cause and effect essay on obesity in america

Obesity in America: Cause and Effect Essay Sample

It is clear that the American lifestyle has contributed to the increasing prevalence of obesity. With estimates from the Washington-based Centers for Disease Prevention in the Department of Health and Human Services indicating that one in three American adults is overweight, it is evident that the country is facing an obesity epidemic. To better understand the causes and effects of obesity, research is needed to further explore the issue. For those struggling with obesity, coursework assistance may be available to help them make the necessary lifestyle changes in order to live a healthier life.

Writing a thesis paper on the topic of obesity can be extremely challenging. It requires extensive research and time to adequately cover the subject. However, there are services available that can provide assistance with the writing process. Pay for a thesis allows for the benefit of having an experienced professional provide guidance and support throughout the entire process.

Causes of Obesity

Every phenomenon must have a reason. In order to write a cause and effect essay , you need to analyze the topic carefully to cover all aspects. Obesity is considered to be a complex illness, with a number of factors contributing to its development. These can be:

• hereditary;

As you may have guessed, it is the latter category of causes and effects that we are interested in. At this point, we care about the five ones that have made the biggest contribution.

Product Range

The main cause of obesity is junk food and an unbalanced diet rich in simple carbohydrates, fats, and sugars, plus a bunch of additives. Manufactured, processed, refined, and packaged meals are the most popular. Thanks to advances in technology, Americans have come to mass-produce meals that keep fresh longer and taste better. It takes less time to prepare unhealthy, processed foods in the microwave than it does to cook them yourself.

Lack of a work-life balance, high-stress levels, insufficient sleeping hours contribute to body weight gain. Not only do these factors contribute to this, but failing to take the time to do your homework can also have a negative impact on your physical health. Without a healthy, balanced approach to work, rest, and play, you may find yourself increasingly dependent on a sedentary lifestyle that can lead to overweight consequences. Many Americans work 50, 60, or more hours a week and suffer from a deficit of leisure hours. Cooking processed foods saves them hours and money, even though they end up costing them a lot more – by causing cardiovascular disease. In addition, obese people feel stressed on a regular basis in the United States metropolitan areas. Many of them are simply binge eating under the influence of negative emotions. Chronic overeating leads to a disturbance in the appetite center in the brain, and the normal amount of food eaten can no longer suppress hunger as much as necessary, affecting the body mass.

Food Deserts

The term ‘ food desert ‘ refers to poor areas (urban, suburban and rural) with limited access to fresh fruit, grains, and vegetables – places where it is much easier to access junk food. A grocery shop in a food desert that sells healthy foods may be 10-15 miles away, while a mini-market or cheap shop that sells harmful snacks is close to the house. In such a world, it takes much more effort to eat healthier, form eating habits, and stay slim.

Everyone’s Passion for Sweets

Consuming sweets in large quantities is addictive: the more and easier we give the body energy, the more the brain uses serotonin and dopamine to encourage it – it will make obese people want sweets again and again during the day. Cakes and pastries are fast carbohydrates that easily satisfy hunger and increase body mass. Despite the harm of sweets, obese people experience the need for them to satiate. Sweetened carbonated drinks are one of the main sources of sugar in the American diet. Moreover, some individuals may be more adversely affected by such diets than others: patients with a genetic predisposition to obesity gain body mass faster from sugary drinks than those without it. This leads to childhood obesity.

The Harm of Tolerance

Every year, the body positive movement is becoming more and more popular all over the world. It would seem that this major trend should have freed us from the problems associated with the cult of thinness and society’s notorious standards. In many ways, a positive attitude towards the body has proved fruitful. For example, the notion of beauty has clearly broadened. Now on fashion shows and magazine covers, you can see not only a girl with perfectly retouched skin and without a single hint of body fat but also an ordinary person with its inherent features: overweight, wrinkles, hair, and individual skin features. In general, all the things that we are all so familiar with in real life.

Does it really make that much sense? Is this a positive thing in terms of the cause and effect topic regarding obesity? In short, opinions are divided. Extremes aren’t easy to overcome. Not everyone manages to do it. Researchers have concluded that due to plus size having become positioned as a variant of the norm, more persons have become obese. Many obese Americans have formed the opinion that it is really quite normal, and they have become oblivious to the damage it does to their health. This is what we are going to focus on next.

Effects of Obesity

We all know that obesity is dangerous to health. However, medical studies show that most adults are unaware of the number of complications and diseases that obesity in America entails. So they are fairly comfortable with becoming gradually fatter. But indifference is replaced by concern when obesity related diseases begin to occur.

For interesting examples of students writing that also reveal the causes and effects of other phenomena, consult the custom essay service offering essays by professionals. In this way, you will realize the importance of highlighting the effects right after the causes.

Is obesity an aesthetic disadvantage, an inconvenience, a limitation in physical activity or is it an illness after all? How does it affect health, and what are the consequences? The visible signs of obesity are by no means the only complication associated with this condition. Obesity creates a high risk of life-threatening diseases such as atherosclerosis, hypertension, heart attack, myocardial infarction, and kidney and liver problems. Moreover, it can also lead to disability.

Cardiovascular Disease

This is the most serious and damaging impact on the body and blood vessels in particular. Every extra kilo is a huge additional load on the heart. Obesity increases the risk of heart attacks. Experts from the American Heart Association have developed a paper on the relationship between obesity and cardiovascular disease, which discusses the impact of obesity on the diagnosis and outcomes of patients with atherosclerotic cardiovascular disease, heart failure, and arrhythmias. Childhood obesity aggravates the course of cardiovascular disease from a very early age. The fact that even kids and adolescents are obese is associated with high blood pressure, dyslipidemia, and hyperglycemia.

The result is excessive insulin production in the body. This, in turn, leads to an overabundance of insulin in the blood, which makes the peripheral tissues more resistant to it. As a consequence of the above, sodium metabolism is disturbed, and blood pressure rises. It is important to remember that excessive carbohydrate food intake leads to increased production of insulin by the pancreas. Excess insulin in the human body easily converts glucose into fat. And obesity reduces tissue sensitivity to insulin itself. This kind of vicious circle leads to type 2 diabetes.

Effects on Joints

Obesity increases the load on joints to a great extent, especially if one undergoes little or no physical activity. For instance, if one lives in a megalopolis, where all physical activity consists of getting off the sofa, walking to the car, and plumping up in an office chair at work. All this leads to a reduction in muscle mass, which is already weak, and all the load falls on the joints and ligaments.

The result is arthritis, arthrosis, and osteochondrosis. Consequently, a seemingly illogical situation is formed – there is practically no exercise, but joints are worn out harder than in the case of powerlifters. In turn, according to a study by the University of California, reducing body weight reduces the risk of osteoarthritis.

Infertility

In most cases, being obese leads to endocrine infertility, as it causes an irregular menstrual cycle. Women experience thyroid disease, polycystic ovarian syndrome, problems with conception, and decreased progesterone hormone. Obese men are faced with erectile dysfunction, reduced testosterone levels, and infertility. It should be noted that the mother’s obesity affects not only her health but also the one of her unborn child. These children are at higher risk of congenital malformations.

Corresponding Inconveniences

Public consciousness is still far from the notion that obese people are sick individuals. The social significance of the issue is that people who are severely obese find it difficult to get a job. They experience discriminatory restrictions on promotion, daily living disadvantages, restrictions on mobility, clothing choices, discomfort with adequate hygiene, and sexual dysfunction. Some of these individuals not only suffer from illness and limited mobility but also have low self-esteem, depression, and other psychological problems due to involuntary isolation by watching television or playing video games. Therefore, the public has to recognize the need to establish and implement national and childhood obesity epidemic prevention programs.

Society today provokes unintentional adult and childhood obesity among its members by encouraging the consumption of high-fat, high-calorie foods and, at the same time, by technological advances, promoting sedentary lifestyles like spending time watching television or playing video games. These social and technological factors have contributed to the rise in obesity in recent decades. Developing a responsible attitude towards health will only have a full impact if people are given the opportunity to enjoy a healthy lifestyle. At the level of the community as a whole, it is therefore important to support people in adhering to dieting recommendations through the continued implementation of evidence-based and demographic-based policies to make regular physical activity and good nutrition both affordable and feasible for all. It is recommended to cut down on the food consumed.

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State of Obesity 2022: Better Policies for a Healthier America

Trust for America’s Health’s (TFAH) 19th annual report on the nation’s obesity crisis found that 19 states have obesity rates over 35 percent, up from 16 states in 2021, and that social and economic factors are key drivers of increasing obesity rates.  The report includes data by race, age, and state of residence and recommendations for policy action.

