{"id":184,"date":"2021-02-17T02:50:07","date_gmt":"2021-02-17T02:50:07","guid":{"rendered":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/?post_type=chapter&p=184"},"modified":"2021-02-18T15:32:27","modified_gmt":"2021-02-18T15:32:27","slug":"obesity","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/chapter\/obesity\/","title":{"raw":"Obesity","rendered":"Obesity"},"content":{"raw":"Obesity<\/b>\u00a0is a\u00a0medical condition\u00a0in which excess\u00a0body fat\u00a0has accumulated to an extent that it may have a negative effect on health.[1]<\/a><\/sup>\u00a0People are generally considered obese when their\u00a0body mass index<\/a>\u00a0(BMI), a measurement obtained by dividing a person's weight by the square of the person's height\u2014despite known\u00a0allometric<\/a>\u00a0inaccuracies[a]<\/a><\/sup>\u2014is over\u00a030\u00a0kg\/m2<\/sup><\/span>; the range\u00a025\u201330\u00a0kg\/m2<\/sup><\/span>\u00a0is defined as\u00a0overweight.[1]<\/a><\/sup>\u00a0Some\u00a0East Asian\u00a0countries use lower values.[10]<\/a><\/sup>\u00a0Obesity is correlated with\u00a0various diseases and conditions, particularly\u00a0cardiovascular diseases<\/a>,\u00a0type 2 diabetes<\/a>,\u00a0obstructive sleep apnea<\/a>, certain types of\u00a0cancer<\/a>, and\u00a0osteoarthritis<\/a>.[2]<\/a><\/sup>\u00a0High BMI is a marker of risk, but not proven to be a direct cause, for diseases caused by diet, physical activity, and environmental factors.[11]<\/a><\/sup>\u00a0A reciprocal link has been found between obesity and\u00a0depression<\/a>, with obesity increasing the risk of clinical depression and also depression leading to a higher chance of developing obesity.[3]<\/a><\/sup>\r\n\r\nObesity has individual, socioeconomic, and environmental causes, including diet, physical activity,\u00a0automation,\u00a0urbanization,\u00a0genetic susceptibility,\u00a0medications<\/a>,\u00a0mental disorders<\/a>,\u00a0economic policies<\/a>,\u00a0endocrine disorders<\/a>, and exposure to\u00a0endocrine-disrupting chemicals<\/a>.[1]<\/a><\/sup>[4]<\/a><\/sup>[12]<\/a><\/sup>[13]<\/a><\/sup>\u00a0While a majority of obese individuals at any given time are attempting to lose weight and often successful, research shows that maintaining that weight loss over the long term proves to be rare.[14]<\/a><\/sup>\u00a0The reasons for\u00a0weight cycling<\/a>\u00a0are not fully understood but may include decreased energy expenditure combined with increased biological urge to eat during and after caloric restriction.[14]<\/a><\/sup>\u00a0More studies are needed to determine if weight cycling and\u00a0yo-yo dieting<\/a>\u00a0contribute to inflammation and disease risk in obese individuals.[14]<\/a><\/sup>\r\n
Yo-yo dieting<\/b>\u00a0or\u00a0yo-yo effect<\/b>, also known as\u00a0weight cycling<\/b>, is a term coined by\u00a0Kelly D. Brownell\u00a0at\u00a0Yale University, in reference to the cyclical loss and gain of weight, resembling the up-down motion of a\u00a0yo-yo<\/a>. In this process, the dieter is initially successful in the pursuit of\u00a0weight loss\u00a0but is unsuccessful in maintaining the loss long-term and begins to gain the weight back. The dieter then seeks to lose the regained weight, and the cycle begins again.<\/div>\r\n
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Effects of Yo yo dieting on health<\/span><\/h2>\r\nThis kind of diet is associated with extreme food deprivation as a substitute for\u00a0healthy diet\u00a0and\u00a0exercise\u00a0techniques. As a result, the dieter may experience loss of both\u00a0muscle\u00a0and\u00a0body fat\u00a0during the initial weight-loss phase (weight-bearing exercise is required to maintain muscle). After completing the diet, the dieter is likely to experience the body's\u00a0starvation response, leading to rapid weight gain of only fat. This is a cycle that changes the body's fat-to-muscle ratio, one of the more important factors in health. A report by the\u00a0American Psychological Association<\/a>\u00a0reviewed thirty-one diet studies and found that after two years of dieting up to a third of dieters weighed more than they did before they began the diet, another third regained the weight they lost, and the last third kept the loss weight off[3]<\/a><\/sup>\u00a0One study in rats showed those made to yo-yo diet were more efficient at gaining weight.[4]<\/a><\/sup>\u00a0However the research compiled by Atkinson et al. (1994)[5]<\/a><\/sup>\u00a0showed that there are \u201cno adverse effects of weight cycling on body composition, resting metabolic rate, body fat distribution, or future successful weight loss\u201d, and that there is not enough evidence to show risk factors for cardiovascular disease being directly dependent on cyclical dieting patterns. A more recent review concluded \"...evidence for an adverse effect of weight cycling appears sparse, if it exists at all\".[6]<\/a><\/sup>\r\n\r\nSince there is \"no single definition of weight cycling [that] can be endorsed\", it is almost impossible for research to draw specific conclusions about the actual effects of cyclical dieting, until it becomes more definitely defined.[5]<\/a><\/sup>\r\n\r\n<\/div>\r\n

Effects of Obesity on health<\/span><\/h2>\r\nExcessive body\u00a0weight\u00a0is associated with various\u00a0diseases and conditions, particularly\u00a0cardiovascular diseases<\/a>,\u00a0diabetes mellitus type 2<\/a>,\u00a0obstructive sleep apnea<\/a>, certain types of\u00a0cancer<\/a>,\u00a0osteoarthritis<\/a>,[2]<\/a><\/sup>\u00a0and\u00a0asthma<\/a>.[2]<\/a><\/sup>[36]<\/a><\/sup>\u00a0As a result, obesity has been found to reduce\u00a0life expectancy<\/a>.[2]<\/a><\/sup>\r\n

Mortality<\/span><\/h3>\r\nObesity is one of the leading\u00a0preventable causes of death\u00a0worldwide.[38]<\/a><\/sup>[39]<\/a><\/sup>[40]<\/a><\/sup>\u00a0A number of reviews have found that mortality risk is lowest at a BMI of 20\u201325\u00a0kg\/m2<\/sup>[41]<\/a><\/sup>[42]<\/a><\/sup>[43]<\/a><\/sup>\u00a0in non-smokers and at 24\u201327\u00a0kg\/m2<\/sup>\u00a0in current smokers, with risk increasing along with changes in either direction.[44]<\/a><\/sup>[45]<\/a><\/sup>\u00a0This appears to apply in at least four continents.[43]<\/a><\/sup>\u00a0In contrast, a 2013 review found that grade 1 obesity (BMI 30\u201335) was not associated with higher mortality than normal weight, and that overweight (BMI 25\u201330) was associated with \"lower\" mortality than was normal weight (BMI 18.5\u201325).[46]<\/a><\/sup>\u00a0Other evidence suggests that the association of BMI and waist circumference with mortality is U- or J-shaped, while the association between\u00a0waist-to-hip ratio<\/a>\u00a0and\u00a0waist-to-height ratio<\/a>\u00a0with mortality is more positive.[47]<\/a><\/sup>\u00a0In Asians the risk of negative health effects begins to increase between 22\u201325\u00a0kg\/m2<\/sup>.[48]<\/a><\/sup>\u00a0A BMI above 32\u00a0kg\/m2<\/sup>\u00a0has been associated with a doubled\u00a0mortality rate\u00a0among women over a 16-year period.[49]<\/a><\/sup>\u00a0In the United States, obesity is estimated to cause 111,909 to 365,000 deaths per year,[2]<\/a><\/sup>[40]<\/a><\/sup>\u00a0while 1\u00a0million (7.7%) of deaths in Europe are attributed to excess weight.[50]<\/a><\/sup>[51]<\/a><\/sup>\u00a0On average, obesity reduces life expectancy by six to seven\u00a0years,[2]<\/a><\/sup>[52]<\/a><\/sup>\u00a0a BMI of 30\u201335\u00a0kg\/m2<\/sup>\u00a0reduces life expectancy by two to four years,[42]<\/a><\/sup>\u00a0while severe obesity (BMI\u00a0>\u00a040\u00a0kg\/m2<\/sup>) reduces life expectancy by ten years.[42]<\/a><\/sup><\/sup>\r\n
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allostatic load<\/h3>\r\nThe term allostatic load<\/strong> is \"the wear and tear on the body\" which accumulates as an individual is exposed to repeated or chronic\u00a0stress.[1]<\/a><\/sup>\u00a0It was coined by McEwen and Stellar in 1993.[2]<\/a><\/sup>\r\n\r\nThe term is part of the regulatory model of\u00a0allostasis<\/a>, where the predictive regulation or stabilisation of internal sensations in response to stimuli is ascribed to the brain.[3]<\/a><\/sup>\u00a0Allostasis involves the regulation of\u00a0homeostasis<\/a>\u00a0in the body to decrease physiological consequences on the body.[4]<\/a><\/sup>[5]<\/a><\/sup>\u00a0Predictive regulation refers to the brain's ability to anticipate needs and prepare to fulfill them before they arise.[3]<\/a><\/sup>\r\n\r\nPart of efficient regulation is the reduction of uncertainty. Humans naturally do not like feeling as if surprise is inevitable. Because of this, we constantly strive to reduce the uncertainty of future outcomes, and allostasis helps us do this by anticipating needs and planning how to satisfy them ahead of time.[6]<\/a><\/sup>\u00a0But it takes a considerable amount of the brain's energy to do this, and if it fails to resolve the uncertainty, the situation may become chronic and result in the accumulation of allostatic load.[6]<\/a><\/sup>\r\n\r\nThe concept of allostatic load provides that \"the neuroendocrine, cardiovascular, neuroenergetic, and emotional responses become persistently activated so that blood flow turbulences in the coronary and cerebral arteries, high blood pressure, atherogenesis, cognitive dysfunction and depressed mood accelerate disease progression.\"[6]<\/a><\/sup>\u00a0All long-standing effects of continuously activated\u00a0stress<\/a>\u00a0responses are referred to as allostatic load. Allostatic load can result in permanently altered brain architecture and systemic pathophysiology.[6]<\/a><\/sup>\r\n\r\nAllostatic load minimizes an organism's ability to cope with and reduce uncertainty in the future.[6]<\/a><\/sup>\r\n

