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

doi:10.1136/bmj.329.7468.736

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

Boyd Swinburn, professor of population health¹, Garry Egger, adjunct professor²

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

Correspondence to: B Swinburn swinburn@deakin.edu.au

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 weightmanagement

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

Introduction

The chronic positive energy balance that leads to obesity isapparently relatively small.¹ It is therefore paradoxical thatobesity is so persistent and difficult to treat, because, inWestern countries at least, the basic causes of obesity arereadily apparent to everyone (eating too much and exercisingtoo little). Obesity is associated with a substantial loss ofquality of life and with social stigmatisation; awareness ofthe health consequences of obesity has never been greater. Eventhe body's physiological systems try to prevent weight gainby minimising the impact of energy imbalance on weight change.²

To help explain this apparent paradox, we propose that numerousvicious cycles are acting as "accelerators" that maintain andeven increase overweight. We liken the situation to a "runawayweight gain train" (figure), which already has high momentumfrom the downhill slope of obesogenic (obesity promoting) environmentsbut 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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