(Washington, DC – September 27, 2022) – State of Obesity 2022: Better Policies for a Healthier America found that four in ten American adults have obesity, and obesity rates continue to climb nationwide and within population groups. These persistent increases in obesity rates underscore that obesity is caused by a combination of factors including societal, biological, genetic, and environmental, which are often beyond personal choice. The report’s authors conclude that addressing the obesity crisis will require attending to the economic and structural factors of where and how people live.

The report, based in part on 2021 data from the Centers for Disease Control and Prevention’s Behavioral Risk Factors Surveillance System, and analysis by TFAH, tracks rates of overweight and obesity by age, race, and state of residence.

Among the report’s findings are: Nineteen states have adult obesity rates over 35 percent , up from 16 states last year.  West Virginia, Kentucky, and Alabama have the highest rate of adult obesity at 40.6 percent, 40.3 percent, and 39.9 percent, respectively. The District of Columbia, Hawaii, and Colorado have the lowest adult obesity rates at 24.7 percent, 25 percent, and 25.1 percent respectively.

A decade ago, no state had an adult obesity rate at or above 35 percent.

National data from the 2017-2020 National Health and Nutrition Examination Survey also included in the report show the following:

• Nationally, 41.9 percent of adults have obesity.
• Black adults had the highest level of adult obesity at 49.9 percent.
• Hispanic adults had an obesity rate of 45.6 percent.
• White adults had an obesity rate of 41.4 percent.
• Asian adults had an obesity rate of 16.1 percent.
• Rural parts of the country had higher rates of obesity than did urban and suburban areas.

The report, released the day before the 2022 White House Conference on Hunger, Nutrition and Health, helps amplify the importance of focused attention on the obesity issue. Both the conference and the report spotlight the links between hunger, nutrition, and health, and diet-related diseases including obesity. In addition, they are intended to drive policy action to address food insecurity and health disparities, factors often at the root of diet-related health issues.

Obesity is multifactored and involves more than individual behavior

Structural and social determinants are significantly influencing the rates of obesity among adults and youth, according to the report authors.  Factors such as structural racism, discrimination, poverty, food insecurity, housing instability, and lack of access to quality healthcare are key drivers of the differences in obesity rates across racial and ethnic groups. These systemic barriers make it inappropriate to assign blame to individuals with obesity for their weight. The purpose of this report is to analyze conditions in people’s lives which make them more likely to develop obesity and recommend policies to address those conditions.

A special section of the report looks at the relationship between food insecurity and obesity. Food insecurity, defined as being uncertain of having or unable to acquire enough food because of insufficient money or resources, is driven by many of the same social and economic factors that drive obesity including poverty and living in communities with many fast-food establishments but limited or no access to healthy, affordable foods such as available in full-service supermarkets. Being food and nutrition insecure often means families must eat food that costs less but is also high in calories and low in nutritional value.

Addressing obesity is critical because it is associated with a range of diseases including type 2 diabetes, heart disease, stroke, arthritis, sleep apnea, and some cancers. Obesity is estimated to increase U.S. healthcare spending by $170 billion annually (including billions by Medicare and Medicaid).

The report includes recommendations for policy actions that federal, state, and local policymakers and other stakeholders should take including:

• Increase funding for the CDC’s National Center for Chronic Disease Prevention and Health Programs to prevent obesity and related chronic diseases. Funding increases need to be sufficient to put proven obesity prevention programs to work in every state and should prioritize those communities where the need is greatest to address health inequities.
• Make healthy school meals for all students a permanent policy, extend COVID-19 flexibilities that expand nutrition access for students and their families, strengthen school nutrition standards, and increase students’ opportunities for physical activity during the school day.
• Expand the CDC’s social determinants of health program to address the upstream, structural drivers of chronic disease.
• Decrease food insecurity and improve the nutritional quality of available food by increasing funding for and participation in nutrition assistance programs such as the Supplemental Nutrition Assistance Program (SNAP), the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and the Child and Adult Care Food Program.
• End unhealthy food marketing to children by closing tax loopholes and eliminating business-cost deductions related to the advertising of unhealthy food and beverages to young people.
• Impose excise taxes on sugary drinks and devote the revenue to local obesity prevention programs and to reduce health disparities.
• Expand support for maternal and child health, including supporting breastfeeding.
• Fund active transportation projects like pedestrian and biking paths in all communities and make local spaces more conducive to physical activity.
• Expand access to healthcare and require insurance coverage with no cost sharing for U.S. Preventive Task Force recommended obesity prevention programs.

Read the full report

Additional resources, watch the 2022 state of obesity webinar, related reading.

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Obesity Essay

Last updated on: Feb 9, 2023

Obesity Essay: A Complete Guide and Topics

By: Nova A.

11 min read

Reviewed By: Jacklyn H.

Published on: Aug 31, 2021

Are you assigned to write an essay about obesity? The first step is to define obesity.

The obesity epidemic is a major issue facing our country right now. It's complicated- it could be genetic or due to your environment, but either way, there are ways that you can fix it!

Learn all about what causes weight gain and get tips on how you can get healthy again.

On this Page

What is Obesity

What is obesity? Obesity and BMI (body mass index) are both tools of measurement that are used by doctors to assess body fat according to the height, age, and gender of a person. If the BMI is between 25 to 29.9, that means the person has excess weight and body fat.

If the BMI exceeds 30, that means the person is obese. Obesity is a condition that increases the risk of developing cardiovascular diseases, high blood pressure, and other medical conditions like metabolic syndrome, arthritis, and even some types of cancer.

Obesity Definition

Obesity is defined by the World Health Organization as an accumulation of abnormal and excess body fat that comes with several risk factors. It is measured by the body mass index BMI, body weight (in kilograms) divided by the square of a person’s height (in meters).

Obesity in America

Obesity is on the verge of becoming an epidemic as 1 in every 3 Americans can be categorized as overweight and obese. Currently, America is an obese country, and it continues to get worse.

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Causes of obesity

Do you see any obese or overweight people around you?

You likely do.

This is because fast-food chains are becoming more and more common, people are less active, and fruits and vegetables are more expensive than processed foods, thus making them less available to the majority of society. These are the primary causes of obesity.

Obesity is a disease that affects all age groups, including children and elderly people.

Now that you are familiar with the topic of obesity, writing an essay won’t be that difficult for you.

How to Write an Obesity Essay

The format of an obesity essay is similar to writing any other essay. If you need help regarding how to write an obesity essay, it is the same as writing any other essay.

Obesity Essay Introduction

The trick is to start your essay with an interesting and catchy sentence. This will help attract the reader's attention and motivate them to read further. You don’t want to lose the reader’s interest in the beginning and leave a bad impression, especially if the reader is your teacher.

A hook sentence is usually used to open the introductory paragraph of an essay in order to make it interesting. When writing an essay on obesity, the hook sentence can be in the form of an interesting fact or statistic.

Head on to this detailed article on hook examples to get a better idea.

Once you have hooked the reader, the next step is to provide them with relevant background information about the topic. Don’t give away too much at this stage or bombard them with excess information that the reader ends up getting bored with. Only share information that is necessary for the reader to understand your topic.

Next, write a strong thesis statement at the end of your essay, be sure that your thesis identifies the purpose of your essay in a clear and concise manner. Also, keep in mind that the thesis statement should be easy to justify as the body of your essay will revolve around it.

Body Paragraphs

The details related to your topic are to be included in the body paragraphs of your essay. You can use statistics, facts, and figures related to obesity to reinforce your thesis throughout your essay.

If you are writing a cause-and-effect obesity essay, you can mention different causes of obesity and how it can affect a person’s overall health. The number of body paragraphs can increase depending on the parameters of the assignment as set forth by your instructor.

Start each body paragraph with a topic sentence that is the crux of its content. It is necessary to write an engaging topic sentence as it helps grab the reader’s interest. Check out this detailed blog on writing a topic sentence to further understand it.

End your essay with a conclusion by restating your research and tying it to your thesis statement. You can also propose possible solutions to control obesity in your conclusion. Make sure that your conclusion is short yet powerful.

Obesity Essay Examples

Essay about Obesity (PDF)

Childhood Obesity Essay (PDF)

Obesity in America Essay (PDF)

Essay about Obesity Cause and Effects (PDF)

Satire Essay on Obesity (PDF) 

Obesity Argumentative Essay (PDF)

Obesity Essay Topics

Choosing a topic might seem an overwhelming task as you may have many ideas for your assignment. Brainstorm different ideas and narrow them down to one, quality topic.

