Clinical Obesity in Adults and Children

Peter G. Kopelman, Ian D. Caterson, William H. Dietz, Peter G. Kopelman, Ian D. Caterson, William H. Dietz

• Publisher: Wiley-Blackwell
• Year: 2022
• Print ISBN:
  9781119695271
• eBook ISBN:
  9781119695325
• Edition: 4
• Topic: Medicine
• Subtopic: Endocrinology & Metabolism

Clinical Obesity in Adults and Children

A comprehensive and incisive exploration of obesity in society and the clinical setting

In the newly revised Fourth Edition of Clinical Obesity in Adults and Children, a team of expert medical practitioners deliver a comprehensive exploration of the increasingly widespread disease of obesity. The book discusses topics such as the causes of obesity, the disease-model of obesity, the management of adult and childhood obesity, and policy approaches to obesity.

Designed to enable readers to better understand the full complexity of obesity — both within society and in the clinical setting — the book discusses a disease that is the leading cause of ill health around the world. The editors have included contributions from leading international experts in their respective fields that address every major aspect of this often misunderstood disease.

Readers will also benefit from the inclusion of:

• Introductions to the history and scale of the obesity problem across the world and its epidemiology and social determinants
• Comprehensive explorations of those affected by obesity, including fetal and infant origins, genetic causes, bias and stigma encountered by those affected by obesity, and the psychobiology of obesity
• Practical discussions of obesity as a disease, including its co-morbidities of dyslipidemia, fertility, cardiovascular consequences, and obstructive sleep apnea
• In-depth examinations of the management of obesity in adults and children, including contemporary approaches to clinical and dietary management, and behavioral treatments

Perfect for doctors and allied health professionals who regularly work with patients suffering from obesity, Clinical ;Obesity in Adults and Children will also earn a place in the libraries of health researchers and scholars studying obesity and nutrition, dieticians, nutritionists, and anyone else with a professional interest in an increasingly prevalent health problem.

1
Obesity

1
Obesity – Introduction: History and the Scale of the Problem Worldwide

W. Philip T. James¹ and Tim Gill²

¹ Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK

² Boden Initiative, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia

Obesity is a complex condition and, although much remains to be elucidated, our understanding of the many facets of overweight and obesity has advanced greatly over the last few decades. Current research is often focussed on the genetic and molecular patho‐physiological drivers which derange energy balance and lead to excess body fat, but it is important that clinicians have an appreciation of the history and context of these findings and an awareness of the significant challenges created by the different features of obesity that continue to be revealed. Different patterns of obesity emerging across the world may also have different impacts on the public health burden and may require a different approach to the development of prevention and treatment strategies.

The condition of obesity has been recognized for millennia, and its historical context was described in detail by George Bray [1], who highlighted the representation of obesity in images and figurines produced in Europe about 23,000–25,000 years ago. These ancient individuals may well have had a severe form of genetic obesity, and Bray suggests that they may have been considered deities – this would not have seemed unreasonable in societies constantly striving to avoid food shortages. This predicament might still have applied to the general population in the early agricultural period 5000–6000 years BC in Mesopotamia and later in Egypt, but by then, with greater food availability, obesity was particularly seen in the ruling classes. However, Bray points out that by then, obesity was considered objectionable rather than reflecting a remarkable and unusual status akin to that of a deity. These individuals most likely suffered from not only the common problems of backache and arthritis but also the impact of comorbidities such as diabetes. Chinese and Indian medicine also dealt with obesity as a problem condition, and the particular propensities for Asians and the people of the Middle East to display ill health on weight gain are discussed later. Further on the Roman Galen distinguished between “moderate” and “immoderate” obesity, so in a European rather than an Asian or Middle Eastern context, there may have been a sizable number of overweight individuals with few complications, whereas others were handicapped by their adiposity without this automatically being a reflection of the degree of obesity.

