Extreme obesity: a new medical crisis in the United States.

The prevalence of obesity has markedly increased in the past few decades, and this disorder is responsible for more health care expenditures than any other medical condition. The greater the body mass index (BMI) (calculated as weight in kilograms divided by the square of height in meters), the greater the risk of comorbidities, including diabetes mellitus, hypertension, obstructive sleep apnea, many cancers, dyslipidemia, cardiovascular disease, and overall mortality. Class III (extreme) obesity, defined as a BMI of 40 kg/m2 or greater, has also increased such that it now affects almost 1 in 20 Americans. The prevalence of extreme obesity is greater among women than among men and greater among blacks than among non-Hispanic whites or Hispanics. The effect of extreme obesity on mortality is greater among young than among older adults, greater among men than among women, and greater among whites than among blacks. The current permissive environment that promotes increased dietary energy intake and decreased energy expenditure through reduced daily physical activity coupled with genetic susceptibility is an important pathogenic factor. The number of bariatric surgical procedures performed annually is relatively small but increasing.

[1]  Claudia M Toth,et al.  Childhood maltreatment in extremely obese male and female bariatric surgery candidates. , 2005, Obesity research.

[2]  Roger B. Davis,et al.  Health care expenditures associated with overweight and obesity among US adults: importance of age and race. , 2005, American journal of public health.

[3]  G. O. Lignac.  [Actual causes of death]. , 1951, Nederlands tijdschrift voor geneeskunde.

[4]  J Tsevat,et al.  Impact of morbid obesity on medical expenditures in adults , 2005, International Journal of Obesity.

[5]  K. Brownell,et al.  Bias, discrimination, and obesity. , 2001, Obesity research.

[6]  G. Bray.  Obesity: historical development of scientific and cultural ideas. , 1990, International journal of obesity.

[7]  R. Sturm,et al.  The effects of obesity, smoking, and drinking on medical problems and costs. , 2002, Health affairs.

[8]  Christina Wee,et al.  Screening for Cervical and Breast Cancer: Is Obesity an Unrecognized Barrier to Preventive Care? , 2000, Annals of Internal Medicine.

[9]  Laura Kettel Khan,et al.  Trends and correlates of class 3 obesity in the United States from 1990 through 2000. , 2002, JAMA.

[10]  G. Blackburn,et al.  Physical activity in the prevention and treatment of obesity and its comorbidities. , 1999, Medicine and science in sports and exercise.

[11]  G. L. Heck,et al.  Psychological Profile of the Morbidly Obese , 2004 .

[12]  J. Ricci,et al.  Lost Productive Time Associated With Excess Weight in the U.S. Workforce , 2005, Journal of occupational and environmental medicine.

[13]  M. Caroli,et al.  Role of television in childhood obesity prevention , 2004, International Journal of Obesity.

[14]  H. Christopoulou-Aletra,et al.  Methods Used by the Hippocratic Physicians for Weight Reduction , 2004, World Journal of Surgery.

[15]  J. Gerberding,et al.  Correction: actual causes of death in the United States, 2000. , 2005, JAMA.

[16]  Walter C Willett,et al.  Television watching and other sedentary behaviors in relation to risk of obesity and type 2 diabetes mellitus in women. , 2003, JAMA.

[17]  Ross C Brownson,et al.  Declining rates of physical activity in the United States: what are the contributors? , 2005, Annual review of public health.

[18]  J. Manson,et al.  Annual deaths attributable to obesity in the United States. , 1999, JAMA.

[19]  Chi-Chang Chen,et al.  Use and costs of bariatric surgery and prescription weight-loss medications. , 2005, Health affairs.

[20]  M. Rowland,et al.  Self-reported weight and height. , 1990, The American journal of clinical nutrition.

[21]  B. Popkin,et al.  Trends in energy intake in U.S. between 1977 and 1996: similar shifts seen across age groups. , 2002, Obesity research.

[22]  G R Hunter,et al.  The etiology of obesity: relative contribution of metabolic factors, diet, and physical activity. , 1998, The American journal of medicine.

[23]  N. Chalasani,et al.  Nonalcoholic fatty liver disease in individuals with severe obesity. , 2004, Clinics in liver disease.

[24]  A. Manley.  Physical Activity And Health: A Report Of The Surgeon General , 2004 .

[25]  E. Finkelstein,et al.  The Costs of Obesity among Full-Time Employees , 2005, American journal of health promotion : AJHP.

[26]  E. Finkelstein,et al.  National medical spending attributable to overweight and obesity: how much, and who's paying? , 2003, Health affairs.