Allostatic load is generally measured through a composite index of indicators of cumulative strain on several organs and tissues, primarily biomarkers associated with the neuroendocrine, cardiovascular, immune and metabolic systems.<\/span>[12]<\/a><\/sup><\/sup>Indices of allostatic load are diverse across studies and are frequently assessed differently, using different biomarkers and different methods of assembling an allostatic load index. Allostatic load is not unique to humans and may be used to evaluate the physiological effects of chronic or frequent stress in non-human primates as well.<\/span>[12]<\/a><\/sup>In the endocrine system, the increase or repeated levels of stress results in the increased levels of the hormone Corticotropin-Releasing Factor (CRH), which is associated with activation of HPA axis.<\/span>[5]<\/a><\/sup>\u00a0The\u00a0<\/span>Hypothalamic\u2013pituitary\u2013adrenal axis<\/a>\u00a0is the central stress response system responsible for modulating inflammatory responses throughout the body. Prolonged stress levels can lead to decreased levels of cortisol in the morning and increased levels in the afternoon, leading to greater daily output of cortisol which in the long term increases blood sugar levels.<\/span>In the nervous system, structural and functional abnormalities are a result of chronic prolonged stress. The increase of stress levels causes a shortening of dendrites in a neuron. Therefore, the shortening of dendrites causes the decrease in attention.<\/span>[5]<\/a><\/sup>\u00a0Chronic stress also causes greater response to fear of the unlearned in the nervous system, and fear conditioning.<\/span>In the immune system, the increase in levels of chronic stress results in the elevation of inflammation. The increase in inflammation levels is caused by the ongoing activation of the sympathetic nervous system.<\/span>[5]<\/a><\/sup>\u00a0The impairment of cell-mediated acquired immunity is also a factor resulting in the immune system due to chronic stress.<\/span>[5]<\/a><\/sup><\/p>\r\n\r\n<\/div>\r\n \r\n\r\n<\/div>\r\n

Morbidity<\/span><\/h3>\r\nObesity increases the risk of many physical and mental conditions. These comorbidities are most commonly shown in\u00a0metabolic syndrome<\/a>,[2]<\/a><\/sup>\u00a0a combination of medical disorders which includes:\u00a0diabetes mellitus type 2<\/a>,\u00a0high blood pressure<\/a>,\u00a0high blood cholesterol<\/a>, and\u00a0high triglyceride levels<\/a>.[53]<\/a><\/sup>\r\n\r\nComplications are either directly caused by obesity or indirectly related through mechanisms sharing a common cause such as a poor diet or a\u00a0sedentary lifestyle<\/a>. The strength of the link between obesity and specific conditions varies. One of the strongest is the link with\u00a0type 2 diabetes<\/a>. Excess body fat underlies 64% of cases of diabetes in men and 77% of cases in women.[54]<\/a><\/sup>\r\n\r\nHealth consequences fall into two broad categories: those attributable to the effects of increased fat mass (such as\u00a0osteoarthritis<\/a>,\u00a0obstructive sleep apnea<\/a>, social stigmatization) and those due to the increased number of\u00a0fat cells<\/a>\u00a0(diabetes<\/a>,\u00a0cancer<\/a>,\u00a0cardiovascular disease<\/a>,\u00a0non-alcoholic fatty liver disease<\/a>).[2]<\/a><\/sup>[55]<\/a><\/sup>\u00a0Increases in body fat alter the body's response to insulin, potentially leading to\u00a0insulin resistance<\/a>. Increased fat also creates a\u00a0proinflammatory state<\/a>,[56]<\/a><\/sup>[57]<\/a><\/sup>\u00a0and a\u00a0prothrombotic<\/a>\u00a0state.[55]<\/a><\/sup>[58]<\/a><\/sup>\r\n\r\nObesity increases the risk of developing serious illness from\u00a0coronavirus disease 2019<\/a>.[59]<\/a><\/sup>\r\n

Causes of Obesity<\/span><\/h2>\r\nAt an individual level, a combination of excessive\u00a0food energy<\/a>\u00a0intake and a lack of\u00a0physical activity<\/a>\u00a0is thought to explain most cases of obesity.[88]<\/a><\/sup>\u00a0A limited number of cases are due primarily to genetics, medical reasons, or psychiatric illness.[13]<\/a><\/sup>\u00a0In contrast, increasing rates of obesity at a societal level are felt to be due to an easily accessible and palatable diet,[89]<\/a><\/sup>\u00a0increased\u00a0reliance on cars<\/a>, and mechanized manufacturing.[90]<\/a><\/sup>[91]<\/a><\/sup>\r\n\r\nA 2006 review identified ten other possible contributors to the recent increase of obesity: (1)\u00a0insufficient sleep<\/a>, (2)\u00a0endocrine disruptors<\/a>\u00a0(environmental\u00a0pollutants<\/a>\u00a0that interfere with lipid metabolism), (3) decreased variability in ambient temperature, (4) decreased rates of\u00a0smoking<\/a>, because smoking suppresses appetite, (5) increased use of medications that can cause weight gain (e.g.,\u00a0atypical antipsychotics<\/a>), (6) proportional increases in ethnic and age groups that tend to be heavier, (7) pregnancy at a later age (which may cause susceptibility to obesity in children), (8)\u00a0epigenetic<\/a>\u00a0risk factors passed on generationally, (9)\u00a0natural selection<\/a>\u00a0for higher BMI, and (10)\u00a0assortative mating<\/a>\u00a0leading to increased concentration of obesity risk factors (this would increase the number of obese people by increasing population variance in weight).[92]<\/a><\/sup>\u00a0According to the Endocrine Society, there is \"growing evidence suggesting that obesity is a disorder of the\u00a0energy homeostasis<\/a>\u00a0system, rather than simply arising from the passive accumulation of excess weight\".[93]<\/a><\/sup>\r\n

Sedentary lifestyle<\/span><\/h3>\r\nA\u00a0sedentary lifestyle<\/a>\u00a0plays a significant role in obesity.[114]<\/a><\/sup>\u00a0Worldwide there has been a large shift towards less physically demanding work,[115]<\/a><\/sup>[116]<\/a><\/sup>[117]<\/a><\/sup>\u00a0and currently at least 30% of the world's population gets insufficient exercise.[116]<\/a><\/sup>\u00a0This is primarily due to increasing use of mechanized transportation and a greater prevalence of labor-saving technology in the home.[115]<\/a><\/sup>[116]<\/a><\/sup>[117]<\/a><\/sup>\u00a0In children, there appear to be declines in levels of physical activity due to less walking and physical education.[118]<\/a><\/sup>\u00a0World trends in active leisure time\u00a0physical activity<\/a>\u00a0are less clear. The\u00a0World Health Organization<\/a>\u00a0indicates people worldwide are taking up less active recreational pursuits, while a study from Finland[119]<\/a><\/sup>\u00a0found an increase and a study from the United States found leisure-time physical activity has not changed significantly.[120]<\/a><\/sup>\u00a0A 2011 review of physical activity in children found that it may not be a significant contributor.[121]<\/a><\/sup>\r\n\r\nIn both children and adults, there is an association between television viewing time and the risk of obesity.[122]<\/a><\/sup>[123]<\/a><\/sup>[124]<\/a><\/sup>\u00a0A review found 63 of 73 studies (86%) showed an increased rate of childhood obesity with increased media exposure, with rates increasing proportionally to time spent watching television.[125]<\/a><\/sup>\r\n

<\/h3>\r\n
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Set point theory of weight<\/h3>\r\n
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\r\n\r\nSet point theory<\/b>, as it pertains to human body weight, states that there is a biological control method in humans that actively regulates weight towards a predetermined set weight for each individual.[1]<\/a><\/sup>\u00a0This may occur through regulation of energy intake (e.g.via increased or decreased appetite) or energy expenditure (e.g. via reduced metabolism or feelings of lethargy).[1]<\/a><\/sup>[2]<\/a><\/sup>\u00a0Set point theory explains why it is difficult for dieters to maintain weight loss over time, as calorie restriction may become less effective or more difficult to maintain as regulatory mechanisms in the body actively push the body back towards the set point weight.\r\n\r\nSet point theory differentiates between active compensation and passive compensation. In active compensation, a regulatory mechanism in the body effects energy expenditure or intake. In passive compensation, a decrease in body fat levels leads to a decrease in energy compensation even without a regulatory mechanism as there is less weight to be carried. Set point theory posits active compensation in addition to passive compensation.[3]<\/a><\/sup>\r\n\r\nSet point theory can be construed as implying weight regulation in a wide or tight range around the set point,[4]<\/a><\/sup>\u00a0in a symmetric or in an asymmetric manner (i.e. treating weight gain and loss either the same or differently),[4]<\/a><\/sup>\u00a0and may apply to regulation of body fat levels specifically (in a multi-compartment model) or to overall body weight.[5]<\/a><\/sup>\r\n\r\nSet point theory applies to both downward and upward adjustment of weight.[2]<\/a><\/sup>[5]<\/a><\/sup>\u00a0This return to the pre-change weight occurs faster than would be expected if individuals simply returned to their normal caloric intake and energy expenditure even after accounting for lower energy needs after weight loss, indicating an active response by the body encouraging weight gain.[3]<\/a><\/sup>\u00a0While the set point applies to both deviations driven by weight loss and weight gain, the set point response driving a person to regain weight to regain the set point is stronger than the response to lose weight after gaining weight above the set point,[5]<\/a><\/sup>\u00a0implying that it may be easier to gain than to lose weight.\r\n\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n \r\n

