com/content/4/1/1
http://en.wikipedia.org/wiki/Sedentary_lifestyle
7
http://en.wikipedia.org/wiki/Obesity#cite_note-WHO_2000_p.6-1
6

Cheaper processed foods tend to be more energy-dense and nutrient-poor (high macro / low micro) providing
many calories but relatively few vitamins and minerals and other non essential but health promoting
compounds such as phytochemicals and antioxidants. US studies show the cost of fruits and vegetables to
have increased as a component of food budgets, while fats and oils, starches and sugars have decreased.
Cheap non-perishable food commodities are now being mass produced, ignoring the old nutritional adage that:
Good food goes bad!
The pervasive and powerful marketing of energy-dense foods, particularly to children, the composition,
presentation and supersizing of cheap energy-dense food and the proliferation of fast-food outlets are driving
the global adverse nutrient transition (Koplan, Liverman & Kraak 2005). This shift to processed foods is also
illustrated by the trends in UK sugar utilisation where the substantial decline in household purchase of sugar
has been matched by an increase in sugar being used in manufactured food and beverage products e.g. soft
drinks, snacks, confectionery (Lobstein T. and Jackson Leach R 2007).8
Social determinants
While genetic influences are important to understanding obesity, they cannot explain the current dramatic
increase seen within specific countries or globally. Though it is accepted that energy consumption in excess of
energy expenditure leads to obesity on an individual basis, the cause of the shifts in these two factors on the
societal scale is much debated. There are a number of theories as to the cause but most believe it is a
combination of various factors.
The correlation between social class and BMI varies globally. A review in 1989 found that in developed
countries women of a high social class were less likely to be obese. No significant differences were seen
among men of different social classes. In the developing world, women, men, and children from high social
classes had greater rates of obesity. An update of this review carried out in 2007 found the same
relationships, but they were weaker. The decrease in strength of correlation was felt to be due to the effects
of globalization. Among developed countries, levels of adult obesity, and percentage of teenage children who
are overweight, are correlated with income inequality. A similar relationship is seen among US states: more
adults, even in higher social classes, are obese in more unequal states.
Many explanations have been put forth for associations between BMI and social class. It is thought that in
developed countries, the wealthy are able to afford more nutritious food, they are under greater social pressure
to remain slim, and have more opportunities along with greater expectations for physical fitness.
In undeveloped countries the ability to afford food, high energy expenditure with physical labor, and cultural
values favoring a larger body size are believed to contribute to the observed patterns. Attitudes toward body
weight held by people in one's life may also play a role in obesity. A correlation in BMI changes over time has
been found among friends, siblings, and spouses. Stress and perceived low social status, appear to increase
risk of obesity.
Smoking has a significant effect on an individual's weight. Those who quit smoking gain an average of
4.4 kilograms (9.7 lb) for men and 5.0 kilograms (11.0 lb) for women over ten years. However, changing rates
of smoking have had little effect on the overall rates of obesity.
8

Obesity - A Public Health Crisis A report by: Weight Management Centre January 2010 www.wmc.uk.com

In the United States the number of children a person has is related to their risk of obesity. A woman's risk
increases by 7% per child, while a man's risk increases by 4% per child. This could be partly explained by the
fact that having dependent children decreases physical activity in Western parents.
In the developing world urbanization is playing a role in increasing rate of obesity. In China overall rates of
obesity are below 5%; however, in some cities rates of obesity are greater than 20%.9

