by Pierpaolo Sesana
What is Obesity?
Overweight and obesity are defined by the World Health Organization as “abnormal or excessive fat accumulation that presents a health risk.” For most people, these conditions are caused by an imbalance between the energy consumed through diet and the energy expended through physical activity, however, several other factors, such as obesogenic environments, psychosocial factors, and genetic variations, also play crucial roles in the development of obesity. In the United States alone, poor eating habits and a lack of physical activity contribute to approximately 300,000 deaths each year, and in light of these numbers, the impact of obesity on health is as severe as poverty, smoking, or alcohol abuse, while the correlated health risks are well-documented and known.
In 2019, an estimated 5 million deaths from noncommunicable diseases (NCDs), such as cardiovascular diseases, diabetes, cancers, neurological disorders, chronic respiratory diseases, and digestive disorders, were attributed to a higher-than-optimal BMI. Even modest weight gain can significantly increase the risk of developing obesity-related diseases; for instance, gaining 5 to 8 kg can double the risk of developing type 2 diabetes, while a gain of 20 kg or more can quadruple it. The effects on heart health are similarly concerning, 4 to 9 kg of weight gain increases a woman’s risk of coronary heart disease by 1.25 times and a man’s by 1.6 times. The greater the weight gain, the higher the risk becomes, and women with a BMI of 34 or higher face over six times the risk of developing endometrial cancer. Furthermore, obesity exacerbates chronic conditions like hypertension and high cholesterol, while also leading to social stigmatization, discrimination, and negative body image.
Obesity: A Challenge for Everybody
For centuries, the drive to increase body size was essential for human survival. Just over a hundred years ago, malnutrition and deficiency diseases were significant threats to human development, and events like the Great Irish Famine devastated countries like Ireland, reducing the population by about 20% and leading to widespread death and mass migration. In the past century, humanity has managed to largely overcome famine, leading to a new modern paradox: today, more people die from obesity than from starvation, a reality that would have been unimaginable just a century ago.
Nowadays, one out of every eight people globally is affected by obesity. Adult obesity rates have more than doubled since 1990, while obesity among adolescents has increased fourfold. In total, 2.5 billion adults were overweight in 2022, with 890 million of them classified as obese. Only in the US, 42% of the adult population is considered obese, while in 1980, 15% of them qualified as such. A recent report from the World Obesity Federation states that if global trends keep growing at this pace, by 2035, about half of the worldwide population will be overweight or obese. However, even if it’s true that, around the world, obesity rates keep rising, in high-income countries such as the US, the increases in BMI are slowing down, and to some extent, even starting to plateau, at the same time, the global growth is being driven by the rapid increase among low and middle-income countries.
The Cost of Health: How Culture, Economics, and Gender Shape Global Eating Habits
In many developing countries, the cost of eating healthy is shockingly out of reach, making it difficult for billions to maintain a nutritious diet. Research reveals that in these regions, getting a calorie from eggs is nearly 12 times more expensive than from starchy staples, while sugary snacks are relatively cheap at just under three times the cost. In contrast, in wealthier nations, the price gap is much smaller, with eggs only being about 2.6 times more expensive and sugary snacks just 1.43 times more. This stark difference in food affordability is a significant driver behind the rising consumption of unhealthy foods in developing countries. Sugar-sweetened beverages are increasingly popular, and global sales of packaged foods—often loaded with added sugars, unhealthy fats, and low in essential nutrients—jumped from 67.7 kg per person in 2005 to 76.9 kg in 2017.
But it’s not just about cost, culture plays a significant role too. In some places, a chubby child is seen as a sign of prosperity, and indulging in unhealthy foods can even carry social prestige. Additionally, in cultures where physical inactivity is linked to high social status, burning off those extra calories becomes even less likely. Interestingly, women in nearly all developing countries are more prone to being overweight or obese compared to men. This gender disparity is shaped by a variety of factors: from different physiological and hormonal responses to early-life nutrition and energy expenditure to the weight gain associated with pregnancies, lower physical activity levels, depression, economic challenges, and societal ideals about body size and fitness. All these elements combine to create a complex picture of obesity and health that varies widely across different parts of the world.
A Call to Action
Addressing the global obesity crisis requires a multifaceted approach. Environmental changes are crucial in mitigating the obesity epidemic and targeted public policies can drive significant improvements. Recent FDA regulations mandating calorie and nutrition labeling on all food products have increased consumer awareness, while the ban on trans fats in restaurants and grocery stores has removed a harmful ingredient from the diet. Focusing on obesity prevention in children is also crucial, and local governments can support this by restricting fast-food establishments near schools and promoting healthy food vendors. Enhancing physical education programs also contributes to healthier habits, additionally, implementing taxes on sugar-sweetened beverages and subsidizing healthy foods can deter unhealthy eating. Designing activity-friendly communities with bike paths and walking trails further supports active lifestyles, showcasing how comprehensive environmental and policy changes can effectively address and prevent obesity.
However, it's not just about individual choices or about creating environments where healthy options are accessible and affordable. Other interventions like pharmaceuticals and surgery have a significant role in fighting such a complex disease. The conversation around obesity and weight loss is rapidly evolving, particularly with the advent of GLP-1 receptor agonists. These innovative medications are shifting public perceptions by framing obesity not as merely a lifestyle choice, but as a legitimate disease. This change in perspective aligns with the long-standing views of clinicians and health experts who have long recognized the complex, multifaceted nature of obesity. As these drugs gain traction, they not only offer new avenues for effective treatment but also contribute to a broader acceptance and understanding of obesity as a serious health condition, rather than just a matter of personal willpower.
A Unified Response
The global obesity crisis presents one of the most pressing health challenges of these times. With its roots in the complex interplay of dietary habits, physical activity, environmental factors, and genetics, obesity is far more than just a personal issue, it is a societal problem that demands collective action. As the understanding of obesity deepens, it becomes increasingly clear that addressing this epidemic requires more than just encouraging individual willpower, it involves creating environments that make healthy choices accessible and affordable for everyone while also acknowledging and treating obesity as the complex, multifaceted disease that it is. The fight against obesity is a fight for better health, quality of life, and longevity on a global scale. By taking coordinated action across various sectors, it is possible to make significant strides in reversing the current trends and safeguarding the health of future generations.
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