Genetics<\/span><\/h3>\r\n
<\/div>\r\n
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[caption id=\"\" align=\"alignleft\" width=\"290\"]\"A<\/a> A 1680 painting by\u00a0Juan Carreno de Miranda\u00a0of a girl presumed to have\u00a0Prader\u2013Willi syndrome[126][\/caption]<\/div>\r\n<\/div>\r\nLike many other medical conditions, obesity is the result of an interplay between genetic and environmental factors.[127]<\/a><\/sup>\u00a0Polymorphisms<\/a>\u00a0in various\u00a0genes<\/a>\u00a0controlling\u00a0appetite<\/a>\u00a0and\u00a0metabolism<\/a>\u00a0predispose to obesity when sufficient food energy is present. As of 2006, more than 41 of these sites on the human genome have been linked to the development of obesity when a favorable environment is present.[128]<\/a><\/sup>\u00a0People with two copies of the\u00a0FTO gene<\/a>\u00a0(fat mass and obesity associated gene) have been found on average to weigh 3\u20134\u00a0kg more and have a 1.67-fold greater risk of obesity compared with those without the risk\u00a0allele<\/a>.[129]<\/a><\/sup>\u00a0The differences in BMI between people that are\u00a0due to genetics<\/a>\u00a0varies depending on the population examined from 6% to 85%.[130]<\/a><\/sup>\r\n\r\nObesity is a major feature in several syndromes, such as\u00a0Prader\u2013Willi syndrome<\/a>,\u00a0Bardet\u2013Biedl syndrome<\/a>,\u00a0Cohen syndrome<\/a>, and\u00a0MOMO syndrome<\/a>. (The term \"non-syndromic obesity\" is sometimes used to exclude these conditions.)[131]<\/a><\/sup>\u00a0In people with early-onset severe obesity (defined by an onset before 10\u00a0years of age and body mass index over three\u00a0standard deviations<\/a>\u00a0above normal), 7% harbor a single point DNA mutation.[132]<\/a><\/sup>\r\n\r\nStudies that have focused on inheritance patterns rather than on specific genes have found that 80% of the offspring of two\u00a0obese parents<\/a>\u00a0were also obese, in contrast to less than 10% of the offspring of two parents who were of normal weight.[133]<\/a><\/sup>\u00a0Different people exposed to the same environment have different risks of obesity due to their underlying genetics.[134]<\/a><\/sup>\r\n\r\nThe\u00a0thrifty gene hypothesis<\/a>\u00a0postulates that, due to dietary scarcity during human evolution, people are prone to obesity. Their ability to take advantage of rare periods of abundance by storing energy as fat would be advantageous during times of varying food availability, and individuals with greater adipose reserves would be more likely to survive\u00a0famine<\/a>. This tendency to store fat, however, would be maladaptive in societies with stable food supplies.[135]<\/a><\/sup>\u00a0This theory has received various criticisms, and other evolutionarily-based theories such as the\u00a0drifty gene hypothesis<\/a>\u00a0and the\u00a0thrifty phenotype hypothesis<\/a>\u00a0have also been proposed.[136]<\/a><\/sup>[137]<\/a><\/sup>\r\n

Other illnesses<\/span><\/h3>\r\nCertain physical and mental illnesses and the pharmaceutical substances used to treat them can increase risk of obesity. Medical illnesses that increase obesity risk include several rare genetic syndromes (listed above) as well as some congenital or acquired conditions:\u00a0hypothyroidism<\/a>,\u00a0Cushing's syndrome<\/a>,\u00a0growth hormone deficiency<\/a>,[138]<\/a><\/sup>\u00a0and some\u00a0eating disorders<\/a>\u00a0such as\u00a0binge eating disorder<\/a>\u00a0and\u00a0night eating syndrome<\/a>.[2]<\/a><\/sup>\u00a0However, obesity is not regarded as a psychiatric disorder, and therefore is not listed in the\u00a0DSM-IVR<\/a>\u00a0as a psychiatric illness.[139]<\/a><\/sup>\u00a0The risk of overweight and obesity is higher in patients with psychiatric disorders than in persons without psychiatric disorders.[140]<\/a><\/sup>\r\n\r\nCertain medications may cause weight gain or changes in\u00a0body composition<\/a>; these include\u00a0insulin<\/a>,\u00a0sulfonylureas<\/a>,\u00a0thiazolidinediones<\/a>,\u00a0atypical antipsychotics<\/a>,\u00a0antidepressants<\/a>,\u00a0steroids<\/a>, certain\u00a0anticonvulsants<\/a>\u00a0(phenytoin<\/a>\u00a0and\u00a0valproate<\/a>),\u00a0pizotifen<\/a>, and some forms of\u00a0hormonal contraception<\/a>.[2]<\/a><\/sup>\r\n

Social determinants<\/span><\/h3>\r\n
<\/div>\r\n
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\r\n\r\n[caption id=\"\" align=\"alignright\" width=\"290\"]\"\"<\/a> The disease scroll (Yamai no soshi, late 12th century) depicts a woman moneylender with obesity, considered a disease of the rich.[\/caption]\r\n\r\n
\r\n\r\nObesity in developed countries is correlated with\u00a0<\/span>economic inequality<\/a>\r\n\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\nWhile genetic influences are important to understanding obesity, they cannot explain the current dramatic increase seen within specific countries or globally.[141]<\/a><\/sup>\u00a0Though 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.\r\n\r\nThe correlation between\u00a0social class<\/a>\u00a0and 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.[142]<\/a><\/sup>\u00a0An 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\u00a0globalization<\/a>.[143]<\/a><\/sup>\u00a0Among developed countries, levels of adult obesity, and percentage of teenage children who are overweight, are correlated with\u00a0income inequality<\/a>. A similar relationship is seen among US states: more adults, even in higher social classes, are obese in more unequal states.[144]<\/a><\/sup>\r\n\r\n\"\"<\/a>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\u00a0physical fitness<\/a>. In\u00a0undeveloped countries<\/a>\u00a0the 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.[143]<\/a><\/sup>\u00a0Attitudes 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.[145]<\/a><\/sup>\u00a0Stress and perceived low social status appear to increase risk of obesity.[144]<\/a><\/sup>[146]<\/a><\/sup>[147]<\/a><\/sup>\r\n\r\nSmoking has a significant effect on an individual's weight. Those who quit smoking gain an average of 4.4\u00a0kilograms (9.7\u00a0lb) for men and 5.0\u00a0kilograms (11.0\u00a0lb) for women over ten years.[148]<\/a><\/sup>\u00a0However, changing rates of smoking have had little effect on the overall rates of obesity.[149]<\/a><\/sup>\r\n\r\nIn 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.[150]<\/a><\/sup>\u00a0This could be partly explained by the fact that having dependent children decreases physical activity in Western parents.[151]<\/a><\/sup>\r\n\r\nIn 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%.[152]<\/a><\/sup>\r\n\r\nMalnutrition<\/a>\u00a0in early life is believed to play a role in the rising rates of obesity in the\u00a0developing world<\/a>.[153]<\/a><\/sup>\u00a0Endocrine changes that occur during periods of malnutrition may promote the storage of fat once more food energy becomes available.[153]<\/a><\/sup>\r\n\r\nConsistent with\u00a0cognitive epidemiological<\/a>\u00a0data, numerous studies confirm that obesity is associated with cognitive deficits.[154]<\/a><\/sup>[155]<\/a><\/sup>\r\n\r\nWhether obesity causes cognitive deficits, or vice versa is unclear at present.\r\n

Public health<\/span><\/h2>\r\nObesity prevention<\/strong> requires a complex approach, including interventions at community, family, and individual levels.[1]<\/a><\/sup>[11]<\/a><\/sup>\u00a0Changes to\u00a0diet\u00a0and\u00a0exercising\u00a0are the main treatments recommended by health professionals.[2]<\/a><\/sup>\u00a0Diet quality can be improved by reducing the consumption of energy-dense foods, such as those high in fat or sugars, and by increasing the intake of\u00a0dietary fiber.[1]<\/a><\/sup>\u00a0However, large-scale analyses have found an inverse relationship between energy density and energy cost of foods in developed nations.[15]<\/a><\/sup>\u00a0Low-income populations are more likely to live in neighborhoods that are considered \"food deserts<\/a>\" or \"food swamps\" where nutritional groceries are less available.[16]<\/a><\/sup>\u00a0Medications\u00a0can be used, along with a suitable diet, to reduce appetite or decrease fat absorption.[5]<\/a><\/sup>\u00a0If diet, exercise, and medication are not effective, a\u00a0gastric balloon<\/a>\u00a0or\u00a0surgery\u00a0may be performed to reduce stomach volume or length of the intestines, leading to feeling full earlier or a reduced ability to absorb nutrients from food.[6]<\/a><\/sup>[17]<\/a><\/sup>\r\n\r\nObesity is a leading\u00a0preventable cause of death\u00a0worldwide, with increasing rates in adults and\u00a0children.[1]<\/a><\/sup>[18]<\/a><\/sup>\u00a0In 2015, 600\u00a0million adults (12%) and 100\u00a0million children were obese in 195 countries.[7]<\/a><\/sup>\u00a0Obesity is more common in women than in men.[1]<\/a><\/sup>\u00a0Authorities view it as one of the most serious\u00a0public health\u00a0problems of the 21st\u00a0century.[19]<\/a><\/sup>\u00a0Obesity is\u00a0stigmatized\u00a0in much of the modern world (particularly in the\u00a0Western world), though it was seen as a symbol of wealth and\u00a0fertility\u00a0at other times in history and still is in some parts of the world.[2]<\/a><\/sup>[20]<\/a><\/sup>\u00a0In 2013, several medical societies, including the\u00a0American Medical Association<\/a>\u00a0and the\u00a0American Heart Association<\/a>, classified obesity as a\u00a0disease.[21]<\/a><\/sup>[22]<\/a><\/sup>[23]<\/a><\/sup>\r\n\r\nThe\u00a0World Health Organization<\/a>\u00a0(WHO) predicts that\u00a0overweight<\/a>\u00a0and obesity may soon replace more traditional\u00a0public health<\/a>\u00a0concerns such as\u00a0undernutrition<\/a>\u00a0and\u00a0infectious diseases<\/a>\u00a0as the most significant cause of poor health.[169]<\/a><\/sup>\u00a0Obesity is a public health and policy problem because of its prevalence, costs, and health effects.[170]<\/a><\/sup>\u00a0The\u00a0United States Preventive Services Task Force<\/a>\u00a0recommends screening for all adults followed by behavioral interventions in those who are obese.[171]<\/a><\/sup>\u00a0Public health efforts seek to understand and correct the\u00a0environmental factors<\/a>\u00a0responsible for the increasing prevalence of obesity in the population. Solutions look at changing the factors that cause excess food energy consumption and inhibit physical activity. Efforts include federally reimbursed meal programs in schools, limiting direct\u00a0junk<\/a>\u00a0food marketing<\/a>\u00a0to children,[172]<\/a><\/sup>\u00a0and decreasing access to sugar-sweetened beverages in schools.[173]<\/a><\/sup>\u00a0The World Health Organization recommends the taxing of sugary drinks.[174]<\/a><\/sup>\u00a0When constructing urban environments, efforts have been made to increase access to parks and to develop pedestrian routes.[175]<\/a><\/sup>\u00a0There is low quality evidence that nutritional labelling with energy information on menus can help to reduce energy intake while dining in restaurants.[176]<\/a><\/sup>\r\n

