Obesity

Obesity is a medical condition, considered a disease by multiple organizations, in which excess body fat has accumulated to such an extent that it can have negative effects on health. People are classified as obese when their body mass index (BMI)—a person's weight divided by the square of the person's height—is over 30 kg/m2; the range 25–30 kg/m2 is defined as overweight. Some East Asian countries use lower BMI thresholds to define obesity. Obesity is a major cause of disability and is correlated with various diseases and conditions, particularly cardiovascular diseases, type 2 diabetes, obstructive sleep apnea, certain types of cancer, and osteoarthritis. Obesity has individual, socioeconomic, and environmental causes. Some known causes are diet, low physical activity, automation, urbanization, genetic susceptibility, medications, mental disorders, economic policies, and endocrine disorders. Exposure to endocrine-disrupting chemicals is a risk factor. While many people with obesity attempt to lose weight and are often successful, maintaining weight loss long-term is rare. Preventing obesity requires a multifaceted approach, including interventions at medical, societal, community, family, and individual levels. Changes to diet as well as exercising are the main treatments recommended by health professionals. Diet 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 dietary fiber. The World Health Organization stresses that the disease is a societal responsibility and that these dietary choices should be made the most available, affordable, and accessible options. Medications can be used, along with a suitable diet, to reduce appetite or decrease fat absorption. If diet, exercise, and medication are not effective, a gastric balloon or surgery may be performed to reduce stomach volume or length of the intestines, leading to earlier satiety, or a reduced ability to absorb nutrients from food. Metabolic surgery promotes weight loss not only by reducing caloric intake but also by inducing sustained changes in the secretion of gut hormones involved in appetite and metabolic regulation. Obesity is a leading preventable cause of death worldwide, with increasing rates in adults and children. In 2022, over 1 billion people lived with obesity worldwide (879 million adults and 159 million children), representing more than double the adult cases (and four times higher than cases among children) registered in 1990. Obesity is more common in women than in men. Obesity is often stigmatized in many parts of the world. Conversely, some cultures, past and present, have a favorable view of obesity, seeing it as a symbol of wealth and fertility. The World Health Organization, the US, Canada, Japan, Portugal, Germany, the European Parliament and medical societies (such as the American Medical Association) classify obesity as a disease. Others, such as the UK, do not.

Classification

Obesity is typically defined as a substantial accumulation of body fat that could impact health. Medical organizations tend to classify people living with obesity based on body mass index (BMI) – a ratio of a person's weight in kilograms to the square of their height in meters. For adults, the World Health Organization (WHO) defines "overweight" as a BMI 25 or higher, and "obesity" as a BMI 30 or higher. The U.S. Centers for Disease Control and Prevention (CDC) further subdivides obesity based on BMI, with a BMI 30 to 35 called class 1 obesity; 35 to 40, class 2 obesity; and 40+, class 3 obesity. For children, obesity measures take age into consideration along with height and weight. For children aged 5–19, the WHO defines obesity as a BMI two standard deviations above the median for their age (a BMI around 18 for a five-year old; around 30 for a 19-year old). For children under five, the WHO defines obesity as a weight three standard deviations above the median for their height. Some modifications to the WHO definitions have been made by particular organizations. The surgical literature breaks down class II and III or only class III obesity into further categories whose exact values are still disputed.

Any BMI ≥ 35 or 40 kg/m2 is severe obesity. A BMI of ≥ 35 kg/m2 and experiencing obesity-related health conditions or ≥ 40 or 45 kg/m2 is morbid obesity. A BMI of ≥ 45 or 50 kg/m2 is super obesity. As Asian populations develop negative health consequences at a lower BMI than Caucasians, some nations have redefined obesity; Japan has defined obesity as any BMI greater than 25 kg/m2 while China uses a BMI of greater than 28 kg/m2. The preferred obesity metric in scholarly circles is the body fat percentage (BF%) – the ratio of the total weight of person's fat to his or her body weight, and BMI is viewed merely as a way to approximate BF%. According to American Society of Bariatric Physicians, levels in excess of 32% for women and 25% for men are generally considered to indicate obesity. BMI is now viewed as outdated in some countries because it ignores variations between individuals in amounts of lean body mass, particularly muscle mass. Individuals involved in heavy physical labor or sports may have high BMI values despite having little fat. For example, more than half of all NFL players are classified as "obese" (BMI ≥ 30), and 1 in 4 are classified as "extremely obese" (BMI ≥ 35), according to the BMI metric. However, their mean body fat percentage, 14%, is well within what is considered a healthy range. Similarly, Sumo wrestlers are typically categorized by BMI as "severely obese" or "very severely obese", but one study of college-aged Sumo wrestlers found that 40% of them were no longer categorized as obese when body fat percentage (with a cutoff of <25%) was used instead of BMI; this was attributed to their very high lean body mass. The Edmonton Obesity Staging System (EOSS), developed in Canada, supplements BMI-based classification by incorporating medical, functional, and mental-health factors into a five-stage clinical framework.

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