If you need some examples to help you with your essay topic related to obesity, dive into this article and choose from the list of obesity essay topics.

Childhood Obesity

As mentioned earlier, obesity can affect any age group, including children. Obesity can cause several future health problems as children age.

Here are a few topics you can choose from and discuss for your childhood obesity essay:

• What are the causes of increasing obesity in children?
• Obese parents may be at risk for having children with obesity.
• What is the ratio of obesity between adults and children?
• What are the possible treatments for obese children?
• Are there any social programs that can help children with combating obesity?
• Has technology boosted the rate of obesity in children?
• Are children spending more time on gadgets instead of playing outside?
• Schools should encourage regular exercises and sports for children.
• How can sports and other physical activities protect children from becoming obese?
• Can childhood abuse be a cause of obesity among children?
• What is the relationship between neglect in childhood and obesity in adulthood?
• Does obesity have any effect on the psychological condition and well-being of a child?
• Are electronic medical records effective in diagnosing obesity among children?
• Obesity can affect the academic performance of your child.
• Do you believe that children who are raised by a single parent can be vulnerable to obesity?
• You can promote interesting exercises to encourage children.
• What is the main cause of obesity, and why is it increasing with every passing day?
• Schools and colleges should work harder to develop methodologies to decrease childhood obesity.
• The government should not allow schools and colleges to include sweet or fatty snacks as a part of their lunch.
• If a mother is obese, can it affect the health of the child?
• Children who gain weight frequently can develop chronic diseases.

Obesity Argumentative Essay Topics

Do you want to write an argumentative essay on the topic of obesity?

The following list can help you with that!

Here are some examples you can choose from for your argumentative essay about obesity:

• Can vegetables and fruits decrease the chances of obesity?
• Should you go for surgery to overcome obesity?
• Are there any harmful side effects?
• Can obesity be related to the mental condition of an individual?
• Are parents responsible for controlling obesity in childhood?
• What are the most effective measures to prevent the increase in the obesity rate?
• Why is the obesity rate increasing in the United States?
• Can the lifestyle of a person be a cause of obesity?
• Does the economic situation of a country affect the obesity rate?
• How is obesity considered an international health issue?
• Can technology and gadgets affect obesity rates?
• What can be the possible reasons for obesity in a school?
• How can we address the issue of obesity?
• Is obesity a chronic disease?
• Is obesity a major cause of heart attacks?
• Are the junk food chains causing an increase in obesity?
• Do nutritional programs help in reducing the obesity rate?
• How can the right type of diet help with obesity?
• Why should we encourage sports activities in schools and colleges?
• Can obesity affect a person’s behavior?

Health Related Topics for Research Paper

If you are writing a research paper, you can explain the cause and effect of obesity.

Here are a few topics that link to the cause and effects of obesity.Review the literature of previous articles related to obesity. Describe the ideas presented in the previous papers.

• Can family history cause obesity in future generations?
• Can we predict obesity through genetic testing?
• What is the cause of the increasing obesity rate?
• Do you think the increase in fast-food restaurants is a cause of the rising obesity rate?
• Is the ratio of obese women greater than obese men?
• Why are women more prone to be obese as compared to men?
• Stress can be a cause of obesity. Mention the reasons how mental health can be related to physical health.
• Is urban life a cause of the increasing obesity rate?
• People from cities are prone to be obese as compared to people from the countryside.
• How obesity affects the life expectancy of people? What are possible solutions to decrease the obesity rate?
• Do family eating habits affect or trigger obesity?
• How do eating habits affect the health of an individual?
• How can obesity affect the future of a child?
• Obese children are more prone to get bullied in high school and college.
• Why should schools encourage more sports and exercise for children?

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Topics for Essay on Obesity as a Problem

Do you think a rise in obesity rate can affect the economy of a country?

Here are some topics for your assistance regarding your economics related obesity essay.

• Does socioeconomic status affect the possibility of obesity in an individual?
• Analyze the film and write a review on “Fed Up” – an obesity epidemic.
• Share your reviews on the movie “The Weight of The Nation.”
• Should we increase the prices of fast food and decrease the prices of fruits and vegetables to decrease obesity?
• Do you think healthy food prices can be a cause of obesity?
• Describe what measures other countries have taken in order to control obesity?
• The government should play an important role in controlling obesity. What precautions should they take?
• Do you think obesity can be one of the reasons children get bullied?
• Do obese people experience any sort of discrimination or inappropriate behavior due to their weight?
• Are there any legal protections for people who suffer from discrimination due to their weight?
• Which communities have a higher percentage of obesity in the United States?
• Discuss the side effects of the fast-food industry and their advertisements on children.
• Describe how the increasing obesity rate has affected the economic condition of the United States.
• What is the current percentage of obesity all over the world? Is the obesity rate increasing with every passing day?
• Why is the obesity rate higher in the United States as compared to other countries?
• Do Asians have a greater percentage of obese people as compared to Europe?
• Does the cultural difference affect the eating habits of an individual?
• Obesity and body shaming.
• Why is a skinny body considered to be ideal? Is it an effective way to reduce the obesity rate?

Obesity Solution Essay Topics

With all the developments in medicine and technology, we still don’t have exact measures to treat obesity.

Here are some insights you can discuss in your essay:

• How do obese people suffer from metabolic complications?
• Describe the fat distribution in obese people.
• Is type 2 diabetes related to obesity?
• Are obese people more prone to suffer from diabetes in the future?
• How are cardiac diseases related to obesity?
• Can obesity affect a woman’s childbearing time phase?
• Describe the digestive diseases related to obesity.
• Obesity may be genetic.
• Obesity can cause a higher risk of suffering a heart attack.
• What are the causes of obesity? What health problems can be caused if an individual suffers from obesity?
• What are the side effects of surgery to overcome obesity?
• Which drugs are effective when it comes to the treatment of obesity?
• Is there a difference between being obese and overweight?
• Can obesity affect the sociological perspective of an individual?
• Explain how an obesity treatment works.
• How can the government help people to lose weight and improve public health?

Writing an essay is a challenging yet rewarding task. All you need is to be organized and clear when it comes to academic writing.

• Choose a topic you would like to write on.
• Organize your thoughts.
• Pen down your ideas.
• Compose a perfect essay that will help you ace your subject.
• Proofread and revise your paper.

Were the topics useful for you? We hope so!

However, if you are still struggling to write your paper, you can pick any of the topics from this list, and our essay writer will help you craft a perfect essay.

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If writing an essay is the actual problem and not just the topic, you can always hire an essay writing service for your help. Essay experts at 5StarEssays can help compose an impressive essay within your deadline.

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As a Digital Content Strategist, Nova Allison has eight years of experience in writing both technical and scientific content. With a focus on developing online content plans that engage audiences, Nova strives to write pieces that are not only informative but captivating as well.

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26 Conclusion: Obesity and its prevention in the 21st century

• Published: September 2010
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The case for a preventative approach to the obesity epidemic is compelling. Obesity poses what is arguably one of the most significant threats to population health that is currently faced. The data presented in this book highlight just how common obesity has become in children and in adults across the globe, and how it impacts disproportionately on the poor. This chapter presents a summary of the discussions in the preceding chapters.

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Obesity: Risk factors, complications, and strategies for sustainable long‐term weight management

Sharon m. fruh.

1 College of Nursing, University of South Alabama, Mobile, Alabama

Background and Purpose

The aims of this article are to review the effects of obesity on health and well‐being and the evidence indicating they can be ameliorated by weight loss, and consider weight‐management strategies that may help patients achieve and maintain weight loss.

Narrative review based on literature searches of PubMed up to May 2016 with no date limits imposed. Search included terms such as “obesity,” “overweight,” “weight loss,” “comorbidity,” “diabetes,” cardiovascular,” “cancer,” “depression,” “management,” and “intervention.”

Conclusions

Over one third of U.S. adults have obesity. Obesity is associated with a range of comorbidities, including diabetes, cardiovascular disease, obstructive sleep apnea, and cancer; however, modest weight loss in the 5%–10% range, and above, can significantly improve health‐related outcomes. Many individuals struggle to maintain weight loss, although strategies such as realistic goal‐setting and increased consultation frequency can greatly improve the success of weight‐management programs. Nurse practitioners have key roles in establishing weight‐loss targets, providing motivation and support, and implementing weight‐loss programs.

