The worldwide epidemic of obesity is reaching critical proportions.1,2,3 An estimated 250 million people in the world are obese, and this number is predicted to reach 300 million by 2025.1 Obesity is a chronic disease that is caused by eating more calories than are expended. Obese people are, therefore, stigmatized. Obesity causes pathologic changes in the body: enlarged or hypertrophic fat cells produce associated clinical complications such as diabetes mellitus, gallbladder disease, hypertension, and some forms of cancer by releasing more free fatty acids, cytokines, and other products of fat cell metabolism
As a major risk factor for a number of noncommunicable diseases, including diabetes mellitus, coronary heart disease, hypertension, osteoarthritis, gallbladder disease, and some forms of cancer, obesity merits a high priority for strategies for prevention and, where this fails, for clinical management. The increasing prevalence of obesity will have a major effect on health care costs.4 In addition to the direct costs, there are many indirect economic and social costs that are often forgotten. Obesity has joined the ranks of chronic diseases that have displaced undernutrition and infectious diseases as the major killers of people.5
Preventive strategies are the primary tools to slow or reverse the worldwide explosion of obesity.1 This is where governmental research and demonstration projects are urgently needed. No matter how effective preventive strategies may be, however, there will still be a large pool of people who are already at risk of complications from their obesity and who need treatment. Viewing obesity as a multifactorial disease with distinctive pathologic and pathophysiologic processes provides a medical framework in which to consider treatment. A major difference exists between obesity and other chronic diseases such as hypertension or atherosclerosis. The presence of obesity is evident to obese people as well as to casual observers—that of hypertension and atherosclerosis is not. Thus, the management strategies for treatment and secondary prevention of weight regain must be appropriate and safe enough for use by all overweight people, even those who may be without clear medical indications for intensive interventions such as drug treatment.6
The problem of managing obesity needs to be tackled immediately. Although health care services for obesity exist in many countries, these tend to be located in cities (often in specialist hospitals), where people often have to pay for their treatment. This limits the service to the more affluent, depriving those in rural areas and people of lower socioeconomic status or those belonging to ethnic minorities of these services. Yet, people in lower socioeconomic groups have a high incidence of obesity.7 This group needs to be targeted for treatment but is being excluded by the health care system. In some countries, health insurance companies pay for the treatment of obesity, but most insurance carriers in North America do not. Funding is a major consideration in the management of all chronic diseases, but this is complicated further in patients with obesity, a disease that is still not recognized as such in many countries.7 This is an area that urgently needs public and governmental action.
An international obesity management strategy could provide a framework on which to base national guidelines for the management of obesity. Many political, attitudinal, cultural, and geographic factors need to be taken into consideration when implementing guidelines. Many government and health systems have a negative attitude to obesity, which highlights the need to raise awareness of obesity as a serious health condition.5
A multinational campaign for people to “Know your body mass index” could be a first step in raising public and professional awareness of this global epidemic. When the ravages of hypertension and atherosclerosis were recognized, governmental programs were aimed at encouraging the public to “Know your blood pressure” and “Know your cholesterol” and to seek treatment when needed.
Although many countries are starting to recognize the problem and to take it seriously, much still needs to be done to prevent and manage obesity effectively. The vital link between the lack of funding and lower socioeconomic status will need special consideration in all strategies to manage obesity.