<\/h2>\r\n
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stress<\/h3>\r\n

Stress eating<\/strong> is consuming food in response to stress, especially when you are not hungry. Similarly, emotional eating is eating in response to feeling. Emotional eating means that your emotions\u2014not your body\u2014dictate when and how much you eat.<\/p>\r\n\r\n

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Causes<\/span><\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n

Some emotional eaters binge\u00a0when they are sad or confused.\u00a0For others, eating can be a way of avoiding thinking about problems or taking the action required to solve them.<\/p>\r\n\r\n

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So why do we eat when we are stressed? Because for most of us, food offers comfort. And unfortunately, the least\u00a0healthy foods\u00a0usually offer the most comfort.<\/p>\r\n\r\n

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If we reached for veggies in times of emotional discomfort, we'd be OK. But how many people turn to carrot sticks when they're feeling stressed? It's the high-fat, high-calorie foods we love that make us feel better. The more fattening, sweeter or the saltier the food, the better we seem to feel.<\/p>\r\n\r\n<\/div>\r\n \r\n

Management of Obesity<\/span><\/h2>\r\nThe main treatment for obesity consists of\u00a0weight loss<\/a>\u00a0via calorie restricted\u00a0dieting<\/a>\u00a0and\u00a0physical exercise<\/a>.[21]<\/a><\/sup>[88]<\/a><\/sup>[183]<\/a><\/sup>[184]<\/a><\/sup>\u00a0Dieting, as part of a lifestyle change, produces sustained weight loss, despite slow weight regain over time.[21]<\/a><\/sup>[185]<\/a><\/sup>[186]<\/a><\/sup>[187]<\/a><\/sup>\u00a0Although 87% of participants in the\u00a0National Weight Control Registry<\/a>\u00a0were able to maintain 10% body weight loss for 10 years,[188]<\/a><\/sup>\u00a0the most appropriate dietary approach for long term weight loss maintenance is still unknown.[189]<\/a><\/sup>\u00a0Intensive behavioral interventions combining both dietary changes and exercise are recommended.[21]<\/a><\/sup>[183]<\/a><\/sup>[190]<\/a><\/sup>\u00a0Intermittent fasting has no additional benefit of weight loss compared to continuous energy restriction.[189]<\/a><\/sup>\u00a0Adherence is a more important factor in weight loss success than whatever kind of diet an individual undertakes.[189]<\/a><\/sup>[191]<\/a><\/sup>\r\n\r\nSeveral hypo-caloric diets are effective.[21]<\/a><\/sup>\u00a0In the short-term low carbohydrate diets appear better than low fat diets for weight loss.[192]<\/a><\/sup>\u00a0In the long term, however, all types of low-carbohydrate and low-fat diets appear equally beneficial.[192]<\/a><\/sup>[193]<\/a><\/sup>\u00a0A 2014 review found that the heart disease and diabetes risks associated with different diets appear to be similar.[194]<\/a><\/sup>\u00a0Promotion of the Mediterranean diets among the obese may lower the risk of heart disease.[192]<\/a><\/sup>\u00a0Decreased intake of\u00a0sweet drinks<\/a>\u00a0is also related to weight-loss.[192]<\/a><\/sup>\u00a0Success rates of long-term weight loss maintenance with lifestyle changes are low, ranging from 2\u201320%.[195]<\/a><\/sup>\u00a0Dietary and lifestyle changes are effective in limiting excessive weight gain in\u00a0pregnancy<\/a>\u00a0and improve outcomes for both the mother and the child.[196]<\/a><\/sup>\u00a0Intensive behavioral counseling is recommended in those who are both obese and have other risk factors for heart disease.[197]<\/a><\/sup>\r\n

Medical interventions<\/span><\/h2>\r\nThe most effective treatment for obesity is\u00a0<\/span>bariatric surgery<\/a>.<\/span>[6]<\/a><\/sup>[21]<\/a><\/sup>\u00a0The types of procedures include\u00a0<\/span>laparoscopic adjustable gastric banding<\/a>,\u00a0<\/span>Roux-en-Y gastric bypass<\/a>,\u00a0<\/span>vertical-sleeve gastrectomy<\/a>, and\u00a0<\/span>biliopancreatic diversion<\/a>.<\/span>[198]<\/a><\/sup>\u00a0Surgery for severe obesity is associated with long-term weight loss, improvement in obesity-related conditions,<\/span>[203]<\/a><\/sup>\u00a0and decreased overall mortality, however, improved metabolic health results from the weight loss, not the surgery.<\/span>[204]<\/a><\/sup>\u00a0One study found a weight loss of between 14% and 25% (depending on the type of procedure performed) at 10\u00a0years, and a 29% reduction in all cause mortality when compared to standard weight loss measures.<\/span>[205]<\/a><\/sup>\u00a0Complications occur in about 17% of cases and reoperation is needed in 7% of cases.<\/span>[203]<\/a><\/sup>\u00a0Due to its cost and risks, researchers are searching for other effective yet less invasive treatments including devices that occupy space in the stomach.<\/span>[206]<\/a><\/sup>\u00a0For adults who have not responded to behavioral treatments with or without medication, the US guidelines on obesity recommend informing them about bariatric surgery.<\/span>[183]<\/a><\/sup>\r\n
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How Cognitive Behavioral Therapy Can Help Treat Food Addiction<\/h1>\r\n

If you have difficulty with overeating, you may wonder whether\u00a0cognitive\u00a0behavioral therapy<\/a>\u00a0(CBT) can help you stop your problem behaviors and food addiction. This example puts you in the place of a fictitious person who has characteristics and circumstances often seen in people who come for treatment for\u00a0food addiction<\/a>. This can show you what happens in CBT and how it can help people stop overeating.<\/p>\r\n\r\n

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Overeating and Binge Eating Behaviors<\/span><\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n

You are a binge eater who binges on candy, cookies, and chocolate several times a day. Your\u00a0overeating<\/a>\u00a0started in childhood when you would eat candy in secret at night. You describe your binges as emotional eating\u00a0because you eat when you felt upset.<\/p>\r\n

You do everything you can to prevent weight gain, including skipping regular meals, exercising for hours, using laxatives to \"clear yourself out,\" and occasionally, making yourself vomit. Your family doctor became concerned that you were developing problems with incontinence from laxative overuse, and she referred you to CBT to help you stop overeating.<\/p>\r\n\r\n

Overeating Due to Emotional Reasoning<\/span><\/h2>\r\n

Your cognitive-behavioral therapist\u00a0guides you in recording the thoughts and feelings you experience before, during and after bingeing on sweet food. By analyzing the thoughts and feelings you have around food, you and your therapist come to understand that you are emotional eating and possibly even binge eating in response to negative emotions due to faulty thinking (cognitive distortions).<\/p>\r\n\r\n

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As your weight has increased, your self-esteem has worsened. Many times a day, you would interpret small chance occurrences as reasons to feel bad about yourself. Once you start keeping track of your thought processes, you realize how often this is happening.<\/span><\/div>\r\n<\/div>\r\n<\/div>\r\n
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For example, if someone pushed in front of you in line, you would feel that this must mean you are a worthless person, and you would immediately buy a bar of chocolate to eat and make yourself feel better. One day, a colleague didn't respond when you said \"Good morning,\" and you reasoned this was because your colleague disliked you.<\/p>\r\n\r\n

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At your first opportunity, you made an excuse to slip out and buy a pack of cookies\u00a0and ate the whole pack. Your performance review at work was rated \"good,\" and you thought that anything less than \"excellent\" meant you were terrible at your job, so you spent the evening eating cake and ice cream.<\/span><\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n
<\/div>\r\n

Each time a minor disappointment of this sort occurred, which was almost daily, you would go to your secret stash of chocolate or head to the grocery store for a binge. In spite of this well-established pattern of behavior, although you wanted to stop overeating, you just did not know another way to handle your uncomfortable feelings of worthlessness.<\/p>\r\n\r\n

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Using Cognitive Behavioral Therapy to Treat Food Addiction<\/span><\/div>\r\n<\/div>\r\n

The CBT therapist explains to you that your binge eating is based on emotional reasoning and, although eating might make you feel temporarily comforted, would not help you feel better about yourself. In fact, overeating was having the opposite effect\u00a0and was actually making you feel worse about yourself, which would then worsen your overeating.<\/p>\r\n\r\n

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With your therapist you learn ways to challenge the faulty thinking and also learn alternative coping strategies to deal with the negative emotions. Together, you plan a different approach to handling disappointment. With practice, you are able to interpret people\u2019s responses more realistically, so you are not constantly feeling inadequate. You also practice\u00a0<\/span>methods for improving your self-esteem<\/a>. As your self-esteem improves, you became more able to refrain from snacking and bingeing and began to eat more nutritious food.<\/span><\/div>\r\n<\/div>\r\n<\/div>\r\n
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CBT for Children<\/h3>\r\n[embed]https:\/\/youtu.be\/L0IqzvOn8Ck[\/embed]\r\n\r\n<\/div>\r\n \r\n
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Childhood OBESITY<\/h3>\r\nThe healthy BMI range varies with the age and sex of the child. Obesity in children and adolescents is defined as a BMI greater than the 95th\u00a0percentile<\/a>.[29]<\/a><\/sup>\u00a0The reference data that these percentiles are based on is from 1963 to 1994 and thus has not been affected by the recent increases in rates of obesity.[30]<\/a><\/sup>\u00a0Childhood obesity has reached epidemic proportions in the 21st\u00a0century, with rising rates in both the developed and the developing world. Rates of obesity in Canadian boys have increased from 11% in the 1980s to over 30% in the 1990s, while during this same time period rates increased from 4 to 14% in Brazilian children.[256]<\/a><\/sup>\u00a0In the UK, there were 60% more obese children in 2005 compared to 1989.[257]<\/a><\/sup>\u00a0In the US, the percentage of overweight and obese children increased to 16% in 2008, a 300% increase over the prior 30 years.[258]<\/a><\/sup>\r\n\r\nAs with obesity in adults, many factors contribute to the rising rates of childhood obesity. Changing diet and decreasing physical activity are believed to be the two most important causes for the recent increase in the incidence of child obesity.[259]<\/a><\/sup>\u00a0Antibiotics in the first 6 months of life have been associated with excess weight at age seven to twelve years of age.[158]<\/a><\/sup>\u00a0Because childhood obesity often persists into adulthood and is associated with numerous chronic illnesses, children who are obese are often tested for\u00a0hypertension<\/a>,\u00a0diabetes<\/a>,\u00a0hyperlipidemia<\/a>, and\u00a0fatty liver disease<\/a>.[88]<\/a><\/sup>\u00a0Treatments used in children are primarily lifestyle interventions and behavioral techniques, although efforts to increase activity in children have had little success.[260]<\/a><\/sup>\u00a0In the United States, medications are not FDA approved for use in this age group.[256]<\/a><\/sup>\u00a0Multi-component behaviour change interventions that include changes to dietary and physical activity may reduce BMI in the short term in children aged 6 to 11 years, although the benefits are small and quality of evidence is low.[261]<\/a><\/sup>\r\n

