Obesity

Please add to this project those who died with Obesity as the primary or contributing factor to the Cause of Death. If it was a contributing factor, be sure to add the person to the primary cause of death also.

Obesity is a medical condition in which excess body fat has accumulated to an extent that it may have a negative effect on health.

Obesity is a complex disease involving an excessive amount of body fat. It is a medical problem that increases the risk of other diseases and health problems, such as heart disease, diabetes, high blood pressure and certain cancers.

There are many reasons why some people have difficulty avoiding obesity. Usually, obesity results from a combination of inherited factors, combined with the environment and personal diet and exercise choices.

Symptoms:

• Obesity is diagnosed when your body mass index (BMI) is 30 or higher. To determine your body mass index, divide your weight in pounds by your height in inches squared and multiply by 703. Or divide your weight in kilograms by your height in meters squared.
• For most people, BMI provides a reasonable estimate of body fat. However, BMI doesn't directly measure body fat, so some people, such as muscular athletes, may have a BMI in the obesity category even though they don't have excess body fat.

Causes

• The fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expended.
• The causes of obesity can be roughly divided into five groups: Food production & intake, politics, society, wealth & activity.
  • The lack of control over nutrition labels, ingredients and effects of food on a person’s health has given the large industrial producers little incentives to change anything about their production of high fat and high sugar foods.
  • With every country in the EU having more than 50% overweight people it has become the new “normal” to have more overweight people around one’s community. This has caused a “normalization” of the actual issue.
  • An increase of physical inactivity due to the increasingly sedentary nature of many forms of work, changing modes of transportation, and increasing urbanizations caused some humans over time to burn less calories than they consume.
  • Wealth or the lack thereof dictates how and what we eat. In low-income countries, however, personal wealth is often shown through the excessive consumption of high fat western junk food.
• Although there are genetic, behavioral, metabolic and hormonal influences on body weight, obesity occurs when you take in more calories than you burn through exercise and normal daily activities. Your body stores these excess calories as fat.
• Most Americans' diets are too high in calories — often from fast food and high-calorie beverages. People with obesity might eat more calories before feeling full, feel hungry sooner, or eat more due to stress or anxiety.

Risk factors

• Obesity usually results from a combination of causes and contributing factors:
  • Family inheritance and influences
    • The genes you inherit from your parents may affect the amount of body fat you store, and where that fat is distributed. Genetics may also play a role in how efficiently your body converts food into energy, how your body regulates your appetite and how your body burns calories during exercise.
    • Obesity tends to run in families. That's not just because of the genes they share. Family members also tend to share similar eating and activity habits.
  • Lifestyle choices
    • Unhealthy diet. A diet that's high in calories, lacking in fruits and vegetables, full of fast food, and laden with high-calorie beverages and oversized portions contributes to weight gain.
    • Liquid calories. People can drink many calories without feeling full, especially calories from alcohol. Other high-calorie beverages, such as sugared soft drinks, can contribute to significant weight gain.
    • Inactivity. If you have a sedentary lifestyle, you can easily take in more calories every day than you burn through exercise and routine daily activities. Looking at computer, tablet and phone screens is a sedentary activity. The number of hours you spend in front of a screen is highly associated with weight gain.
  • Certain diseases and medications
    • In some people, obesity can be traced to a medical cause, such as Prader-Willi syndrome, Cushing syndrome and other conditions. Medical problems, such as arthritis, also can lead to decreased activity, which may result in weight gain.
    • Some medications can lead to weight gain if you don't compensate through diet or activity. These medications include some antidepressants, anti-seizure medications, diabetes medications, antipsychotic medications, steroids and beta blockers.
  • Social and economic issues
    • Social and economic factors are linked to obesity. Avoiding obesity is difficult if you don't have safe areas to walk or exercise. Similarly, you may not have been taught healthy ways of cooking, or you may not have access to healthier foods. In addition, the people you spend time with may influence your weight — you're more likely to develop obesity if you have friends or relatives with obesity.
  • Age
    • Obesity can occur at any age, even in young children. But as you age, hormonal changes and a less active lifestyle increase your risk of obesity. In addition, the amount of muscle in your body tends to decrease with age. Generally, lower muscle mass leads to a decrease in metabolism. These changes also reduce calorie needs, and can make it harder to keep off excess weight. If you don't consciously control what you eat and become more physically active as you age, you'll likely gain weight.
    • WHO defines Adult Overweight as a BMI greater than or equal to 25; Obesity is a BMI greater than or equal to 30.
    • WHO defines Children under 5 y/o
      • Overweight is weight-for-height greater than 2 standard deviations above WHO Child Growth Standards median; and
      • Obesity is weight-for-height greater than 3 standard deviations above the WHO Child Growth Standards median.
    • Children aged between 5–19 years
      • overweight is BMI-for-age greater than 1 standard deviation above the WHO Growth Reference median; and
      • obesity is greater than 2 standard deviations above the WHO Growth Reference median.
  • Other factors
    • Pregnancy
    • Quitting smoking
    • Lack of sleep
    • Stress
    • Microbiome (Your gut bacteria are affected by what you eat and may contribute to weight gain or difficulty losing weight.)
    • Previous attempts to lose weight