[27]  L. Tucker,et al.  Obesity and Absenteeism: An Epidemiologic Study of 10,825 Employed Adults , 1998, American journal of health promotion : AJHP.

[28]  D. Allison,et al.  Years of life lost due to obesity. , 2003, JAMA.

[29]  L. Sjöström,et al.  Assessment of quality of life before and after surgery for severe obesity. , 1992, The American journal of clinical nutrition.

[30]  J. Hebebrand,et al.  Does obesity surgery improve psychosocial functioning? A systematic review , 2003, International Journal of Obesity.

[31]  Michael J Thun,et al.  Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. , 2003, The New England journal of medicine.

[32]  S. Olshansky,et al.  A potential decline in life expectancy in the United States in the 21st century. , 2005, The New England journal of medicine.

[33]  D. Gadaleta,et al.  A Study of Discrimination within the Medical Community as Viewed by Obese Patients , 2002, Obesity surgery.

[34]  D. Arterburn,et al.  Association of body weight with condition-specific quality of life in male veterans. , 2004, The American journal of medicine.

[35]  T. Wadden,et al.  Psychiatric Diagnoses and Psychiatric Treatment Among Bariatric Surgery Candidates , 2004, Obesity surgery.

[36]  K. Flegal,et al.  Prevalence of overweight and obesity in the United States, 1999-2004. , 2006, JAMA.

[37]  K. Flegal,et al.  Prevalence and trends in obesity among US adults, 1999-2000. , 2002, JAMA.

[38]  G C Hogelin,et al.  The behavioral risk factor surveys: II. Design, methods, and estimates from combined state data. , 1985, American journal of preventive medicine.

[39]  B. Popkin,et al.  Patterns and trends in food portion sizes, 1977-1998. , 2003, JAMA.

[40]  G. Colditz,et al.  The disease burden associated with overweight and obesity. , 1999, JAMA.

[41]  C. Rosik.  Psychiatric Symptoms among Prospective Bariatric Surgery Patients: Rates of Prevalence and their Relation to Social Desirability, Pursuit of Surgery, and Follow-Up Attendance , 2005, Obesity surgery.

[42]  A. Mokdad,et al.  Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. , 2003, JAMA.

[43]  M. Thun,et al.  The effect of age on the association between body-mass index and mortality. , 1998, The New England journal of medicine.

[44]  M. Clark,et al.  Interindividual Variation in Posture Allocation: Possible Role in Human Obesity , 2005, Science.

[45]  R. Sturm.  Increases in clinically severe obesity in the United States, 1986-2000. , 2003, Archives of internal medicine.

[46]  B. Popkin,et al.  Changes in beverage intake between 1977 and 2001. , 2004, American journal of preventive medicine.

[47]  Katherine M. Kosa,et al.  Economic causes and consequences of obesity. , 2005, Annual review of public health.

[48]  C. Rand,et al.  Morbidly Obese Patients' Perceptions of Social Discrimination Before and After Surgery for Obesity , 1990, Southern medical journal.

[49]  C. Lewis,et al.  Mortality and Cardiac and Vascular Outcomes in Extremely Obese Women , 2006 .

[50]  G. Bray,et al.  How do we get fat? An epidemiologic and metabolic approach. , 2004, Clinics in dermatology.

[51]  T. Strine,et al.  Disability, arthritis, and body weight among adults 45 years and older. , 2004, Obesity research.

[52]  M. Cabana,et al.  National trends in bariatric surgery, 1996-2002. , 2006, Archives of surgery.

[53]  E. Arias,et al.  United States life tables, 2005. , 2010, National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.

[54]  S. Finlayson,et al.  National trends in utilization and outcomes of bariatric surgery , 2005, Surgical Endoscopy And Other Interventional Techniques.

[55]  G. Oster,et al.  Estimated Economic Costs of Obesity to U.S. Business , 1998, American journal of health promotion : AJHP.

[56]  M. Thun,et al.  Body-mass index and mortality in a prospective cohort of U.S. adults. , 1999, The New England journal of medicine.

[57]  F. Que,et al.  Perioperative care of patients undergoing bariatric surgery. , 2006, Mayo Clinic proceedings.

[58]  P. Garcia-Lorda,et al.  Prevalence of Co-morbidities in Obese Patients before Bariatric Surgery: Effect of Race , 2003, Obesity surgery.

[59]  J. Levine.  Non-exercise activity thermogenesis (NEAT). , 2004, Nutrition reviews.

[60]  Diet and obesity , 2004, Current opinion in gastroenterology.

[61]  J. Gerberding,et al.  Actual causes of death in the United States, 2000. , 2004, JAMA.