Other animals<\/span><\/h2>\r\nObesity in pets is common in many countries. In the United States, 23\u201341% of dogs are overweight, and about 5.1% are obese.[262]<\/a><\/sup>\u00a0The rate of obesity in cats was slightly higher at 6.4%.[262]<\/a><\/sup>\u00a0In Australia the rate of obesity among dogs in a veterinary setting has been found to be 7.6%.[263]<\/a><\/sup>\u00a0The risk of obesity in dogs is related to whether or not their owners are obese; however, there is no similar correlation between cats and their owners.[264]<\/a><\/sup>\r\n\r\n<\/div>\r\n ","rendered":"

Obesity<\/b>\u00a0is a\u00a0medical condition\u00a0in which excess\u00a0body fat\u00a0has accumulated to an extent that it may have a negative effect on health.[1]<\/a><\/sup>\u00a0People are generally considered obese when their\u00a0body mass index<\/a>\u00a0(BMI), a measurement obtained by dividing a person’s weight by the square of the person’s height\u2014despite known\u00a0allometric<\/a>\u00a0inaccuracies[a]<\/a><\/sup>\u2014is over\u00a030\u00a0kg\/m2<\/sup><\/span>; the range\u00a025\u201330\u00a0kg\/m2<\/sup><\/span>\u00a0is defined as\u00a0overweight.[1]<\/a><\/sup>\u00a0Some\u00a0East Asian\u00a0countries use lower values.[10]<\/a><\/sup>\u00a0Obesity is correlated with\u00a0various diseases and conditions, particularly\u00a0cardiovascular diseases<\/a>,\u00a0type 2 diabetes<\/a>,\u00a0obstructive sleep apnea<\/a>, certain types of\u00a0cancer<\/a>, and\u00a0osteoarthritis<\/a>.[2]<\/a><\/sup>\u00a0High BMI is a marker of risk, but not proven to be a direct cause, for diseases caused by diet, physical activity, and environmental factors.[11]<\/a><\/sup>\u00a0A reciprocal link has been found between obesity and\u00a0depression<\/a>, with obesity increasing the risk of clinical depression and also depression leading to a higher chance of developing obesity.[3]<\/a><\/sup><\/p>\n

Obesity has individual, socioeconomic, and environmental causes, including diet, physical activity,\u00a0automation,\u00a0urbanization,\u00a0genetic susceptibility,\u00a0medications<\/a>,\u00a0mental disorders<\/a>,\u00a0economic policies<\/a>,\u00a0endocrine disorders<\/a>, and exposure to\u00a0endocrine-disrupting chemicals<\/a>.[1]<\/a><\/sup>[4]<\/a><\/sup>[12]<\/a><\/sup>[13]<\/a><\/sup>\u00a0While a majority of obese individuals at any given time are attempting to lose weight and often successful, research shows that maintaining that weight loss over the long term proves to be rare.[14]<\/a><\/sup>\u00a0The reasons for\u00a0weight cycling<\/a>\u00a0are not fully understood but may include decreased energy expenditure combined with increased biological urge to eat during and after caloric restriction.[14]<\/a><\/sup>\u00a0More studies are needed to determine if weight cycling and\u00a0yo-yo dieting<\/a>\u00a0contribute to inflammation and disease risk in obese individuals.[14]<\/a><\/sup><\/p>\n

Yo-yo dieting<\/b>\u00a0or\u00a0yo-yo effect<\/b>, also known as\u00a0weight cycling<\/b>, is a term coined by\u00a0Kelly D. Brownell\u00a0at\u00a0Yale University, in reference to the cyclical loss and gain of weight, resembling the up-down motion of a\u00a0yo-yo<\/a>. In this process, the dieter is initially successful in the pursuit of\u00a0weight loss\u00a0but is unsuccessful in maintaining the loss long-term and begins to gain the weight back. The dieter then seeks to lose the regained weight, and the cycle begins again.<\/div>\n
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Effects of Yo yo dieting on health<\/span><\/h2>\n

This kind of diet is associated with extreme food deprivation as a substitute for\u00a0healthy diet\u00a0and\u00a0exercise\u00a0techniques. As a result, the dieter may experience loss of both\u00a0muscle\u00a0and\u00a0body fat\u00a0during the initial weight-loss phase (weight-bearing exercise is required to maintain muscle). After completing the diet, the dieter is likely to experience the body’s\u00a0starvation response, leading to rapid weight gain of only fat. This is a cycle that changes the body’s fat-to-muscle ratio, one of the more important factors in health. A report by the\u00a0American Psychological Association<\/a>\u00a0reviewed thirty-one diet studies and found that after two years of dieting up to a third of dieters weighed more than they did before they began the diet, another third regained the weight they lost, and the last third kept the loss weight off[3]<\/a><\/sup>\u00a0One study in rats showed those made to yo-yo diet were more efficient at gaining weight.[4]<\/a><\/sup>\u00a0However the research compiled by Atkinson et al. (1994)[5]<\/a><\/sup>\u00a0showed that there are \u201cno adverse effects of weight cycling on body composition, resting metabolic rate, body fat distribution, or future successful weight loss\u201d, and that there is not enough evidence to show risk factors for cardiovascular disease being directly dependent on cyclical dieting patterns. A more recent review concluded “…evidence for an adverse effect of weight cycling appears sparse, if it exists at all”.[6]<\/a><\/sup><\/p>\n

Since there is “no single definition of weight cycling [that] can be endorsed”, it is almost impossible for research to draw specific conclusions about the actual effects of cyclical dieting, until it becomes more definitely defined.[5]<\/a><\/sup><\/p>\n<\/div>\n

Effects of Obesity on health<\/span><\/h2>\n

Excessive body\u00a0weight\u00a0is associated with various\u00a0diseases and conditions, particularly\u00a0cardiovascular diseases<\/a>,\u00a0diabetes mellitus type 2<\/a>,\u00a0obstructive sleep apnea<\/a>, certain types of\u00a0cancer<\/a>,\u00a0osteoarthritis<\/a>,[2]<\/a><\/sup>\u00a0and\u00a0asthma<\/a>.[2]<\/a><\/sup>[36]<\/a><\/sup>\u00a0As a result, obesity has been found to reduce\u00a0life expectancy<\/a>.[2]<\/a><\/sup><\/p>\n

Mortality<\/span><\/h3>\n

Obesity is one of the leading\u00a0preventable causes of death\u00a0worldwide.[38]<\/a><\/sup>[39]<\/a><\/sup>[40]<\/a><\/sup>\u00a0A number of reviews have found that mortality risk is lowest at a BMI of 20\u201325\u00a0kg\/m2<\/sup>[41]<\/a><\/sup>[42]<\/a><\/sup>[43]<\/a><\/sup>\u00a0in non-smokers and at 24\u201327\u00a0kg\/m2<\/sup>\u00a0in current smokers, with risk increasing along with changes in either direction.[44]<\/a><\/sup>[45]<\/a><\/sup>\u00a0This appears to apply in at least four continents.[43]<\/a><\/sup>\u00a0In contrast, a 2013 review found that grade 1 obesity (BMI 30\u201335) was not associated with higher mortality than normal weight, and that overweight (BMI 25\u201330) was associated with “lower” mortality than was normal weight (BMI 18.5\u201325).[46]<\/a><\/sup>\u00a0Other evidence suggests that the association of BMI and waist circumference with mortality is U- or J-shaped, while the association between\u00a0waist-to-hip ratio<\/a>\u00a0and\u00a0waist-to-height ratio<\/a>\u00a0with mortality is more positive.[47]<\/a><\/sup>\u00a0In Asians the risk of negative health effects begins to increase between 22\u201325\u00a0kg\/m2<\/sup>.[48]<\/a><\/sup>\u00a0A BMI above 32\u00a0kg\/m2<\/sup>\u00a0has been associated with a doubled\u00a0mortality rate\u00a0among women over a 16-year period.[49]<\/a><\/sup>\u00a0In the United States, obesity is estimated to cause 111,909 to 365,000 deaths per year,[2]<\/a><\/sup>[40]<\/a><\/sup>\u00a0while 1\u00a0million (7.7%) of deaths in Europe are attributed to excess weight.[50]<\/a><\/sup>[51]<\/a><\/sup>\u00a0On average, obesity reduces life expectancy by six to seven\u00a0years,[2]<\/a><\/sup>[52]<\/a><\/sup>\u00a0a BMI of 30\u201335\u00a0kg\/m2<\/sup>\u00a0reduces life expectancy by two to four years,[42]<\/a><\/sup>\u00a0while severe obesity (BMI\u00a0>\u00a040\u00a0kg\/m2<\/sup>) reduces life expectancy by ten years.[42]<\/a><\/sup><\/sup><\/p>\n

\n
\n

allostatic load<\/h3>\n

The term allostatic load<\/strong> is “the wear and tear on the body” which accumulates as an individual is exposed to repeated or chronic\u00a0stress.[1]<\/a><\/sup>\u00a0It was coined by McEwen and Stellar in 1993.[2]<\/a><\/sup><\/p>\n

