Clinical Review

Science, medicine, and the future: Obesity treatment

BMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7114.997 (Published 18 October 1997) Cite this as: BMJ 1997;315:997
  1. John Wilding (J.P.H.Wilding@liverpool.ac.uk), senior lecturer in medicinea
  1. a Diabetes and Endocrinology Clinical Research Unit, University Clinical Departments at Aintree, Fazakerley Hospital, Liverpool L9 7AL Series edited by: John Savill

    Introduction

    Obesity now affects 15% of the population, and is an underlying factor in many diseases, yet, surprisingly, it has until recently attracted little medical or scientific interest. The epidemic of obesity is probably a result of increasingly sedentary lifestyles combined with easy availability of palatable, high fat foods. However, not everyone exposed to this environment becomes obese, and there is good evidence that the tendency to develop obesity is inherited—in the vast majority of cases as a complex polygenic trait, with a few rare cases of extreme obesity being due to single gene defects.

    Doctors readily accept the need to treat the consequences of obesity, but obesity itself is often ignored because available treatments are considered ineffective or unsafe. Public health measures to prevent obesity are important, but the evidence that even modest weight loss is beneficial, as long as it is maintained, makes a strong case for managing obesity in its own right. In this article I review the mechanisms that control body weight and discuss how understanding these may lead to the development of new, effective, and safe treatments for obese people.

    Definition of obesity

    • A body mass index (kg/m2) >25 is considered overweight

    • In Britain obesity is defined as a body mass index >30

    • An alternative to calculating body mass index is to measure waist circumference:

    Suggested cutoffs indicating significantly increased risk are >80 cm for women and >94 cm for men

    Waist sizes at which intervention is considered necessary are >88 cm for women and >102 cm for men

    The obesity epidemic

    Over half of the British population are now overweight. Between 1980 and 1995, the prevalence of obesity in Britain doubled from 8% to 15%. The myriad medical consequences of obesity make it relevant for most doctors.

    Mortality rises exponentially with increasing body weight.1 The risk of coronary heart …

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