BMJ  2004;329:736-739 (25 September), doi:10.1136/bmj.329.7468.736

Education and debate

The runaway weight gain train: too many accelerators, not enough brakes

¹ School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Melbourne, Victoria 3125, Australia, ² Southern Cross University, Military Road, East Lismore, New South Wales 2480, Australia

Obesity seems to be perpetuated by a series of vicious cycles, which, in combination with increasingly obesogenic environments, accelerate weight gain and represent a major challenge for weight management

The first 150 words of the full text of this article appear below.

Introduction

The chronic positive energy balance that leads to obesity is apparently relatively small.¹ It is therefore paradoxical that obesity is so persistent and difficult to treat, because, in Western countries at least, the basic causes of obesity are readily apparent to everyone (eating too much and exercising too little). Obesity is associated with a substantial loss of quality of life and with social stigmatisation; awareness of the health consequences of obesity has never been greater. Even the body's physiological systems try to prevent weight gain by minimising the impact of energy imbalance on weight change.²

To help explain this apparent paradox, we propose that numerous vicious cycles are acting as "accelerators" that maintain and even increase overweight. We liken the situation to a "runaway weight gain train" (figure), which already has high momentum from the downhill slope of obesogenic (obesity promoting) environments but is getting faster as the . . . [Full text of this article]

The downhill slope of obesogenic environments

Ineffective brakes

Vicious cycles as accelerators

Movement inertia cycle

Mechanical dysfunction cycle

Psychological dysfunction cycle

Dieting cycle

Low socioeconomic status cycle

Conclusion

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