Implications for Practice

With their in‐depth understanding of the research in the field of obesity and weight management, nurse practitioners are well placed to effect meaningful changes in weight‐management strategies deployed in clinical practice.

Introduction

Obesity is an increasing, global public health issue. Patients with obesity are at major risk for developing a range of comorbid conditions, including cardiovascular disease (CVD), gastrointestinal disorders, type 2 diabetes (T2D), joint and muscular disorders, respiratory problems, and psychological issues, which may significantly affect their daily lives as well as increasing mortality risks. Obesity‐associated conditions are manifold; however, even modest weight reduction may enable patients to reduce their risk for CVD, diabetes, obstructive sleep apnea (OSA), and hypertension among many other comorbidities (Cefalu et al., 2015 ). A relatively small and simple reduction in weight, for example, of around 5%, can improve patient outcomes and may act as a catalyst for further change, with sustainable weight loss achieved through a series of incremental weight loss steps. In facilitating the process of losing weight for patients, nurse practitioners play an essential role. Through assessing the patient's risk, establishing realistic weight‐loss targets, providing motivation and support, and supplying patients with the necessary knowledge and treatment tools to help achieve weight loss, followed by tools for structured lifestyle support to maintain weight lost, the nurse practitioner is ideally positioned to help patient's achieve their weight‐loss—and overall health—targets.

The obesity epidemic

The World Health Organization (WHO) defines overweight and obesity as abnormal or excessive fat accumulation that presents a risk to health (WHO, 2016a ). A body mass index (BMI) ≥25 kg/m 2 is generally considered overweight, while obesity is considered to be a BMI ≥ 30 kg/m 2 . It is well known that obesity and overweight are a growing problem globally with high rates in both developed and developing countries (Capodaglio & Liuzzi, 2013 ; WHO, 2016a , 2016b ).

In the United States in 2015, all states had an obesity prevalence more than 20%, 25 states and Guam had obesity rates >30% and four of those 25 states (Alabama, Louisiana, Mississippi, and West Virginia) had rates >35% (Centres for Disease Control and Prevention, 2016 ; Figure ​ Figure1). 1 ). Approximately 35% and 37% of adult men and women, respectively, in the United States have obesity (Yang & Colditz, 2015 ). Adult obesity is most common in non‐Hispanic black Americans, followed by Mexican Americans, and non‐Hispanic white Americans (Yang & Colditz, 2015 ). Individuals are also getting heavier at a younger age; birth cohorts from 1966 to 1975 and 1976 to 1985 reached an obesity prevalence of ≥20% by 20–29 years of age, while the 1956–1965 cohort only reached this prevalence by age 30–39 years (Lee et al., 2010 ). Additionally, the prevalence of childhood obesity in 2‐ to 17‐year‐olds in the United States has increased from 14.6% in 1999–2000 to 17.4% in 2013–2014 (Skinner & Skelton, 2014 ). Childhood obesity is an increasing health issue because of the early onset of comorbidities that have major adverse health impacts, and the increased likelihood of children with obesity going on to become adults with obesity (50% risk vs. 10% for children without obesity; Whitaker, Wright, Pepe, Seidel, & Dietz, 1997 ).

U.S. obesity epidemic 2015.

Source . Figure adapted from Centers for Disease Control and Prevention (CDC). Retrieved from https://www.cdc.gov/obesity/data/prevalence-maps.html .

Association of obesity with mortality and comorbid disease

Obesity is associated with a significant increase in mortality, with a life expectancy decrease of 5–10 years (Berrington de Gonzalez et al., 2010 ; Kuk et al., 2011 ; Prospective Studies Collaboration et al., 2009 ). There is evidence to indicate that all‐cause, CVD‐associated, and cancer‐associated mortalities are significantly increased in individuals with obesity, specifically those at Stages 2 or 3 of the Edmonton Obesity Staging System (EOSS; Kuk et al., 2011 ; Figure ​ Figure2). 2 ). Mortality related to cancer is, however, also increased at Stage 1, when the physical symptoms of obesity are marginal (Figure ​ (Figure2). 2 ). Recently, a large‐scale meta‐analysis that included studies that had enrolled over 10 million individuals, indicated that, relative to the reference category of 22.5 to <25 kg/m 2 , the hazard ratio (HR) for all‐cause mortality rose sharply with increasing BMI (The Global BMI Mortality Collaboration, 2016 ). For a BMI of 25.0 to <30.0 kg/m 2 , the HR was 1.11 (95% confidence interval [CI] 1.10, 1.11), and this increased to 1.44 (1.41, 1.47), 1.92 (1.86, 1.98), and 2.71 (2.55, 2.86) for a BMI of 30.0 to <35.0, 35.0 to <40.0, and 40.0 to <60.0 kg/m 2 , respectively.

Association between EOSS stage and risk of all‐cause (A), CVD (B), cancer (C), and non‐CVD or noncancer mortality (D) in men and women. © 2011.

Source . Reproduced with permission from NRC Research Press, from Kuk et al. ( 2011 ). CVD, cardiovascular disease; NW, normal weight.

Comorbidities

Obesity is a chronic disease that is associated with a wide range of complications affecting many different aspects of physiology (Dobbins, Decorby, & Choi, 2013 ; Guh et al., 2009 ; Martin‐Rodriguez, Guillen‐Grima, Marti, & Brugos‐Larumbe, 2015 ; summarized in Table ​ Table1). 1 ). To examine these obesity‐related morbidities in detail is beyond the scope of this review and therefore only a brief overview of some of the key pathophysiological processes is included next.

Morbidities associated with obesity (Hamdy, 2016 ; Petry, Barry, Pietrzak, & Wagner, 2008 ; Pi‐Sunyer, 2009 ; Sakai et al., 2005 ; Smith, Hulsey, & Goodnight, 2008 ; Yosipovitch, DeVore, & Dawn, 2007 )

The progression from lean state to obesity brings with it a phenotypic change in adipose tissue and the development of chronic low‐grade inflammation (Wensveen, Valentic, Sestan, Turk Wensveen, & Polic, 2015 ). This is characterized by increased levels of circulating free‐fatty acids, soluble pro‐inflammatory factors (such as interleukin [IL] 1β, IL‐6, tumor necrosis factor [TNF] α, and monocyte chemoattractant protein [MCP] 1) and the activation and infiltration of immune cells into sites of inflammation (Hursting & Dunlap, 2012 ). Obesity is also usually allied to a specific dyslipidemia profile (atherogenic dyslipidemia) that includes small, dense low‐density lipoprotein (LDL) particles, decreased levels of high‐density lipoprotein (HDL) particles, and raised triglyceride levels (Musunuru, 2010 ). This chronic, low‐grade inflammation and dyslipidemia profile leads to vascular dysfunction, including atherosclerosis formation, and impaired fibrinolysis. These, in turn, increase the risk for CVD, including stroke and venous thromboembolism (Blokhin & Lentz, 2013 ).

The metabolic and cardiovascular aspects of obesity are closely linked. The chronic inflammatory state associated with obesity is established as a major contributing factor for insulin resistance, which itself is one of the key pathophysiologies of T2D (Johnson, Milner, & Makowski, 2012 ). Furthermore, central obesity defined by waist circumference is the essential component of the International Diabetes Federation (IDF) definition of the metabolic syndrome (raised triglycerides, reduced HDL cholesterol, raised blood pressure, and raised fasting plasma glucose; International Diabetes Federation, 2006 ).

Obesity is also closely associated with OSA. To start, a number of the conditions associated with obesity such as insulin resistance (Ip et al., 2002 ), systemic inflammation, and dyslipidemia are themselves closely associated with OSA, and concurrently, the obesity‐associated deposition of fat around the upper airway and thorax may affect lumen size and reduce chest compliance that contributes to OSA (Romero‐Corral, Caples, Lopez‐Jimenez, & Somers, 2010 ).

The development of certain cancers, including colorectal, pancreatic, kidney, endometrial, postmenopausal breast, and adenocarcinoma of the esophagus to name a few, have also been shown to be related to excess levels of fat and the metabolically active nature of this excess adipose tissue (Booth, Magnuson, Fouts, & Foster, 2015 ; Eheman et al., 2012 ). Cancers have shown to be impacted by the complex interactions between obesity‐related insulin resistance, hyperinsulinemia, sustained hyperglycemia, oxidative stress, inflammation, and the production of adipokines (Booth et al., 2015 ). The wide range of morbidities associated with obesity represents a significant clinical issue for individuals with obesity. However, as significant as this array of risk factors is for patient health, the risk factors can be positively modified with weight loss.

