Intended for healthcare professionals

Practice ABC of obesity

Strategies for preventing obesity

BMJ 2006; 333 doi: (Published 02 November 2006) Cite this as: BMJ 2006;333:959
  1. Mike Lean,
  2. Jose Lara,
  3. James O Hill
  1. clinical research fellow in the Division of Developmental Medicine, Human Nutrition, University of Glasgow, USA.
  2. director of the Center for Human Nutrition at the University of Colorado, USA.

    Obesity is an epidemic, says the World Health Organization. The prevalence of adult obesity has exceeded 30% in the United States, is over 20% in most of Europe (5-23% in men, 7-36% in women), and is 40-70% in the Gulf states and Polynesian islands. Obesity is also present in low income countries, and low socioeconomic groups are affected most. In most countries the prevalence of obesity now exceeds 15%, the figure used by WHO to define the critical threshold for intervention in nutritional epidemics.

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    Obesity is increasingly affecting younger people, with warning signs for the future from the increasing prevalence of overweight in childhood

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    Differences between individual and population based approaches to obesity. Adapted from Swinburn et al (see Further Reading box)

    Obese people are at high risk of multiple health problems and need full medical management. The numbers are so great (and rising), however, that individual medical care becomes impractical and prohibitively expensive. Currently, the cost of obesity to a country's health service is estimated at up to 9%, and the overall social cost of the condition is seen as a major hindrance to economic development. An even larger proportion of the population is overweight, with increased morbidity. Virtually all the costs (personal, health, and economic) of obesity are met in adulthood and result from fat that has accumulated in adulthood, but there is a likely additional cost due to inactivity and overweight in childhood that should also be considered.

    Achieving energy balance

    Obesity is a disorder of energy balance (“energy in” equals “energy out”). Weight is steady when energy is balanced. “Positive energy balance” is when the amount of energy consumed as food and drink exceeds the energy used. UK adults on average consume 20 kcal a day more than they expend, leading to an average weight gain of 1 kg …

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