In this ancient literature, it was clear that obesity was considered a clinically unusual event, and so it is little wonder that the original classification of diseases being steadily developed in France during the 19th century included obesity along with other clearly identified clinical abnormalities, some of which were only really apparent on postmortem examination. This classification of diseases was taken over by the World Health Organization (WHO) on its formation in 1948, so in practice, WHO recognized obesity as a disease entity from its inception. However, at this stage, WHO’s primary focus was public health with a heavy emphasis on the poorer countries of the world at a time when obesity was not a problem in lower‐income countries.

Obesity as a public health problem

It is commonly perceived that obesity has only recently been recognized as a public health issue and its potential impact on population health is still yet to be completely acknowledged. However, in his book titled “Fat in the Fifties,” Rasmussen [2] describes a period in post‐World War II America when obesity was being described as the greatest threat to public health. During the 1940s, heart disease replaced infectious diseases as the major cause of death in the United States. At the same time, data from insurance companies identified that higher body weight (relative to height) was associated with an increased risk of premature death, including those from heart disease, and thus obesity was defined as the major public health concern to be addressed. In the 1950s, research by Keys and his colleagues suggested that the three major risk factors for coronary heart disease (CHD) were smoking, high blood pressure, and a high plasma cholesterol level. These findings were seized upon and promoted by vested interests such as the sugar industry that were threatened by the suggestion that excess calories were driving the rise in heart disease and cancer. Although it was recognized that weight gain increased both blood pressure and blood cholesterol levels but obesity per se did not seem to be nearly as important as an independent predictor; in Key’s analysis, the olive oil eating, fatter Greek men had one of the lowest CHD rates. As a consequence, obesity lost its prominence as a key public health issue and was buried by the avalanche of concern around what was then described as the “true” risk factors for heart disease.

Obesity was again raised as a serious public health issue in the early 1970s. One author (W.P.T. James) was involved in producing the UK report on obesity for the UK Department of Health and Social Services and the Medical Research Council [3]. At that stage, obesity was being defined as a percentage excess weight above the desirable weight for height listed by the US Metropolitan Life Insurance Company in complex tables with weights in clothes for three personally chosen frame sizes. These figures relating to pre‐Second World War mortality statistics that were collected on millions of insurance‐eligible Americans. The UK report wanted a standardized measure of body weight that would account for people of different sizes and adopted the approach of the Belgian mathematician Quetelet’s from 1835, who recommended that this could be best achieved deriving the index W/H² in metric units; a unit now termed the body mass index (BMI). It became apparent that when taking the insurance tables and then considering only the lower limits of the small frame size and the upper limit of the large frame size that the derived Quetelet index was almost the same across a huge range in heights. This ideal body weight from the insurance tables translated into an index of 19.1–24.6 for women and to 19.7–24.9 for men after adjusting for the weight of light clothing and shoe heights. John Garrow, a member of the committee, then rounded these numbers for clinical use to BMI of 20–25. Based on the insurance company’s approach of specifying obesity when weights were 20% above ideal, obesity cut‐off was set at BMI 30.

Lower limits of BMIs in non‐Caucasians?

The BMI limits of 20–25 for minimum mortality rates based on US life insurance data set out in the early 1970s were reaffirmed in the 1983 analysis from the London Royal College of Obesity [4] using data from the US Cancer Society that analyzed data on smokers and nonsmokers separately. Therefore, the big issue was whether these limits applied globally. It was hoped that this could be answered with the establishment of the International Obesity Task Force (IOTF) in 1996, but at that time, there was limited longitudinal data on adult weights and heights and their subsequent mortality in non‐Caucasian populations. However, when the IOTF proposed in 1997 cut‐off points of 25 and 30 to define new WHO criteria and set out policies for tackling global obesity, the Japanese delegate desired a lower upper normal BMI cut‐off point of 23.0, whereas the US delegate favored a higher normal cut point of 28.0 despite the original mortality data being derived fro...

Table of contents

• Cover
• Table of Contents
• Title Page
• Copyright Page
• List of Contributors
• Preface
• Dedication
• List of Abbreviations
• 1 Obesity
• 2 Causes of Obesity
• 3 Obesity as a Disease
• 4 Management of Adult Obesity
• 5 Childhood Obesity
• 6 Policy Approaches
• Index
• End User License Agreement