Obesity‐related morbidities in children and adolescents

As was referred to earlier, children and adolescents are becoming increasingly affected by obesity. This is particularly concerning because of the long‐term adverse consequences of early obesity. Obesity adversely affects the metabolic health of young people and can result in impaired glucose tolerance, T2D, and early‐onset metabolic syndrome (Pulgaron, 2013 ).There is also strong support in the literature for relationships between childhood obesity and asthma, poor dental health (caries), nonalcoholic fatty liver disease (NAFLD), and gastroesophageal reflux disease (GERD; Pulgaron, 2013 ). Obesity can also affect growth and sexual development and may delay puberty in boys and advance puberty in some girls (Burt Solorzano & McCartney, 2010 ). Childhood obesity is also associated with hyperandrogenism and polycystic ovary syndrome (PCOS) in girls (Burt Solorzano & McCartney, 2010 ). Additionally, obesity is associated with psychological problems in young people including attention deficit hyperactivity disorder (ADHD), anxiety, depression, poor self‐esteem, and problems with sleeping (Pulgaron, 2013 ).

Modest weight loss and its long‐term maintenance: Benefits and risks

Guidelines endorse weight‐loss targets of 5%–10% in individuals with obesity or overweight with associated comorbidities, as this has been shown to significantly improve health‐related outcomes for many obesity‐related comorbidities (Cefalu et al., 2015 ; Figure ​ Figure3), 3 ), including T2D prevention, and improvements in dyslipidemia, hyperglycemia, osteoarthritis, stress incontinence, GERD, hypertension, and PCOS. Further benefits may be evident with greater weight loss, particularly for dyslipidemia, hyperglycemia, and hypertension. For NAFLD and OSA, at least 10% weight loss is required to observe clinical improvements (Cefalu et al., 2015 ).

Benefits of modest weight loss. Lines demonstrate the ranges in which weight loss has been investigated and shown to have clinical benefits. Arrows indicate that additional benefits may be seen with further weight loss.

Source . Figure adapted from Cefalu et al. ( 2015 ).

Importantly, the weight‐loss benefits in terms of comorbidities are also reflected in improved all‐cause mortality. A recent meta‐analysis of 15 studies demonstrated that relatively small amounts of weight loss, on average 5.5 kg in the treatment arm versus 0.2 kg with placebo from an average baseline BMI of 35 kg/m 2 , resulted in a substantial 15% reduction in all‐cause mortality (Kritchevsky et al., 2015 ).

Cardiovascular health

Weight loss is associated with beneficial changes in several cardiovascular risk markers, including dyslipidemia, pro‐inflammatory/pro‐thrombotic mediators, arterial stiffness, and hypertension (Dattilo & Kris‐Etherton, 1992 ; Dengo et al., 2010 ; Goldberg et al., 2014 ; Haffner et al., 2005 ; Ratner et al., 2005 ). Importantly, weight loss was found to reduce the risk for CVD mortality by 41% up to 23 years after the original weight‐loss intervention (Li et al., 2014 ; Figure ​ Figure4). 4 ). Evidence including the biological effects of obesity and weight loss, and the increased risk for stroke with obesity indicates that weight loss may be effective for primary‐ and secondary‐stroke prevention (Kernan, Inzucchi, Sawan, Macko, & Furie, 2013 ).

Reduction in cardiovascular mortality with modest weight reduction. Cumulative incidence of CVD mortality during 23 years of follow‐up in the Da Qing study (Li et al., 2014 ). Figure © 2014 Elsevier.

Source . Reproduced with permission from Li et al. ( 2014 ).

Type 2 diabetes

Three major long‐term studies, the Diabetes Prevention Program (DPP), the Diabetes Prevention Study (DPS), and the Da Qing IGT and Diabetes (Da Qing) study, have demonstrated that modest weight loss through short‐term lifestyle or pharmacologic interventions can reduce the risk for developing T2D by 58%, 58%, and 31%, respectively, in individuals with obesity and prediabetes (DPP Research Group et al., 2009 ; Pan et al., 1997 ; Tuomilehto et al., 2001 ). Long‐term benefits were maintained following the interventions; for example, in the DPP, the risk reduction of developing T2D versus placebo was 34% at 10 years and 27% at 15 years following the initial weight‐loss intervention (DPP Research Group, 2015 ; DPP Research Group et al., 2009 ). Weight loss increased the likelihood of individuals reverting from prediabetes to normoglycemia (DPP Research Group et al., 2009 ; Li et al., 2008 ; Lindstrom et al., 2003 , 2006 ; Tuomilehto et al., 2001 ), and also improved other aspects of glycemic control including fasting and postprandial glucose, and insulin sensitivity (Haufe et al., 2013 ; Li et al., 2008 ).

Sleep apnea

Data indicate that weight loss is beneficial, although not curative, in patients with obesity who experience OSA. Meta‐analyses of patients who underwent treatment with either intensive lifestyle intervention (Araghi et al., 2013 ) or bariatric surgery (Greenburg, Lettieri, & Eliasson, 2009 ) demonstrated improvements in apnea‐hypopnea index (AHI) following treatment. In the first of these meta‐analyses, in randomized controlled trials, lifestyle intervention lead to a mean reduction in BMI of 2.3 kg/m 2 , which was associated with a decrease in mean AHI of 6.0 events/h. As expected, weight loss was much higher in the second meta‐analysis that investigated the effect of bariatric surgery on measures of OSA, and this was associated with greater reductions in AHI; the mean BMI reduction of 17.9 kg/m 2 resulted in AHI events being reduced by a mean of 38.2 events/h. Once these improvements in AHI have occurred, they seem to persist for some time, irrespective of a certain degree of weight regain. In one study, an initial mean weight loss of 10.7 kg resulted in a persistent improvement in AHI over a 4‐year period despite weight regain of approximately 50% by Year 4 (Kuna et al., 2013 ).

Intentional weight loss of >9 kg reduced the risk for a range of cancers including breast, endometrium, and colon in the large‐scale Iowa Women's Health Study (Parker & Folsom, 2003 ). The overall reduction in the incidence rate of any cancer was 11% (relative risk, 0.89; 95% CI 0.79, 1.00) for participants who lost more than 9 kg compared with those who did not achieve a more than 9 kg weight loss episode. Additionally, weight loss in participants with obesity has been established to be associated with reductions in cancer biomarkers including soluble E‐selectin and IL‐6 (Linkov et al., 2012 ).

Additional health benefits

The substantial weight loss associated with bariatric surgery has been shown to improve asthma with a 48%–100% improvement in symptoms and reduction in medication use (Juel, Ali, Nilas, & Ulrik, 2012 ); however, there is a potential threshold effect so that modest weight loss of 5%–10% may lead to clinical improvement (Lv, Xiao, & Ma, 2015 ). Similarly, modest weight loss of 5%–10% improves GERD (Singh et al., 2013 ) and liver function (Haufe et al., 2013 ). A study utilizing MRI scanning to examine the effects of weight loss on NAFLD has reported a reduction in liver fat from 18.3% to 13.6% ( p = .03), a relative reduction of 25% (Patel et al., 2015 ). Taking an active role in addressing obesity through behavioral modifications or exercise can also reduce the symptoms of depression (Fabricatore et al., 2011 ), improve urinary incontinence in men and women (Breyer et al., 2014 ; Brown et al., 2006 ), and improve fertility outcomes in women (Kort, Winget, Kim, & Lathi, 2014 ). Additionally, weight loss can reduce the joint‐pain symptoms and disability caused by weight‐related osteoarthritis (Felson, Zhang, Anthony, Naimark, & Anderson, 1992 ; Foy et al., 2011 ).

Mitigating risks

Despite the array of benefits, weight loss can also be linked with certain risks that may need to be managed. One such example is the risk for gallstones with rapid weight loss, which is associated with gallstone formation in 30%–71% of individuals. Gallstone formation is particularly associated with bariatric surgery when weight loss exceeds 1.5 kg/week and occurs particularly within the first 6 weeks following surgery when weight loss is greatest. Slower rates of weight loss appear to mitigate the risk for gallstone formation compared to the general population but may not eliminate it entirely; as was noted in the year‐long, weight‐loss, SCALE trial that compared liraglutide 3.0 mg daily use to placebo and resulted in gallstone formation in 2.5% of treated subjects compared to 1% of subjects taking placebo. For this reason, the risk for cholethiasis should be considered when formulating weight‐loss programs (Weinsier & Ullmann, 1993 ).