The term is part of the regulatory model of\u00a0allostasis<\/a>, where the predictive regulation or stabilisation of internal sensations in response to stimuli is ascribed to the brain.[3]<\/a><\/sup>\u00a0Allostasis involves the regulation of\u00a0homeostasis<\/a>\u00a0in the body to decrease physiological consequences on the body.[4]<\/a><\/sup>[5]<\/a><\/sup>\u00a0Predictive regulation refers to the brain’s ability to anticipate needs and prepare to fulfill them before they arise.[3]<\/a><\/sup><\/p>\n

Part of efficient regulation is the reduction of uncertainty. Humans naturally do not like feeling as if surprise is inevitable. Because of this, we constantly strive to reduce the uncertainty of future outcomes, and allostasis helps us do this by anticipating needs and planning how to satisfy them ahead of time.[6]<\/a><\/sup>\u00a0But it takes a considerable amount of the brain’s energy to do this, and if it fails to resolve the uncertainty, the situation may become chronic and result in the accumulation of allostatic load.[6]<\/a><\/sup><\/p>\n

The concept of allostatic load provides that “the neuroendocrine, cardiovascular, neuroenergetic, and emotional responses become persistently activated so that blood flow turbulences in the coronary and cerebral arteries, high blood pressure, atherogenesis, cognitive dysfunction and depressed mood accelerate disease progression.”[6]<\/a><\/sup>\u00a0All long-standing effects of continuously activated\u00a0stress<\/a>\u00a0responses are referred to as allostatic load. Allostatic load can result in permanently altered brain architecture and systemic pathophysiology.[6]<\/a><\/sup><\/p>\n

Allostatic load minimizes an organism’s ability to cope with and reduce uncertainty in the future.[6]<\/a><\/sup><\/p>\n

Allostatic load is generally measured through a composite index of indicators of cumulative strain on several organs and tissues, primarily biomarkers associated with the neuroendocrine, cardiovascular, immune and metabolic systems.<\/span>[12]<\/a><\/sup><\/sup>Indices of allostatic load are diverse across studies and are frequently assessed differently, using different biomarkers and different methods of assembling an allostatic load index. Allostatic load is not unique to humans and may be used to evaluate the physiological effects of chronic or frequent stress in non-human primates as well.<\/span>[12]<\/a><\/sup>In the endocrine system, the increase or repeated levels of stress results in the increased levels of the hormone Corticotropin-Releasing Factor (CRH), which is associated with activation of HPA axis.<\/span>[5]<\/a><\/sup>\u00a0The\u00a0<\/span>Hypothalamic\u2013pituitary\u2013adrenal axis<\/a>\u00a0is the central stress response system responsible for modulating inflammatory responses throughout the body. Prolonged stress levels can lead to decreased levels of cortisol in the morning and increased levels in the afternoon, leading to greater daily output of cortisol which in the long term increases blood sugar levels.<\/span>In the nervous system, structural and functional abnormalities are a result of chronic prolonged stress. The increase of stress levels causes a shortening of dendrites in a neuron. Therefore, the shortening of dendrites causes the decrease in attention.<\/span>[5]<\/a><\/sup>\u00a0Chronic stress also causes greater response to fear of the unlearned in the nervous system, and fear conditioning.<\/span>In the immune system, the increase in levels of chronic stress results in the elevation of inflammation. The increase in inflammation levels is caused by the ongoing activation of the sympathetic nervous system.<\/span>[5]<\/a><\/sup>\u00a0The impairment of cell-mediated acquired immunity is also a factor resulting in the immune system due to chronic stress.<\/span>[5]<\/a><\/sup><\/p>\n<\/div>\n

 <\/p>\n<\/div>\n

Morbidity<\/span><\/h3>\n

Obesity increases the risk of many physical and mental conditions. These comorbidities are most commonly shown in\u00a0metabolic syndrome<\/a>,[2]<\/a><\/sup>\u00a0a combination of medical disorders which includes:\u00a0diabetes mellitus type 2<\/a>,\u00a0high blood pressure<\/a>,\u00a0high blood cholesterol<\/a>, and\u00a0high triglyceride levels<\/a>.[53]<\/a><\/sup><\/p>\n

Complications are either directly caused by obesity or indirectly related through mechanisms sharing a common cause such as a poor diet or a\u00a0sedentary lifestyle<\/a>. The strength of the link between obesity and specific conditions varies. One of the strongest is the link with\u00a0type 2 diabetes<\/a>. Excess body fat underlies 64% of cases of diabetes in men and 77% of cases in women.[54]<\/a><\/sup><\/p>\n

Health consequences fall into two broad categories: those attributable to the effects of increased fat mass (such as\u00a0osteoarthritis<\/a>,\u00a0obstructive sleep apnea<\/a>, social stigmatization) and those due to the increased number of\u00a0fat cells<\/a>\u00a0(diabetes<\/a>,\u00a0cancer<\/a>,\u00a0cardiovascular disease<\/a>,\u00a0non-alcoholic fatty liver disease<\/a>).[2]<\/a><\/sup>[55]<\/a><\/sup>\u00a0Increases in body fat alter the body’s response to insulin, potentially leading to\u00a0insulin resistance<\/a>. Increased fat also creates a\u00a0proinflammatory state<\/a>,[56]<\/a><\/sup>[57]<\/a><\/sup>\u00a0and a\u00a0prothrombotic<\/a>\u00a0state.[55]<\/a><\/sup>[58]<\/a><\/sup><\/p>\n

Obesity increases the risk of developing serious illness from\u00a0coronavirus disease 2019<\/a>.[59]<\/a><\/sup><\/p>\n

Causes of Obesity<\/span><\/h2>\n

At an individual level, a combination of excessive\u00a0food energy<\/a>\u00a0intake and a lack of\u00a0physical activity<\/a>\u00a0is thought to explain most cases of obesity.[88]<\/a><\/sup>\u00a0A limited number of cases are due primarily to genetics, medical reasons, or psychiatric illness.[13]<\/a><\/sup>\u00a0In contrast, increasing rates of obesity at a societal level are felt to be due to an easily accessible and palatable diet,[89]<\/a><\/sup>\u00a0increased\u00a0reliance on cars<\/a>, and mechanized manufacturing.[90]<\/a><\/sup>[91]<\/a><\/sup><\/p>\n

A 2006 review identified ten other possible contributors to the recent increase of obesity: (1)\u00a0insufficient sleep<\/a>, (2)\u00a0endocrine disruptors<\/a>\u00a0(environmental\u00a0pollutants<\/a>\u00a0that interfere with lipid metabolism), (3) decreased variability in ambient temperature, (4) decreased rates of\u00a0smoking<\/a>, because smoking suppresses appetite, (5) increased use of medications that can cause weight gain (e.g.,\u00a0atypical antipsychotics<\/a>), (6) proportional increases in ethnic and age groups that tend to be heavier, (7) pregnancy at a later age (which may cause susceptibility to obesity in children), (8)\u00a0epigenetic<\/a>\u00a0risk factors passed on generationally, (9)\u00a0natural selection<\/a>\u00a0for higher BMI, and (10)\u00a0assortative mating<\/a>\u00a0leading to increased concentration of obesity risk factors (this would increase the number of obese people by increasing population variance in weight).[92]<\/a><\/sup>\u00a0According to the Endocrine Society, there is “growing evidence suggesting that obesity is a disorder of the\u00a0energy homeostasis<\/a>\u00a0system, rather than simply arising from the passive accumulation of excess weight”.[93]<\/a><\/sup><\/p>\n

Sedentary lifestyle<\/span><\/h3>\n

A\u00a0sedentary lifestyle<\/a>\u00a0plays a significant role in obesity.[114]<\/a><\/sup>\u00a0Worldwide there has been a large shift towards less physically demanding work,[115]<\/a><\/sup>[116]<\/a><\/sup>[117]<\/a><\/sup>\u00a0and currently at least 30% of the world’s population gets insufficient exercise.[116]<\/a><\/sup>\u00a0This is primarily due to increasing use of mechanized transportation and a greater prevalence of labor-saving technology in the home.[115]<\/a><\/sup>[116]<\/a><\/sup>[117]<\/a><\/sup>\u00a0In children, there appear to be declines in levels of physical activity due to less walking and physical education.[118]<\/a><\/sup>\u00a0World trends in active leisure time\u00a0physical activity<\/a>\u00a0are less clear. The\u00a0World Health Organization<\/a>\u00a0indicates people worldwide are taking up less active recreational pursuits, while a study from Finland[119]<\/a><\/sup>\u00a0found an increase and a study from the United States found leisure-time physical activity has not changed significantly.[120]<\/a><\/sup>\u00a0A 2011 review of physical activity in children found that it may not be a significant contributor.[121]<\/a><\/sup><\/p>\n

In both children and adults, there is an association between television viewing time and the risk of obesity.[122]<\/a><\/sup>[123]<\/a><\/sup>[124]<\/a><\/sup>\u00a0A review found 63 of 73 studies (86%) showed an increased rate of childhood obesity with increased media exposure, with rates increasing proportionally to time spent watching television.[125]<\/a><\/sup><\/p>\n

<\/h3>\n
\n

Set point theory of weight<\/h3>\n
\n
\n
\n

Set point theory<\/b>, as it pertains to human body weight, states that there is a biological control method in humans that actively regulates weight towards a predetermined set weight for each individual.[1]<\/a><\/sup>\u00a0This may occur through regulation of energy intake (e.g.via increased or decreased appetite) or energy expenditure (e.g. via reduced metabolism or feelings of lethargy).[1]<\/a><\/sup>[2]<\/a><\/sup>\u00a0Set point theory explains why it is difficult for dieters to maintain weight loss over time, as calorie restriction may become less effective or more difficult to maintain as regulatory mechanisms in the body actively push the body back towards the set point weight.<\/p>\n

Set point theory differentiates between active compensation and passive compensation. In active compensation, a regulatory mechanism in the body effects energy expenditure or intake. In passive compensation, a decrease in body fat levels leads to a decrease in energy compensation even without a regulatory mechanism as there is less weight to be carried. Set point theory posits active compensation in addition to passive compensation.[3]<\/a><\/sup><\/p>\n

Set point theory can be construed as implying weight regulation in a wide or tight range around the set point,[4]<\/a><\/sup>\u00a0in a symmetric or in an asymmetric manner (i.e. treating weight gain and loss either the same or differently),[4]<\/a><\/sup>\u00a0and may apply to regulation of body fat levels specifically (in a multi-compartment model) or to overall body weight.[5]<\/a><\/sup><\/p>\n

