Humans against Obesity: Who Will Win?

https://doi.org/10.1093/advances/nmy055Get rights and content
Under an Elsevier user license
open archive

ABSTRACT

The global obesity epidemic continues its relentless advance, currently affecting >2 billion people. This paper explores alternative ways to assess the potential disease impact of the epidemic, which is currently based almost exclusively on body mass index (BMI) data. It also argues in favor of concerted efforts to modify the built ecosystem that is driving the obesity epidemic. Most of the epidemiologic data on obesity are based on BMI (in kg/m2) and use the ranges of 18.5–24.9 for normality, 25–29.9 for overweight, and ≥30 for obesity. But the gap between the median of the “normal” BMI distribution (∼22) and the current population BMI of, for example, the United States (27.7) has become so wide that it is unlikely that we will be able to close that gap in the near future. Furthermore, the correlation between BMI and disease risk is not linear. Over 60% of the global disease burden of obesity affects individuals with a BMI ≥30, who comprise only ∼10% of the global population of overweight/obese persons. Furthermore, BMI accounts for only ∼17% of the risk of insulin resistance and subsequent type 2 diabetes in the BMI ≥25 population. Epigenetics, specifically DNA methylation, appears to play a far more important role than BMI in determining the risk of obesity’s comorbidities, such as diabetes. Similarly, socioeconomic status carries a higher risk than BMI level for the development of obesity-related noncommunicable diseases. Finally, the built environment that sustains our species' lifestyle is a major driver of the obesity epidemic. Modifying that ecosystem will require no less than a social movement, one able to promote and sustain the necessary coordinated action of virtually all sectors of society.

epidemiology
international health
obesity
obesity epidemiology
public health

Cited by (0)

Published in a supplement to Advances in Nutrition. Presented at the International Union of Nutritional Sciences (IUNS) 21st International Congress of Nutrition (ICN) held in Buenos Aires, Argentina, October 15-20, 2017. The International Union of Nutritional Sciences (IUNS) thanks Mead Johnson Nutrition and Herbalife Nutrition for generously providing grants to support the publication and distribution of the present supplement from the 21st International Union of Nutritional Sciences. The contents of this supplement are solely the responsibility of the authors and do not necessarily represent official views of the IUNS. The supplement coordinators were Angel Gil and Alfredo Martinez. The supplement coordinators had no conflicts of interest to disclose.

Author disclosures: BC, no conflicts of interest.Publication costs for this supplement were defrayed in part by the payment of page charges. This publication must therefore be hereby marked “advertisement” in accordance with 18 USC section 1734 solely to indicate this fact. The opinions expressed in this publication are those of the authors and are not attributable to the sponsors or the publisher, Editor, or Editorial Board of Advances in Nutrition.

Abbreviations used: PA, physical activity; SES, socioeconomic status; T2D, type 2 diabetes.