Strategies to help individuals achieve and maintain weight loss

Rogge and Gautam have covered the biology of obesity and weight regain within another section of this supplement (Rogge & Gautam, 2017 ), so here we focus on some of the clinical strategies for delivering weight loss and weight loss maintenance lifestyle programs. Structured lifestyle support plays an important role in successful weight management. A total of 34% of participants receiving structured lifestyle support from trained‐nursing staff achieved weight loss of ≥5% over 12 weeks compared with approximately 19% with usual care (Nanchahal et al., 2009 ). This particular structured program, delivered in a primary healthcare setting, included initial assessment and goal setting, an eating plan and specific lifestyle goals, personalized activity program, and advice about managing obstacles to weight loss. Additionally, data from the National Weight Control Registry (NWCR), which is the longest prospective compilation of data from individuals who have successfully lost weight and maintained their weight loss, confirm expectations that sustained changes to both diet and activity levels are central to successful weight management (Table ​ (Table2). 2 ). Therefore, an understanding of different clinical strategies for delivery‐structured support is essential for the nurse practitioner.

Lifestyle factors associated with achieving and maintaining weight loss

Note . Data from (NWCR, 2016 ).

a Walking was the most common activity undertaken.

Realistic weight‐loss targets

From the outset, a patient's estimate of their achievable weight loss may be unrealistic. Setting realistic weight‐loss goals is often difficult because of misinformation from a variety of sources, including friends, media, and other healthcare professionals (Osunlana et al., 2015 ). Many individuals with obesity or overweight have unrealistic goals of 20%–30% weight loss, whereas a more realistic goal would be the loss of 5%–15% of the initial body weight (Fabricatore et al., 2007 ). Promoting realistic weight‐loss expectations for patients was identified as a key difficulty for nurse practitioners, primary care nurses, dieticians, and mental health workers (Osunlana et al., 2015 ). Visual resources showing the health and wellness benefit of modest weight loss may thus be helpful (Osunlana et al., 2015 ). Healthcare practitioners should focus on open discussion about, and re‐enforcement of, realistic weight‐loss goals and assess outcomes consistently according to those goals (Bray, Look, & Ryan, 2013 ).

Maintaining a food diary

The 2013 White Paper from the American Nurse Practitioners Foundation on the Prevention and Treatment of Obesity considers a food diary as an important evidence‐based nutritional intervention in aiding weight loss (ANPF). Consistent and regular recording in a food diary was significantly associated with long‐term weight‐loss success in a group of 220 women (Peterson et al., 2014 ). This group lost a mean of 10.4% of their initial body weight through a 6‐month group‐based weight‐management program and then regained a mean of 2.3% over a 12‐month follow‐up period, during which participants received bimonthly support in person, by telephone, or by e‐mail (Peterson et al., 2014 ). Over the 12‐month follow‐up, women who self‐monitored consistently (≥50% of the extended‐care year) had a mean weight loss of 0.98%, while those who were less consistent (<50%) gained weight (5.1%; p < .01). Therefore, frequent and consistent food monitoring should be encouraged, particularly in the weight‐maintenance phase of any program.

Motivating and supporting patients

Motivational interviewing is a technique that focuses on enhancing intrinsic motivation and behavioral changes by addressing ambivalence (Barnes & Ivezaj, 2015 ). Interviews focus on “change talk,” including the reasons for change and optimism about the intent for change in a supportive and nonconfrontational setting, and may help individuals maintain behavioral changes.

For patients that have achieved weight loss, the behavioral factors associated with maintaining weight loss include strong social support networks, limiting/avoiding disinhibited eating, avoiding binge eating, avoiding eating in response to stress or emotional issues, being accountable for one's decisions, having a strong sense of autonomy, internal motivation, and self‐efficacy (Grief & Miranda, 2010 ). Therefore, encouraging feelings of “self‐worth” or “self‐efficacy” can help individuals to view weight loss as being within their own control and achievable (Cochrane, 2008 ).

Strengthening relationships with patients with overweight or obesity to enhance trust may also improve adherence with weight‐loss programs. Patients with hypertension who reported having “complete trust” in their healthcare practitioner were more than twice as likely to engage in lifestyle changes to lose weight than those who lacked “complete trust” (Jones, Carson, Bleich, & Cooper, 2012 ). It may be prudent to ensure the healthcare staff implementing weight‐loss programs have sufficient time to foster trust with their patients.

Continued support from healthcare staff may help patients sustain the necessary motivation for lifestyle changes. A retrospective analysis of 14,256 patients in primary care identified consultation frequency as a factor that can predict the success of weight‐management programs (Lenoir, Maillot, Guilbot, & Ritz, 2015 ). Individuals who successfully maintained ≥10% weight loss over 12 months visited the healthcare provider on average 0.65 times monthly compared with an average of 0.48 visits/month in those who did not maintain ≥10% weight loss, and 0.39 visits/month in those who failed to achieve the initial ≥10% weight loss ( p < .001; Lenoir et al., 2015 ).

Educational and environmental factors

It is important to consider a patient's education and environment when formulating a weight loss strategy as environmental factors may need to be challenged to help facilitate weight loss. A family history of obesity and childhood obesity are strongly linked to adult obesity, which is likely to be because of both genetic and behavioral factors (Kral & Rauh, 2010 ). Parents create their child's early food experiences and influence their child's attitudes to eating through learned eating habits and food choices (Kral & Rauh, 2010 ). Families can also impart cultural preferences for less healthy food choices and family food choices may be affected by community factors, such as the local availability and cost of healthy food options (Castro, Shaibi, & Boehm‐Smith, 2009 ). Alongside this, genetic variation in taste sensation may influence the dietary palate and influence food choices (Loper, La Sala, Dotson, & Steinle, 2015 ). For example, sensitivity to 6‐n‐propylthiouracil (PROP) is genetically determined, and PROP‐tasting ability ranges from super taster to nontaster. When offered buffet‐style meals over 3 days, PROP nontasters consumed more energy, and a greater proportion of energy from fat compared with super tasters. So it is possible that a family's genetic profile could contribute to eating choices. To address behavioral factors, it is important to ensure that families have appropriate support and information and that any early signs of weight gain are dealt with promptly.

A healthy home food environment can help individuals improve their diet. In children, key factors are availability of fresh fruit and vegetables at home and parental influence through their own fresh fruit and vegetable intake (Wyse, Wolfenden, & Bisquera, 2015 ). In adults, unhealthy home food environment factors include less healthy food in the home and reliance on fast food ( p = .01) are all predictors of obesity (Emery et al., 2015 ).

Family mealtimes are strongly associated with better dietary intake and a randomized controlled trial to encourage healthy family meals showed a promising reduction in excess weight gain in prepubescent children (Fulkerson et al., 2015 ). Another study showed that adolescents with any level of baseline family meal frequency, 1–2, 3–4, and ≥5 family meals/week, had reduced odds of being affected by overweight or obesity 10 years later than adolescents who never ate family meals (Berge et al., 2015 ). Community health advocates have identified the failure of many families to plan meals or prepare food as a barrier to healthy family eating patterns (Fruh, Mulekar, Hall, Fulkerson et al., 2013 ). Meal planning allows healthy meals to be prepared in advance and frozen for later consumption (Fruh, Mulekar, Hall, Adams et al., 2013 ) and is associated with increased consumption of vegetables and healthier meals compared with meals prepared on impulse (Crawford, Ball, Mishra, Salmon, & Timperio, 2007 ; Hersey et al., 2001 ).

The role of the nurse practitioner

The initial and ongoing interactions between patient and nurse practitioner are keys for the determination of an effective approach and implementation of a weight loss program and subsequent weight maintenance. The initial interaction can be instigated by either the nurse practitioner or the patient and once the decision has been made to manage the patient's weight, the evaluation includes a risk assessment, a discussion about the patient's weight, and treatment goal recommendations (American Nurse Practitioner Foundation, 2013 ). Across this process, it may be advantageous to approach this using objective data and language that is motivational and/or nonjudgmental. Patients may struggle with motivation, and therefore, ongoing discussions around the health benefits and improvements to quality of life as a result of weight loss may be required (American Nurse Practitioner Foundation, 2013 ). It may be valuable to allocate personalized benefits to the weight loss such as playing with children/grandchildren (American Nurse Practitioner Foundation, 2013 ). Treatment approaches encompass nonpharmacological and pharmacological strategies; however, it is important to remember that any pharmacological agent used should be used as an adjunct to nutritional and physical activity strategies (American Nurse Practitioner Foundation, 2013 ). Pharmacotherapy options for weight management are discussed further in the article by Golden in this supplement.

