Intended for healthcare professionals

Practice ABC of obesity

Obesity—can we turn the tide?

BMJ 2006; 333 doi: (Published 14 December 2006) Cite this as: BMJ 2006;333:1261
  1. Mike Lean, professor of nutrition1,
  2. Laurence Gruer, director of public health science2,
  3. George Alberti, emeritus professor of medicine3,
  4. Naveed Sattar, professor of metabolic medicine1
  1. 1University of Glasgow
  2. 2NHS Health Scotland
  3. 3University of Newcastle Medical School

    The problem of rising prevalence in obesity may get much worse—rates could climb still further, bankrupting the health system and leading soon to reductions in life expectancy. So, can we offer effective management? And can we reverse the rising trend in the prevalence of obesity, and if so, when?

    Recent headlines highlighting the current and projected obesity levels in the United Kingdom—in 2010 a third of adults will be obese—reiterate the cry that “it's time to do something about it.” As already shown in this series, the consequences of obesity affect all ages and nearly all organ systems. Obesity diminishes quality of life, and many problems begin well before reaching a body mass index of 30. Well over half the entire population of the UK have a BMI of >25, and they will experience greater morbidity and total mortality.

    Medical complications of obesity

    Trends in obesity in adults in England, 1980-2002 (graph adapted from Health Survey for England 2004). Projected levels suggest that by 2010 nearly a third of adult men and 28% of women in England will be obese (Forecasting obesity to 2010, The figures will be higher for older people

    Vicious cycle of weight gain. Food provides short term pleasure and is addictive

    Whose responsibility?

    Although the old attitude of “pull yourself together, eat less, and exercise more” is receding, it is still evident among less perceptive health professionals and is commonly voiced by the media. Most overweight or obese individuals would prefer to be normal weight, and many are doing as much as they can to keep their weight lower than it would otherwise be.

    It is increasingly apparent that most individuals are unable to make enough “proactive” changes to prevent excess weight gain but are simply “reactive” to their environment. Thus education alone will fail to …

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