Review articleObesity is an environmental issue
Introduction
Obesity, defined as a body mass index (BMI)≥30, is a serious health concern in industrialized nations [1]. Age-adjusted prevalence rates for men and women in the US are 19.5 and 25.0%, respectively [1], [2]. Based on prevalence data over the past 30 years, Foreyt and Goodrick [3] predicted that the entire US population will be obese by the 23rd century. Obesity extracts significant societal and personal costs in the forms of increased risk for disease and death, health care costs associated with increased frequency of comorbid medical and psychiatric conditions, and reduced social status, educational attainment, and employment opportunities [1], [2]. Recognizing these significant costs, the American Heart Association (AHA) recently reclassified obesity as a major modifiable risk factor for coronary heart disease [4], [5].
Obesity is not a unitary disease and its causes are multifactorial, including polygenic, metabolic, psychosocial, and environmental influences [6], [7], [8]. While recent research has emphasized the etiological role of genetic influences, in the form of susceptibility genes, and gene-environment interactions, we believe that the environment significantly overwhelms the minor influence of genes. The purpose of this article is to review the role of the environment and evaluate its importance in understanding and treating obesity.
Section snippets
Genes are not the answer
It is tempting to promote genetic explanations because, as some investigators suggest, they may help reduce bias and prejudice against obese individuals by emphasizing that obesity is not due to lack of willpower or poor self-control [9]. We agree that prejudice against obese persons is an important issue, but acknowledging that the environment plays a significant role in the etiology of obesity should not shift blame for obesity onto the individual. Environmental models suggest that fat
It’s the environment!
Obesity is a relatively recent public health concern [20]. In non-industrial and non-western societies, obesity is uncommon as a health problem and it is essentially absent in societies that still exist as hunter/gatherers [2], [21]. In contrast, the prevalence of obesity in the US increased from 14.4 to 22.3% between 1980 and 1991, an increase of 7.9 percentage points [1]. The Framingham Study, a longitudinal cohort investigation, reported that severe overweight (i.e. BMI≥31.1 for men and 32.2
Effects of the toxic environment: natural experiments
The ‘toxic environment’ refers to aspects of western living that promote unhealthy eating and activity patterns [35]. The environment in industrialized nations like the US is characterized by unlimited access to highly palatable and very calorically-dense foods [34]. At the same time, most Americans expend very little energy during a typical day because of the abundance of labor-saving devices such as cars, elevators, escalators, television remote controls, and garage door openers. This
Caloric consumption
People in industrialized and westernized nations eat too much food and too many calories. Food supply or disappearance data suggest that total caloric production increased by almost 500 calories per person per day in the US between the 1930’s (∼3200 kcal/day) and 1990’s (∼3700 kcal/day) [53]. While some experts debate the trend in dietary fat intake [54], [55], total caloric consumption per person increased by ∼200 kcal/day just in the last decade [32], [56], [57]. Although the percentage of
Can we fix the environment?
Because the environment plays the major role in the etiology of obesity, we believe that developed nations need to change factors that are disease promoting. Unfortunately, this is not a simple task because individuals in developed societies are not going to return to hunter–gatherer lifestyles. Results of health promotional and educational obesity interventions do not suggest that long-term behavioral change is possible with limited interventions [1], [79]. Long-term weight maintenance
Summary
In summary, we believe that obesity is primarily an environmental problem. Despite the recent interest and progress in genetic research, major public health advances only will occur when we take the environment seriously [10]. We believe that acknowledging the significant role of the environment in the etiology of obesity will help us to stop focusing on the individual, which is encouraged by genetic and biological explanations [88], and to begin focusing on changing the toxic environment.
Acknowledgements
The authors wish to acknowledge that this work was partially supported by a Minority Scientist Development Award to Dr Poston from the American Heart Association and with funds contributed by the AHA, Puerto Rico Affiliate, and a grant from the National Heart, Lung, and Blood Institute, HL47052.
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