Elsevier

Atherosclerosis

Volume 146, Issue 2, October 1999, Pages 201-209
Atherosclerosis

Review article
Obesity is an environmental issue

https://doi.org/10.1016/S0021-9150(99)00258-0Get rights and content

Abstract

Obesity is an environmental issue. Societies that are transitioning to westernized lifestyles are experiencing substantial increases in its prevalence. The primary environmental determinants of obesity are high calorie intake and low levels of activity. Socioeconomic status and place of residence are important contributors. These factors together comprise an obesogenic or ‘toxic’ environment where the development of obesity is the expected course for humans leading lifestyles incompatible with their evolutionary development. Only by addressing and modifying the toxic environment will we be able to stem the obesity epidemic.

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.

References (88)

  • C.S. Fox et al.

    Is a low leptin concentration, a low resting metabolic rate, or both the expression of the ‘thrifty genotype’? Results from Mexican Pima Indians

    Am. J. Clin. Nutr.

    (1998)
  • S.T. McGarvey

    Obesity in Samoans and a perspective on its etiology in polynesians

    Am. J. Clin. Nutr.

    (1991)
  • D.J. Galanis et al.

    Ten-year changes in the obesity, abdominal adiposity, and serum lipoprotein cholesterol measures of Western Samoan men

    J. Clin. Epidemiol.

    (1995)
  • J.B. Allred

    Too much of a good thing? An overemphasis on eating low-fat foods may be contributing to the alarming increase in overweight among US adults

    J. Am. Diet Assoc.

    (1995)
  • A.M. Stephen et al.

    Trends in individual consumption of dietary fat in the United States, 1920–1984

    Am. J. Clin. Nutr.

    (1990)
  • L.R. Young et al.

    Food labels consistently underestimate the actual weights of single-serving baked products

    J. Am. Diet Assoc.

    (1995)
  • G. Turrell

    Structural, material, and economic influences on the food-purchasing choices of socioeconomic groups

    Aust. N.Z. J. Med.

    (1996)
  • A. Golay et al.

    Similar weight loss with low- or high-carbohydrate diets

    Am. J. Clin. Nutr.

    (1996)
  • National Institutes of Health (NIH), National Heart, Lung, and Blood Institute (NHLBI). Clinical guidelines on the...
  • World Health Organization (WHO). Obesity: Preventing and managing the global epidemic. Report of a WHO consultation on...
  • American Heart Association (AHA). Obesity and heart disease. Circulation...
  • American Heart Association (AHA). American Heart Association Call to Action: Obesity as a major risk factor for...
  • Bouchard C. Genetics of obesity: Overview and research direction. In Bouchard CB, editor. The Genetics of Obesity. Boca...
  • C.S. Crandall et al.

    Anti-fat prejudice: Beliefs, values, and American culture

    Obes. Res.

    (1998)
  • Sallis JF, Owen N. Ecological models. In: Glanz K, Lewis FM, Rimer BK, editors. Health behavior and health education:...
  • Skinner BF. Science and human behavior. New York: Free Press,...
  • R.E. Ferrell

    Obesity: Choosing genetic approaches from a mixed menu

    Hum. Bio.

    (1993)
  • P. James

    Discussion

    Nutr. Rev.

    (1998)
  • Y.C. Chagnon et al.

    The human obesity gene map: The update

    Obes. Res.

    (1997)
  • Bouchard C, Pérusse L. The genetics of human obesity. In: Bray GA, Bouchard C, James WPT, editors. Handbook of obesity....
  • C. Bouchard

    Genetics of obesity: An update on molecular markers

    Int. J. Obes. Relat. Metab. Disord.

    (1995)
  • D.A. Greenberg

    Linkage analysis of ‘necessary’ disease loci versus ‘susceptability’ loci

    Am. J. Hum. Genet.

    (1993)
  • D. Carmelli et al.

    Clustering of hypertension, diabetes, and obesity in adult male twins: Same genes or same environments?

    Am. J. Hum. Genet.

    (1994)
  • C. Bouchard

    Genetics and the metabolic syndrome

    Int. J. Obes. Relat. Metab. Disord.

    (1995)
  • Brown PJ, Bentley-Condit VK. Culture, evolution, and obesity. In: Bray GA, Bouchard C, James WPT, editors. Handbook of...
  • J.K. Hewitt

    The genetics of obesity: What have genetic studies told us about the environment

    Behav. Genet.

    (1997)
  • C.L. Ogden et al.

    Prevalence of overweight among preschool children in the United States, 1971–1994

    Pediatrics

    (1997)
  • R.P. Troiano et al.

    Overweight prevalence and trends for children and adolescents: The National Health and Nutrition Examination Surveys, 1963–1991

    Arch. Pediatr. Adolesc. Med.

    (1995)
  • J.P. Foreyt et al.

    Diet, genetics, and obesity

    Food Technol.

    (1997)
  • Hathaway ML, Foard ED. Heights and weights of adults in the United States. Home economics research report No. 10....
  • Eaton SB, Konner M, Shostak M. The paleolithic prescription. New York: Harper & Row,...
  • B.M. Popkin

    The nutrition transition and its health implications in lower-income countries

    Public Health Nutr.

    (1998)
  • S.B. Eaton

    Humans, lipids and evolution

    Lipids

    (1992)
  • Lenfant C, Ernst N. Daily dietary fat and total food-energy intakes — Third National Health and Nutrition Examination...
  • Cited by (171)

    • Rewards that are near increase impulsive action

      2021, iScience
      Citation Excerpt :

      Under our hypothesis, we expected participants to behave more impulsively when appetitive cues for smaller-sooner reward amounts were near compared with when the same kinds of cues were far from participants. With human discounting behavior being reasonably well characterized by a hyperbolic function (Green et al., 2005; Hill et al., 2003; Lake and Townshend, 2016; Walker and Foreyt, 1999), we used the hyperbolic model (Mazur, 1987; Westbrook and Frank, 2018) to obtain individual estimates of discounting rates (parameter k) for both near and far conditions, as a measure of impulsive choice (for detailed estimation procedures see Supplemental information). Across participants we observed little difference in impulsive behavior between the near (sqrt(k) = −2.218) and far (sqrt(k) = −3.390) distance manipulations (Figure 4).

    • Design and Implementation of Obesity Healthcare System (OHS) Using Flutter Platform

      2023, Lecture Notes of the Institute for Computer Sciences, Social-Informatics and Telecommunications Engineering, LNICST
    View all citing articles on Scopus
    View full text