Conclusions/summary

The importance of obesity management is underscored both by the serious health consequences for individuals, but also by its increasing prevalence globally, and across age groups in particular. Obesity promotes a chronic, low‐grade, inflammatory state, which is associated with vascular dysfunction, thrombotic disorders, multiple organ damage, and metabolic dysfunction. These physiological effects ultimately lead to the development of a range of morbidities, including CVD, T2D, OSA, and certain cancers along with many others, as well as causing a significant impact on mortality.

However, even modest weight loss of 5%–10% of total body weight can significantly improve health and well‐being, and further benefits are possible with greater weight loss. Weight loss can help to prevent development of T2D in individuals with obesity and prediabetes and has a positive long‐term impact on cardiovascular mortality. Beneficial, although not curative, effects have also been noted on OSA following >10% weight loss. In addition, weight loss reduces the risk for certain cancer types and has positive effects on most comorbidities including asthma, GERD, liver function, urinary incontinence, fertility, joint pain, and depression.

Weight‐loss programs that include realistic weight loss goals, frequent check‐in, and meal/activity diaries may help individuals to lose weight. Setting realistic weight‐loss goals can be difficult; however, visual resources showing the health and wellness benefit of weight loss may be helpful in discussing realistic goals, and help motivate the patient in maintaining the weight loss. Techniques such as motivational interviewing that focus on addressing resistance to behavioral change in a supportive and optimistic manner may help individuals in integrating these changes to allow them to become part of normal everyday life and thus help with maintaining the weight loss. Positive reinforcement in terms of marked early‐weight loss may also assist in improving adherence, so this should be a key goal for weight‐loss programs. Encouraging feelings of “self‐worth” or “self‐efficacy” can help individuals to view weight loss as being within their own control.

Nurse practitioners play a major role in helping patients achieve weight loss through all aspects of the process including assessment, support, motivation, goal‐setting, management, and treatment. With their in‐depth understanding of the research in the field of obesity and weight management, nurse practitioners are well placed to effect meaningful changes in the weight‐management strategies deployed in clinical practice.

List of helpful resources

Acknowledgments

The authors are grateful to Watermeadow Medical for writing assistance in the development of this manuscript. This assistance was funded by Novo Nordisk, who also had a role in the review of the manuscript for scientific accuracy. The author discussed the concept, drafted the outline, commented in detail on the first iteration, made critical revision of later drafts, and has revised and approved the final version for submission.

Dr. Sharon Fruh serves on the Novo Nordisk Obesity Speakers Bureau. In compliance with national ethical guidelines, the author reports no relationship with business or industry that would post a conflict of interest.

Writing and editorial support was provided by Watermeadow Medical, and funded by Novo Nordisk.

The copyright line in this article was changed on 9 August 2018 after online publication.

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Home — Essay Samples — Nursing & Health — Obesity — Cause and Effect of Obesity

Cause and Effect of Obesity

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Why, Exactly, Are Ultraprocessed Foods So Hard to Resist? This Study Is Trying to Find Out.

Understanding why they’re so easy to overeat might be key to making them less harmful, some researchers say.

Supported by

By Alice Callahan

Photographs by Lexey Swall

Alice Callahan spent two days at the National Institutes of Health in Bethesda, Md., and interviewed more than a dozen researchers about ultraprocessed foods.

• Published July 30, 2024 Updated July 31, 2024

It was 9 a.m. on a Friday in March, and Ernest Jones III was hungry.

From a hospital bed at a research facility at the National Institutes of Health in Maryland, he surveyed his meal tray: Honey Nut Cheerios with fiber-enriched whole milk, a plastic-wrapped blueberry muffin and margarine.

Listen to this article with reporter commentary

“Simple, old school,” one of those “Saturday morning breakfasts from back in the day,” said Mr. Jones, 38, who is studying to become a pastor.

He was about halfway through his 28-day stay at the N.I.H., and Mr. Jones was one of 36 people participating in a nutrition trial that is expected to be completed in late 2025. For one month each, researchers will draw participants’ blood, track their body fat and weight, measure the calories they burn, and feed them three meticulously designed meals per day.

The subjects don’t know it, but their job is to help answer some of the most pressing questions in nutrition: Are ultraprocessed foods harmful to health? Are they a major driver of weight gain and obesity? And why is it so easy to eat so many of them?

If researchers can answer these questions, they say, perhaps there are ways to make ultraprocessed foods healthier.

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Why the war on childhood obesity is failing

Sugar taxes and obesity drugs will not be enough.

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S UZIE JIMENEZ cried as she waited in the car park. Her 14-year-old son was in the emergency department, suffering from stomach pains. He felt humiliated when doctors in Austin, Texas, told him that because of his bigger body he would need to have a CT scan rather than an ultrasound. He was scared to tell them he weighed 360 pounds (163kg). A shortage of Wegovy had meant that despite being approved for the weight-loss drug, he had not yet been able to start it. Ms Jimenez, at times the sole breadwinner for her family of five, says they sometimes ate fast food for “comfort”.

Obesity is one of the world’s most serious public-health crises. It increases the risks of developing diabetes, heart disease, stroke and some cancers. Since 1990 global rates have doubled among adults and quadrupled among children. Today more than 1bn people, including 7% of girls and 9% of boys, are classified as obese (see chart). In 2019 it led to around 5m deaths, 20 times as many as malnutrition did. Obesity is no longer just a rich-world problem. Childhood rates are highest on the islands of the Pacific and the Caribbean, and rising fastest in developing countries such as Cambodia and Lesotho.

Most of the economic costs of obesity are borne by individuals, who take more time off work or miss more days of school, and are more likely to be low-paid or unemployed. Obese children are more often targets for bullies, too. But the burden on the state is also considerable. Last year the Institute for Fiscal Studies, a British think-tank, estimated the annual costs of overweight and obese adults through health-care expenditures, formal social care and inactivity at work, excluding those individual costs (which most studies do not). Even after discounting the grisly “savings” from related deaths, they amounted to about £32bn ($41bn), or 1% of Britain’s GDP .

Although telling adults what to eat and when to move can be seen as interfering, governments should try to prevent children becoming obese and encourage their weight-loss efforts. Early interventions could reap benefits later: children with obesity are five times more likely to be obese as adults than their slimmer peers. The trouble is, nobody knows how best to go about it. No country has ever managed to reduce obesity; the more successful ones have merely stemmed it. The problem is too complex to be solved by simple public-health measures or obesity drugs alone. The hunt is on to find evidence for interventions that work together, and quickly.

Behind rising obesity rates lies a mix of biological, economic and social factors. Much of the world is awash with highcalorie foods even as many people live sedentary lives. No single nutrient or food group is to blame, but items containing high proportions of refined wheat, sugar and vegetable oils are under the spotlight. Highly processed foods, which are widely accessible and relatively inexpensive, are the ultimate example.

At the same time, even in rich countries, many neighbourhoods lack fresh, healthy alternatives. In Texas the Department of Agriculture estimates that one in five people live in poor areas with limited access to nutritious foods. Children from such places are more likely to be obese than those from richer ones. Processed foods are convenient, take much less time to prepare and—calorie for calorie—work out cheaper, explains Samir Softic, a specialist in fatty-liver disease at Kentucky Children’s Hospital. His state has the second-highest rate of childhood obesity in America after West Virginia. It also has the second-highest number of fast-food outlets per person.

The evolution of the human body is another important factor. Losing weight is not simply a matter of reducing one’s calorie consumption. The body adapted to survive famines, not feasts, so it clings onto weight it gains. It then resists the loss of fat by reducing the amount of energy it needs to survive and by increasing hunger signals; it will fight to regain the lost weight for years. This is why most long-term efforts at significant weight loss fail.

Keeping track of trends is difficult. Body-mass index ( BMI ), which divides a person’s weight (in kilograms) by the square of their height (in metres), is fine as a common measure of obesity for most adults but inaccurate for brawny types, since it cannot distinguish between fat and muscle. It is not helpful in children, whose bodies are growing and changing. Boffins from the World Health Organisation consider a child obese if his or her BMI is more than two standard deviations above the median for their age using a model from 2007 as a reference—an imperfect measure. Experts also consider increases in associated childhood diseases. Globally, the age-standardised incidence rate of type-2 diabetes has jumped by 57% in 15- to 19-year-olds over the past 30 years.