Complications

• Heart disease and strokes. Obesity makes you more likely to have high blood pressure and abnormal cholesterol levels, which are risk factors for heart disease and strokes. (WHO - the leading cause of death in 2012)
• Type 2 diabetes. Obesity can affect the way the body uses insulin to control blood sugar levels, raising the risk of insulin resistance and diabetes.
• Certain cancers: Obesity increases the risk of cancer of the uterus, cervix, endometrium, ovary, prostate, breast, colon, rectum, esophagus, liver, gallbladder, pancreas, kidney and prostate.
• Digestive problems. Obesity increases the likelihood of developing heartburn, gallbladder disease and liver problems.
• Gynecological and sexual problems. Obesity may cause infertility and irregular periods in women and can cause erectile dysfunction in men.
• Sleep apnea. People with obesity are more likely to have sleep apnea, a potentially serious disorder in which breathing repeatedly stops and starts during sleep.
• Musculoskeletal disorders (especially osteoarthritis – a highly disabling degenerative disease of the joints)
• The risk for noncommunicable diseases increases with increases in BMI.
• Childhood obesity is associated with a higher chance of obesity, premature death and disability in adulthood. But in addition to increased future risks, obese children experience breathing difficulties, increased risk of fractures, hypertension, early markers of cardiovascular disease, insulin resistance and psychological effects.

Statistics

• The CDC estimates that 42.4 percent of Americans 20 years old and older had obesity in 2017 to 2018
• Globally seen, the United States is no longer the clear leader in overweight and obesity rates even though today 70.7% of the US population is overweight and one-third of the population is obese. Australia and New Zealand are growing heavier with both having 29% obese people, which is almost double the amount from 1980. Especially obesity in the Middle East is also becoming a severe problem. Kuwait leads with 43% of people obese and UAE, Jordan, Egypt and Saudi Arabia are all having rates above 30%. (LinkedIn – The Global Obesity Crisis. By Meiert J Gootes, June 23, 2017)
• From 1999–2000 through 2017–2018, the prevalence of obesity increased from 30.5% to 42.4%, and the prevalence of severe obesity increased from 4.7% to 9.2%.
• Obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of cancer that are some of the leading causes of preventable, premature death.
• The estimated annual medical cost of obesity in the United States was $147 billion in 2008 US dollars; the medical cost for people who have obesity was $1,429 higher than those of normal weight.
• Non-Hispanic blacks (49.6%) had the highest age-adjusted prevalence of obesity, followed by Hispanics (44.8%), non-Hispanic whites (42.2%) and non-Hispanic Asians (17.4%).
• The prevalence of obesity was 40.0% among young adults aged 20 to 39 years, 44.8% among middle-aged adults aged 40 to 59 years, and 42.8% among adults aged 60 and older.
• Overall, men and women with college degrees had lower obesity prevalence compared with those with less education.
• By race/ethnicity, the same obesity and education pattern was seen among non-Hispanic white, non-Hispanic black, and Hispanic women, and also among non-Hispanic white men, although the differences were not all statistically significant. Although the difference was not statistically significant among non-Hispanic black men, obesity prevalence increased with educational attainment. Among non-Hispanic Asian women and men and Hispanic men there were no differences in obesity prevalence by education level.
• Among men, obesity prevalence was lower in the lowest and highest income groups compared with the middle income group. This pattern was seen among non-Hispanic white and Hispanic men. Obesity prevalence was higher in the highest income group than in the lowest income group among non-Hispanic black men.
• Among women, obesity prevalence was lower in the highest income group than in the middle and lowest income groups. This pattern was observed among non-Hispanic white, non-Hispanic Asian, and Hispanic women. Among non-Hispanic black women, there was no difference in obesity prevalence by income.
• For children and adolescents aged 2-19 years:
  • The prevalence of obesity was 18.5% and affected about 13.7 million children and adolescents.
  • Obesity prevalence was 13.9% among 2- to 5-year-olds, 18.4% among 6- to 11-year-olds, and 20.6% among 12- to 19-year-olds. Childhood obesity is also more common among certain populations.
  • Hispanics (25.8%) and non-Hispanic blacks (22.0%) had higher obesity prevalence than non-Hispanic whites (14.1%).
  • Non-Hispanic Asians (11.0%) had lower obesity prevalence than non-Hispanic blacks and Hispanics.
  • The prevalence of obesity decreased with increasing level of education of the household head among children and adolescents aged 2-19 years.
  • Obesity prevalence was 18.9% among children and adolescents aged 2-19 years in the lowest income group, 19.9% among those in the middle income group, and 10.9% among those in the highest income group.
  • Obesity prevalence was lower in the highest income group among non-Hispanic Asian and Hispanic boys.
  • Obesity prevalence was lower in the highest income group among non-Hispanic white, non-Hispanic Asian, and Hispanic girls. Obesity prevalence did not differ by income among non-Hispanic black girls.
• From: WHO - Obesity & overweight fact sheet
  • Worldwide obesity has nearly tripled since 1975.
  • In 2016, more than 1.9 billion adults, 18 years and older, were overweight. Of these over 650 million were obese.
  • 39% of adults aged 18 years and over were overweight in 2016, and 13% were obese.
  • Most of the world's population live in countries where overweight and obesity kills more people than underweight.
  • 38 million children under the age of 5 were overweight or obese in 2019.
  • Over 340 million children and adolescents aged 5-19 were overweight or obese in 2016.
• Obesity is preventable.