Set point theory applies to both downward and upward adjustment of weight.[2]<\/a><\/sup>[5]<\/a><\/sup>\u00a0This return to the pre-change weight occurs faster than would be expected if individuals simply returned to their normal caloric intake and energy expenditure even after accounting for lower energy needs after weight loss, indicating an active response by the body encouraging weight gain.[3]<\/a><\/sup>\u00a0While the set point applies to both deviations driven by weight loss and weight gain, the set point response driving a person to regain weight to regain the set point is stronger than the response to lose weight after gaining weight above the set point,[5]<\/a><\/sup>\u00a0implying that it may be easier to gain than to lose weight.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

 <\/p>\n

Genetics<\/span><\/h3>\n
<\/div>\n
\n
\n
\"A<\/a><\/p>\n

A 1680 painting by\u00a0Juan Carreno de Miranda\u00a0of a girl presumed to have\u00a0Prader\u2013Willi syndrome[126]<\/p>\n<\/div>\n<\/div>\n<\/div>\n

Like many other medical conditions, obesity is the result of an interplay between genetic and environmental factors.[127]<\/a><\/sup>\u00a0Polymorphisms<\/a>\u00a0in various\u00a0genes<\/a>\u00a0controlling\u00a0appetite<\/a>\u00a0and\u00a0metabolism<\/a>\u00a0predispose to obesity when sufficient food energy is present. As of 2006, more than 41 of these sites on the human genome have been linked to the development of obesity when a favorable environment is present.[128]<\/a><\/sup>\u00a0People with two copies of the\u00a0FTO gene<\/a>\u00a0(fat mass and obesity associated gene) have been found on average to weigh 3\u20134\u00a0kg more and have a 1.67-fold greater risk of obesity compared with those without the risk\u00a0allele<\/a>.[129]<\/a><\/sup>\u00a0The differences in BMI between people that are\u00a0due to genetics<\/a>\u00a0varies depending on the population examined from 6% to 85%.[130]<\/a><\/sup><\/p>\n

Obesity is a major feature in several syndromes, such as\u00a0Prader\u2013Willi syndrome<\/a>,\u00a0Bardet\u2013Biedl syndrome<\/a>,\u00a0Cohen syndrome<\/a>, and\u00a0MOMO syndrome<\/a>. (The term “non-syndromic obesity” is sometimes used to exclude these conditions.)[131]<\/a><\/sup>\u00a0In people with early-onset severe obesity (defined by an onset before 10\u00a0years of age and body mass index over three\u00a0standard deviations<\/a>\u00a0above normal), 7% harbor a single point DNA mutation.[132]<\/a><\/sup><\/p>\n

Studies that have focused on inheritance patterns rather than on specific genes have found that 80% of the offspring of two\u00a0obese parents<\/a>\u00a0were also obese, in contrast to less than 10% of the offspring of two parents who were of normal weight.[133]<\/a><\/sup>\u00a0Different people exposed to the same environment have different risks of obesity due to their underlying genetics.[134]<\/a><\/sup><\/p>\n

The\u00a0thrifty gene hypothesis<\/a>\u00a0postulates that, due to dietary scarcity during human evolution, people are prone to obesity. Their ability to take advantage of rare periods of abundance by storing energy as fat would be advantageous during times of varying food availability, and individuals with greater adipose reserves would be more likely to survive\u00a0famine<\/a>. This tendency to store fat, however, would be maladaptive in societies with stable food supplies.[135]<\/a><\/sup>\u00a0This theory has received various criticisms, and other evolutionarily-based theories such as the\u00a0drifty gene hypothesis<\/a>\u00a0and the\u00a0thrifty phenotype hypothesis<\/a>\u00a0have also been proposed.[136]<\/a><\/sup>[137]<\/a><\/sup><\/p>\n

Other illnesses<\/span><\/h3>\n

Certain physical and mental illnesses and the pharmaceutical substances used to treat them can increase risk of obesity. Medical illnesses that increase obesity risk include several rare genetic syndromes (listed above) as well as some congenital or acquired conditions:\u00a0hypothyroidism<\/a>,\u00a0Cushing’s syndrome<\/a>,\u00a0growth hormone deficiency<\/a>,[138]<\/a><\/sup>\u00a0and some\u00a0eating disorders<\/a>\u00a0such as\u00a0binge eating disorder<\/a>\u00a0and\u00a0night eating syndrome<\/a>.[2]<\/a><\/sup>\u00a0However, obesity is not regarded as a psychiatric disorder, and therefore is not listed in the\u00a0DSM-IVR<\/a>\u00a0as a psychiatric illness.[139]<\/a><\/sup>\u00a0The risk of overweight and obesity is higher in patients with psychiatric disorders than in persons without psychiatric disorders.[140]<\/a><\/sup><\/p>\n

Certain medications may cause weight gain or changes in\u00a0body composition<\/a>; these include\u00a0insulin<\/a>,\u00a0sulfonylureas<\/a>,\u00a0thiazolidinediones<\/a>,\u00a0atypical antipsychotics<\/a>,\u00a0antidepressants<\/a>,\u00a0steroids<\/a>, certain\u00a0anticonvulsants<\/a>\u00a0(phenytoin<\/a>\u00a0and\u00a0valproate<\/a>),\u00a0pizotifen<\/a>, and some forms of\u00a0hormonal contraception<\/a>.[2]<\/a><\/sup><\/p>\n

Social determinants<\/span><\/h3>\n
<\/div>\n
\n
\n
\"\"<\/a><\/p>\n

The disease scroll (Yamai no soshi, late 12th century) depicts a woman moneylender with obesity, considered a disease of the rich.<\/p>\n<\/div>\n

\n

Obesity in developed countries is correlated with\u00a0<\/span>economic inequality<\/a><\/p>\n<\/div>\n<\/div>\n<\/div>\n

While genetic influences are important to understanding obesity, they cannot explain the current dramatic increase seen within specific countries or globally.[141]<\/a><\/sup>\u00a0Though 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.<\/p>\n

The correlation between\u00a0social class<\/a>\u00a0and 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.[142]<\/a><\/sup>\u00a0An 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\u00a0globalization<\/a>.[143]<\/a><\/sup>\u00a0Among developed countries, levels of adult obesity, and percentage of teenage children who are overweight, are correlated with\u00a0income inequality<\/a>. A similar relationship is seen among US states: more adults, even in higher social classes, are obese in more unequal states.[144]<\/a><\/sup><\/p>\n

\"\"<\/a>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\u00a0physical fitness<\/a>. In\u00a0undeveloped countries<\/a>\u00a0the 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.[143]<\/a><\/sup>\u00a0Attitudes 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.[145]<\/a><\/sup>\u00a0Stress and perceived low social status appear to increase risk of obesity.[144]<\/a><\/sup>[146]<\/a><\/sup>[147]<\/a><\/sup><\/p>\n

Smoking has a significant effect on an individual’s weight. Those who quit smoking gain an average of 4.4\u00a0kilograms (9.7\u00a0lb) for men and 5.0\u00a0kilograms (11.0\u00a0lb) for women over ten years.[148]<\/a><\/sup>\u00a0However, changing rates of smoking have had little effect on the overall rates of obesity.[149]<\/a><\/sup><\/p>\n

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.[150]<\/a><\/sup>\u00a0This could be partly explained by the fact that having dependent children decreases physical activity in Western parents.[151]<\/a><\/sup><\/p>\n

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%.[152]<\/a><\/sup><\/p>\n

Malnutrition<\/a>\u00a0in early life is believed to play a role in the rising rates of obesity in the\u00a0developing world<\/a>.[153]<\/a><\/sup>\u00a0Endocrine changes that occur during periods of malnutrition may promote the storage of fat once more food energy becomes available.[153]<\/a><\/sup><\/p>\n

Consistent with\u00a0cognitive epidemiological<\/a>\u00a0data, numerous studies confirm that obesity is associated with cognitive deficits.[154]<\/a><\/sup>[155]<\/a><\/sup><\/p>\n

Whether obesity causes cognitive deficits, or vice versa is unclear at present.<\/p>\n

Public health<\/span><\/h2>\n

Obesity prevention<\/strong> requires a complex approach, including interventions at community, family, and individual levels.[1]<\/a><\/sup>[11]<\/a><\/sup>\u00a0Changes to\u00a0diet\u00a0and\u00a0exercising\u00a0are the main treatments recommended by health professionals.[2]<\/a><\/sup>\u00a0Diet quality can be improved by reducing the consumption of energy-dense foods, such as those high in fat or sugars, and by increasing the intake of\u00a0dietary fiber.[1]<\/a><\/sup>\u00a0However, large-scale analyses have found an inverse relationship between energy density and energy cost of foods in developed nations.[15]<\/a><\/sup>\u00a0Low-income populations are more likely to live in neighborhoods that are considered “food deserts<\/a>” or “food swamps” where nutritional groceries are less available.[16]<\/a><\/sup>\u00a0Medications\u00a0can be used, along with a suitable diet, to reduce appetite or decrease fat absorption.[5]<\/a><\/sup>\u00a0If diet, exercise, and medication are not effective, a\u00a0gastric balloon<\/a>\u00a0or\u00a0surgery\u00a0may be performed to reduce stomach volume or length of the intestines, leading to feeling full earlier or a reduced ability to absorb nutrients from food.[6]<\/a><\/sup>[17]<\/a><\/sup><\/p>\n

Obesity is a leading\u00a0preventable cause of death\u00a0worldwide, with increasing rates in adults and\u00a0children.[1]<\/a><\/sup>[18]<\/a><\/sup>\u00a0In 2015, 600\u00a0million adults (12%) and 100\u00a0million children were obese in 195 countries.[7]<\/a><\/sup>\u00a0Obesity is more common in women than in men.[1]<\/a><\/sup>\u00a0Authorities view it as one of the most serious\u00a0public health\u00a0problems of the 21st\u00a0century.[19]<\/a><\/sup>\u00a0Obesity is\u00a0stigmatized\u00a0in much of the modern world (particularly in the\u00a0Western world), though it was seen as a symbol of wealth and\u00a0fertility\u00a0at other times in history and still is in some parts of the world.[2]<\/a><\/sup>[20]<\/a><\/sup>\u00a0In 2013, several medical societies, including the\u00a0American Medical Association<\/a>\u00a0and the\u00a0American Heart Association<\/a>, classified obesity as a\u00a0disease.[21]<\/a><\/sup>[22]<\/a><\/sup>[23]<\/a><\/sup><\/p>\n