Governments looking to cut childhood obesity have few models to draw on. Start in Amsterdam, which once seemed to have a smart strategy. The Dutch capital received international plaudits when rates of overweight and obese children fell from 21% to 18.5% between 2012 and 2015. The local government sought to change individual behaviour: it provided nutrition classes for parents and children in poor neighbourhoods, put children on care plans, offered free sports such as ice-skating and discouraged junk food in schools. But the results did not last. Rates ticked up slightly to 18.7% in 2017; then the municipality stopped publishing them.

Then there is Chile, where over half of 4- to 14-year-olds are overweight or obese. In 2016 the government slapped black warning labels, shaped like stop signs, on the front of packaged foods high in calories, sugar, saturated fat and salt. Eight other countries have since copied the move. Chile also introduced strict bans on the marketing of these foods to under-14s, and a programme of exercise and nutrition in schools. Despite all this, a study published this year in the Pan-American Journal of Public Health showed no change in prevalence rates in the three years after the legislation was enacted. (Professor Camila Corvalán, an adviser to the Chilean government on the scheme, cautions that it is too early to draw conclusions.)

Now consider Britain, which has experimented with a sugar tax of sorts. Its levy on sugar-sweetened drinks, implemented in 2018, has had mixed success. Big brands reformulated their products to avoid it, resulting in a drop in sugar consumption of 4.8g per day among children. Researchers at the University of Cambridge found a slight reduction in obesity rates among 10- to 11-year-old girls, though not in younger children or 10- to 11-year-old boys, who consume more of the beverages.

Selective taxes “can sometimes not give you the right outcomes”, argues Chris Hogg, global head of public affairs at Nestlé, the world’s largest food and drink company. For the best public-health outcomes, he reckons, it is better to have room for policies and guidance “to steer [the industry] in the direction that policymakers think makes most sense”. Such guidance has long been standard practice in places such as Britain. The drinks levy aside, all other industry measures to reduce childhood obesity in Britain have been voluntary and largely unsuccessful.

So what to try next? Most health professionals and policymakers argue that current measures do not go far enough. Public-health experts are trying to pull together a guide to sugar taxes. In the 70-odd countries where taxes on sweetened drinks have been tried, the biggest impacts were felt in poorer countries such as South Africa, where consumers are more sensitive to price changes. Some now want to broaden taxes to stop people shifting to other unhealthy products. Last year Danone, a big dairy company, called for a wider tax on foods that are high in fat, salt and sugar, arguing that regulation is the only way to get firms to make their products healthier.

Critics of sugar taxes and their ilk say they are regressive. Because the poor spend a higher share of their income on food, and so are more likely to buy cheap, highly processed items, they are also more likely to be hit by additional levies on them. To offset this, Barry Popkin of the University of North Carolina is working with countries in Latin America and Africa to develop subsidy regimes for fruit and vegetables. He reckons that warning labels with pictures on junk food, like the ones on cigarette packets, will be tried next.

Obesity drugs are another tool attracting attention. The market for GLP-1 medications such as Wegovy is expected to reach $100bn a year by 2030. But they cannot be the main solution for the world’s obese people: they cost too much. Jonathan Gruber, an American economist, reckons that buying them for the 40% of Americans with obesity would cost about $1trn a year, or roughly 4% of America’s GDP .

The price will probably drop eventually. But even then, many adults and youngsters will not want to take GLP-1 drugs. They cause side-effects such as nausea; one study found that after one year, just 32% of patients were still taking them. There are also growing concerns over rare side-effects such as pancreatitis and intestinal obstructions. Yet sustained use of these drugs is needed to keep the weight off, along with diet and lifestyle changes to maximise health.

Measured approach

Where else is there to turn? Japan offers a glimpse of how influential cultural mores can be. “As a whole, Japanese people are very health-conscious,” says Yokote Koutaro of the Japan Society for the Study of Obesity. Japanese diets have become more Westernised over the years, but people still eat traditional food, which tends to be fresh and is often relatively healthy. They also eat modest portions. Take McDonald’s, says Mr Yokote. If you order a large-size drink in Japan, you slurp less than if you ordered a “small” one in America.

Social norms and government nudges seem to be working. Japan lacks strict rules on labelling or advertising fatty foods. But its cities are walkable, and even convenience stores often stock nutritious options such as salads. The government has long required schools to serve balanced lunches. Its other interventions are sometimes intolerably nannyish: in 2008 it told companies to start measuring the waistlines of their employees.

There will be no single solution to fighting obesity in children. Taxes, regulation and obesity drugs will play a part, as will consumers. Governments need to evaluate interventions over the long term. The goal should be to ensure that making healthy choices is far easier than the alternative. The problem is getting there. ■

This article appeared in the International section of the print edition under the headline “Tipping the balance”

From the August 10th 2024 edition

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The FDA should withdraw approval of more than 400 tainted medicines

By Suzanne Robotti Aug. 12, 2024

W hen the FDA learned that a testing facility in India had submitted fraudulent data for more than 400 drugs (most of them generics), the agency should have withdrawn them from the market. Instead, it has allowed these drugs to continue to be prescribed and distributed for at least a year as the pharmaceutical companies retest them for equivalency to the original brand-name drugs.

As someone whose work focuses on the hidden and minimized side effects of prescription and over-the-counter drugs, I know the FDA’s decision is wrong. That’s why I published an open letter to the agency asking that approval be withdrawn for all of these medicines until new, clean data has been submitted, reviewed, and approved by the FDA. The European Medicine Agency (EMA) has already suspended distribution of these 400-plus drugs.

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I also requested that the FDA release the names of those 400 questionable drugs. But it has declined, because the FDA considers the information surrounding how, where, and by whom any drugs are tested as “confidential commercial information.”

Commercial interests should not be put ahead of patients’ health and safety.

According to a Viewpoint essay in JAMA by two Harvard-affiliated researchers, early on the FDA imposed upon itself a strict limit on disclosing testing and related information that pharmaceutical companies submit to the agency as a way to protect their employees from the risk of lawsuits. The JAMA article offers a blueprint for rescinding this misguided guideline and restoring trust and transparency in the FDA.

To be sure, there would be pain if the FDA withdraws the approvals for these tainted drugs because patients, doctors, and pharmacists will have to scramble to adjust prescriptions. But it is necessary pain. Most of the drugs are generics, which play an incredibly important role in keeping the price of drugs lower than they might be and are crucial to maintaining the pipeline of necessary medicines to protect patients from manufacturing shortfalls. But generic drugs can only fill these needs if people trust them and if they are truly equivalent to brand name medicines.

There would also be financial pain for the pharmaceutical companies if they suddenly could not sell these drugs. But that pain should be felt by these companies so they will work harder to ensure they don’t accept bad data and pass it along to the FDA.

The FDA detected “significant anomalies” in the testing lab’s data. The agency wrote to the testing lab : “In five of your studies, we identified multiple pairs of study subjects that have nearly identical data … Additionally, in two of these studies, we identified individual study subjects that produced nearly identical results when treated with the test drug and the reference drug. While it would be unusual for two subjects in a single study to have nearly identical data, this occurred for multiple pairs of subjects, in multiple studies…” The letter detailed many other falsifications.

If the FDA identified these discrepancies, the pharmaceutical companies that paid for the testing should have done the same. Theirs is the responsibility and should bear the cost. Not the American public.

The FDA Adverse Event Reporting System (FAERS) makes it possible — even easy — for patients, doctors, and pharmaceutical companies to report unanticipated side effects and adverse events. To date, the FDA has not found any uptick in problems with these tainted drugs. But that does not excuse the FDA’s inaction. These medications could have too little of the active ingredient, causing undertreatment, or too much, causing a toxic response. They could contain impurities or could have been made with additives that can cause allergic reactions. Because of the flawed testing data, we just don’t know.

An individual prescribed a drug has the right to assume that it has the composition promised on the label.

The FDA’s mission is to protect Americans from drugs that are unsafe or ineffective. When it comes to the more than 400 tainted drugs it recently learned about, I say to the FDA: This is your time to stand for America, not for pharmaceutical companies.

Suzanne Robotti is the founder and president of MedShadow Foundation , a nonprofit organization focused on researching and explaining the hidden and minimized side effects of over-the-counter and prescription drugs, and has been a consumer representative on the FDA’s Drug Safety and Risk Management Committee since 2017.

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