Historical attitudes

• Ancient Greek medicine recognizes obesity as a medical disorder, and records that the Ancient Egyptians saw it in the same way. Hippocrates wrote that "Corpulence is not only a disease itself, but the harbinger of others". The Indian surgeon Sushruta (6th century BCE) related obesity to diabetes and heart disorders. He recommended physical work to help cure it and its side effects. For most of human history mankind struggled with food scarcity. Obesity has thus historically been viewed as a sign of wealth and prosperity. It was common among high officials in Europe in the Middle Ages and the Renaissance as well as in Ancient East Asian civilizations. In the 17th century, English medical author Tobias Venner is credited with being one of the first to refer to the term as a societal disease in a published English language book
• With the onset of the Industrial Revolution it was realized that the military and economic might of nations were dependent on both the body size and strength of their soldiers and workers
• Many cultures throughout history have viewed obesity as the result of a character flaw.
• Public perceptions in Western society regarding healthy body weight differ from those regarding the weight that is considered ideal – and both have changed since the beginning of the 20th century. The weight that is viewed as an ideal has become lower since the 1920s.
• Obesity is still seen as a sign of wealth and well-being in many parts of Africa. This has become particularly common since the HIV epidemic began.
• The first sculptural representations of the human body 20,000–35,000 years ago depict obese females. Some attribute the Venus figurines to the tendency to emphasize fertility while others feel they represent "fatness" in the people of the time.
• Corpulence is, however, absent in both Greek and Roman art, probably in keeping with their ideals regarding moderation. This continued through much of Christian European history, with only those of low socioeconomic status being depicted as obese.

Mortality Rate:

• The mortality rates of normal-weight individuals who were formerly overweight or obese were 47.48 and 66.67 per 1000 person-years, respectively, while individuals who never exceeded normal weight had a mortality rate of 27.93 per 1000 person-years.
• Overall, obesity is estimated to increase the cardiovascular mortality rate 4-fold and the cancer-related mortality rate 2-fold. [7, 8, 9] As a group, people who are severely obese have a 6- to 12-fold increase in the all-cause mortality rate.

Notables who died from Obesity

1. Ranker – The Top 10 Fattest Celebrities Who Died Young Were obese, but most died from other causes
2. Bossip – Larger Than Live: 8 Overweight Celebs Who Died Too Soon

• Dom Deluise -- famous actor whose main work of note was in the 1970s. He always struggled with weight issues, and it led to his death indirectly in 2009.
• Heavy D -- a legendary rapper who was known as Heavy D the Overweight Love. His death was related to obesity and breathing problems. He was 44.
• Chris Farley (1964-1997) - The insanely-funny chubby lumpkins went from Saturday Night Live to starring in one of the funniest comedies ever (“Tommy Boy”) before his love for booze and drugs (coupled with morbid obesity) lead to his untimely death at 33.

Resources & Additional Reading

• Mayo Clinic Obesity – Overview
• CDC – Adult obesity facts
• CDC – Childhood obesity facts
• Wikipedia – Obesity
• Healthline – What is obesity?
• YouTube – Obesity (5:37 min)
• My Endo Health – Obesity is now a global epidemic!
• LinkedIn – The Global Obesity Crisis. By Meiert J Gootes, June 23, 2017
• Arizona Wellness Group – The Global Rise of Obesity, 11 Apr 2016
• Bloomberg – The World is Getting Fatter and No One Knows How to Stop It. By: John Tozzi & Jeremy Scott Diamond, 6 Apr 2016
• Medscape – What is the mortality rate for individuals with obesity? 24 Sept 2020
• Medscape – Obesity. Updated 1 Jul 2020. By: Osama Hamdy, MD, PhD; Chief Editor: Romesh Khardori, MD, PhD, FACP

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