The\u00a0World Health Organization<\/a>\u00a0(WHO) predicts that\u00a0overweight<\/a>\u00a0and obesity may soon replace more traditional\u00a0public health<\/a>\u00a0concerns such as\u00a0undernutrition<\/a>\u00a0and\u00a0infectious diseases<\/a>\u00a0as the most significant cause of poor health.[169]<\/a><\/sup>\u00a0Obesity is a public health and policy problem because of its prevalence, costs, and health effects.[170]<\/a><\/sup>\u00a0The\u00a0United States Preventive Services Task Force<\/a>\u00a0recommends screening for all adults followed by behavioral interventions in those who are obese.[171]<\/a><\/sup>\u00a0Public health efforts seek to understand and correct the\u00a0environmental factors<\/a>\u00a0responsible for the increasing prevalence of obesity in the population. Solutions look at changing the factors that cause excess food energy consumption and inhibit physical activity. Efforts include federally reimbursed meal programs in schools, limiting direct\u00a0junk<\/a>\u00a0food marketing<\/a>\u00a0to children,[172]<\/a><\/sup>\u00a0and decreasing access to sugar-sweetened beverages in schools.[173]<\/a><\/sup>\u00a0The World Health Organization recommends the taxing of sugary drinks.[174]<\/a><\/sup>\u00a0When constructing urban environments, efforts have been made to increase access to parks and to develop pedestrian routes.[175]<\/a><\/sup>\u00a0There is low quality evidence that nutritional labelling with energy information on menus can help to reduce energy intake while dining in restaurants.[176]<\/a><\/sup><\/p>\n

<\/h2>\n
\n

stress<\/h3>\n

Stress eating<\/strong> is consuming food in response to stress, especially when you are not hungry. Similarly, emotional eating is eating in response to feeling. Emotional eating means that your emotions\u2014not your body\u2014dictate when and how much you eat.<\/p>\n

\n
\n
\n
\n
\n
\n
Causes<\/span><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

Some emotional eaters binge\u00a0when they are sad or confused.\u00a0For others, eating can be a way of avoiding thinking about problems or taking the action required to solve them.<\/p>\n

<\/div>\n

So why do we eat when we are stressed? Because for most of us, food offers comfort. And unfortunately, the least\u00a0healthy foods\u00a0usually offer the most comfort.<\/p>\n

<\/div>\n

If we reached for veggies in times of emotional discomfort, we’d be OK. But how many people turn to carrot sticks when they’re feeling stressed? It’s the high-fat, high-calorie foods we love that make us feel better. The more fattening, sweeter or the saltier the food, the better we seem to feel.<\/p>\n<\/div>\n

 <\/p>\n

Management of Obesity<\/span><\/h2>\n

The main treatment for obesity consists of\u00a0weight loss<\/a>\u00a0via calorie restricted\u00a0dieting<\/a>\u00a0and\u00a0physical exercise<\/a>.[21]<\/a><\/sup>[88]<\/a><\/sup>[183]<\/a><\/sup>[184]<\/a><\/sup>\u00a0Dieting, as part of a lifestyle change, produces sustained weight loss, despite slow weight regain over time.[21]<\/a><\/sup>[185]<\/a><\/sup>[186]<\/a><\/sup>[187]<\/a><\/sup>\u00a0Although 87% of participants in the\u00a0National Weight Control Registry<\/a>\u00a0were able to maintain 10% body weight loss for 10 years,[188]<\/a><\/sup>\u00a0the most appropriate dietary approach for long term weight loss maintenance is still unknown.[189]<\/a><\/sup>\u00a0Intensive behavioral interventions combining both dietary changes and exercise are recommended.[21]<\/a><\/sup>[183]<\/a><\/sup>[190]<\/a><\/sup>\u00a0Intermittent fasting has no additional benefit of weight loss compared to continuous energy restriction.[189]<\/a><\/sup>\u00a0Adherence is a more important factor in weight loss success than whatever kind of diet an individual undertakes.[189]<\/a><\/sup>[191]<\/a><\/sup><\/p>\n

Several hypo-caloric diets are effective.[21]<\/a><\/sup>\u00a0In the short-term low carbohydrate diets appear better than low fat diets for weight loss.[192]<\/a><\/sup>\u00a0In the long term, however, all types of low-carbohydrate and low-fat diets appear equally beneficial.[192]<\/a><\/sup>[193]<\/a><\/sup>\u00a0A 2014 review found that the heart disease and diabetes risks associated with different diets appear to be similar.[194]<\/a><\/sup>\u00a0Promotion of the Mediterranean diets among the obese may lower the risk of heart disease.[192]<\/a><\/sup>\u00a0Decreased intake of\u00a0sweet drinks<\/a>\u00a0is also related to weight-loss.[192]<\/a><\/sup>\u00a0Success rates of long-term weight loss maintenance with lifestyle changes are low, ranging from 2\u201320%.[195]<\/a><\/sup>\u00a0Dietary and lifestyle changes are effective in limiting excessive weight gain in\u00a0pregnancy<\/a>\u00a0and improve outcomes for both the mother and the child.[196]<\/a><\/sup>\u00a0Intensive behavioral counseling is recommended in those who are both obese and have other risk factors for heart disease.[197]<\/a><\/sup><\/p>\n

Medical interventions<\/span><\/h2>\n

The most effective treatment for obesity is\u00a0<\/span>bariatric surgery<\/a>.<\/span>[6]<\/a><\/sup>[21]<\/a><\/sup>\u00a0The types of procedures include\u00a0<\/span>laparoscopic adjustable gastric banding<\/a>,\u00a0<\/span>Roux-en-Y gastric bypass<\/a>,\u00a0<\/span>vertical-sleeve gastrectomy<\/a>, and\u00a0<\/span>biliopancreatic diversion<\/a>.<\/span>[198]<\/a><\/sup>\u00a0Surgery for severe obesity is associated with long-term weight loss, improvement in obesity-related conditions,<\/span>[203]<\/a><\/sup>\u00a0and decreased overall mortality, however, improved metabolic health results from the weight loss, not the surgery.<\/span>[204]<\/a><\/sup>\u00a0One study found a weight loss of between 14% and 25% (depending on the type of procedure performed) at 10\u00a0years, and a 29% reduction in all cause mortality when compared to standard weight loss measures.<\/span>[205]<\/a><\/sup>\u00a0Complications occur in about 17% of cases and reoperation is needed in 7% of cases.<\/span>[203]<\/a><\/sup>\u00a0Due to its cost and risks, researchers are searching for other effective yet less invasive treatments including devices that occupy space in the stomach.<\/span>[206]<\/a><\/sup>\u00a0For adults who have not responded to behavioral treatments with or without medication, the US guidelines on obesity recommend informing them about bariatric surgery.<\/span>[183]<\/a><\/sup><\/p>\n

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How Cognitive Behavioral Therapy Can Help Treat Food Addiction<\/h1>\n

If you have difficulty with overeating, you may wonder whether\u00a0cognitive\u00a0behavioral therapy<\/a>\u00a0(CBT) can help you stop your problem behaviors and food addiction. This example puts you in the place of a fictitious person who has characteristics and circumstances often seen in people who come for treatment for\u00a0food addiction<\/a>. This can show you what happens in CBT and how it can help people stop overeating.<\/p>\n

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Overeating and Binge Eating Behaviors<\/span><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

You are a binge eater who binges on candy, cookies, and chocolate several times a day. Your\u00a0overeating<\/a>\u00a0started in childhood when you would eat candy in secret at night. You describe your binges as emotional eating\u00a0because you eat when you felt upset.<\/p>\n

You do everything you can to prevent weight gain, including skipping regular meals, exercising for hours, using laxatives to “clear yourself out,” and occasionally, making yourself vomit. Your family doctor became concerned that you were developing problems with incontinence from laxative overuse, and she referred you to CBT to help you stop overeating.<\/p>\n

Overeating Due to Emotional Reasoning<\/span><\/h2>\n

Your cognitive-behavioral therapist\u00a0guides you in recording the thoughts and feelings you experience before, during and after bingeing on sweet food. By analyzing the thoughts and feelings you have around food, you and your therapist come to understand that you are emotional eating and possibly even binge eating in response to negative emotions due to faulty thinking (cognitive distortions).<\/p>\n

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As your weight has increased, your self-esteem has worsened. Many times a day, you would interpret small chance occurrences as reasons to feel bad about yourself. Once you start keeping track of your thought processes, you realize how often this is happening.<\/span><\/div>\n<\/div>\n<\/div>\n
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For example, if someone pushed in front of you in line, you would feel that this must mean you are a worthless person, and you would immediately buy a bar of chocolate to eat and make yourself feel better. One day, a colleague didn’t respond when you said “Good morning,” and you reasoned this was because your colleague disliked you.<\/p>\n

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At your first opportunity, you made an excuse to slip out and buy a pack of cookies\u00a0and ate the whole pack. Your performance review at work was rated “good,” and you thought that anything less than “excellent” meant you were terrible at your job, so you spent the evening eating cake and ice cream.<\/span><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n
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Each time a minor disappointment of this sort occurred, which was almost daily, you would go to your secret stash of chocolate or head to the grocery store for a binge. In spite of this well-established pattern of behavior, although you wanted to stop overeating, you just did not know another way to handle your uncomfortable feelings of worthlessness.<\/p>\n

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Using Cognitive Behavioral Therapy to Treat Food Addiction<\/span><\/div>\n<\/div>\n

The CBT therapist explains to you that your binge eating is based on emotional reasoning and, although eating might make you feel temporarily comforted, would not help you feel better about yourself. In fact, overeating was having the opposite effect\u00a0and was actually making you feel worse about yourself, which would then worsen your overeating.<\/p>\n

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With your therapist you learn ways to challenge the faulty thinking and also learn alternative coping strategies to deal with the negative emotions. Together, you plan a different approach to handling disappointment. With practice, you are able to interpret people\u2019s responses more realistically, so you are not constantly feeling inadequate. You also practice\u00a0<\/span>methods for improving your self-esteem<\/a>. As your self-esteem improves, you became more able to refrain from snacking and bingeing and began to eat more nutritious food.<\/span><\/div>\n<\/div>\n<\/div>\n
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CBT for Children<\/h3>\n