Conclusion
Obesity experts now agree that the epidemic of obesity is a public health crisis (Haslam & James 2005). It is
causing an immense burden of morbidity and mortality resulting in enormous economic, social and human
costs.10
Disease is a disorder of structure or function in a human, animal, or plant, especially one that produces
specific signs or symptoms or that affects a specific location and is not simply a direct result of physical injury.
A disease is an abnormal condition that affects the body of an organism. It is often construed as a medical
condition associated with specific symptoms and signs.[1] It may be caused by factors originally from an
external source, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune
diseases. In humans, "disease" is often used more broadly to refer to any condition that causes pain,
dysfunction, distress, social problems, or death to the person afflicted, or similar problems for those in contact
with the person. In this broader sense, it sometimes includes injuries, disabilities, disorders, syndromes,
infections, isolated symptoms, deviant behaviors, and atypical variations of structure and function, while in
other contexts and for other purposes these may be considered distinguishable categories. Diseases usually
affect people not only physically, but also emotionally, as contracting and living with many diseases can alter
one's perspective on life, and one's personality.
Epidemic is a widespread occurrence of an infectious disease in a community at a particular time.
Is obesity a disease?
Only when childhood obesity becomes high on the public agenda will the
necessary research funds from government and private agencies become
available.
J. O. Hill and F. L. Trowbridge, Childhood Obesity, 1998
I argue that the obesity epidemic is a new breed of what I call
postmodern epidemics, epidemics in which unevenly medicalized
phenomena lacking a clear pathological basis get cast in the language and
moral panic of traditional epidemics.
Natalie Boero, All the News Thats Fat to Print, 200711
9

http://en.wikipedia.org/wiki/Obesity#cite_note-WHO_2000_p.6-1
Obesity - A Public Health Crisis A report by: Weight Management Centre January 2010 www.wmc.uk.com
11
The Childhood Obesity Epidemic: Health Crisis or Social Construction?
by Tina Moffat
Department of Anthropology
McMaster University
10

As quoted at the beginning of this article, Natalie Boero characterizes the obesity epidemic as a postmodern
epidemic, epidemics in which unevenly medicalized phenomena lacking a clear pathological basis get cast in
the language and moral panic of traditional epidemics (Boero 2007:41). I begin with Boeros use of the term
traditional epidemics. Martin and Martin-Granel (2006) trace the semantic shifts in the use of epidemic from
Homers Odyssey, used nonmedically as who is in the country through to Hippocratess (430 B.C.E.) use of
the term to mean a collection of medical syndromes. Today, we are familiar with the 19th century attribution of
an epidemic to a specific genus and species of a microorganism, and more recently these microbes have been
defined by molecular markers. Martin and Marin-Granel (2006), however, note the late-20th-century application
of the term epidemic to noninfectious diseases such as cancer and heart disease, and even to social problems
such as crack cocaine addiction. Here epidemic is used as a metaphor, and it is to this metaphoric usage that
critical theorists object.
What makes the use of the metaphor of the epidemic dangerous? Saguy and Riley (2005) argue that the use
of the epidemic as a metaphor creates a sense of general chaos and moral panic, or shame and blame that is
particularly acute around children. In fact, they warn that it could even invoke the abridgement of civil liberties,
as epidemics can do by prompting quarantine or the prohibition of certain The Childhood Obesity Epidemic 5
rights such as crossing national borders. Murray (2008) goes further to describe it as fat panic, arguing: The
notion of the epidemic exemplifies the function of disciplinary medicine as Foucault understands it. It has
powerful, productive implications, many of which remain tacit. If, for example, a community is in the grip of an
infectious disease epidemic, it is expected and understood that all members of this community will take
rigorous steps to protect themselves and their families from, and to prevent the spread of, the pathogen that
threatens not only their own bodies, but the body politic more generally. [Murray 2008:9]
Perhaps the more pressing concern, however, according to de Vries (2007) is the medicalization of obesity that
goes along with the use of the term epidemic.
By analogy, if childhood obesity is an epidemic then obesity must be a disease. Indeed, as de Vries (2007)
points out, there has been a subtle shift in the medical literature in the characterization of obesity as a risk
factor for a number of diseases, such as heart disease and diabetes, to obesity as a disease unto itself. De
Vries (2007) argues that as a society we tend to medicalize that which we find morally unacceptable. Defining
obesity as a disease is also a practical way to get coverage of obesity treatment by medical insurance, as in
2004 when U.S. Medicare declared obesity a disease and therefore subject to coverage (U.S. Department of
Health and Human Services 2004). Whatever the reason for conceiving of obesity as a disease, however, it
affects the way we treat and categorize children, as all obese children become patients who must be cured
(deVries 2007).12

12

The Childhood Obesity Epidemic: Health Crisis or Social Construction?

by Tina Moffat
Department of Anthropology
McMaster University